Aboriginal Health from a Health Service Perspective

1
Aboriginal Health from a Health Service
Perspective

• The Pika Wiya Health Service is situated in Port
  Augusta and has responsibility for four (4)
  clinics within the region. These clinics are
  based at -
• Community Health Centre Copley Clinic
• Davenport Clinic Nepabunna Clinic

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Aboriginal Health from a Health Service
Perspective

• The Pika Wiya Health Service region includes
  Quorn, Hawker, Copley, Nepabunna, Marree,
  Lyndhurst, Leigh Creek South and surrounding
  areas which includes Homelands with this area.
• Pika Wiya Health Service has a -
• - Vision.
• - Mission.
• - Purpose.
• - Philosophy.
• The Health Service has a total of 89 staff with a
  high in favour of females.
• Programs conducted out of PWHS are too numerous
  to mention but include programs such as the
  Aboriginal Primary Health Care Access Program,
  Child Health, Immunisation, Oral Health, Social
  and Emotional Wellbeing, Women's Health, Mens
  Health and Home and Community Care Programs.
• The PWHS is currently celebrating its 21st year
  in providing a primary health care service to
  Aboriginal people within the region.

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Aboriginal Health from a Health Service
Perspective

• Ongoing activities of the organisation include -
  
• - Regular promotional events
• - School screening
• - Specialist Clinics
• - Staff Development
• - Ongoing provision of an outreach service
• - Collaboration with other service providers in
  the region
• Some of the gaps, unmet needs and barriers
  include -
• - Inadequate dental service
• - No local drug and alcohol treatment program
• - Lack of trained Aboriginal drug and alcohol
  workers
• - An Inadequate dietetic service
• - Lack of trained staff to cover periods of
  leave such as the Aboriginal Liaison Officer and
  Diabetes.

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Aboriginal Health from a Health Service
Perspective

• Summary
• The Program staff have endeavoured to provide a
  high quality service to clients that
• inspires trust and confidence in Pika Wiya as an
  organisation and meets the cultural and
• health cares of the community.
• Current
• PWHS currently has 3680 active clients and
  services those clients with approximately
• 8393 clinical visits annually.
• Health Issues
• Diseases prevalent amongst Aboriginal Australians
  are
• Chronic Diseases Infectious
  Diseases
• Circulatory Illnesses - Hepatitis A and B, C
• Diabetes - Tuberculosis
• Cardiovascular - HIV / AIDS

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Aboriginal Health from a Health Service
Perspective

• Health Issues (cont.)
• Cancer - Gastrointestinal
• Renal Disease
• The higher incidence of circulatory and
  respiratory illnesses can be attributed to -
• Low socio-economic status
• Poor education
• Smoking
• Unemployment relying on welfare, etc
• Overcrowding in housing
• Poor nutrition leading to obesity
• Alcohol
• Drugs
• Lack of exercise

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Aboriginal Health from a Health Service
Perspective

• Reasons for poor health status
• The poor health of ATSI people can be attributed
  to a complex set of interacting
• Factors, one of the most important of which is
  the impact of colonisation and its flow-on
• effect. These effects include social factors such
  as -
• Low socio-economic status (income, education and
  unemployment) and
• Health risk factors such as poor living
  environments, poor nutrition, excessive alcohol
  consumption, smoking and a lack of physical
  activity.
• Other issues characteristic of the ATSI
  population that impact on health status
• Include external loss of control, lack of social
  capital, and pervasiveness of loss and grief.
• A major obstacle to improved health status has
  been the consistently poor level of access
• to appropriate health services available to ATSI
  people, whether they live in urban, rural
• or remote locations.

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Aboriginal Health from a Health Service
Perspective

• Cultural Barriers
• Some of the barriers to an effective healthcare
  service for Aboriginal people could
• include -
• Language barriers (Get em box!) (Take medicine
  all at once, get better quicker!)
• The frequency of visits by health professionals
  to the community
• Males unlikely to accept treatment from medical
  staff of the opposite sex
• The lack of Aboriginal staff at that medical
  facility
• Living in remote locations throughout Australia
• Culturally inappropriate and therefore poorly
  received by Aboriginal people.
• Misunderstanding or confusion about medicines
  leading to patients abandoning their treatment
  before completion.

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Aboriginal Health from a Health Service
Perspective

• Barriers (cont.)
• For people living in very remote areas, factors
  affecting access that we, on many
• occasions take for granted, come down to daily
  practicalities such as -
• Communication systemstelephone or radio contact
  with services and agencies to arrange / report
  emergencies.
• Lack of transport / reliable transport in the
  community
• Condition of roads flooded / potholed, etc.
• Condition and proximity of airstrips
• Weather conditions for aircraft
• Poverty unable to afford food or prescribed
  medicine.

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Aboriginal Health from a Health Service
Perspective

• Mental Health
• There is also a high incidence of mental health
  issues among Aboriginal people which
• for many reasons, they do not practice their
  culture, beliefs and way of life from today's
  society and as a result they have a loss of
  identity, culture and place.
• Younger Aboriginal people have a perception that
  their health status is predetermined
• and they have this defeated mentality.
• Many Aboriginal people, young and old, see and
  live with the direct results of sexual, physical,
  drugs and alcohol abuse which has an indirect
  effect on their families and the general
  population and/or communityand this is inherited
  by the next generation.

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Aboriginal Health from a Health Service
Perspective

• Expectation of life from Birth for Aboriginal
  people and the total population
• 1999 2001. ABS (2005) Deaths Australia 2004

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Aboriginal Health from a Health Service
Perspective

• When comparison is useful Aboriginal and Torres
  Strait Islander inequality
• For some groups who experience structural and /
  or historical disadvantage, comparison
• can be useful to emphasise the impact of this
  disadvantage on their health.
• There is justification to talk about comparisons
  to bring attention to the health needs of
• particular groups. Aboriginal people in
  Australia, for example, experience disadvantage
  or
• poor health levels as a result of social
  exclusion and institutionalised discrimination!
• (Bob Pease Contributor to the publication
  Primary Health Care to Mens Health 2007)

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Aboriginal Health from a Health Service
Perspective

• The Social Determinants of Health
• (Wilkinson, R Marmot, M. (2003) . Social
  Determinants of Health the solid facts,
• World Health organisation.
• This publication, prepared for the World Health
  Organisation, outlines the social
• determinants of health and their relation to
  public policy. The authors focus on the
• role that public policy can play in shaping the
  social environment in ways conducive to
• better health. They list ten (10) major social
  determinants of health. In introducing
• these, they note
• While medical care can prolong survival and
  improve prognosis after some serious
• diseases, more important for the health of the
  population as a whole are the social
• and economic conditions that make people ill and
  in need of medical care in the first
• place. Nevertheless, universal access to medical
  care is clearly one of the social
• determinants of health.

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Aboriginal Health from a Health Service
Perspective

• Social Determinants -
• The social gradient
• life expectancy is shorter and most diseases are
  more common further down the social ladder in
  each society. Health policy must tackle the
  social and economic determinants of health.
• Stress
• stressful circumstances, making people worried,
  anxious and unable to cope, are damaging to
  health and may lead to premature death.
• Early life
• a good start to life means supporting mothers
  and young children the health impact of early
  development and education lasts a lifetime.

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Aboriginal Health from a Health Service
Perspective

• Social exclusion
• life is short where its quality is poor. By
  causing hardship and resentment, poverty, social
  exclusion and discrimination costs lives
• Work
• stress in the workplace increases the risk of
  disease. People who have more control over their
  work have better health.
• Unemployment
• job security increases health, wellbeing and job
  satisfaction. Higher rates of unemployment cause
  more illness and premature death.
• Social support
• friendship, good social relations and strong
  supportive networks improve health at home, at
  work and in the community

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Aboriginal Health from a Health Service
Perspective

• Addiction
• individuals turn to alcohol, drugs and tobacco
  and suffer from their use, but use is influenced
  by the wider social setting.
• Food
• because global market forces control the food
  supply, healthy food is a political issue
• Transport
• healthy transport means reducing driving and
  encouraging more walking and cycling, backed up
  by better public transport.

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Aboriginal Health from a Health Service
Perspective

• Consequences of lack of access for aboriginal
  people -
• Due to the fact that many Aboriginal people are
  not receiving timely or adequate health
• Care the consequences of this is seen in rates of
  diseases, secondary complications,
• Disability and premature death. For example -
• A lack of early detection and treatment for ear,
  eyes and skin infections are linked to deafness,
  blindness and the onset of chronic disease in
  later life.
• Lack of early detection and the proper management
  of chronic disease can lead to secondary
  complications such as renal failure and
  blindness.
• Poor access to maternal and child health services
  can contribute to infant mortality rate, which of
  course are still unacceptably high compared with
  those for non-indigenous babies.
• Evidence is now emerging, both nationally and
  internationally, that access to appropriate
• health care, particularly primary health care,
  can make a significant difference in reducing
• rates of morbidity and mortality in populations
  with a very low health status.
• (Better Health Care Studies in the successful
  delivery of Primary Health Care Services for ATSI
  
• peoples Commonwealth of Australia 2001)

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Aboriginal Health from a Health Service
Perspective

• Conclusion
• ATSI people have poor health status for a complex
  range of reasons. The health system
• has a critical role in addressing this situation
  but has not worked well with ATSI people.
• Historically, the systems has not provided the
  level and quality of care required and has
• failed to prevent ill health through early
  intervention mechanisms.
• A number of barriers still restrict access to
  health care through mainstream systems and
• there has been systematic action in Australia
  since the mid 1970s to improve the
• responsiveness of the health care system.
• Many mainstream services are not structured to
  take an active integrated approach to
• health maintenance, primary and secondary disease
  prevention. To do so would require
• a shift from the current focus on individuals and
  specific diseases, to identifying morbidity
• profiles in the client population and addressing
  these in a comprehensive way.
• (Better Health Care Commonwealth of Australia
  2001)