Essay: Advancements of the health of First Nations people

Part 1
1) Health inequities observed in Aboriginal and Torres Strait Islander people today result from their historical context of social persecution, beginning with colonisation in 1788 (Hampton & Toombs, 2013). Colonisation was the European settlers’ expansion in Australia, where First Nations people were actively killed, and exposed to diseases such as smallpox, measles and influenza that diminished their population (Hampton & Toombs, 2013). As European settlers established themselves in Australia, the effects of colonisation moved away from overt violence to interventionist strategies that compromised their autonomy (Vickery et. al, 2004). The colonial mindset is reflected in paternalistic legislation affecting First Nations people’s health today, who still lack autonomy in matters affecting their own health (Bond, 2005).
Dispossession followed colonisation, as European settlers declared terra Nullius and forcefully expelled First Nations people from their traditional lands, with little regard for tribal associations or spiritual connections (Durey & Thompson, 2012). This disrupted social structures and played a key role in reducing the First Nations people’s autonomy, as legislation and infrastructure (including the healthcare system) were developed without considering the needs of First Nations people (Vickery et. al, 2004). Racist policy complemented this forceful removal, forcing assimilation and the disruptment of families, leading to intergenerational trauma (Vickery et. al, 2004)
Racism towards First Nations people is discriminatory behaviour against them based on notions of inferiority or negative stereotypes about their appearance, behaviour or capabilities (Vickery et. al, 2004). Racism is individual, such as by healthcare professionals who change the quality of their care based on stereotypes, and institutional, whereby racist values are embedded and perpetuated by social structures such as legislation (Hampton & Toombs, 2013). Bond (2005) adds that internalised racism leads to risk-taking behaviours such as smoking and substance abuse, as individuals begin to conform to stereotypes of behaviour or entitlement to healthcare services.
First Nation’s people’s culture is the beliefs and traditions upholding their society, including housing, diet, a spiritual connection to the land and social networks (Vickery et. al, 2004). The loss of culture through colonialism and dispossession affects mental health as social and spiritual aspects are lost, and physical health from the loss of a traditional lifestyle – First Nations populations experience consistently higher rates of lifestyle disease than non-indigenous Australians (ABS, 2004). Bond (2005) suggests mainstream healthcare is inaccessible to First Nation’s people as it discounts the importance of culture and holistic health – this population visits a general practitioner at a quarter of the rate of the non-indigenous Australians despite having generally poorer health, perpetuating existing inequities (ABS, 2004).
Identity is an individual’s perception of oneself, personal values and belonging (Hampton & Toombs, 2013). The context of historical persecution is key to understanding how First Nation’s people’s identity affects health – racism has associated their identity with negative stereotypes (Tynan et. al, 2004). In the health field, Aboriginality has been reduced from a complex identity to a set of risks and problems (Bond, 2005). This affects the self-esteem and sense of belonging of First Nations people, particularly youth (Tynan et. al, 2004). Psychological distress among First Nations people demonstrates this – in 2012-13, 30% of this population group aged over 18 reported high or very high levels of psychological distress in the past month (ABS, 2014).
Part 2
1) The World Health Organisation (WHO) (1946), describes health as a “state of complete physical, social, mental and spiritual wellbeing, and not just the absence of disease” (WHO, pp. 2) The purpose of human rights is to ensure all people are equal in fundamental ways that affect their social contexts and opportunities – for individuals, and societies as a whole (Braithwaite, 2008). This is reflected in the acknowledgment of a high standard of health as a human right by the WHO. Furthermore, fundamental rights such as health must be fulfilled for all people without discrimination based on gender, race, income, nationality or any other aspects of their social context (Gray, 2007). Hence, equality (i.e. for all to enjoy the advantages of good health and wellbeing and the associated improvements in quality of life) and social justice are the underlying philosophies behind the right to health (Braithwaite, 2008).
2) The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) is consistent with the WHO definition of health as it acknowledges the physical wellbeing of indigenous peoples, and the improvement of their social circumstances to achieve equality without compromising their independence and autonomy (UNDRIP, 2007). It also treats healthcare as a complex social structure, not an individual doctor-patient paradigm (Hampton & Toombs, 2013). The right to self-determination, self-governance and autonomy are emphasised as a means of improving health – Article 24 states the right for Indigenous people to enjoy “the highest attainable level of physical and mental wellbeing” (UNDRIP 2007, pp. 9), practice traditional healthcare, and access healthcare services without discrimination (UNDRIP, 2007). The Declaration places the responsibility to reduce health inequities on the state; Article 29.3 requires the state to pursue the surveillance, maintenance and restoration of indigenous people’s health, without undermining their autonomy, with an emphasis on their continuous active involvement (UNDRIP, 2007).
3) The UNDRIP is highly relevant to the advancements of the health of First Nations people, as many of the rights outlined therein have not been fulfilled, resulting in the significant health inequities observed today (Panaretto et. al, 2014). Mainstream approaches to healthcare are not as successful in Aboriginal and Torres Strait Islander populations as they are for the general population (Tynan et. al, 2004). Hence, the promotion of these rights may alleviate these inequities, for which UNDRIP provides an ideological framework (Black & McBean, 2016). Acknowledging health as a right to be pursued shapes legislation and social action that promotoes First Nations people’s health in a positive way (National Aboriginal Community Controlled Health Organisation, 2016). The UNDRIP’s approach of indigenous people’s active involvement and leadership in the health system at all levels reflects an approach to healthcare that has historically proven effective in achieving improved health outcomes (Arthur, 2001).
For example, the Aboriginal Community Health Service (ACHS) is a sector of the healthcare system acting on similar principles to those of the UNDRIP by providing healthcare tailored to, and developed by, First Nations people with relative autonomy since the 1970’s (NACCHO, 2016). Despite initially being underfunded, this approach has proven successful in providing primary care for Indigenous Australian communities, with consistent increase in rates of First Nations people’s participation in ACHSs than mainstream health services (Panaretto et. al, 2014). NACCHO (2016) suggests an approach of autonomy with financial/political support from governments and the Australian community could produce similar progress on a larger scale.
Working in accordance with the UNDRIP also necessitates positive First Nations representation and participation in the health workforce and policymaking process (UNDRIP, 2007). Organisations such NACCHO encourage Aboriginal and Torres Strait Islander representation in decision-making positions and across the workforce, to promote needs-based and culturally appropriate healthcare (NACCHO, 2016). This overcomes some barriers to seeking healthcare for First Nations people and increases the effectiveness of health promotion campaigns (Bond, 2005). Representation in authority positions is also key to achieving the autonomy emphasised in the UNDRIP (2007), promoting the recognition of First Nations people’s health-related knowledge and improving this population’s holistic health (Black & McBean, 2016).