Indigenous culture and health

3.2 Indigenous culture and health


The word Indigenous, meaning native, is used to describe the ancient or native population of a country. Indigenous populations have almost always been affected by colonization and migration of other populations and are almost always in a position of social disadvantage relative to the rest of the country’s population. This social disadvantage is reflected in major inequalities of health.


There are Indigenous populations in countries throughout the Asia–Pacific region, as well as elsewhere in the world. For this chapter, the editors asked Paul Bauert and Francis Abbott to write about Aboriginal and Torres Strait Islander children in Australia, and Leo Buchanan to write about the Maori and Pacific island populations in New Zealand.



Part 1 aboriginal and torres strait islanders


Paul Bauert, Francis Abbott



A definition of Aboriginal and Torres Strait Islander people


In Australia, the word Indigenous is used to refer to the Aboriginal and Torres Strait Islander peoples of Australia and is used by the Australian Bureau of Statistics (Indigenous Statistics for Schools), which also outlines the most widely adopted definition of Aboriginal or Torres Strait Islander (the ’Commonwealth working definition’):



‘An Aboriginal or Torres Strait Islander is



• a person of Aboriginal or Torres Strait Islander descent,


• who identifies as being of Aboriginal or Torres Strait Islander origin and


• who is accepted as such by the community with which the person associates.’


Australian Indigenous peoples are many diverse groups, with varying cultural ways, languages, traditions and names for themselves. The health-care professional should use a formal, accepted and respected name that people in the local community use to refer to themselves, some examples of which are:



• New South Wales – Koori


• Victoria – Koorie


• Queensland/North New South Wales – Murri


• South Australia – Nungah


• Western Australia (south-west) – Noongar


• Tasmania – Palawa


• North-east Arnhem Land, Northern Territory – Yolngu


• Tiwi Islands, Northern Territory – Tunuwi


• Jabiru region, Northern Territory – Binjing.



Health care and cultural safety


Expressions such as ‘cultural awareness’, ‘cultural safety’, ‘cultural security’ and ‘cultural competence’ are often used and discussed in the literature in relation to organizations, health services and health care, and to individual service providers’ abilities to interact appropriately and effectively with people of other cultures. Individual cultural competence has been described by the Northern Territory Government as having four components:



• Awareness of one’s own cultural world view


• Attitude towards cultural differences


• Knowledge of different cultural practices and world views


• Cross-cultural skills.


Many jurisdictions and organizations, both governmental and non-governmental, have developed organizational policies, frameworks, resources and training around this cultural competence continuum. The National Health and Medical Research Council produced a guide to cultural competency, and a number of regions have developed various frameworks and resources based on this guide.


None of our diverse cultures, including Australian Indigenous culture, can be adequately described in one short chapter. However, this information can be a starting point in the progression from cultural awareness to cultural competence. Online generic courses concerning Indigenous culture are also available, including both free and accredited courses. Cultures, including Australian Indigenous culture, are never static but constantly changing with time, and there is much diversity within cultures.


Generic information and courses need to be built on by accessing any available face-to-face courses, resources and local Indigenous ‘cultural brokers’, in order to learn location-specific and role-specific cultural information, historical information, cultural contexts and protocols concerning the community being served. ‘Cultural brokers’ may be people such as: community elders, community workers, Aboriginal Health Workers, people working in Aboriginal Liaison roles, community/local councils, local Boards, and Aboriginal Controlled Services.



Implications for a health-care professional’s practice




• For an individual to be ‘culturally competent’ requires a willingness to change, to be empathic, adaptable and ‘other centred’, and to develop along a continuum that starts with a level of awareness, to being able to practice in a culturally competent manner.


• All health-care professionals working with Indigenous people should endeavour to access cultural competency training and resources relevant to Australian Indigenous culture in order to achieve this.


• Research any cultural competency guides, frameworks and resources that may have been developed for the local region and health services.


• Organizations’ and individuals’ cultural competence affects Indigenous people’s ability and willingness to be able to access and use services.


• Find out who are the appropriate local cultural brokers to learn from.



Population


Accurate figures for the number of Indigenous people living in Australia at the time of white settlement are not known. Anthropologists and others have suggested various numbers ranging from 300 000 to 1 000  000. Archaeological research has suggested that the land could have supported 750 000 people before white settlement.


Whatever the numbers were before 1788, they ‘declined dramatically under the impact of new diseases, repressive and often brutal treatment, dispossession, and social and cultural disruption and disintegration’ (Year Book Australia, 1994 – Australian Bureau of Statistics). ‘The decline of the Indigenous population continued well into the twentieth century’, according to Australia’s Health 2010, the 12th biennial health report of the Australian Institute of Health and Welfare.


By 2009, the estimated Indigenous population had increased to about 550 000, comprising 2.5% of Australia’s population (Australian Bureau of Statistics). These figures include 6% who identified as being of Torres Strait Islander origin and 4% as being of both Aboriginal and Torres Strait Islander. These increases are ‘in excess of those which can be attributed to natural increase in the Indigenous population’. ‘Changing social attitudes, political developments, improved statistical coverage, and a broader definition of Indigenous origin have all contributed to the increased likelihood of people identifying as being of Aboriginal or Torres Strait Islander origin’ (Australia’s Health 2010). Some 32% live in major cities, 43% in regional areas, and 25% in remote or very remote areas. Approximately 30% of the Northern Territory population are Indigenous people, the highest proportion in Australia. In comparison, Victoria has the lowest proportion, at 0.7%.


The Aboriginal and Torres Strait Islander population of Australia is very different from the rest of the population in age range as a result of higher birth rates and earlier age at death. In 2006, the median age was 21 years for Indigenous people and 37 years for the non-Indigenous population.



Implications for a health-care professional’s practice




• Find out whether the population in the area your health service covers includes Indigenous people.


• Consider whether the service is accessible and culturally appropriate for those people.


• Consult with the community as to what measures, if any, the people would like to see introduced to assist with this.


• Are there local Indigenous people employed in the service, or training and employment opportunities to help increase the numbers of Indigenous people in the organization?


• Are there health programmes that cater for the needs of the Indigenous community’s age demographics?



Mortality


The Australian Institute of Health and Welfare (AIHW) considers data from New South Wales, Queensland, Western Australia, South Australia and the Northern Territory as the most complete. The combined data from 2003–2007 demonstrate that mortality rates for all age groups of Indigenous males and females were approximately twice as high as for non-Indigenous people, except for those aged 75 years and over, where the ratio was only 1.2.


Life expectancy at birth is approximately 67 years for Indigenous males and 73 for females (compared with 78 and 83 years respectively for non-Indigenous males and females).


The AIHW considers that the mortality rate for children aged under 5 years is a key indicator of the general health and wellbeing of a population. In the period 2003–2007, the 692 deaths of Aboriginal and Torres Strait Islander children aged 0–4 years was around twice the rate for non-Indigenous children during this period. ‘For injury and poisoning, and respiratory diseases, which were common causes of death among children of this age group, Indigenous children died at 3 and 4 times the rate of non-Indigenous children respectively’ (Australia’s Health 2010).



Implications for a health-care professional’s practice




• Indigenous people accessing care away from home may need assistance with planning for early return home as they may be culturally obliged to return for funeral ceremonies and ‘sorry business’ and/or may want the company of family while grieving.


• Unresolved or ongoing grief is highly likely to be impacting on the mental health and social and emotional wellbeing of people who have relatively frequent losses of close relatives.


• There may be reluctance to attend a health service where a relative has died. There may be a need to have a ceremony to ‘cleanse’ such an area. Seek guidance from local Indigenous people as to their wishes regarding this.


• People will be likely to want (and have a right to) a thorough and meaningful explanation of the cause of death of a family member. Keep in mind and respect the fact that people may also have their own cultural explanations for the cause of death.


• A dying person will usually want to return to ‘country’ (the land they are connected to) and family for particular processes and ceremonies associated with dying and to pass away there. The health-care professional may need to put processes in place to help facilitate this as soon as possible.


• Many Indigenous people do not use the name of a deceased person for a long time, if at all, after someone has died. A health-care professional talking with a family about someone who has passed away should use a relationship term instead, such as ‘your aunty’, ‘grandfather’, etc., or the local term specifically used for this situation.



Health and illness beliefs


A definition of health as perceived by Aboriginal peoples was developed by the National Aboriginal Health Strategy in 1989:



“Aboriginal health” means not just the physical wellbeing of an individual but refers to 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 thereby bringing about the total wellbeing of their community. It is a whole of life view and includes the cyclical concept of life – death – life.


For many Indigenous people, the spiritual or supernatural side of life remains an unquestioned reality. Many still retain a strong traditional belief in the causes of illness different to that of the western biomedical model, even if that is well explained, understood and accepted. The cause can be attributed to ‘sorcery’ or as a consequence of having transgressed some traditional law. The person may have to put this right to bring about a complete cure; they may want to continue ‘western’ medical treatment but may also need to return home to carry out correct traditional practices to restore health. Many people still access their own traditional healer, traditional medicines and healing practices.


Men’s business/Women’s business: This term refers to health and treatment matters of a personal nature concerning the bowels, bladder, genital areas, sexual matters, childbirth, etc. It is usually very difficult and ‘shameful’ for a male or female Indigenous person to discuss these or be treated in this area by someone of the opposite sex. However, Indigenous people, like others, are of course practical and, with adequate and respectful explanation, appreciate that sometimes a same-sex staff member is not available, although it is really preferable not to cross these boundaries.



Implications for a health-care professional’s practice




• When providing a service, keep in mind the holistic definition of health as defined above and work within this.


• Be guided by any available community cultural brokers as to people’s concept of health and any traditional resources they access.


• If the community wishes, collaborate in incorporating these in the service.


• If the person is far from their community accessing health care, it may be necessary to help facilitate ongoing care and return to the community so that the person can also attend to cultural matters surrounding their illness beliefs.


• Endeavour to have sufficient numbers of both male and female staff, including Indigenous staff, employed in the service.


• If possible and appropriate, when no professional of the same sex as the client is available, have a ‘chaperone’ of the same sex as the person to accompany and support the professional and client while treating or discussing ‘men’s/women’s business’ matters.



History, disadvantage and health


For a discussion on Australian Indigenous history since 1788, and its devastating impact on past and current health and welfare, the reader is encouraged to examine the Australian Indigenous HealthInfoNet. Dispossession, introduction of new diseases, epidemics causing depopulation and consequent disruption in family systems and culture, loss of autonomy, destruction of traditional food and economic systems and ceremonial life and culture, separation of families and family members (including policies and practices that led to the Stolen Generations), and loss of control over much of daily life, are among the many contributing factors discussed. The ‘clear relationship between the social inequalities experienced by Indigenous people and their current health status’ is described. Loss of control over daily life is increasingly acknowledged as a significant cause of chronic stress, a contributor to chronic disease.


In their regular reporting of key indicators of Indigenous disadvantage, the Productivity Commission describes six ‘headline indicators’: post-secondary education; disability and chronic disease; household and individual income; substantiated child abuse and neglect; imprisonment and juvenile detention; family and community violence. In all of these indicators, Australian Indigenous people suffer substantial disadvantage compared with the rest of the population, despite some minor gains in some indicators over recent years:



• Australian Indigenous people endure an overall burden of ill-health that is 2.5 times that of the total Australian population.


• The leading causes of morbidity and mortality for Australian Indigenous people include: cardiovascular disease (including rheumatic fever and rheumatic heart disease); mental health problems and social and emotional wellbeing issues (‘7 out of 10 Indigenous children were living in families that had experienced three or more major life stress events such as death in the family, serious illness, family breakdown, financial problems or arrest … and 22% had experienced seven or more of such events’); respiratory diseases; type 2 diabetes; chronic kidney disease; and injury.


• Co-morbidity of cardiovascular disease, diabetes and chronic kidney disease often occurs in the general population. However, this particular co-morbidity is even more common among Indigenous Australians.


• Cancer rates are lower for Indigenous people, but cancer death rates are approximately 1.5 times higher for Indigenous males and females than for non-Indigenous people. The main causes of Indigenous cancer deaths include cancers of the digestive organs and lung cancer. Among Indigenous people, smoking-related cancers are more common than among non-Indigenous people.


• Ear disease and hearing loss is higher than for the general Australian population, predominantly among children and young adults.

Related posts:

  1. Hyperactivity and inattention
  2. Bone mineral disorders
  3. Resuscitation
  4. The newborn infant: stabilization and examination

Stay updated, free articles. Join our Telegram channel
Tags:
Aug 4, 2016 | Posted by in PEDIATRICS | Comments Off on Indigenous culture and health

Full access? Get Clinical Tree
Get Clinical Tree app for offline access