An Essay on Indigenous Health

This is an essay I wrote some 10 or 11 years ago, as part of a Bachelor degree course in Nursing. It remains relevant, sadly, to this day.

The health status of Australia’s indigenous people today remains far below that of the general population, with life expectancies comparable to India and Central Africa. Many nurses working in Australia find themselves in remote areas caring mainly for Aboriginal people of whom they have little understanding. It is hoped this paper will provide a basic awareness of indigenous Australians and the reasons for the ill health they experience today.

Indigenous Australians have lived in Australia for over 50,000 years and their culture encompassed over 500 tribes with individual languages and customs, with certain commonalities that could perhaps be compared to the common links between different European cultures.

In the lifetime of a few generations this distinct culture has had to adapt to changes which took thousands of years to spread in other parts of the world.

When Captain Cook landed in Australia in 1770, despite encounters with indigenous people, he claimed that the land was uninhabited and Britain procured ‘legal’ ownership by classifying Australia as ‘terra nullius’, meaning ’empty continent’.

There was both legal and scientific support for a racist attitude towards the indigenous population, who were used by Charles Darwin and the evolutionary scientists as evidence of a “missing link” between man and the animal kingdom. This resulted in treatment such as hunting, rape and massacre of the Aboriginal people on a huge scale.

It is acknowledged that “few doubted at the time that Genocide was official policy. A government report in the 1850s spoke of the success of poisoning Aborigines; 100 of them laid out at a time”. Although the Aborigines resisted, their population was swiftly decimated by violence, as well as a lack of immunity to introduced diseases.

Since European colonisation, Australian governments have dominated the lives of indigenous Australians, who are claimed to be the most legislated people in the world. Reserves and missions were set up and Aborigines were forcibly moved to them, where they lived in crowded, dirty conditions, with high morbidity and mortality rates.

Until the early 1970s an Assimiliation Policy legalised the forcible removal of light skinned children from their darker parents, in an attempt to assimilate these ‘half castes’ into mainstream society. Police were used to find and take the children, with orders not to tell the children or parents where they were being taken. Although there were some exceptions, most parents did not freely give up their children, and usually contact between families was discouraged or prevented. The experiences of these children were varied, from those exposed to various forms of exploitation, to those who found happiness with adoptive families.

Many Australians today will argue that the practises of forcible removal had beneficial outcomes for the children who were taken. Irrespective of the intentions of the policy makers at the time, the National Inquiry into the Stolen Generations found that compared with people who were not removed, these children are in fact not better educated, not more likely to be employed, and not receiving significantly higher incomes. They are twice as likely to have been arrested more than once in the past five years, and twice as likely to assess their own health status as poor or only fair.

In the 1950s the Australian government sanctioned the testings of nine nuclear bombs by the British government on Australian land in Maralinga, South Australia and Monte Bello, Western Australia. These bombs were twenty times greater than the Nagasaki and Hiroshima bombs. It was known at the time that Aboriginal people were living in these areas. The effects included los of sight, skin rashes, radiation poisoning and hundreds of families forced to leave their homelands due to severe contamination.

Other legislation affecting Aboriginal people has included lack of equal pay, segregation and inequality of health care, curfews from certain towns and cities, and alcohol prohibition.

The 1991 census counted the indigenous population at 265,459, or 1.6% of the total Australian population. Their unemployment statistics were almost three times those for non indigenous people. 63.5% of Aborigines reportedly earned less than $12,000 p/a, while 2.2% earned above $35,000. Females die 19 years younger and males 18 years younger than their non indigenous counterparts. Hospitalisation occurs at 70% (males) and 57% (females) higher than the national average. 25% of Aborigines live in remote areas, that is towns with less than 1,000 people, limiting their access to various services including health.

Despite these statistics, there is a belief within segments of Australian society, that Aborigines are not disadvantaged, and even that they live privileged lifestyles on government money.

Alcohol prohibition to Aborigines was enforced in individual states and territories until between 1957-1972. This did not prevent their access to alcohol or other drugs, so they were often arrested for using alcohol. Exemption clauses existed, whereby those who could prove they complied with required standards of hygiene, intellect and good (non indigenous) company, could legally consume alcohol. Like many other indigenous populations throughout the world, some Aborigines now associate ‘drinking alcohol’ with ‘equality and status’. Further causes of alcohol and substance abuse in the indigenous population include low self esteem, depression and alienation.

Growing use of other illegal substances such as petrol sniffing and kava misuse are creating major social problems in some areas. Related causes of morbidity and mortality include accidental or violent injury, toxicity, epilepsy, heart disease, hypoglycaemia, pancreatitis, cirrhossis and pneumonia.

Aboriginal people are placed in police custody at up to 26 times the rate for non indigenous people. They are over represented for offences of disorderliness, assault and drunkenness, whilst being under represented for homicide, robbery, theft, fraud, sexual offences, driving and drug offences.

In 1991 the Royal Commission into Aboriginal Deaths in Custody published it’s final report. Despite evidence showing likelihood that a considerable number of Aboriginal deaths in custody between 1982 and 1991 were the result of violence by police or prison officers, investigations into these cases were not recommended and have not taken place. However, the recommendations made did include vetting police and prison officers, abolishing public drunkenness as an offence, and presuming homicide rather than suicide when investigating future cases of Aboriginal deaths in custody.

Diseases such as obesity, diabetes mellitus, hypertension and cardiovascular disease are causing high rates of premature mortality in the indigenous population. Many Aboriginal people consume large amounts of sugar, meat and tea, which became their staple diet during the days of missions and reserves.

Renal disease is ten times higher in the Aboriginal population than non indigenous Australians. There are a number of reasons, including non insulin dependent diabetes, glomerulonephritis (often resulting from widespread outbreaks of streptococcal skin infections), hypertension and chronic infections.

Malnutrition is experienced by half of the children in some communities. Reasons for this include poor maternal health, low birth weight, diarrhoeal and other diseases resulting in loss of appetite and malabsorption, along with the social issues of family disruption and disintegration.

Although infant mortality has declined since the 1970s, childhood infectious diseases remain rife and are recognised as having a close relationship with standards of living. Diarrhoeal disease is acknowledged as a serious health problem in many Aboriginal communities, especially among infants and children who are at higher risk of associated dehydration and malnutrition. Lack of good quality water, poor hygiene, unsafe sewage disposal and contact with poorly kept animals such as dogs which carry and transmit bacteria and parasites are common reasons. Other conditions resulting from substandard living conditions which are prevalent in Aboriginal children include pneumonia, upper airway infections, otitis media and skin infections.

Trachoma is disproportionately prevalent in the Aboriginal population. This results in a large proportion of avoidable blindness in Aborigines.

Tuberculosis among Aborigines is 15 to 20 times higher than in non indigenous people. Overcrowding and homelessness combined with diseases such as malnutrition, alcoholism, renal failure and diabetes mellitus are all high risk factors for tuberculosis infection.

Sexually Transmitted Diseases (STDs) are very high among certain Aboriginal groups and can be difficult to diagnose and treat. Whilst HIV is thought to be uncommon in Aborigines at present, the infection rate could change rapidly given it’s history of rapid change in overseas populations, and the high risk factors Aborigines are exposed to.

Given the disproportionately high rates of hospitalisation occurring in the indigenous population, the overall health care system which serves these people remains dominated by a western, authoritarian approach. It is vital that nurses and other health care professionals working with Aboriginal people educate themselves in the issues specific to Aboriginal health. Understanding the ways in which Aboriginal people view health and illness will provide the health professional with an understanding of why hospitalisation is resisted by many and only used as a last resort.

Aboriginal people today combine traditional therapies with mainstream health care methods. Traditional healers will sometimes visit patients in hospital to perform or administer therapies, and they are used much more frequently in community settings.

Australians often perceive neglect and vandalism of houses as a form of cultural behaviour inherent in Aboriginal people. However, a publication about health inequalities in Britain noted that bad design of buildings can lead to a lack of respect by some inhabitants. Living in squalid conditions was in turn associated with depression and mental illness.

A study conducted in a remote Australian community in 1994 negated the theory that lack of respect in Aboriginal housing can be explained by ‘cultural’ behaviour. To the contrary, it was found that when functional houses are provided which are adequately maintained, for example plumbing and electrical faults repaired, Aboriginal people do look after their homes. Poor construction was attributable to 70% of the maintenance costs in this study.

A survey in 1992 found that over 300 Aboriginal communities nationwide did not have adequate water supplies and 134 did not have a proper sewerage system. In 1991 one third of the Northern Territory’s Aboriginal population were reported to have no access to a safe water supply. Personal accounts are heard of Aboriginal people spending large amounts of their small income on purchasing bottled water for domestic consumption.

In the 1990s both the Native Title Act and the Wik Decision were passed in Australian courts amidst a frenzy of fear and protest. The Native Title Act overturned the previously held law of “terra nullius” which had stood for 200 years. Indigenous people now had a legal basis to claim ownership of land with which they can prove they have maintained traditional ties. The High Court recognise that Native Title has been extinguished on all freehold and most leasehold land due to dispossession of such land from the indigenous people since European colonisation. As a result, Native Title only applies to a small percentage of Aboriginal people and mainly to remote Australia.

The Wik Decision 1996 was passed on appeal by the High Court of Australia. It concluded that the Wik and Thayorre people of Far North Queensland had native title of the land on which they live, which is an Aboriginal reserve upon hich their people have maintained continuous occupation. Such title is in co-existence with a pastoral lease of the same land which has never been permanently occupied or fenced, and carries a small number of unbranded cattle. The current lease expires in 2004. However, the High Court ruled that native title rights would be subordinate to those of the leaseholder in any cases of conflict.

Despite these facts, and although pastoralists have never had exclusive possession of pastoral lease land, the frenzy in the wake of the Wik Decision led to leasehold pastoralists en masse, demanding freehold title to their leasehold land, which Prime Minister Howard is in support of.

Sheryl Kernot, the leader of the Australian Democrat Party, in 1997 called for an “understanding of the way in which traditional and historical connection to land and water and cultural resources is central to the identity of indigenous Australians, to their community, and to their sense of justice”. Land which indigenous people have maintained traditional ties with should, as a basic human right which we are all entitled to, be inherited by it’s inhabitants. Evidence shows that when such land rights are accorded to Aboriginal people, they become capable of self determination and the resulting positive effects include improved health. To this day, mainstream political support for indigenous land rights remains unattainable.

Conclusion

It is recognised by many that indigenous people themselves need to make positive changes to their circumstances, and take responsibility for their own health status. Aboriginal people are calling for self determination. However, a self determining culture requires the necessary resources, such as educational standards within their own population, and political support, before they can take control of their own situation.

This paper demonstrates the link between Aboriginal culture, Australian history and the ill health of Australia’s indigenous people today. There is an argument for stronger social and political support, for renouncing the dominant ethnocentric view and trying to understand the broader needs of a disadvantaged people. Our association with Aboriginal communities gives health professionals a responsibility to be informed about the wider issues affecting their individual and social health. Nurses have a unique and important role to play in advocating for the needs of indigenous people.

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Struggling to write

Hmmmm, well it’s now two weeks since I added anything to my blog. I’m finding it hard to write here, almost a feeling of having ‘writers block’. Hopefully the more I write, the more comfortable I will become with writing.

In the past two weeks, a lot has happened. I have sold one home (an investment property in Darwin), and purchased another here in Alice Springs, which will be the first home I’ve ever owned and lived in, so I am very excited about my new status as an “owner-occupier”!

I spent Easter in NSW with my cousin, Rachel. We spent two nights in the Hunter Valley, staying at a beautiful hotel, the Sebel Kirkton Park, a lovely new but heritage-style complex with stunning Italian style gardens and great views over the valley. We had a day cycling around the wineries, and generally just spoilt ourselves.

Work is going great-guns, I have some very special days where I’m not only busy but also challenged on a number of levels, and it’s certainly never boring. While we only see about six cases of active TB per year, we do a lot of preventive work, which involves treating people who we know are infected with TB, to prevent them from becoming unwell. We also spend a lot of energy looking for active TB, which means talking to people who are contacts of people with known TB, and testing them and following them up. I spend a lot of my time with people who speak the Arrernte language, and am slowly but surely becoming an un-fluent Arrernte speaker!

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