Closing the Gap: Nurses and midwives making a difference
School of Nursing, Midwifery and Nutrition, James Cook University, Cairns QLD
Senior Indigenous Nurse Advisor, Office of the Chief Nursing Officer, Queensland Health, Brisbane QLD
Australian Bureau of Statistics (ABS). (2008). Maps and Census Profiles, Australian Indigenous Geographical Classification 2006. Commonwealth of Australia, Canberra:
Australian Bureau of Statistics. Australian Bureau of Statistics (ABS). (2009). Deaths, Australia, 2009. Commonwealth of Australia, Canberra: Australian Bureau of Statistics.
Australian Institute of Health and Welfare. (2008). The Health of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra, ACT: AIHW.
Azzopardi, P., & Gray, N. (2010). Developing country health in a developed country: Personal perspectives. Journal of Paediatrics and Child Health, 46, 549-551.
Browne, A., & Smye, V. (2002). A post-colonial analysis of healthcare discourses addressing aboriginal women. Nurse Researcher, 9(3), 28-41.
Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) (2008). First steps in Closing the Gap. Retrieved January 25, 2011 from http://www.facs.gov.au/about/publicationsarticles/corp/BudgetPAES/budget2008-09/Documents/Minsterial%20Statement/part3.htm
McDermott, R., Tulip, F., Schmidt, B., & Sinha, A. (2003). Sustaining better diabetes care in remote Indigenous Australian communities. British Medical Journal, 327, 428-430.
Mitchell, M., & Hussey, L. (2006). The Aboriginal health worker. Medical Journal of Australia, 184(10), 529-510.
Snowden, W. (Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery) (2010). Anti-tobacco workforce announced on 'World no Tobacco Day'. Media release 31 May, Department of Health and Ageing, Canberra. Retrieved October 10, 2010 from http://www.health.gov.au/internet/ministers/publicity.nsf/Content/mr-yr10-ws-ws052.htm
Shadow Report. (2010). Shadow report on the Australian Government's progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians. A Close the Gap Steering Committee for Indigenous Health Equality report, February 2010. Retrieved March 19, 2010, from http://www.oxfam.org.au/resources/filestore/originals/OAus-CloseTheGapShadowReport-0210.pdf
West, R., Usher, K., & Foster, K. (2010). Increased numbers of Australian Indigenous nurses could make a significant contribution to 'closing the gap' in Indigenous health: What is getting in the way? Contemporary Nurse 36(1-2), 121-130.
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Life expectancy at birth is one of the main indicators of health inequality. Current health and social status indicators for Australian Indigenous people demonstrate major discrepancies in comparison to other Australians. For example, in Australia in 2005-2007 the Indigenous life expectancy gap at birth was 11.5 years for males and 9.7 years for females (Australian Bureau of Statistics, 2009). This gap has remained relatively constant over the last few decades (ABS, 2008). While the main causes of death for Indigenous Australians are similar to those of non-Indigenous Australians, the percentages attributed to the different disease categories are significantly different. For example, death from external causes is 16.2% for the Indigenous population compared to 6.3% for non-Indigenous, and diabetes is 8% for Indigenous Australians compared to 2.4% for non-Indigenous (ABS, 2008; AIHW, 2008). The Australian Government's response to this troubling issue, urged on by unprecedented support from the public, was the Close the Gap initiative which aims to reduce the gap in life expectancy within a generation (Shadow Report, 2010). Since the introduction of the Close the Gap strategy there have been some claims of success. For example, the Honourable Warren Snowden (Snowden, 2010), Minister for Indigenous Health, outlines some of the changes that have occurred as a result of the implementation of the Indigenous Chronic Disease Package, funded at $805.5 million over four years, as: 294 new positions added to the Indigenous Health Workforce; 29,799 Indigenous adult health checks completed, which is an increase of 26% on 2008-2009 figures; employment of the first national Coordinator for Tackling Indigenous Smoking, Mr Tom Calma, who will lead and mentor the new Tackling Smoking workforce.
Importantly, the Government has also recognised the need to provide an accessible primary health service for all Indigenous Australians and the need to work in partnership with Indigenous people in the delivery of these services. Further, they have recently committed $19 million over three years for strengthening the Indigenous health workforce and encouraging more Indigenous people to enter the health professions (FaHCSIA, 2008). Increasing the number of Indigenous nurses has previously been suggested as one way to help close the gap, as Indigenous nurses provide culturally appropriate care and understand the issues faced by Indigenous people when they access health services (West, Usher, & Foster, 2010 for example). Likewise, Indigenous Health Workers, a currently under-utilised group of health workers, have the potential to make a significant impact on the health of Indigenous Australians as they have been shown to effectively reduce hospital admissions and mortality (McDermott, Tulip, Schmidt, & Sinha, 2003). Similarly to Indigenous nurses, this group has insider cultural knowledge, as they usually reside and work in the community (Mitchell & Hussey, 2006).
However, it has been argued that much of the excess burden of disease on Indigenous people can be prevented and managed with better access to health services, education, and lifestyle changes (Snowden, 2010). This is an astute claim because the underlying determinants of poor health outcomes are closely linked to poverty, low educational attainment, limited employment opportunities, overcrowded and unsatisfactory housing, racism and social, cultural and political disempowerment (Azzopardi & Gray, 2010), as well as the oppressive forces of colonialism (Browne & Smye, 2002). Azzopardi and Gray (2010, pp. 549-551) similarly argue that incentives to improve Indigenous health must do more than just target 'low hanging fruit' but rather engage in comprehensive community engagement. While the current approach may help prevent children dying before they reach the age of five, it will not have succeeded in closing the gap until their communities and the nation can offer them the conditions necessary to lead a healthy, safe and productive life. Such an outcome requires ongoing consultation with communities and the development of programs to educate Indigenous people to deliver the relevant programs in the future.
This special edition of Contemporary Nurse (ISBN 978-1-921348-89-1) provides the latest scholarly work related to closing the gap and importantly highlights some of the outstanding work being done by nurses, midwives and others in the area. The collection of papers in this second edition, focusing on the specific needs of Indigenous people, adds significantly to the current knowledge in the area and we are proud to offer the collection as part of our ongoing commitment to Indigenous health. It demonstrates that nurses and midwives are indeed making a difference and contributing significantly to closing the gap.