Critical Review: Indigenous Health

Introduction

This paper presents a critical review of a strategic healthcare issue (indigenous health) in the Australia Healthcare system. Strategic issues are simply understood as those that require a strategy in order to address and thus a subject of long term planning (Ginter et al., 2013). In recent times, strategic management approaches have become popular in the healthcare context, with an aim of creating structured decision making under the guidance of well established planning activities. The process entails several steps such as coming up with goals/objectives and putting them into coherent statements, allocating resources, implementing strategy and monitoring and evaluation. Other important facets of strategic management entail coming up with the mission, vision and value statements that guide a healthcare system or organization, including other strategy-related acts. Swayne, Duncan & Ginter (2012) posit a summary of the strategic management process as strategic thinking, strategic planning and strategic momentum. This model can be used to address recalcitrant health issues such as indigenous health. The latter entails a range of health problems affecting the Aboriginal and Torres Strait Islander people in Australia. This paper shall offer a detailed description of the problematic health issue, a rationale for its strategic nature, how it can be addressed at the national/state level and how strategic management can be applied to resolve it at the workplace. 

Description of Problematic Healthcare Issue

Indigenous health is a hugely problematic health issue in the Australian Healthcare system. The scope and nature of the problem has been widely documented. According to HealthInfoNet (2017), the Aboriginal and Torres Strait Islander people have comparatively poor quality life and shorter life expectancy. Their reduced life expectancy and poor quality of life compared to non-indigenous populations has been directly related to a huge burden of chronic diseases.  For instance, they were 1.5 times more likely to die of cancer than their non-indigenous counterparts. Additionally, 13% of their total population was suffering from diabetes while they were five times more likely to be admitted in hospital for pneumonia and chronic obstructive pulmonary disease (COPD) than non-indigenous people (Australian Human Rights Commission, 2012). The pattern is repeated for almost every chronic disease, including cardiovascular disorders. Therefore, chronic disease burden had led to generally lower life expectancy and poor quality life in the indigenous Australian population.

The state of indigenous health is disproportionately poor due to contextual and historical factors that are unique to the Aboriginal and Torres Strait Islander people. First, this population is largely exposed to unhealthy lifestyles that predispose them to lifestyle diseases. Smoking and drinking behavior is one of the risk factors that have contributed significantly to a huge burden of chronic diseases (HealthInfoNet, 2017). Alcohol abuse was historically instituted by the colonists after they introduced it as a reward for labor when they occupied parts of Australia amongst indigenous people. Colonialism also introduced alcohol bans which led to the Aboriginal and Torres Strait Islander people resorting to illicit and unsafe alcohol drinking practices that have never been done away with to date. However, the most profound issues are cultural. Apart from being subjected to racism, alienation and ridicule, the indigenous population lack access to health facilities that can appreciate and understand their culture. They hardly identify themselves as aboriginal for fear of stereotyping and may not relate positively to mainstream medicine (Australian Human Rights Commission, 2012). Thus, accessing culturally appropriate healthcare and collecting useful data to aid health planning is still complicated for them. These historical and contextual factors have largely contributed to poor health amongst the indigenous population.

An equally significant health issue in this population relates to equity and access of care. Most of the Aboriginal and Torres Strait Islander people live in the countryside where there are few if any medical facilities. Those available lack necessary referral facilities to handle chronic diseases (Howard et al., 2014). Most of the indigenous people have to therefore use non-indigenous health facilities where there are language issues and failure to understand certain cultural issues relating to their health. More importantly, majority of the indigenous people have little to no education, poor employment and therefore cannot afford healthcare. They need empowerment in order to be able to have equitable access to both indigenous and non indigenous health facilities.

Rationale for its Strategic Nature

Indigenous health qualifies as a strategic issue on many grounds. First, strategic issues are those that touch on the fundamental goals/ policies/mission of an organization or system (Ginter et al., 2013). As such, indigenous health qualifies as it touches on the provision of universal, comprehensive and equitable healthcare goals of the Australian Healthcare System. By having comparatively poor health outcomes and quality of life, the Aboriginal and Torres Strait Islander people render the Australian health system inequitable and disproportionate. Another qualification of the health problem as strategic is on its long term nature. Strategic issues often affect organizations/systems on the long term and can only be addressed by long term planning. In this respect, it can be noted that poor indigenous health has been a recalcitrant problem with roots in the colonial era. The failure to successfully address it over the years only points to the fact that there is need to adopt a long term approach to it. More importantly, strategic issues require a strategy in order to resolve them (Ginter et al., 2013). This is apparent in the case of indigenous health due to its multifaceted nature. There was need to address the cultural factors affecting indigenous health, the social determinants of health that led to poor health and quality of life, the historical and contextual factors among other issues with respect to the Aboriginal and Strait Islander’s people’s health. All these factors cannot be determined through ad hoc methods and instead require a clearly spelt out strategy. There is thus no doubt that indigenous health was a strategic issue. 

Addressing Indigenous Health at the National/State Level

Indigenous health has been subject to discussion and deliberation at the national and state levels for quite some time. There have been efforts to address core issues through policy and national level strategies in numerous occasions to varied results. The following are some of the methods that can be used to address the issue in a more successful manner.

The Australian Human Rights Commission (2012) suggested a human rights approach to addressing population health issues among the Aboriginal and Strait islander people. This is a plausible method given that access and equity of health is a right of every Australian including its indigenous people. Suffice to this, there was need for commitment at both the state and national levels to enforcing this right by addressing some of the issues in the current frame in a deliberate manner. It should not be approached as a policy or strategy initiative whose implementation lies in the goodwill of the state and national governments but rather seen as a right whose relation to the indigenous people is inalienable. Both state and national governments can therefore be brought to account on the premises of human rights for failing to ensure equity and access of care besides addressing any other factors affecting indigenous health. This will lead to allocation of more resources to the health problem, addressing it as a fundamental national and state problem and hence ensuring indigenous health is the core subject of any health policy forum in the public level. For instance, it is apparent that the indigenous population has less access to health infrastructure, safe housing, clean drinking water and suitable sewerage systems (Australian Human Rights Commission, 2012). These can be addressed through a human rights approach that compels all levels of government to address the problem. The approach ensures both commitment and obligation to address aboriginal health issues by the state and national governments. 

Yet another method of addressing indigenous health is by ensuring there are proper records that can help in planning and policy decision making. There is need for good quality data on the effectiveness of the current policies and measures in place in order to effectively structure future plans. Such data also helps to understand the current health status and healthcare delivery to the population, which has been hampered by poor attitudes of the aboriginals towards non-indigenous health facilities, refusal identify as aboriginal for fear of discrimination  and the lack of a consistent strategy initiative of collecting such data. Van Gaans et al (2015) highlighted the lack of proper longitudinal data on indigenous health as a major obstacle to understanding the variations in health outcomes among them over time. There were no proper entries of date of birth, place of residence and names in the population which made it impossible to use the data for long term planning. Therefore, the provision of good quality data is an important facet of improving indigenous health in the long term. 

More importantly, there is need for a fresh, revitalized and encompassing national strategy for improving indigenous health. Such a strategy should be broad based and cover all the factors, both risk and protective contributing to the health of aboriginal and strait Islander people. For instance, the Aboriginal people have highlighted in numerous surveys and studies that health provision to them is a matter of dignity, self-esteem, family values, justice and maintaining control over their physical environment rather than the mere provision of hospitals, health professionals and other components of the healthcare infrastructure (Howard et al., 2014). The national policy must thereby endeavor to take care of such needs in their broadest sense to ensure that indigenous health is wholly integrated into the healthcare system.

Addressing indigenous Health at the Workplace (Using Strategic Management)

The strategic management framework is largely applicable in addressing a health problem like indigenous health at the workplace due to the compatibility of strategic planning. Swayne, Duncan & Ginter (2012) explicitly stated that strategic planning is unique to organizations and differs from national level policy and strategy. It encompasses the organizational-specific activities through which a strategy is coined, documented, realized and improved. This section shall explain how the strategic management framework can be applied at the workplace level to improve indigenous health.

One of the methods of addressing indigenous health under the strategic management framework is through strategic thinking. In this context, the healthcare organization orients externally, scanning the environment to understand the latest issues and trends. This includes new challenges in relation to indigenous health and emerging methods of promoting equity and access. Strategic thinking also entails challenging assumptions which in this case involves sweeping generalizations and stereotyping of aboriginal and Torres Strait Islander people (Ginter et al., 2013). The organization thus endeavors to collect data scientifically to approve and disprove various theses, hence developing a concrete understanding of the health status of the aboriginals. Through strategic thinking, there is generation of new ideas that can guide better delivery of healthcare to the indigenous population.

Strategic planning is also an effective method through which the health of aboriginals and Torres Strait islander people can be addressed. The process entails situational analysis, strategic formulation and strategic implementation (Swayne, Duncan & Ginter, 2012). In carrying out situational analysis, the organization can scan both the internal and external environment to unravel issues affecting indigenous health such as the lack of access to primary care, cultural issues and discrimination. After understanding these issues, strategies are crafted for cultural integration, improving access to healthcare and broadening the scope on indigenous healthcare facilities. Strategies can then be implemented to ensure that aboriginal and strait islander people have better health status overall. Examples of strategies in this regard include provision of culturally appropriate services in non-indigenous health facilities and integration of Aboriginals and strait islander people into the provision, planning and design of healthcare services (Howard et al., 2014). Strategic planning is therefore an effective tool that the workplace can adopt in addressing the health of indigenous people. 

Conclusion

In conclusion, it is important to note that indigenous population is a major issue in the Australian Healthcare System. First, there is low life expectancy and poor quality life amongst the aboriginal and strait islander people due to a huge burden of chronic diseases. Additionally, there are contextual and historical issues contributing to ill health besides issues of access and equity of care. By virtue of the need for strategy, the long term nature of the problem and its effect on the goals of the Australian health system, indigenous healthcare qualifies as a strategic issue. It can be addressed at the national level through a national strategy, quality recordkeeping, and a human rights approach. At the organizational/workplace level, there is need to apply the strategic management framework, especially strategic thinking and strategic planning. These measures collectively address the problematic indigenous health on the long term. 

References

Australian Human Rights Commission. (2012). Achieving Aboriginal and Torres Strait Islander Health equality within a generation–A human Rights based approach. 2005 Social Justice Report.

Ginter, P. M., Duncan, W. J., Swayne, L. E., & ebrary, I. (2013). Strategic management of health care organizations. In P.M. Ginter, W.D. Duncan & L.E. Swayne (Eds), The nature of strategic management (pp. 3-33). San Francisco, CA: Jossey-Bass.

HealthInfoNet, A. I. (2017). Summary of Aboriginal and Torres Strait Islander health. NSW, 229(31), 3-0.

Howard, M., Ingram, S., Liu, H., Mentha, R., & Peiris, D. (2014). To your door: Factors that influence Aboriginal and Torres Strait Islander peoples seeking care. Kanyini Qualitative Study Monograph Series, 1.

Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons.

Van Gaans, D., Ahmed, S., D’Onise, K., Taylor, S. M., & McDermott, R. (2016). Managing Aboriginal and Torres Strait Islander Data for Public Health Research. Online journal of public health informatics, 8(3).