The health status of Indigenous peoples is a global concern with mortality and hospitalisation data indicating that the health of indigenous groups falls below that of other ethnic groups within their countries.
From an Australian perspective, Aboriginal people generally have higher rates of hypertension, heart disease, respiratory ailments, stroke, diabetes, cancer and renal failure. Mental health, drug dependence, violence and other indicators of social marginalisation and cultural disintegration are also of concern.
Aboriginal children are more likely to be born prematurely, have lower birth weights, exhibit slower growth, have higher hospital admission rates and greater mortality in the first year of life.
These indicators of Aboriginal and Torres Strait Islander people’s health status results in an average life expectancy of 17 years below that of non-Indigenous Australians and is not isolated to remote areas but is a consistent finding across all areas of Australia including urban, rural and remote.
As outlined by Oxfam Australia in 2006 in their Commonwealth Games briefing paper: Aboriginal and Torres Strait Islander Health, the Australian situation is in contrast to improvements made in the health status of indigenous people living in other Commonwealth countries such as Canada and New Zealand.
Closing the gap
The goal of working towards achieving equality in health status and life expectancy is a huge task and all areas of government and services need to play their role. As outlined in the Close the Gap initiative, one area that needs to be addressed to enable equal access to health services is ensuring that Aboriginal and Torres Strait Islander peoples are actively involved in the design, delivery, and control of these services. As outlined by Dr William Jones as part of the support for the Close the Gap initiative:
For Indigenous peoples to participate in Australian society as equals requires that we be able to live our lives free from assumptions by others about what is best for us. It requires recognition of our values, culture and traditions so that they can co-exist with those of mainstream society. It requires respecting our difference and celebrating it within the diversity of the nation.
Coordinating a response
Hospital Boards and CEOs are now required to respond to this challenge, especially as many current federal and state/territory health funding agreements include requirements to improve the health of Aboriginal and Torres Strait Islander people.
So how might hospitals in Australia respond differently and play their part in improving the health status of Aboriginal and Torres Strait Islander people?
The importance of feedback
An essential starting point involves seeking feedback from Aboriginal patients and their families about their issues of concern when they attend hospitals for treatment. This feedback is crucial if hospitals are going to improve their service response to the Aboriginal and Torres Strait Islander community.
There are many strategies that not only facilitate the gathering of such feedback from Aboriginal patients but also aim to achieve organisational change and improved practice based on that feedback.
Using a Cultural Respect Framework
The Cultural Respect Framework provides a guiding principle for jurisdictions and healthcare organisations in the development of policy and healthcare services for Aboriginal and Torres Strait Islander people. The key focus of this framework is to encourage the strengthening of the relationship between the health care system and Aboriginal and Torres Strait Islander people. This framework has been used successfully by hospitals to guide their quality improvement activities and improving their relationship with their local Aboriginal community.
Focusing on continuous quality improvement
One proven strategy for bringing about such change, which is currently mandated as part of hospital practices, is continuous quality improvement. A key advantage of this approach is that it is embedded within hospital processes rather than relying on individual staff for its success. In the past this approach has been used primarily for technical issues such as hygiene, but it can also be adapted to play a role in improving the cultural response to the Aboriginal community.
The Improving the Culture of Hospitals Project (ICHP) has examined hospitals that have implemented successful Aboriginal and Torres Strait Islander health initiatives. This was an opportunity to explore successful programs undertaken by hospitals, within a quality improvement framework, to see how this work could be replicated and sustained across a wide range of hospital environments.
Factors contributing to success
Our findings from these case studies indicated that hospitals that were considered to be successfully addressing the issues of their Aboriginal patients shared the following:
- strong partnerships with Aboriginal communities
- leadership by hospital Boards, CEOs and clinical staff
- strategic policies within the hospitals
- structural and resource supports
- a well supported Aboriginal workforce
- enabling state and federal policy environments.
These findings were corroborated by other research that has identified that quality improvement in the health sector is most effective when it is focused on organisational priorities and has good engagement of high level managers. The intervention needs to be clearly formulated and the organisation must be ready for change. Other key factors include a relationship of trust with practitioners, adequate information systems and a supportive external environment.
Trialing the toolkit
Building on all this information the project generated a draft quality improvement framework or toolkit which incorporated a continuous quality improvement process with accompanying tools and guidelines for each stage of the process, all of which have been proved to be effective instruments to sustain cultural change within the hospital environment.
A work in progress
The draft toolkit was then trialled at another four hospitals across Australia to elicit feedback on the usefulness of the toolkit along with suggested improvements and additions. This second version of the toolkit was developed using this feedback. It should not be seen as the final version but more a ‘work in progress’.
For more information on this project please refer to the Lowitja Institute website at
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