Like what the age-old adage from Desiderius Erasmus states “prevention is better than cure”, population health is the approach that looks at the broader picture of developing and maintaining a realistic and culturally acceptable health plan for the Australian Aboriginal communities. Rather than merely addressing the management of diseases, population health goes deeper by aiming to manage the factors that may have caused or developed the diseases, and ensure that the World Health Organization’s (cited in Queensland Health 2012, p. ) definition of health as “a state of complete physical, mental and social wellbeing” is achieved holistically.
Therefore, more than just preventing diseases from recurring and spreading in the communities involved, the social, cultural and economic factors that have contributed or may contribute to future health problems in a community must be properly addressed, and thereby introducing a new specialization nursing that will provide nursing care in partnership with the concerned community group (Queensland Health, 2009) like the Aborigines and the Torres Strait Islanders. This growing specialization is called community health nursing.
Community health nursing is crucial in ensuring that the correct approaches to the Aborigines’ and Torres Strait islanders’ community health, are applied and are popularly supported by the concerned indigenous groups. It is important that the community health nurses are equipped and oriented to their broader roles and responsibilities which include patient education, individual and family advocacy, case management and interdisciplinary approach (Van Loon 2008, pp. 315 – 330). Obviously, these skills are addressed minimally, or are not totally addressed in the present nursing education system.
And government and community support is needed to ensure that future community health nurses acquire the skills or competencies of clinical knowledge and practice, but also that of community leadership and management. With this in place, the aboriginal communities themselves will be active participants in health policy-making and implementation as well. Therefore, government and non-government agencies should give appropriate attention and support to these shifts and expansions of roles of community health nurses, and make health population a priority strategy in alleviating the health problems of Australia’s marginalized groups.
This is critical because the success of this strategy could become the blueprint for managing the health issues and problems concerning the other marginalized sectors. Community Health Nursing: Community health nursing is a nursing practice specialty primarily focused on families, and defined community groups, aimed at providing them the proper nursing care based on evidences based on community immersions involving the participation of the community concerned.
In the process, the corresponding community values needs to be appreciated and analysed to avoid deprivation of their rights or curtailing their freedom of choice as to the more effective nursing care approach and program based on their observations and experiences. As compared to a community nurse who works in a community setting to manage specific diseases and provide public health care as a matter of health promotion, community health nursing goes beyond the traditional goal of understanding the particular health problem and the methods of preventing and controlling within the community setting (Van Loon 2008, pp. 15 – 316).
Community nursing focuses on population health by analysing the existing community health program and its effectiveness based on the different determinants of health namely socio-economic, political and environmental. Community health nurses therefore need to be highly skilled not only in the clinical practice or technical knowledge of identifying and controlling the health problems, but also in developing a community-based and population focused approach to planning, delivering and evaluating nursing care (Fahrenwald & Maurer 2000, p. ).
As such, Zotti, Brown, and Stotts (cited in Fahrenwald & Maurer 2000, p. 2) explains that community nurses need to be skilled as community development workers as well, with knowledge on areas of case management, patient and community health education, individual and family advocacy, policy formation, research, consultation, collaboration, management of care groups, and delegated functions. Therefore, leadership is an essential skill for the new community health nurses.
The need for community health nurses to forge partnership with the community, and in this case the Australian Aborigines and Torres Strait islanders, is a very important process which may later serve as a blueprint to handle marginalized groups apart from the Aborigines. One of the more important issues addressed by community health nursing is not only the accessibility factor of remote Australia, but also the cultural values and beliefs of the different aboriginal groups and tribes (Van Loon 2008, p. 318), which must be addressed carefully so as to avoid clashes which might jeopardize the health programs.
Remote Australia One of the main objectives of community health nursing is to be able to empower and help the Aborigines and the Torres Straight islanders to have access to the government’s health facilities and services by developing their own health prevention and risk management program in partnership with community-based health nurses or nursing agencies. One of the known reasons for the failure of these indigenous groups in availing of these services is because of the remoteness of their location.
Until today, there are still 68% of the Aborigines and the Torres Strait islanders who live outside of the major cities, and 9% still live in remote areas, while 15% live in very remote areas like Tenant Creek, and other aboriginal communities (Australian Human Rights Commission 2012, p. 4). The term “remote” refers to the distance that these Aborigines or Torres Strait islanders need to travel just to avail of the health services (Australian Human Rights Commission 2012, p. 4).
Compared to non-indigenous groups who have but 2% of their population living in remote areas, and more than 69% living in major cities and metropolis, the Aborigines and Torres Strait islanders are far from the mainstream activities and as such have grown in the practice and use of their indigenous languages, making it more difficult for them to appreciate and understand national and regional campaigns on health promotion which include their social, mental and physical well-being (cited in Department of Aboriginal Affairs NSW Briefing, p. 2; and Aboriginal and Torres Strait Islander Social Justice Commissioner, note 15.
To better understand the need for community or grassroots’ approach to health development in the form of community health nursing; let us first get to know the Aborigines and the Torres Strait islanders, and their importance in the Australian health scenario. Aborigines and Torres Strait Islanders Population Defined The Aborigines and the Torres Strait islanders are the first settlers of Australia who are historically endowed with the right to live in settlement areas, which they have occupied since time immemorial, by virtue of their native titles (Australian Human Rights Commission 2012, p. 20).
The Aborigines and Torres Strait islanders comprise around 2. 5% of the total population of Australia. As of 2006, they have been registered at 517,174. One-third of their population is living in major cities like Sydney, Melbourne, and Brisbane. The rest still live in regional areas, remote areas, and 15% in very remote areas where aboriginal settlements are found like Tenant Creek. It is remarkable that wherever they are living, they have managed to retain their cultural identity, which includes diverse languages, cultural practices and kinship structures, as well as their way of living in general.
The Aborigines, who were Australia’s earlier settlers, were believed to have arrived by boats from Indonesia about 40,000 to 60,000 years ago (Hiscock 2008, p 82; and Mulvaney & Kamminga 1999, p. 1-2) So it is presumed that even before Captain James Cook’s discovery of Australia in 1770, these Aborigines were already occupying most of the lands. But colonization changed it all for them. Their traditional rights to the lands and waters have been ignored by the colonizers and have been extinguished by the creation of titles and interests over the lands.
Until today, these native titles that the Aborigines and Torres Strait islanders hold on to as their sense of heritage and legacy, has not yet ripened to legal rights, except for aboriginal mission or cemetery area, as well as national parks. Colonization also resulted to the creation of an Australian Constitution that did not recognize the existence and rights of the Aborigines and Torres Strait islanders, and allowed room for racial discrimination.
However, in 1991 until 2000, efforts were made to reconcile the Aborigines and the Torres Strait islanders with the non-indigenous people group of Australia. In 2000, the roadmap for reconciliation was established (Australian Human Rights Commission, p. 17). The colonization brought pain and suffering to the Aborigines and the Torres Strait islanders. Because of colonization, many of the aboriginal children and those of the Torres Strait islanders suffered from forcible removal from their families by duress, compulsion, or undue influence, using the child welfare and protection laws as their shield.
The forcible removal was intended to allow the aboriginal youth to absorb, merge, and assimilate the aboriginal and Torres Strait islander youth into the non-indigenous population and adopt their way of life. The same does not apply to children of non-indigenous people, who were only removed from their homes if they were abandoned, abused, or uncontrollable. As a result of these removals, aboriginal children suffered mental, social, and physical pressures and pains. Majority were refrained speaking their own languages and were hysically, emotionally, and sexually abused. Most of them also suffered neglect and were not allowed to establish contact with their parents.
These children were known as the “Stolen Generations” (Australian Human Rights Commission, p. 17). On top of the serious damage to their mental health, cultural identity, and well being as a whole, these “Stolen Generations” lost their right to perform their traditional functions and speak their own languages, and enjoy their way of life. Worse, establishing their genealogical roots became impossible and difficult.
Above all, they were deprived of their childhood right to be nurtured and cared for by a parent or a family. And as if these were not enough, until today, Aborigines and Torres Strait islanders still suffer the discrimination of being marginalized and as such was never seriously considered as a priority, or as an equal interest group to enjoy the benefits of national and regional health benefits and services. The same is true for housing, educational and employment opportunities. That is why until now the Aborigines and Torres Strait islanders are still the poorest sector.
Discrimination goes to such extent as having scarcity of accessible and culturally appropriate health services (Australian Human Rights Commission 2012, p. 8; and Australian Indigenous Health Bulletin 2011, p. 4),. And because of this, the life span of the Aborigines and the Torres Strait islanders are 10-11 years less than the non-indigenous people. Most of them died four times the rate of nonindigenous people for preventable deaths due to lifestyles, which could have been earlier prevented if detected. Up to today, racism is still one of the main reasons for the adverse health conditions of the Aborigines and the Torres Strait islanders.
In fact, recent studies show that 72% of aboriginal youth were happier in the remote areas than those in the urban areas. Aborigines experience poorer health and shorter life spans than nonindigenous people (Nurse Info 2007). Population Health Perspective Population health is defined as the health outcomes of a community or group of people, including the distribution of health within the community or group (Kindig & Stoddart, American Journal Public Health (2003); 93; pp. 380-383). It is not just being free from illness but also encompasses the capacity to respond, adopt and control the changes and challenges in life.
Population health aims to reduce the health inequalities or inequities among people groups through a careful analysis of the different health determinants namely: social, environmental, political, including the distribution of opportunities. Population health is very important in addressing the health problems of Australian Aborigines because there are cultural values and traditions that need to be explored and analyse to create the right approach to a more appropriate program or service, without creating a clash with the aboriginal communities.
Secondly, their lack of access to good education has made it difficult for them to understand the different health promotions and programs, especially for those, which they perceived to be contrary to their practices, customs, and traditions, in the absence of information and education (cited in Department of Aboriginal Affairs NSW Briefing, p. 5).
Population health also helps encourage participation and commitment from the Aborigines and Torres Strait islanders considering their history of pains and sufferings from colonizers in the past, because the process of population health gives importance to their health needs as a people or as a community, which is an act of respecting their rights to heard, to choose, and to decide or build the appropriate health program for their community.
No longer will they resent the intervention by community health nurses as a ploy to get them out of their settlements or to revive the “Stolen Generations” scheme. Their participation in the health process gives a sense of empowerment and self-determination to these indigenous groups, and the fear of losing their sense of control over their communities is diminished (Human Rights and Equal Opportunity Commission Australia, Social Justice Report, 1998, Chapter 4).
Skills that Community Health Nurse Can Utilize To Improve Health Outcomes for Aborigines Community health nursing is crucial in ensuring that the correct approaches to the Aborigines’ and Torres Strait islanders’ community health are applied and are popularly supported by the concerned indigenous groups. This will then lead to the proper and correct policy-making guidelines, which in turn will result to a realistic application of the state and national budgets for these groups’ health programs.
And to achieve these goals, it is important that the community health nurses are equipped and oriented to their broader roles and responsibilities which include patient education, individual and family advocacy, case management and interdisciplinary approach (Van Loon 2008, pp. 315 – 330). As such, a combined knowledge and mastery of primary care practices and illness-oriented medical practice will be needed plus community organization skills like assessment, teaching, negotiation, collaboration, leadership and delegation, as well as critical thinking South Dakota Department of Health, 2000, p. 11).