Editorial

Nurses and midwives closing the gap in Indigenous Australian health care

Sally Goold
Chair, Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN), Bribie Island; Adjunct Professor James Cook and Griffith Universities, QLD

PP: 005 - 007

Article Text

This special issue of Contemporary Nurse is focused on how nurses are helping to close the gap in Indigenous Australian health outcomes. The gap represents the accumulated, appalling statistics that compares the state of Aboriginal and Torres Strait Islander peoples' health and life expectancy to the health and longevity of all other Australians. Close the Gap is a concerted and directed campaign with many signatories including Government, organisations and agencies to reduce the level of disadvantage among Aboriginal and Torres Strait Islander peoples. The Council of Australian Governments (COAG) and Close the Gap identified key areas that require immediate funding and action - health, healthy homes, education, early childhood, safe communities, economic participation and governance and leadership.

Early deaths of Aboriginal and Torres Strait Islander people is linked to the long-term result of policies of removal of children, removal from land and culture, and loss of language and lore. In addition, these issues are compounded by chronic illness, including diabetes, cardiac and lung diseases (due in no small part to changes in lifestyle); poor nutrition and poor access to high quality food; poor mental health, alcohol and substance abuse; and increased rates of incarceration and suicide. Furthermore, poor access to services, lack of infrastructure, and poverty continue despite changing government policies and increased funding for health, housing, education and infrastructure. While there have been some small improvements in longevity as well as improved maternal and infant mortality and morbidity rates (AIHW National Perinatal Statistics Unit, 2009), there is still a long way to go. Armstrong (2004) echoed the critical view of a number of experts in Aboriginal and Torres Strait Islander health when she wrote that if the previous policies and strategies had worked, Aboriginal people should be the healthiest in the world. It is time for action rather than more words and numbers.

While nurses and midwives have made some advances towards closing the gap in Aboriginal and Torres Strait Islander health as described in the articles included in this special edition, there are significant steps nurses and midwives must yet take in order to start to begin to make a real contribution to closing the gap. Some of those steps are personal while others are the responsibility of the nursing and midwifery professions. I have outlined some of these in this foreword.

On a personal level, nurses and midwives really need to understand that the statistics about the health of Aboriginal and Torres Strait Islander people represent real people. To understand each statistic as a person, a child, mother, brother, father, grannie, sister, niece or nephew, helps to make them more than just numbers. Each neo-natal statistic is a newborn baby who died - a death that often could be prevented if the required interventions were provided early enough. Each premature adult death is a mother or father with a family and perhaps little baby grandchildren. Each of these people has friends and family and lives within a community to which they contribute and where they are loved and respected. Furthermore, it is important to recognise that domestic violence figures actually represent families in distress - damaged families where the kids see, hear and feel the abuse of living in a violent and dysfunctional family.

Likewise it follows that the figures surrounding mental illness and Aboriginal and Torres Strait Islander people represents real lives disrupted or destroyed with pain, suffering and anguish with a sickening propensity to end in suicide. The same is the case for people living with alcohol and substance abuse, chronic disease, poor living conditions, poor education, lower socioeconomic status, higher representation in prisons and in child protection. As we are told over and over, Aboriginal and Torres Strait Islander peoples are significantly disadvantaged on every measurable level within our Australian society.

Rather than continue to be overwhelmed by these statistics, it is time for nurses and midwives to begin to make a difference by thinking of Aboriginal and Torres Strait Islander people as people who belong to a family and a community; as real people with real lives and not just a statistic.

Professionally, closing the gap hinges on education as a way of changing professional behaviours and attitudes to ensure nurses and midwives are aware of the disadvantage faced by Aboriginal and Torres Strait Islander peoples and work in a culturally safe and respectful manner. Nurses and midwives who have recently undertaken their education are likely to be familiar with the gap - these statistics are commonly incorporated into undergraduate curricula. Those who were educated in nursing or midwifery more than ten years ago are unlikely to have encountered these statistics in their undergraduate courses, or in their training. In the future, nursing and midwifery undergraduate education will consistently and reliably encompass Aboriginal and Torres Strait Islander health, history and culture as a fundamental requirement for accreditation of each and every nursing or midwifery course across Australia. A modern nursing and midwifery workforce must understand the concepts of - and the importance of working within - a culturally safe and respectful health system. Nurses and midwives must be professionally and academically prepared and required to provide care in a manner that will prevent further harm to Aboriginal and Torres Strait Islander people. The importance of closing the gap is not merely to improve the statistics. Closing the gap can only be achieved through active, sustained and inclusive professional thinking and deeds.

At the 2009 CATSIN Annual Conference, the Aboriginal and Torres Strait Islander Social Justice Commissioner, Mr Tom Calma said, 'The health issues affecting Aboriginal and Torres Strait Islander peoples are not shifted overnight. There needs to be more effort to change behaviours that lead to opportunities to be healthy'.

Bob Beadman is responsible for implementing Working Future, a Northern Territory/Federal Government partnership 'building on all of the policies, programs and targets identified in the over-arching National Agreements', working to ensure the delivery of remote services is occurring in an effective and targeted way to address early childhood, health, housing, education and community safety in 20 nominated towns across the Northern Territory.

In his first report, Beadman (2009a) said:

The building of houses and roads and sewerage systems is the easy part of this development effort; the social reconstruction, the rebuilding of people, the restoration of their pride and self-worth is the far more difficult, and more important.

Beadman (2009b) went on to describe engagement:

'Engagement' means more than consultation; clearly it means intellectual and physical engagement in a shared responsibility to turn this social tragedy around.

The Close the Gap Statement of Intent, to which CATSIN is a signatory, states (in part) that the signatories are committed:

• To ensuring primary health care services and health infrastructure for Aboriginal and Torres Strait Islander peoples which are capable of bridging the gap in health standards by 2018.
• To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples.
• To respect and promote the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable and of good quality.
  Close the Gap, 2008

In 1997, the first national meeting of Aboriginal and Torres Strait Islander nurses was held in Sydney. This meeting became The National Forum for Development of Strategies to Increase the Numbers of Aboriginal and Torres Strait Islander Peoples in Nursing. The Forum determined that Aboriginal and Torres Strait Islander people were reluctant to become nurses and also reiterated that Aboriginal and Torres Strait Islander peoples are reluctant to use mainstream services because of perceived inherent and ongoing racism in health services and in nursing education. CATSIN understands that nursing and midwifery cannot recruit and retain Aboriginal and Torres Strait Islander nurses and midwives in a system where they feel isolated and excluded. Nor can Aboriginal and Torres Strait Islander people use a health system where they are not safe and are not respected, simply on the basis of cultural upbringing, practices and beliefs. As a result, CATSIN has campaigned for more than a decade to have Aboriginal and Torres Strait Islander peoples' health, history and culture included in curricula for courses leading to registration as a nurse or midwife, and continues to campaign to ensure similar inclusions in the curricula of nurse practitioners. In 2007, the Australian Nursing and Midwifery Council released its position statement on Inclusion of Aboriginal and Torres Strait Islander Peoples Health and Cultural Issues in Courses leading to Registration or Enrolment, stating:

The intent of this position statement is to inform providers of nursing and midwifery courses leading to registration or enrolment of the need to include a clearly identified subject, unit or module on Aboriginal and Torres Strait Islander peoples' culture, history and health.
Australian Nursing and Midwifery Council, 2007

CATSIN holds fast on its determination to ensure all nurses and midwives have an understanding of Aboriginal and Torres Strait Islander peoples' health, history and culture, and that nurses and midwives understand how their own attitudes and resulting professional practice can directly affect Aboriginal and Torres Strait Islander clients. Providing care and services in a culturally respectful manner where our people are considered as people and not just a statistic and the provision of care and services in an environment where Aboriginal and Torres Strait Islander peoples' culture and practice of culture is respected, is the most significant step for our profession to contribute towards Closing the Gap.

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