How can nursing and midwifery help close the gap in Indigenous health indicators?
Rosemary B Bryant
Department of Health and Ageing, Australian Federal Government, Canberra ACT
Behrendt, L. (2011). Aboriginal identity: Who is aboriginal? Retrieved March 2, 2011, from http://www.creativespirits.info/aboriginalculture/people/aboriginal-identity.html
Behrendt, L. (2009). The apology one year on. Retrieved January 15, 2010, from http://www.jumbunna.uts.edu.au/research/pdf/ApologyAnniversary2009.pdf
PP: 008 - 009
There are two factors which will be absolutely critical if we are to truly make progress in improving Indigenous health. They are, in my view, the most important steps we can take to closing the gap between Indigenous and non-Indigenous health indicators, and our success or otherwise in achieving these two things will ultimately determine how we will be judged by future generations.
The first is increasing the number of Indigenous health professionals, but particularly nurses and midwives.
Primary health care is the backbone of the health system and nurses and midwives are major contributors to primary health care. Indigenous health professionals are clearly best placed to provide high quality primary care to Indigenous people. They have the expertise and experience in Indigenous health issues as well as deep understanding of cultural, spiritual and community needs.
The second most important way we can improve health outcomes for Indigenous people is to increase our understanding of how health care needs are best interpreted and met for each Indigenous person seeking health care.
To turn to the first point, we have a daunting task. Indigenous nurses constitute 0.8% of all nurses in Australia, while Indigenous Australians make up 2.4% of the population. To make these numbers 'even', we should ideally aim to triple the number of Indigenous nurses and midwives.
While our job may be daunting it is not impossible. Our medical colleagues are proving it can be done. Between 1997 and 2010, Indigenous doctor numbers have increased from 15 to approximately 150 - a 1000% increase!
There are many ways we can work together to raise the numbers of Indigenous nurses and midwives, but generally speaking these involve policy and structural changes which need to be implemented at least initially at the level of the system.
My second point involving the interpretation of individual health needs is one which can be addressed locally at the health service level and by every one of us.
At the outset I should note that I am referring to regional and urban centres as well as rural and remote communities given that only 25% of Indigenous Australians live remotely. Sydney-based Professor Behrendt (2011) reminds us:
I am often asked, 'How often do you visit Aboriginal communities?' And I reply, 'Every day, when I go home'.
People are correct when they say that government and other leaders need to take responsibility to close the gap. They absolutely do. But I believe that if we are to truly make a difference then it's up to each and every one of us as health professionals to take responsibility to do what we can.
Taking responsibility is essential because the 'gap', while deplorable, is only the surface of the story. It is symptom, if you like, of much deeper disorder.
We know that the difference in health indicators between Indigenous and non-Indigenous people reflects profound and long-standing issues, and we must always remember that any measures which address the gap must take into account broader cultural and social factors. Professor Behrendt (2009) again:
... this is not just a simple matter of 'closing the gap', as the popular political catch-phrase describes it. Equality, I would argue, is not simply matching the socioeconomic statistics and giving Aboriginal people and their children the same opportunities, it also includes ensuring that the space is given to ensure that Aboriginal culture and Aboriginal communities remain vibrant and strong and that Aboriginal identity and history is given space in Australia's national story.
This 'giving space' was a very clear message that emerged from the review of maternity services which I led and reported on last year. Without exception, the many submissions I received from Indigenous services and individuals during the review spoke about how Indigenous women have considerably less opportunity to make choices about their health and maternity care than do most non-Indigenous women. Simply put, the majority of Indigenous women who are pregnant are not able to have their rights and needs met, as set out in the Australian Charter of Health Care Rights.
The fundamental needs of pregnant Indigenous women in regards to their maternity care are in no way different to the needs of all people in regards to health care generally. Reasonably easy access to safe, high quality, evidence-based care, in our own communities and ideally from our choice of health practitioner - these are the basic needs and most frequently expressed wishes of women who are pregnant but also of all people.
The difference for Indigenous people lies in how these needs are interpreted. Honouring cultural and spiritual differences in health means recognising that the most important needs in health care are the same for all of us, but that the difference lies in translation.
To return to the maternity example, when Indigenous women are not surrounded - antenatally, in birth and postnatally - by those who care for their cultural and spiritual needs, even though their physical needs may be being met, then the birthing experience cannot act as a true rite of passage. For Aboriginal women, cultural safety, in addition to physical safety, needs to be recognised and embedded in models of maternity care. Likewise, cultural respect, safety and understanding need to be embedded as far as possible in our broader health services.
Ensuring these cultural differences are respected and understood means ensuring that, if we are not Indigenous ourselves, that we have at least received suitable training in providing culturally appropriate care. If we are employers or managers, it means ensuring we provide access to such training and experiences for our staff. If we work in education and training, to ensure future nurses and midwives are equipped with a strong foundation of knowledge of Indigenous issues which can be built upon as required.
As they say, if you're not part of the solution, you are part of the problem, and every concerned nurse and midwife has a role to play and I urge you to think about how you can do your part.
Whether it is redefining models of primary care, designing a new health service, providing education and training, or clinical care to an individual patient, honouring the cultural needs of Indigenous people must lie at the heart of our efforts to close the gap.
It is as simple and as challenging as this - and a challenge which all of us as health professionals have the responsibility to embrace.