Achieving Indigenous health equity requires a sea change in mainstream policies and practices. This includes addressing the role of racism, at both institutional/systemic and interpersonal levels, and acknowledging the impact it has on outcomes.
Changing the way we do business, by truly respecting Indigenous knowledge, beliefs and values is needed. This will require intervention research that goes beyond minor transformations of existing majority population focused interventions.
1. Cultural competency
Cultural competency is the ability of healthcare organizations to collaborate effectively with individuals from diverse cultures. This includes a knowledge of the beliefs, values, and worldviews of those cultures as well as an understanding of how they impact health and wellbeing. Health care organizations that are culturally competent can better meet the needs of their patients and improve patient outcomes. However, achieving cultural competence is challenging. In fact, many healthcare organizations lack the resources needed to implement culturally competent systems.
To become culturally competent, healthcare providers must be willing to change their own perceptions and attitudes about different cultures. This requires a commitment to continuing education and the development of cultural humility. In addition, healthcare providers must understand that there is no single definition of culture. This is important because it helps to avoid imposing one’s own cultural norms on people from other cultures.
Another key aspect of becoming culturally competent is effective communication. This involves active listening, demonstrating empathy, and effective engagement. Healthcare providers must also be aware of the different levels of power that exist in a given situation and how those relationships can impact the quality of care. Finally, healthcare providers must be aware of the different ways that different cultures interpret body language and speech.
A healthcare organization can improve its cultural competency by establishing a Cultural Competence Committee (CCC). The CCC should include representatives from policy making, administration, and service delivery. The committee should develop goals and a plan for implementing those goals. The CCC should also be responsible for evaluating the organization’s progress and adjusting its plans accordingly.
The CCC should also make sure that the organization is using a variety of tools and resources to help achieve its goals. This includes the Heckler Report, which provides guidelines for working with minorities in healthcare settings. In addition, the CCC should look for resources from federally funded technical assistance centers that catalog information on cultural competency.
It’s also helpful to reach out to other healthcare organizations that have implemented culturally competent systems. This can help them share their experiences and provide valuable advice.
2. Access to health services
Among the most common factors that lead to health disparities in Indigenous communities is access to healthcare services. This can be difficult in rural and remote areas where the population is primarily dependent on nurse-led services. Those nurses are often the only members of the healthcare team, and they may be required to have a range of skills and knowledge that they might not have been trained in. They also face challenges such as geographic isolation, which limits their ability to participate in professional development, peer support, and supervision.
The fact that Indigenous peoples are less likely to have adequate access to healthcare services should be seen as a human rights issue. This is particularly true given that they have a long history of colonial disruption that has included disease introduction, forced removal from lands, assaults on culture, and damaging state, federal and local policies and practices. As such, there is a moral imperative for more research to address this problem and to foster local self-determination in the process.
In one study, researchers identified that poor health literacy was a significant barrier to healthcare access in remote regions. This was a result of lack of training, the inability to communicate with non-English speaking staff, and a perception that healthcare providers don’t understand Aboriginal culture. In order to address these barriers, it is important for practitioners and health workers to have access to language services and to be aware of cultural nuances when communicating with their patients.
Additionally, it is important for healthcare professionals to be aware of the different perspectives that Indigenous peoples have on health and their role in care. This includes differences in beliefs and values, family structures, gender roles, and social organization (e.g., matrilineal). Additionally, it is important to respect the wishes and priorities of each individual in their care.
Several studies have shown that programs that provide transportation, lower costs, and involve community members can improve access to healthcare services for Indigenous peoples. These types of interventions can help to reduce the gap between the life expectancy of Indigenous and non-Indigenous Australians.
3. Providing health services in remote areas
The health gap between Indigenous and non-Indigenous Australians is the result of a combination of factors including poorer access to healthcare services, underlying social issues and a history of discrimination. Addressing these factors requires a holistic approach and a commitment from governments, communities and individuals to address the causes of inequality. In addition, there is a need for intervention research that moves beyond minor transformations of mainstream interventions and instead truly respects Indigenous wisdom, knowledge, traditions and aspirations.
Providing effective health services in remote areas is challenging, both for healthcare providers and for patients. Health service providers need to have the right skills and understanding to work effectively in remote locations, and to be able to adapt their care to meet local needs.
This can be difficult, especially in regions that have a high number of remote residents. In Australia, for example, nearly 28% of the population live in rural and remote areas. In these areas, health professionals have fewer opportunities for professional development, peer support and supervision, and often have to travel long distances to visit patients. This can lead to fatigue and burnout, which can affect patient safety and outcomes.
In addition, many remote communities are dependent on a single healthcare provider, usually a nurse, who is responsible for delivering and managing medical treatment for all patients in the community. This can be difficult for nurses, who are often not culturally competent and may feel undervalued or under-supported.
Moreover, a lack of resources and infrastructure can also impact the provision of healthcare services. In some areas, there is no access to specialist care, and people living in remote areas can be at risk of delayed diagnosis or inappropriate or dangerous treatments. Providing healthcare in these conditions can be extremely challenging and requires a commitment to change by all stakeholders, including government and industry.
Despite the challenges, there are some good examples of how healthcare providers in remote areas can improve their work and achieve better outcomes. For example, the Daruk Aboriginal Community Controlled Medical Service has had a successful antenatal program that has resulted in higher attendance and improved birth outcomes. This type of initiative can help to reduce the health gap and empower Indigenous communities to take control of their own futures.
4. Providing health services to Indigenous children
A key challenge in addressing Indigenous health disparities is overcoming the underlying social and economic inequities that contribute to poorer outcomes. In the case of remote areas, this requires greater availability of services through a more integrated service delivery model, affordable healthcare to ensure access and participation by all, and a focus on the cultural context of individual patients (e.g., their tribal affiliation, beliefs, language, family structure, gender roles and expectations).
This is particularly important in child health where cultural values and practices have the potential to skew clinical decisions, such as whether or not children are being breastfed, what types of milk they should consume, and how often they should be seen by a doctor. In addition, there are culturally specific beliefs about illness that impact not only the experience of illness, but also treatment, e.g., the belief that a person who dies from an infectious disease may return to life at some future point. This can impact a patient’s willingness to engage in a course of treatment that they may view as unnatural or harmful.
Furthermore, a key concern is the tendency of some practitioners to blame Indigenous patients for their poor health outcomes. This can be seen in blaming non-compliance with medication regimens on the patient rather than on the lack of clear communication from a health care provider. This victim blaming is a symptom of a larger problem with one-size-fits-all health care approaches that exclude and devalue Indigenous knowledge and beliefs.
These challenges do not only affect the health of Indigenous people, but are a reflection of wider structural inequities that need to be addressed. To address these inequities, the community of health researchers and practitioners is both scientifically and morally obligated to work in partnership with Indigenous communities to develop health promotion and intervention research that is both culturally appropriate and effective. This will require a sea change within mainstream health systems to break down barriers and prevent blaming marginalised communities for their disadvantageous circumstances. The health of Indigenous children depends on this.
