Week 5 Flashcards

(63 cards)

1
Q

Overview of Policy Eras

A
  1. Colonisation, 1788 – 1880
  2. The White Australia Policy, 1850s–1973
  3. Protection – Segregation, 1890’s – 1950’s
  4. Assimilation, 1950 – 1960
  5. Integration, 1967 – 1972
  6. Self Determination, 1972 – 1975
  7. Self-management, 1975 – 1988
  8. Self-management 2, 1988 – 2004
  9. Shared Responsibility, 2004 – 2014
  10. Indigenous Advancement Strategy, 2014 - curent
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2
Q

Colonisation - 1788–1880

A

European settlement claimed the land as uninhabited, or “terra nullius”

As the land was regarded as terra nullius, any attempts Aboriginal people made at resisting were interpreted as rebellion, not war;

Appropriation of Aboriginal homelands and a process of extermination or domestication, sickness and a loss of Aboriginal law, leadership, traditions and language (Eckermann et al., 2012; Smith, 2016)

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3
Q

The White Australia Policy 1850s–

1973

A

Did not specifically target Aboriginal peoples;

Impacted on the national and social development of Australia

Contributed towards the set of white cultural values and beliefs that helped form the national self-identity of Australians;

Excluded and marginalised groups based on their ethnicity and race (Smith, 2016).

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4
Q

‘Protection’ through segregation: 1890s –

1950s

A

Perceived inferiority of the Indigenous peoples (Ethnocentrism);

Indigenous peoples would die out (Social Darwinism);

Era of protection and ‘smoothing the dying pillow’

Forced segregation of Aboriginal people from their homelands onto missions and reserves (Trauma)

Provided with poor living conditions, meagre rations of sugar, tea and flour, as well as controlling substances of tobacco and opium (Health)

Missions and reserves

Forcible removal of children (the stolen generation).

The role of the Chief Protector - control the movement,
speech, marriage, bank accounts, wages, wills, property
and debts of all Aboriginal people (Kidd, 2002)

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5
Q

‘Protection’ through Segregation:
1890s–1950s continued..

(‘aborigine’, rites, customs, etc)

A

The term ‘Aborigine’ was defined by an Act of Parliament and Aboriginal people were not
allowed to drink, vote or receive social service benefits (Kidd, 2002; Langton, 2001).

All rites and customs that were seen as injurious to the welfare of Aboriginal people on the
reserves were prohibited – these included tribal language and law (Eckermann et al.,
2012).

The Constitution of Australia made only two references to Aborigines. Section 127 excluded
them from the census; and Section 51 (Part 26) gave power over Aborigines to the States
rather than to the federal government. This was the situation until the referendum in 1967
(Smith, 2016)

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6
Q

Assimilation: 1950s–1960s

A

Replaced segregation as it was clear that the Aboriginal people were not dying out.

Based on the assumption that Aboriginal Australians would attain the same lifestyle, customs, laws and traditions as other Australians (Broome, 1982).

It became a policy ‘to change Aborigines into Europeans with black skins’ (Broome, 1982, p. 171).

Later found to be both ‘systemic racial discrimination, and genocide, as defined by
international law’ (Human Rights and Equal Opportunity Commission, 1997, p. 266).

In Queensland the policy of segregation continued until 1965 (Smith, 2016).

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7
Q

Integration: 1967–1972

A

In 1967, the federal government held a constitutional
referendum
–90 per cent of Australians voted in favor

In 1971 Indigenous Australians were included in the
census for the first time.

-Placed more emphasis on positive relations (Smith, 2016)

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8
Q

Self-determination: 1972–1975

A

The Federal Department of Aboriginal Affairs (DAA) was
established in 1972.

Responsible for the development of national policies in consultation with Aboriginal and Torres Strait Islander people, thus restoring power to Aboriginal people and Torres Strait Islanders to make their own decisions about their own way of life (Smith, 2016).

The Queensland Government rejected this and continued with assimilation policies until 1982 (Ober et al., 2000).

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9
Q

Self-management 1: 1975–1988

A

Federal Government expected Indigenous Australians to be held accountable for their own decisions and financial management (Eckermann et al., 2012).

With this came a strong push for land rights and separate legal, health and housing services (Smith, 2016)

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10
Q

Self-management 2: 1988–2004

A

Aboriginal and Torres Strait Islander Commission (ATSIC)

Community-elected Aboriginal and Torres Strait Islander peoples to manage some of their own affairs

Council for Aboriginal Reconciliation was established in 1991 but was defunded in 2001

Treaty

Reconciliation

World Health Organization (WHO) reported that Aboriginal health was among the worst of any Indigenous group in the world

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11
Q

Significant acts 1988-2004

A
Community Control
 TREATY
 RECONCILIATION
 1989 National Aboriginal Health Strategy
Aboriginal Health
1992 The Mabo decision
1992 The Redfern Address
1997 Bringing them home: The 'Stolen Children' report
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12
Q

Shared Responsibility: 2004–2014

A

Office of Indigenous Policy Coordination (OIPC)

Department of Immigration, Multicultural and Indigenous Affairs
(DIMIA)

Coordinate a whole-of-government approach to programs and services for Indigenous Australians (Smith, 2016).

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13
Q

Significant acts 2004-2014

A

“The Intervention” 2007

Close the Gap, Oxfam 2007

The Apology, Kevin Rudd’s 2008

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14
Q

Indigenous Advancement Strategy 2014–

current

A

2014 the Office of Aboriginal and Torres Strait Islander Health was amalgamated into the mainstream Department of Health

Department of the Prime Minister and Cabinet, under the leadership of the Prime Minister, and the Minister for Indigenous Affairs, through the ‘Indigenous Advancement Strategy’

Closing the Gap and the Constitutional Recognition campaigns

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15
Q

Intergenerational Trauma

A

What is Intergenerational Trauma?

  • -A trauma that reoccurs across generations, shared collectively, and is continuously compounded in a cyclic nature.
  • -Destruction of ways of dealing with trauma, suppression of unresolved trauma, collective trauma and cultural trauma are components of Aboriginal and Torres Strait Islander transgenerational trauma
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16
Q

Intergenerational Trauma:
part 2

Integenerational trauma Has been due to Australia’s shared history and policies include:

A
– Australia being declared Terra Nullus
– Genocide period, violence and killing
– Loss of land, home, hunting grounds, water holes
– Introduction of diseases
– Protectionism, assimilation
– Stolen wages
– Black deaths in custody
– Stolen generation
– Withdrawal of the Racial Discrimination Act (RDA)
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17
Q

Australian Psychological Society (APS)

- Apology

A

We apologise for:
Our use of diagnostic systems that do not honour cultural belief systems and world views;

The inappropriate use of assessment techniques and procedures that have conveyed misleading and inaccurate messages about the abilities and capacities of Aboriginal and Torres Strait Islander people;

Conducting research that has benefitted the careers of researchers rather than improved the lives of the Aboriginal and Torres Strait Islander participants;

Developing and applying treatments that have ignored Aboriginal and Torres Strait Islander approaches to healing and that have, both implicitly and explicitly, dismissed the importance of culture in understanding and promoting social and emotional
wellbeing; and,

Our silence and lack of advocacy on important policy matters such as the policy of forced removal which resulted in the Stolen Generations

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18
Q

Meaning of health?

1989 National Aboriginal Health Strategy

A

“Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total wellbeing of their Community.

(NAHSWP, 1989)

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19
Q

Who is an Aboriginal and/or Torres Strait

Islander Person?

A

A descendant of First Australians

Identifies as an Aboriginal and/or Torres Strait Islander person

Accepted by his/her community in which he/she lives (ABS, 2015).

NOT colour of skin

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20
Q

Culture

A

Provides Aboriginal and/or Torres Strait Islander people with a strong sense of identity and belonging.

Provides a strong sense of identity

Provides a strong sense of wellbeing

Strength to be confident

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21
Q

Cultural Practices

A
Rituals & Ceremonies
 Traditional Lore
 Bush Medicine
 Food
 Sacred Sites
 Environment
 Spiritual
 Sorry Business
 Traditional Healers
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22
Q

Languages

A

 Prior to colonisation
——- 250+ distinct
languages
———- 600+ dialect variations

 Today
———– 145 languages
(110 of them ‘critically
endangered’)

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23
Q

Languages

A

Primary language groups
 Kalau Lagau Ya
 Kalau Kawau Ya
 Meriam Mir

In addition all of the Torres Strait and Northern Peninsula speak a common language:
 Torres Strait Creole

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24
Q

Population Health / Demographic Profile

of indigenous australians and percentage of total indigenous population

A

WA
88,270 (13.2%)

NT
68,850 (10.3%)

SA
37,408 (5.6%)

QLD
188,954 (28.2%)

NSW
208,476 (31.1%)

Vic
47,333 (7.1%)

ACT
6,160 (0.9%)

TAS
24,165 (3.6%)

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25
Indigenous Population of australia
total australian population = 22.3 mil first peoples = 669,881 or 3% of pop in queensland: - total pop = 4.3 first peoples = 188,954, % of qld pop = 4.2%
26
Geographical Distribution
most first peoples live in major city areas, inner-regional and outer regional areas. only 13.7% live in very remote areas however this is compared to 0.5% of non-indigenous people.
27
Age structure
In general/on average: Indigenous people are much younger and die earlier than non-indigenous
28
Causes of Morbidity
Social and Emotional Wellbeing (SEWB), in 2012-2013 (ABS, 2014): - -3 out of 10 First Peoples reported high or very high levels of psychological stress. - -Hospitalised at twice the rate of non-Indigenous peoples. Respiratory, in 2012-2013 (ABS,2014): • 1 out of 3 First Peoples reported long-term respiratory disease. • Hospitalised at 2.4 times the rate of non-Indigenous peoples. CVD, in 2012-2013 (ABS, 2014). • 1 out of 8 First Peoples over the age of 2, reported having a CVD. • Hospitalised at twice the rate of non-Indigenous peoples.
29
Causes of Morbidity diabetes renal cancer
Diabetes, in 2012-2013 (ABS, 2014): • 2012-2013, 1 out of 10 First Peoples adults had diabetes (ABS, 2014). • Hospitalised at 4 times the rate of non-Indigenous peoples. Chronic Kidney Disease, in 2012-2013 (ABS, 2014): • 2012-2013, 1.8% First Peoples 2+ years old, reported long-term kidney disease. • Hospitalised at 10 times the rate of non-Indigenous peoples. Cancer (AIHW, 2015) - 2004-2008, rate of cancer cases 421 per 100,000 population for First Peoples. - Hospitalised at 0.7 times the rate than for non-Indigenous peoples
30
Leading Causes of Mortality
for ages 0-4 (other causes) - eg stillbirths, miscarriage, death during birth, sids, etc) ages 5-14: External causes (suicide, car accidents, drugs, alcohol, homicide, etc) Ages 15-34 external causes as well Ages 35-44 Cardiovascular and external causes Ages 45-54 CVD, cancer, endocrine Ages 55-64, Cancer, CVD, endocrine Ages 65+ CVD, Cancer, Endocrine
31
Suicide
Suicide rate almost twice the rate than non-Indigenous Australians (based on age standardised rates) (AIHW, 2015). . For 15-19 year olds: rate is five times as high. Kimberley – attempted suicide every week (100 times the national average) (AIHW, 2015). Many factors contribute to these tragic statistics, including:  History of colonisation;  Intergenerational trauma;  Ongoing racism;  The everyday realities in First Peoples communities, such as unemployment, poverty, overcrowding, social marginalisation. indigenous youth suicide was 80% of total Australian suicide in 2010, compared with just 10% back in 1991.
32
What are the Social Determinants of Health?
Understanding disparities between First Peoples and non-Indigenous peoples, is to understand factors and processes outside traditional domains of health. • Structures of society and social conditions in which people grow, live, work and age (Zubrick et al., 2014).
33
social determinants of health Model
Level/ring 0 = individual/.family is in the centre (age, sex and constitutional factors) level/ring 1 = is individual lifestyle factors level/ring 2 = is social and community networks level/ring 3 = living and working conditions (eg, food production, education, work environment, unemployment, water/sanitation, health care services, housing. Level/ring 4 = General socio-economic, cultural and environmental conditions
34
conceptual model of social determinants of indigenous health and health inequities.
See slide for image
35
Social determinants
Schooling – 55% Year 12 completion rate Employment – 4.2 times higher unemployment Incarceration – First Peoples 27% of the prisoner population Housing – 14 times higher homelessness rate Racism – 27% reported experienced regularly
36
Culture as a Determinant
Protection/ promotion of traditional knowledge and practices; Family and kinship; Connection to Country/Community; Contribute to personal and community resilience and wellbeing. Culture central to First Peoples Health in the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Australian Government, 2013).
37
Culture as a determinant image/model
In the middle = Culture (Aboriginal and Torres Strait Islander peoples have the right to live a healthy, safe and empowered life with a healthy strong connection to culture and country) and all of the following factors feed into the above: continually striving to improve accessibility, appropriateness and impact a robust, strong, vibrant and effective community controlled health sector based on the best possible evidence free of racism and inequality Supported by housing, education, employment, and other programs focussed on eliminating the causes of health inequality indiividuals and communities actively engage in decision making and control social and emotional wellbeing as a central platform for prevention and clinical care mothers and babies get the best piossible care and support for a good start to life Growth and development of children lays the basis for long healthy lives youth get the services and support they need to thrive and grow into healthy young adults adults have the health care, support and resources to manage their health and have long, productive lieves older people are able to live out their lives as active, healthy, culturally secure and comfortable as possible
38
the determinants of health originate from what?
The cultural determinants of health originate from and promote a strengths based perspective, acknowledging that stronger connections to culture and country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety. (Lowitja Institute, 2014, n.p).
39
Social and Emotional Wellbeing
indigenous peoples have a high(er) prevalance of SE problems. eg (death of family member ~35%, serious illness ~20%, not able to get a job ~20%, alcohol-related probs ~15%, mental illness ~15 %, Trouble with the police ~10%, gambling poroblems ~5%)
40
Social emotional wellbeing | Clinical Considerations
``` • Culturally appropriate screening tools  Connection to land  Connection to history  Connection to community  Relationships with family ``` * Prevalence of under diagnosis * Spirituality • Interactions between western medicine & bush medicine • Holistic approach
41
Healing
‘Culturally safe’ health care Respect difference Holistic practices Incorporation of concept of SEWB and collectivist worldview Flexible Working in partnership
42
Strengths-based Approaches
Recognises the importance of - - an individual’s resilience - --builds upon existing strengths and capacities (not doing ?) This can contribute to pre-existing negative stereotypes in addition to being disempowering towards individuals
43
Strengths-based Approaches | do what>
``` value the capacity,  skills,  knowledge,  connections and  potential in individuals and communities ```
44
Strengths-based communication Is what? and is not what?
``` IS…  focussing on what is going well and  identifying what is going on when things are going well IS NOT…  avoiding the truth,  focussing only on the “problems”,  focussing only on positive things,  accommodating poor health choices,  one sided ```
45
Communication: | Low & High Cultural Context
LOW: primary purpose of comms is the exchange of info, facts and opinions "High primary purpose of comms is to form and develop rships, contextual info is neeeded.
46
HIGH CONTEXT association =
``` • Depend on trust, build up slowly, are stable. Ones social circle is clearly defined • Attention to group process. • One’s identity is rooted in groups (family, kinships, culture, work) • Social structure & authority are centralised; responsibility is at the top ```
47
Low Context Assocation =
• Relationships begin & end quickly. Many people can be inside one’s circle; circle boundary is not clear • Follows procedures & pays attention to the goal • One’s identity is in oneself and one’s accomplishments • Social structure is decentralised; responsibility goes further down
48
High context interaction =-
High use of nonverbal elements;  Verbal message is implicit;  Verbal message is indirect;  Communication is seen as an art form—a way of engaging someone. • Disagreement is personalized. One is sensitive to conflict expressed in another's nonverbal communication. • Conflict either must be solved before work can progress or must be avoided because it is personally threatening.
49
Low context interaction =
Low use of nonverbal elements. • Verbal message is explicit • Verbal message is direct; • Communication is seen as a way of exchanging information, ideas, and opinions. • Disagreement is depersonalized. One withdraws from conflict with another and gets on with the task. Focus is on rational solutions, not personal ones. One can be explicit about another's bothersome behaviour.
50
high context territoriality =
 Space is communal; people stand close to each other, share the same space.
51
Low context territoriality =
Space is compartmentalized and privately owned; privacy is important, so people are farther apart.
52
high context temporality =
Everything has its own time. Time is not easily scheduled; needs of people may interfere with keeping to a set time. What is important is that activity gets done.  Change is slow. Things are rooted in the past, slow to change, and stable.  Time is a process; it belongs to others and to nature.
53
low context temporality =
Things are scheduled to be done at particular times, one thing at a time. What is important is that activity is done efficiently.  Change is fast. One can make change and see immediate results .  Time is a commodity to be spent or saved. One’s time is one’s own.
54
high context Learning
Knowledge is embedded in the situation; things are connected, synthesized, and global. Multiple sources of information are used.  Learning occurs by first observing others as they model or demonstrate and then practicing.  Groups are preferred for learning and problem solving.  Accuracy is valued. How well something is learned is important.
55
Low context learning =
Reality is fragmented and compartmentalized. One source of information is used to develop knowledge  Learning occurs by following explicit directions and explanations of others.  An individual orientation is preferred for learning and problem solving.  Speed is valued. How efficiently something is learned is important.
56
First People’s Communication
``` Eye contact Silence Gender Roles Kinship Networks Historical impacts Diversity Language Story telling ```
57
First People’s Communication focusses on ....
Non-verbal  Environment  A strong connection to land, country, ancestors and spirits  Gratuitous concurrence  The importance of family, family structure & community – connectedness  Importance of humour
58
Therapeutic Relationships
Cornerstone in Indigenous Health Aboriginal and Torres Strait Islander clients are more likely to access health services where service providers: • communicate respectfully, • have some understanding of culture, • build good relationships with Aboriginal &/or Torres Strait Islander clients, and • where Aboriginal &/or Torres Strait Islander health workers are part of the health care team (Taylor & Guerin, 2014).
59
Biomedical Model
the biomedical or medical (sometimes also known as the biomechanical) model of health - patient is seen as a ‘sick’ body that can be handled, explored and treated independently from their mind and other external considerations.  All illness and all symptoms and signs arise from an underlying abnormality within the body, referred to as a disease.  Health is the absence of disease.  The patient is a victim of circumstance with little or no responsibility for the presence or cause of the illness.  The patient is a passive recipient of treatment, although cooperation with treatment is expected (Wade & Halligan, 2004).
60
Biopsychosocial Model
Proposed by Engel (1977) implies that behaviours, thoughts and feelings may influence a physical state.  Disputes long-held assumption that only the biological factors of health and disease are worthy of study and practice.  Psychological and social factors influence biological functioning and play a role in health and illness.  More realistic model in light of role lifestyles play in a society having entered the new millennium.  Patient seen as a person with an individual lifestyle and not simply as a patient with a disease which has deviated them from normal functioning (McInerney, 2015).
61
Aboriginal health strategy meaning of health
“Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total wellbeing of their Community. (NAHSWP, 1989)
62
Holistic SEWB
takes into account spiritual, physical, social, emotional and cultural aspects. Cultrual, social and political determinants connection to land, to spiritulatity/anscestors, to physical wellbeing, to mental wellbeing, to family/kinship, to community, to culture experiences and expressions
63
Summary
Improve access to high quality, evidenced based, culturally safe & affordable health care  Improve access to modified culturally appropriate screening tools that support a preventative health care model for Aboriginal and/or Torres Strait Islander people  Improve the understanding of the Aboriginal and/or Torres Strait Islander culture to minimise the risk of misdiagnosis &/or mistreatment  Incorporate a SEWB framework to health care and not dismissing the impacts of social determinants & historical impact