Background:

“Aboriginal people are a steady beating heart at the centre of our Australian spiritual identity,” quoted by the famous journalist, Caroline Jones regarding the indigenous population of the country. But the ‘heart’ is gradually being affected which raises doubts about the health status of this community. Indigenous people are a community having a set of particular rights based on their historical bondage to a territory or nation. They are culturally and historically distinctive from other population of the nation. They were facilitated with special set of rights as they are very much vulnerable to exploitation and oppression. Since their settlement is spread all over across the globe, it is very difficult to compile and estimate their population. A report suggested that their population ranges from 300 million to 350 million as of the start of the 21^st century. Indigenous population varies in levels, patterns and courses of health.  But there is an alarming concern regarding their health profile. It is reported that there is a huge gap in the life expectancy between indigenous and non-indigenous populations of several countries like Australia, New Zealand, Canada and the United States (Claydon et al., 2007).  They also have higher rates of ill health as compared to other groups. Due to their inaccessible habitat at remote places, it is very challenging for the governmental authorities to supply better healthcare facilities to them. Moreover, they rely much on their traditional medicines, which are generally derived from plant and animal products.  Due to lack of awareness about current advancement of medicine, they are reluctant to practice it. Our current research proposal focuses on the child sector of these indigenous people. The present assignment will try to address the cause of higher infant mortality rates among such people as compared to the national average of Australia. It will also enlighten the plans and measures for improvement in this field.

Infant Mortality Rate (IMR) is defined as the demise of a child less than one year of age in a calendar year. This rate in Australia has improved gradually over the 20^th century with 5.7 per 1000 live births in 1991. But for the Aboriginal people, the statistic is alarming, and is recorded to be 15 per 1000 live births. According to the census of the nineties, IMR of the Indigenous population is three times that of the national average. This continuing difference in health profile is a major concern. But it is much more important for the researchers to recognize the fallacies in the health care system and recover the disparity before the gap is too widened. Latest studies have showed that indigenous infants generally died due to various reasons which comprise of birth trauma, fetal growth disorders, and pregnancy, labor and delivery complications (Claydon et al., 2007). These conditions originate twice the rate of their non-indigenous counterparts. Other major contributing factors to this death rate are circulatory diseases, cardiovascular diseases, which includes heart disease and stroke, neoplasms, endocrine, metabolic and nutritional disorders, respiratory difficulties and some external causes. Apart from the medical complications, few other factors also contribute to this incidence. Socio-economic factor of a community includes education, job facilities and income. Since the indigenous persons belong to a low-income group, they are socioeconomically disadvantaged. They have minimal access to education. Absence of safe, well maintained and adequate housing poses serious health related issues. Since they reside in remote and poorly accessible regions, they are devoid of better transport, water and electric supply, and sewage clearance. They feed on food having low nutritional value which adversely affects both their physical and mental health (Shannon, 2002). Lack of these basic amenities adds up to their health problem (Gracey, 1998). Additionally, the trend of consumption of alcohol, tobacco and related substances has increased over the last few decades. This factor alone is largely responsible for the poor health status of the indigenous population.

This is a very challenging task for the governmental organizations to provide better civic amenities to Indigenous population at par with the non-indigenous ones. Since the infant mortality rate is comparatively higher in Indigenous population, there is a chance of extinction of their community. Since their statistic of live births per year is low, the number of successors to carry forward their community will be decreasing. So, it can be predicted that after thirty to forty years down the line, there will definitely be a threat to their existence.

Program Improvement Objectives:

Bridging the gap in infant mortality rate between indigenous and non-indigenous Australian population is the main target of the Commonwealth government of Australia. They have furnished few plans and schemes for obtaining the sustainable health benefits for indigenous persons. Regular health checks for the indigenous population have been paced to a faster rate since 2006 (AIHW, 2011). The health services for this group of people are completely government-aided. In the first half of the twentieth century, there was large improvement in social and public health conditions. Steps to promote sanitation and health education were implemented. There was drastic revolution in the field of immunization program. Better treatment facilities were undertaken by the Australian government in neonatal intensive care. The Commonwealth government undertook several drastic health promotion measures which also positively affected various other disciplines like public health, education, anthropology, epidemiology and psychology (NACCHO report). Health is seen comprehensively among the Indigenous population. It includes aspects of physical, mental, social and cultural well being of the concerned people and their territory. Alcohol restriction and illicit substance consumption prohibition has been promoted to address their harmful consequences. Another important step taken by the government is the employment of the Aboriginals, mainly females, as medical assistants in leprosy hospitals.

Table 1: The table depicts the Population, Interventions and possible Outcomes in the course of the                           research.

One approach towards developing health conditions of the Indigenous people is to develop a group of public health leaders. They would bridge between health researchers, medical staffs, Indigenous community and the government. Along with this, continuous monitoring is required to increase the pace of the health network. Target on sufficient resourcing and providing education to young Indigenous population will be a wise strategy in this regard. Currently, steps are also taken to relocate funding from non-operational programs to this field. Monetary assistance from both public and private bodies will strengthen this issue.

More developmental strategies can be implemented for promoting Indigenous health among Aboriginal communities. They can be outlined as follows:

• Developing awareness programs and messages among the Indigenous communities about the modern aspects of medicine and its positive outcomes. This could possibly make those people receptive to health promotion programs;
• Training should be provided to the Indigenous persons, specially youths, so that they can assist in development of action strategies associated with environmental and behavioral change;
• Regular routine health check programs for the infants and their mothers must be implemented.

Throughout the world, it is continuously reported that there is deficits in health care delivery and its scope for improvement for the Indigenous people. There should be respect regarding culturally sensitive issues for understanding Indigenous persons across the globe. It can be suggested that nursing practice empowers the intention of nurses to be holistic. There are several recorded incidences where the nurse communities address the disparities in health, social and educational services to the children of the Indigenous communities (Brascoupe & Waters, 2009). They serve irrespective of colonialism, racism or religious creeds.  Based on practical experience regarding the Aboriginals, professional developmental strategies are undertaken by the Australian government. This learning will help the health professionals to develop analytical and problem-solving skills in the Indigenous territory. Moreover, this will also lead to establish a better understanding of workforce capacity issues. Additionally, it will positively alter the numbers, careers and competence of the community. The health care professionals should adopt holistic approach while offering service to such patients. They should respect local traditions and be careful not to impose their own values. They should function together in multidisciplinary teams and should also include community health representatives.  They must also be sensitive to cross-cultural care. The Indigenous communities make up almost 6% of the total world population. So, delivering advanced and better health services to them must be the goal of all the nations as their health profile also contributes to the national health statistics. Following the above mentioned strategies may surely reduce the disparity in IMR between Indigenous and non-Indigenous population. This will take a tandem effort by all levels of government working together with Aboriginal peoples, and also support from general citizens.

Method:

Inclusion Criteria:

Large scale surveys of population samples are required to be investigated to procure their perceptions and experiences regarding health profile of Aboriginal community across Australia. National Aboriginals and Torres Strait Islanders will be mainly included in the present study. Old aged persons, generally above 55 years, will be enquired to get information about the complete health status of the respective community form his/her childhood to present age. They would also be enquired about any possible migrations by their ancestors. Recently motherhood-experiencing females from age group 22-34 years will also be included in the sampling population. They must accompany their children (till one year) as they will be also included in the study. Such mothers are likely to report the incidences of various neonatal disorders which led to fatality of those infants before attainment of one year age. Additionally, unemployed youths should also be included in the program, which were unaware of modern medical advancement and technological innovations. Middle-aged persons ranging from 28-45 years will also be a part of the study. They can report the average usage of alcohol and other illicit substances and their ill-effects among the community. The non-indigenous population should be collected randomly throughout the continent of Australia. It must include recently motherhood-experiencing women between age group 22-34 years. Similarly, older persons above 55 years should also be included in the study. Questionnaire, diet survey, physical assessments including height, weight, body mass index, body surface area, hip-waist ratio etc will be included in the methodology (Wang & Hoy, 2003). Parameters related to cardiovascular functioning such as the cardiac output will also be assessed. Lung function test will be carried out to confirm the respiratory health status of the sample. Health care professionals such as doctors, nursing staff and medical assistants associated with Aboriginal health care will also be investigated. They can report the cases of diseases affecting infants less than one year age. They can enlighten the infrastructure of health facilities provided to those people. They can also suggest few measures for improving their health profile. Anthropometric measurements provide vital information about physical development of the body (Kondalsamy et. al., 2008). So this technique will be carried out in the study.

Exclusion Criteria:

Employed persons from Aboriginal community, who were associated with delivering health care services and other public welfare programs, should be excluded from the study. As they are well-informed about the aspects of latest biomedical innovations, they will not be a part of the sample. Individuals, those who are consuming alcohol and related illicit substances for more than 25 years are excluded from the study. Children ranging from 10 to 17 years will be also restricted to participate in this study. Aboriginal community residing at a place for less than hundred years should not be included in this study because change in demographics and geographical locations can influence the health status of the community. Communities which have a past record of inter-continental migration (Clatworthy et al., 2007) must be kept separated for the same reason. Persons with poor mental and physical health conditions should also be excluded from the group as it may affect the outcome of the study. Invasive methods of biological examination like blood specimen collection or any kind of pharmacological administration will not be included in the study.

Search Strategy:

Search strategy is the systematic approach for tracking down relevant information related to the proposed research issue. Newspapers, magazines and journals serves as excellent media for procuring information.  Before start searching for data, it is foremost to develop a cohesive search strategy, which consists of defining the search terms and thinking about alternative terms. After that the database can be searched with the key words. These strategies can be applied while searching the internet, databases and library catalogue.  For science based research works, scholarly journals and reviews, books and references are apt. Field research, questionnaires, surveys and interviews also provide very good source of obtaining information. If the main aim of the research is to know basic details of the searched topic then a simple search or basic search will be sufficient. But for a more comprehensive and sensitive search strategy is required for advanced knowledge of the topic. Thus the search strategy varies for different topics in terms of the requirement of the research. The search strategy also varies between different data bases.

For the current assignment, various search engines and databases have been used. The key words that have been used for searching are ‘Health status of Indigenous community’ and ‘Aboriginals’. The databases of Australian Institute of Health and Welfare (AIHW) and National Center for Biotechnology Information (NCBI) PUBMED have been used for the search strategy.

Outcomes of the Search Strategy:

The key words were used in the search strategies to research on the topic. At first these key words were incorporated in the database search engine and after that various results were found on the related topic. The database provided various books and journal articles on the topic. These two databases were chosen as they provided excellent top grade and authentic information, data and statistics about Indigenous health. The Australian Institute of Health and Welfare provided national data related to Aboriginal health status. It also provided information about the measures taken by the Commonwealth government of Australia. It mentioned about the sustainable developmental measures which will be taken by the authority to ensure better medical infrastructure to every citizen of the continent. These databases also mentioned about the alarming reality of high Infant Mortality Rate of the Aboriginals as compared to that of the rest of the Australians. Another database PUBMED provided data about the disparity in ethnics about neonatal mortality. It also provided information on the nutritional status of the Aboriginals.  Screenshots of the respective databases are as follows:

Screenshot 1:

Screenshot of a literature review generated from PUBMED.

This review focuses on the disparities in health outcomes among different ethnic groups, residing in the developed countries, although our knowledge of health care is progressing day by day.

Screenshot 2:

Screenshot of a literature review generated from Australian Institute of Health and Welfare.

This review supplies information about the geographical distributions, determinants of health and welfare and issues related to life expectancy and infant mortality of the Aboriginals.

Conclusion:

It is very much transparent from the study that the health profile of the Indigenous community remains at a low level, when compared with the general public. With the advancement of medical facilities throughout the world, there is vast and extensive improvement in health care system all over the world.  There is sharp decrease in the infant mortality rate of the Aboriginals, but still it is at a high alarming rate. The infant mortality rate of this community is three times as high as the general natives. If this problem is not addressed at once, the consequences will be much more severe. This may lead to extinction of a particular ethnic group or community from the continent. There will loss of both traditional as well as cultural issues. The long term decline in the infant mortality rate is due to proper planning of the health-related schemes and community development programs. Increase in Indigenous health care funding over last few decades have resulted in such encouraging outcome. In spite of all this, there is a significant lower life expectancy for Aboriginal women and men. They die at a much younger age. Low income, poor housing and sanitation, lack of education, all these factors contribute to their poor health status.

There are many excellent cultural programs under the leadership of the Aboriginals, which have been initiated in current times. This kind of programs can have positive impact on improving health status. Primary prevention programs like campaigns against smoking, drugs and illicit substances, nutritional and physical exercise programs, vaccination, immunization and blood pressure monitoring programs have proved to be effective in raising the health standards among Aboriginal communities throughout Australia.

References:

Brascoupé S, and Waters C; 2009; Cultural Safety Exploring the Applicability of the Concept of Cultural  Safety to Aboriginal Health and Community Wellness; Journal of Aboriginal Health, November 2009.

Clatworthy S and Norris J; 2013; Moving Forward, Making a Difference,” in the Aboriginal Policy Research Series; Vol 4.

Kondalsamy-C.S, Hoy WE, Wang Z, Briganti E, Polkinghorne K, Chadban S, Shaw J; AusDiab Study Group; 2008; Anthropometric measurements of Australian Aboriginal adults living in remote areas: comparison with nationally representative findings; Am J Hum Biol. 2008 May-Jun;20(3):317-24.

Vos T, Barker B, Begg B, Stanley S and Lopez A; 2008; Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap; Int. J. Epidemiol. (2009) 38 (2):470-477.

Wang. Z and Hoy W.E; 2003; Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people; European Journal of Clinical Nutrition (2004) 58, 888–893.

Bibliography:

ABS (Australian Bureau of Statistics) 2004. National Aboriginal and Torres Strait Islander Social Survey 2002. ABS cat. no. 4714.0. Canberra: ABS.

Claydon JE, Mitton C, Sankaran K, Lee; 2007; SK; Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit.; Canadian Neonatal Network; J Perinatol. 2007 Jul;27(7):448-52.

Gracey M.; 1998; Australian Aboriginal child health.; Ann Trop Paediatr. Sep;18 Suppl:S53-9. Review.

National Aboriginal Community Controlled Health Organization, 2007. www.naccho.org.au/

Shannon C.; 2002; Acculturation: Aboriginal and Torres Strait Islander nutrition.; Asia Pac J Clin Nutr. 2002; 11 Suppl 3:S576-8. Review.

The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview, 2011.