313394 Final: Indigenous Health Practice Exam Notes
INDIGENOUS EXAM NOTES
WEEK 1:
Definitions of Health:
Health is a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity.
“Aboriginal health” is Social, emotional and cultural wellbeing of the whole community in which
individuals are able to achieve their full potential as a human being, thereby bringing about the total
wellbeing of the community. It is a whole of life view and includes the cyclical concept of life-death-life.
The Cultural Security Scale:
The relationships between health professionals and Aboriginal and Torres Strait Islander people has
been identified as one of the many factors that can have a positive or negative influence Aboriginal
health and wellbeing and therefore the ‘Gap’ that exits between Aboriginal and Torres Strait Islander
people and non-Indigenous populations. An understanding of the role that individual professionals and
inter-professional collaboration plays in the creation and maintenance of culturally secure
environments for Aboriginal people offers students a starting point from which they can develop the
skills required to progress along the cultural continuum. (Bainbridge et al., 2015; Hole et al., 2015;
Coffin, 2007)
Cultural
Awareness
Brokerage
Cultural Safety
Protocols
Cultural Security
Sustainability
Involves
understanding
Aboriginal and
Torres Strait
Islander peoples
by learning
about their
beliefs, values,
practices and
experiences.
It’s about
obtaining
cultural
knowledge.
Understanding
successful and safe
practice. It involves
two way
communication
where both health
practitioner and
Aboriginal clients
are equally
informed and
equally important in
the discussion.
Communication and
respect are of the
utmost importance,
values and ideas are
not pushed but
considerations from
both sides are
equally regarded.
It involves self-
awareness. It’s
about listening and
‘yarning’.
Focuses on the
subjective
experience of the
Aboriginal person
who uses the
health services,
whereby they
experience an
environment that
does not
challenge, assault
or deny their
cultural identity.
It’s about the
Aboriginal and
Torres Strait
Islander person
feeling safe.
Strategy that can
take a culturally
safe practice to a
culturally secure
one. They
formalize the fact
that in an
Aboriginal
context, health
care delivery and
programs need to
be done in
consultation with
the elders and key
stakeholders
within the
particular
community
It’ about
developing
culturally tailored
interventions to
improve the
quality of care.
All health care
providers,
doctors, speech
pathologists,
social workers,
school nurses,
dentists, etc. need
to provide this no
matter what their
role in provision of
health care.
It’s about
intercultural
teams working
together to
provide
culturally secure
services.
Maintenance of
culturally secure
environments.
There is a need to
evaluate a systems-
level intervention
that combines best-
evidence strategies
to reduce disparities
in healthcare
delivery to and
Torres Strait
Islander Australians.
It’s about the
consistent
delivery of high
quality care for
Aboriginal and
Torres Strait
Islander people.
Close the Gap:
Most Australians enjoy one of the highest life expectancies of any country in the world but this is not
true for Aboriginal and Torres Strait Islander people. Today, Aboriginal and Torres Strait Islander
Australians die younger than other Australians. The ‘Gap’ is 10 – 17 years.
Learning more about Aboriginal and Torres Strait Islander peoples is important in order to move forward
and for all Australians to share in our national identity. It means understanding the past and looking to
the future.
The close the gap campaign aims to minimize the level of racism and marginalization between Non-
Indigenous and Indigenous Australians.
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WEEK 2:
Concepts of Health and Wellbeing:
➢ Health is a complex issue. It is not static. Several concepts, definitions and models relating to
health exist.
➢ Health status is the level of health of an individual, person, group or population as assessed
by that individual or objective measures.
➢ Determinants of health are biological, behavioural, social and environmental. The
determinants interact.
➢ How we view the concepts of health and illness, how we think and feel, influence the types of
health behaviours we adopt. In this regard, note that socio-cultural factors influence the
meaning of health including age, gender, family beliefs, current health status,
religion/spirituality, history and subjective experiences as well as geographical location.
➢ Health therefore is not merely the absence of disease. Social and environmental factors
along with perceptions of well-being need to be incorporated into any definition of health.
➢ Health and illness are social concepts and they mean different things to different people.
➢ Culture significantly influences people’s beliefs about what factors contribute to health and ill
health.
➢ The WHO, (1946) grounded the idea of wellbeing within its broad concept of health. Health is
considered to be a positive state. It acknowledges the importance of preventative
behaviours in physical health
➢ Many of us share common factors but the differing cultural values and norms that surround an
Aboriginal and Torres Strait Islander collective philosophy differs from a more individualistic
Western philosophy.
➢ For Aboriginal and Torres Strait Islander people, connection to land, family and community
relationships relate to overall ‘wellbeing’ rather than health.
➢ Several conceptual frameworks (ways of thinking about health and wellbeing) have evolved
over time. These include the medical, bio psychosocial and ecological models.
Measurements of health status
Objective Measures
• Epidemiology offers examples of objective measures in terms of the distribution and frequency
of disease.
• Statistical measures include mortality, morbidity, prevalence and incidence.
• Health is also measured in terms of life expectancy and health inequalities identified using life
expectancy measures (Jones & Creddy, 2012)
Subjective Measures
• Health perceptions (or perceived health status) are subjective ratings.
• Objective and subjective measures allow for comparisons to be made between and within
countries and the information about the health status of a population helps governments shape
health policies to determine how health services should be delivered.
You will recall from the Workshop that you were asked to consider what health is, how it is perceived
and to identify factors that influence those perceptions. These are discussed below.
1. Health is the absence of disease in an individual
Health is understood as having two opposite states: either someone is ‘healthy’ or ‘ill’ – these are
mutually exclusive. This view suggests that health is static, it does not change and is dichotomous.
Health has in the past been related to the functioning of the body, health and illness (biomedical
perspective; Cartesian dualism – separation of mind and body). Health and illness are considered in
terms of a person’s medically defined pathology. This biomedical approach, links to the medical model
which is useful in identifying and reducing disease in individuals. When moving the focus away from
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the individual to populations, the limitations of this model become apparent. Public health initiatives
aim to address population-wide health disadvantages.
2. Health as a dynamic degree of functional capacity and wellness along a continuum
Figure 1: Illness-Wellness Continuum. Adapted from “Wellness Workbook,” by J. Travis and R. Ryan,
2004.
The illness-wellness continuum compares a treatment model with a wellness model. It offers a
graphic illustration of a wellbeing concept. The model connects the treatment and wellness paradigms;
the middle is the neutral point. The wellness paradigm stretches across the model heading towards a
high level of wellness. The treatment paradigm links with the medical model. The neutral point is
where patients can stop. People can sit at this neutral ‘no illness’ state. For example, a person with a
high blood pressure may take medication to control this but there are no accompanying lifestyle
changes. In the wellness model the person would take the medication but also stop smoking and
maybe undertake some exercise. The level of motivation, knowledge and health beliefs are
instrumental in behaviour change.
Six components relating to personal health surround the continuum, these are physical (body
functioning as well as it should be), psychological health and emotional health (stress and coping
mechanisms), social wellbeing (family and friends support), environmental health (air and water,
quality and food safety) and spiritual health (following moral codes and values) (Hettler, 1976).
These components are captured in the bio psychosocial model, which identifies biological,
psychological and social factors that interact in complex ways to impact health in positive or
negative ways.
All people have the capacity to be functional and healthy although they may experience impairments at
different points in time which can temporarily or permanently impact their functioning capacity e.g. an
athlete who suffers a serious injury requiring surgical intervention can result in a temporary disability
but a disability is not an illness. An elderly person with arthritis and limited mobility may not consider
themselves to be ill, they may perceive themselves as having a high level of wellness.
3. Health as a population concept
This conceptualization focuses on communities and population groups rather than on individual
people. This approach considers how health is determined and what factors influence health. It
aims to improve the health of populations by introducing interventions that have the potential to
affect everyone.
4. Health as a holistic concept (broad conceptualisation)
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Document Summary
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Aboriginal health is social, emotional and cultural wellbeing of the whole community in which individuals are able to achieve their full potential as a human being, thereby bringing about the total wellbeing of the community. It is a whole of life view and includes the cyclical concept of life-death-life. Islander peoples by learning about their beliefs, values, practices and experiences. It involves two way communication where both health practitioner and. Aboriginal clients are equally informed and equally important in the discussion. Communication and respect are of the utmost importance, values and ideas are not pushed but considerations from both sides are equally regarded. Aboriginal person who uses the health services, whereby they experience an environment that does not challenge, assault or deny their cultural identity. Strategy that can take a culturally safe practice to a culturally secure one.
