Australia is known for its indigenous community which has been dwelling in the country for thousands of years. Mainly, we can identify two distinct types of Australian indigenous communities in Australia which are Torres Strait Islanders and Aborigines. These communities though different culturally are still part of what makes Australia unique and colourful.

If you are an International medical graduate or a fresh medical professional wishing to serve in Australia you will have the opportunity to treat these communities in metropolitan, rural or even remote areas of the country. And it is crucial to identify the health differences between Australian indigenous communities and non-indigenous Australians. These communities deserve good healthcare just as any other Australian as health is a basic human right that every person deserves.

However, there is an evident health gap that has marginalized the Australian indigenous communities causing it a major issue in Australian healthcare. Due to many different reasons, this has been a challenging process and requires unique approaches. For Indigenous Australians, additional aspects like cultural identity, family/kinship connections, ties to traditional lands, cultural knowledge/beliefs, language use, and participation in cultural practices are also important influencers of health and well-being. These Indigenous-specific factors are interlinked and combine to impact individual and community health outcomes. As careers in indigenous communities are becoming popular, a holistic approach that acknowledges the interdependence of these cultural, social, and environmental factors is important for fully supporting Indigenous wellness.

Australia’s current Aboriginal health situation

Life expectancy and death rates

Life expectancy and death rates are commonly used to measure population health and this can be applied to figure out the status of indigenous health situation. Indigenous Australians have lower life expectancy than non-Indigenous Australians. Indigenous males born around 2015-2017 could expect to live 71.6 years and females 75.6 years. Life expectancy is about 6 years lower for Indigenous people living in remote areas compared to major cities. Median age of death for Indigenous Australians has increased from 56.5 in 2010 to 61.0 in 2020. The leading causes of Indigenous deaths in 2020 were heart disease, diabetes, lung/respiratory diseases, lung cancer, and self-harm. In recent years, cancer has surpassed heart disease as the main cause of death for both Indigenous and non-Indigenous Australians. Between 2006-2018, age-standardized death rates from heart disease fell for Indigenous Australians while cancer death rates rose.

Psychological issues

For Indigenous Australians, social and emotional well-being is the foundation of physical and mental health. It’s a holistic concept encompassing connection to culture, land, spirituality and ancestry. The concept of social and emotional well-being varies across Indigenous cultural groups and individuals.  Social determinants like policies, racism, and colonization impact health inequities and this should be considered when healthcare professionals approach these communities. Social and emotional well-being is distinct from but related to mental health/illness.

Good Indigenous mental health involves belonging, a strong culture, relationships and purpose in life, this creates a unique situation in treating the psychological issues among Indigenous people and healthcare professionals should have a better understanding of these factors when treating these patients which is quite challenging to a non-indigenous mental health specialist or a health specialist who has no proper training working with Australian indigenous communities.  Poor mental health can stem from stressors like removal from family, incarceration, discrimination or unemployment. Based on surveys, around 24% of Aboriginal Australians reported a diagnosed mental health condition in 2018-19, and 31% reported high psychological distress.

Hearing, Vision, And Oral Health

Ear infections (otitis media) and dental problems are common health issues for Indigenous children, especially in remote areas. Otitis media can cause hearing loss, impacting speech, language development, behaviour, education outcomes and employment prospects. Indigenous children also experience higher rates of tooth decay and dental hospitalizations than non-Indigenous children. It could be stated that factors like social disadvantage and lack of appropriate diet/dental services contribute to poorer oral health. Specific programs aim to diagnose/treat ear and dental issues to reduce impacts on communities such as the Northern Territory Remote Aboriginal Investment Oral Health Program, the Northern Territory Hearing Health Outreach Program, and the Queensland Deadly Ears Program. Vision loss greatly reduces quality of life and ability to be mobile, work, study and engage socially as most communities have difficulty accessing the help they require. Preventable vision problems like trachoma, diabetic retinopathy and cataracts affect Indigenous Australians over 40 at much higher rates making their lives harder than it has to be. Indigenous eye health reports monitor inequalities and gaps in vision care provision which should be addressed promptly.

Factors Contributing to Aboriginal Health Disparities

As mentioned above health issues among Australian indigenous communities have become a major issue that needs prompt action. However, to address these issues and to bridge the health gap firstly we have to identify the root causes and create a game plan to resolve these issues.

Psychological factors

Colonization had a devastating impact on Australian Indigenous communities and culture through violence, disease, and land displacement. Forced removal of children from families and communities caused ongoing intergenerational trauma. These factors are recognized as fundamentally impacting Indigenous disadvantage and poor health worldwide. They are also the root causes of mental health issues that are not seen among other Australians. In contrast, cultural identity, participation, and connection to land/family/kinship act as protective factors that can positively influence Indigenous health and well-being. Most Survey data shows Indigenous people living in homelands assess their health more positively. The new National Indigenous Health Plan recognizes the importance of culture and takes a holistic approach, it notes cultural determinants must be considered across the life course, like ensuring housing design supports kinship/community arrangements. Preserving culture and connection to land/community/family is seen as key to promoting their well-being. Most clinics located in rural and aboriginal areas should have a potent system to identify the needs of these communities and a unique adaptive system to treat them.

Socio-Economic factors

Indigenous Australians do not have equal opportunities to achieve the same levels of health as non-Indigenous people. They experience greater socioeconomic disadvantage which increases exposure to behavioural/environmental health risks. A higher proportion of Indigenous households live in conditions not conducive to good health. Indigenous people also lack equal access to primary healthcare services and basic health infrastructure like safe water/sewerage/housing.

Factors such as socioeconomic inequality, poor living conditions and unequal access to healthcare contribute to Indigenous peoples having poorer health outcomes compared to non-Indigenous Australians. There is not enough attention paid to the indigenous community, and in order to improve indigenous health, medical professionals should be encouraged to pursue employment in indigenous areas. Poverty is another factor that affects the health care of these communities. An adequate income is essential for living a healthy life since it provides a person with greater access to nutritious food, better housing, health and other services, and a greater potential for social participation.

The lack of education that causes inadequate monetary support has made it hard to access this healthcare. Housing is also another pressing issue as urban living is too costly and homelessness is growing among the Australian indigenous communities exposing them to major health issues without proper healthcare. A poorer quality diet lacking in nutrients but high in processed foods can contribute to obesity issues.

Food availability and affordability have an impact on diet, and those with low means or living in distant locations may find it challenging to obtain fresh produce because of increased prices and restricted supply. Problems with access can have a detrimental effect on diet quality and health   outcomes, leading to serious long-term health problems.

Battling the health disparities between indigenous vs non-indigenous healthcare

In mid-2020, Australian governments along with the Coalition of Aboriginal and Torres Strait Islander Peak Organizations endorsed a new National Agreement on Closing the Gap. This agreement aims to address longstanding inequality faced by Indigenous Australians to achieve equal life outcomes for all.

The National Agreement outlines 17 targets across key areas. These targets cover various health measures and their underlying social determinants. Specifically, the outcome domains focus on education, employment, health and well-being, justice, safety, housing, land and water rights, and preservation of Indigenous languages. The overarching goal is to establish a framework for achieving equality so that Indigenous peoples can enjoy the same standard of living as other Australians through improved conditions in these important quality-of-life domains. However, these pen-on-paper deals cannot cover the whole inequality faced by Aboriginal communities. For healthcare professionals working with aboriginal communities, medical staff looking for careers in indigenous communities, IMGs and fresh graduate doctors must also have a proper understanding of these communities to deliver proper health solutions.

Improve access to culturally safe and high-quality healthcare for Aboriginal communities.

In order to ensure healthcare services are physically, financially and culturally accessible, healthcare providers need to understand Aboriginal cultures and build trust. Medfuture works with many different medical practices and allied health facilities that acknowledge the Australian indigenous communities and aim to provide comprehensive healthcare that is aligned with their cultural beliefs. We also acknowledge the traditional custodians of the country throughout Australia and has been providing necessary information to Doctors, AHPS, IMGs and other health professionals on the importance of  Aboriginals and how you can be part of it. Paying attention to mental health first and dealing with trauma that has been passed down through generations as a result of residential schooling. Despite being underfunded, holistic, culturally sensitive mental health care is essential for wellbeing.

To improve cultural safety and competency in healthcare doctors and other professionals should undertake ongoing cultural training for better understand Aboriginal cultures, histories and the impact of colonization on health. This will help providers deliver more respectful, appropriate care.

Medical professionals should be able to build trust and relationships in Aboriginal communities. Instead of focusing solely on patient care, medical professionals should try to actively participate in and work in conjunction with local communities. This makes it possible to resolve health inequities and address issues that impact entire communities. putting money into locally run initiatives that use conventional methods of wellness and recovery. Medfuture often posts such community-led clinics and facilities aimed at serving the Australian indigenous communities and encourages medical professionals to join such employment offers mostly careers in indigenous communities. Evidence shows these can be highly effective in empowering communities.

Socio-economic solutions

Address the social determinants of health, such as poverty, housing instability, lack of access to clean water and inadequate sanitation that disproportionately impact Aboriginal people. Investing in education and job opportunities can help lift entire communities out of poverty and vulnerability.

Statistics play a major role and improved data collection could be used to better track and understand Aboriginal health issues. Disaggregated data by gender and region is also needed to identify at-risk groups. Working collaboratively with Aboriginal communities and prioritizing their needs, voices and leadership is key to making meaningful progress on closing the health equity gap over time.

Making healthcare services more accessible and high-quality for Aboriginal people could involve supporting mobile clinics, home visits, traditional healing options, longer appointment times and more. This can resolve a lot of issues in regional areas as well as urban areas.

Prioritizing mental healthcare given the ongoing intergenerational impacts of trauma from policies like residential schools is quite important however healing will require generation-long commitment.

Medical Staff diversity and knowledge

It has been demonstrated that better health results are obtained when Aboriginal people, communities, and organizations are involved in healthcare decision-making. This is especially true of community-controlled organizations headed by Aboriginal people. Being in charge of oneself is liberating. Additionally, this lessens the previously noted employment concerns. Constant moral, financial and cultural support for indigenous students in universities can make their lives easier in achieving their goals and getting into the medical field to serve the community.

Aboriginal students who want to work in healthcare can benefit from mentoring programs. We should also be able to challenge systemic racism within healthcare systems and providers that cause major health disparities. The method that Aboriginal people are treated can be adversely affected by unconscious bias. Cultural competency training is needed for non-indigenous and IMGs planning to join careers in indigenous communities. IMGs and others from outside Aboriginal communities should reflect on how their backgrounds and perspectives impact the way they view and relate to Aboriginal patients.

Overall, it can be stated that the health issues of Australian indigenous communities and the bridge that needs to be gapped are significant. It has been around for years and it is up to the current and future generations of healthcare professionals and other stakeholders to resolve these issues and provide solutions. Fresh graduates who plan to work in rural indigenous community populated areas and IMGs who are planning to work with these communities should be able to identify the changes and differences in healthcare approaches among these communities.