MED2042 WEEK 7 - Indigenous health
Terms
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- What is Aboriginality?
- Aboriginality is when you can trace Aboriginal ancetry, you live as an Aboriginal person, and a community recognises you as Aboriginal.
- What features characterise Aboriginal culture?
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Stong kinship
Tight family bonds
Reciprocity and sharing
Respect for the elders - Quote by Pat Dodson 1994 about Indigenous health.
- "There should be no mistake that the state of Indigenous health in this country is an abuse of human rights. A decent standard of health and life expectancy equivalent to other Australians is not a favour asked by our people. It is our right - simply because we too are human"
- How many more people dying in the age group 25-55 will an Indigenous peron know than a non-indigenous person?
- An indigenous person will know 6 times the number of people who will die in teh 25-55 year age group as a non-indigenous person.
- Indigenous people face the worst of old diseases and of mordern western lifestyle. Explain.
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Indigenous - High morbidity, mortality from communicable diseases, maternal and perinatal conditions, nutritional deficiencies.
Non-indigenous - longer life expectancy, higher proportion of non-communicable disease (cancer & cardiovascular) - What are some ABS stats on Indigenous people?
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- Cardiovascular disease (28.3%) - 2x non-Indigenous
- Inuries (15.6%) - 4x non-Indigenous
- Maglignant neoplasms (15.1%) - 2x non-Indigenous
- respiratory disease (9.1% - 5x non-Indigenous
- diabetes (7.6%) - 10x non-Indigenous
- perinatal deaths - 3x non-Indigenous SA, Native title
- indigenous people are 2x as likely to smoke. - What is the legacy of Aboriginal people?
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- 200 years of management
- Neglect of worsening health
- Loss of control of politics, land
- dispossession
- poor education, employment
- threats to identity
- poverty - Describe the Docker River community.
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- 500km west of Alice
- 1 food store for 360 people
- 3 fridges, 2 washing machines
- 8 people per house on av.
- 100% unemployment
- food marked up by 80-100
- supplies every 4-5 weeks
- Australia'a poorest pay the highest prices - children go hungry - Describe the features of a remote physical environment e.g. Boroloola.
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- Inadequate housing
- Overcrowding
- Polluted water
- Inadequate sanitation
- Diseased animals - What are the eduational factors of Aboriginal people?
- No history of progress to tertiary
- How is substance abuse a problem in Aboriginal people?
- If you don't remove the cause you won't affect a cure.
- Racism.
- prominent.
- What is the Indigenous definition of health?
- "Health is not just the physical wellbeing of an individual, but the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being therby bringing about the total wellbeing of their community" National Aboriginal Community Controlled Health Organisation.
- What are the requirements of good health?
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- provision of healthful housing
- suitable and sufficient diet
- wholesome drinking water
- protection from hazard in the work place
- clean air and waters
- land free of health threatening pollution
- control of pests
- sanitary removal and treatment of waste
- health education and information
- control of communicable diseases
- appropriate facilities for leisure - What does culture include?
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Beliefs
Behaviours
Attitudes
Practices
learned, shared, passed on by members of a group. Adaptive mechanism developed to ensure survival, wellbeing.
Also important:
Ethnic/racial background
Language
Gender
Socio/economic/educational status
Education
Sexual orientation
Physical capacity
Age, personality
Spirituality/religion
Regional perspectives
New immigrant socialisation - What does culture define?
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Health
Aetiology of disease
Establishes the parameters
Prescribes treatment - Why do we need to attend to cultural differences?
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Biochemcial model
- Individual is autonomous, egalitarian, self-assertive, uses open verbal communication
Other cultures e.g. Indigenous
- Community, consensus, non-assertiveness and guarded verbal communiation, lack of questioning.
Rmote and urban!
Message given is not necessarily message received.
English as a second language. - Describe how lack of communication can occur for a patient.
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For the patient,
- no full understanding
- in hospital without information
- Medical treatment without consent
- Mistaken identity
- Inadequate information
- Treatement at odds with cultural beliefs
- Not seeking medical consultations early enough
- Lack of trust in doctors and hospitals
- Lack of cultural safety - Describe how lack of communication can occur for a medical practitioner.
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- Barrier to diagnosing
- Lack of informing patients
- Getting gender issues wrong
- Getting authorities wrong
- Getting death and birth protocols wrong
- Barriers
- Ultimately to:
> misdiagnosis
> lack of informed consent
> poor adherence to treatments
> persistent health-damaging behaviours
> inefficient health promotion strategies - What did Ian Anderson write about power relationships?
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Inherent and insurmountable mismatch in the power relationship.
1. Extent of intellectual and/or educational distance.
2. Consent based on non-Indigenous decision making - What training needs to be done to solve communication difficulties?
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- Holistic approach to patient problems
- Communicate appropriately, repectfully, sensitively
- provide clear and accurate information
- work collaboratively
- self-learning and problem solving - What is cultural competence?
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- Congruent behaviours, attitudes and policies that come together in an individual, institution or profession to enable effective work in cross-cultural situations.
Relies on:
- valuing differences and similarities
- capacity for self-reflection
- understanding cross-cultural dynamics
- building cultural knowledge
- repond to cultural differences, adapt. - What are the steps from cultural destruction to cultural proficiency?
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Cultural destructivenes
--> Cultural incapacity
--> Cultural blindness
--> Cultural pre-competence
--> Cultural competence
--> Cultural proficiency - What is the cultural competence model?
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Unconscious incompetence
Conscious incompetence
Conscious competence
Unconscious compentence - How do different cultures affect health care?
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- Multicultural society
- Many interpretations of health, health care, ill-health
- alternative and complementary medical systems
Guild and workbooks a problem!
Cultural competence resulting from reflection. - What is cultural humility?
- A competent health care provider is culturally competent.
- What is the three-legged stool?
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ATTITUDE
- humility, empathy, curiosity, respect, sensitivity, awareness of own predispostion to racial, cultural, gender & class bias and categorisation etc
KNOWLEDGE
- social issues, historic context, nutrition habits, occupations, housing, healing practices, disease incidence and prevalence
SKILLS
- Interviewing, communication, ability to elicit core-cultural values - What is institutional culture? What is a culture of no culture?
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Does medicine have a culture?
How does it pass on its culture?
Does Monash have a culture?
How does it pass on its culture? - What is cultural safety?
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It is what recipients perceive.
Indigenous people treated as "risk factors"
Hospitals
- where people die
- family restricted
- alien treatments, therapies and technologies - What are other some important issues for Aboriginal people?
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Infrastructure
Health services
Primary health care
Workforce
Housing
Education
Employment
Land
Resources
Programmes