Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?

This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare. What is known about the topic? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people. What does the paper add? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians. What are the implications for practitioners? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia’s First Peoples provides the opportunity for policymakers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.

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Improving Indigenous health through better medication management: an overview

Australian Journal of Primary Health ◽

10.1071/py05003 ◽

2005 ◽

Vol 11 (1) ◽

pp. 17 ◽

Cited By ~ 3

Author(s):

Charlotte de Crespigny ◽

Inge Kowanko ◽

Helen Murray ◽

Carolyn Emden ◽

Scott Wilson

Keyword(s):

Mental Health Problems ◽

Service Providers ◽

Aboriginal People ◽

Indigenous Health ◽

Medication Management ◽

Indigenous Australians ◽

Emotional Wellbeing ◽

Policy Makers ◽

Social And Emotional ◽

Department Of Health

This paper provides an overview of a major South Australian research project with implications for the health of all Indigenous Australians. The researchers set out to explore the medication needs of Aboriginal people with mental health problems and found that most Aboriginal people have to deal with profound challenges to social and emotional wellbeing with significant medication implications. No previous research had investigated the problem of medication use by Aboriginal people in metropolitan, rural and remote locations to the depth and extent of this project. The research therefore is of widespread relevance and holds interest for many Indigenous and non-Indigenous individuals and groups, consumers, service providers and policy-makers. As a research team comprising Indigenous and non-Indigenous members, we were committed to implementing strategies in the course of the project with immediate benefit to project participants as well as longer-term impact on improved use of medications. The design of the project enabled these strategic interventions and we are pleased to promote this model to other researchers. Recommendations from the project concern services, coordination of care, carers and family members, workforce education, and community development. Readers are advised where the project report and other published papers can be accessed. The project was funded by the Commonwealth Department of Health and Ageing.

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'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment

Australian Health Review ◽

10.1071/ah09835 ◽

2011 ◽

Vol 35 (2) ◽

pp. 235 ◽

Cited By ~ 75

Author(s):

Shaouli Shahid ◽

Lizzie Finn ◽

Dawn Bessarab ◽

Sandra C. Thompson

Keyword(s):

Decision Making ◽

Cancer Treatment ◽

Primary Healthcare ◽

Support Services ◽

Aboriginal People ◽

Cultural Safety ◽

System Level ◽

Indigenous Australians ◽

Cancer Outcomes ◽

Treatment Services

Background. Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. Design, setting and participants. Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. Results. The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. Conclusion. To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services. What is known about the topic? Cancer is a major cause of death among Indigenous Australians who are generally diagnosed later with their disease, have poorer continuity of care and lower uptake and completion of cancer treatment. For cancer diagnosis at an equivalent stage of cancer, Aboriginal people have poorer outcomes. What does this paper add? This study documents Aboriginal perspectives on basic infrastructure and logistical problems which impede their accessing hospital-based cancer treatments: transport, accommodation, preparation for the experience of hospital and cancer treatment, service affordability and the certainty of support services. What are the implications for practitioners? There are difficulties for practitioners in addressing the geographic, socioeconomic and cultural differences that Aboriginal people face in accessing cancer treatment. System level changes to ensure cultural safety, social support and better coordination with primary healthcare are essential to improve outcomes of Aboriginal people with cancer.

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Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists

BMC Psychiatry ◽

10.1186/s12888-020-03004-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Åse Lundin ◽

Anna Bergenheim

Keyword(s):

At Risk ◽

Healthcare System ◽

Primary Healthcare ◽

Qualitative Content Analysis ◽

Western Hemisphere ◽

Mental Wellbeing ◽

Healthcare Personnel ◽

Public Health Issue ◽

Structured Interviews ◽

Patients At Risk

Abstract Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.

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