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HLSC/HLSZ Indigenous Health and Culture Assessment Answer

HLSC/HLSZ 120 Written Examination

One case study scenario is provided below. Students are also provided with six (6) questions which are to be used to explore the case study. Students are required to build their knowledge specific to the case study across the semester with the unit content which is being delivered progressively. The exam will comprise the case study and will require you to answer three (3) out of six (6) questions provided below. The three (3) questions for the examination is determined by the teaching team.

Weighting:45%

Length and/or format:This is a two (2) hour exam. Each written response to three (3)

questions will be graded equally out of a maximum of 15 marks.

Purpose:This examination is designed to assess knowledge, skills, and attitudes related to the content delivered in lectures, tutorials and the eLearning modules.

Learning outcomes assessed:1, 2, 3, 4, and 6

How to submit:Students will attend their timetabled examination during the central examination period.

Return of assignment:Following the release of student results for the  semester,

students will be able to schedule a time with the Lecturer in Charge of the unit to review their exam if they require feedback on their exam performance.

Assessment criteria:This assessment task will be graded against a standardised response based on information delivered in both lectures and tutorial yarning circles during the semester. Therefore, students will need to ensure they access eLearning modules and attend all classes and yarning circles to be fully informed on the exam questions.


Exam Case Study

Luke was the first in his family to go to university. He is the eldest of six children and was raised by his mother and her mob. His father was an educator in Aboriginal custom and lore for a large community and was considered as an elder. Unfortunately, he passed away when Luke was 14 years of age. Luke’s father had a complex medical history which included right ear deafness and type two diabetes. It distressed Luke that his father’s early and sudden death occurred despite his vigilance in attending regular appointments at his local Aboriginal Medical Service (AMS).

The university campus was located 300km from country and community. Luke knew there were no other Aboriginal and Torres Strait Islander people from his community at the university. However, he felt he would receive strong cultural support from the university, as he had experienced this on a visit to Open Day. Luke wanted to follow in his father’s footsteps and become a strong and respected leader for his community. Luke felt inevitably driven to education, as he saw this as a link to honour his father’s legacy.

Luke found university difficult and isolating. There was nothing familiar at university and if there were any questions about Aboriginal and Torres Strait Islander issues – he was always asked about it. He felt ashamed when he didn’t know the answers. This was confronting to Luke and made him question his culture and beliefs. At times, Luke felt overwhelmed from being away from country and disconnected from all the supports that his community and kinship had provided for him.

There were lots of expectations of Luke from his family and community to be a good role model to his siblings and to the community. Community was excited to have Luke, as he would be the first from home to succeed at university. He felt he had a responsibility to return to community and improve life by instigating positive changes that would continue his father’s legacy. Luke and his friendship network often discussed the stress of being first generation Aboriginal people; leaving home, working and studying. He also recognised that he would need to undertake a twelve month education internship somewhere far from home, before he returned to community. While working away from home gaining skills and experience, Luke was able to be a role model to his siblings and contribute finances to his mother for the care of the family.



Questions
Learning Outcomes and
Graduate Attributes
Question 1:

List the social determinants of health and discuss those that could have impacted on Luke, his family and his community
Learning Outcomes: 2 and 3
Graduate Attributes: GA2 and GA4
Question 2:

Describe why health service provision to Aboriginal and Torres Strait Islander people has historically been poorly delivered and utilised. Using knowledge of past history specify how culturally safe health care can be delivered to Luke, should he come into your health service.
Learning outcomes: 1, 2, 3 and 4 Graduate Attributes: GA1, GA2 and GA5
Question 3:

Describe your understanding of Luke’s cultural and social factors. Analyse the cultural safety principles you would apply to Luke in order to practice culturally sensitive communication and self-determination.

Learning outcome: 1, 2, 3, and 4

Graduate Attributes: GA1, GA2 and GA4
Question 4:

The community that Luke comes from has received funding for a community health service. Describe why Aboriginal Community Controlled Health Organisations (ACCHO) are fundamental in addressing health inequities.
Learning outcome: 1, 3, 4, 5 and 6

Graduate Attributes: GA1, GA2 and GA5
Question 5:

Luke’s father suffered an early and premature death when compared to life expectancy standards for all Australians.
Analyse how the Closing the Gap campaign seeks to improve the life expectancy for Aboriginal and or Torres Strait Islander people.
Learning outcome: 3 and 4

Graduate Attributes: GA1, GA4 and GA7
Question 6:

Luke believes that Aboriginal and Torres Strait Islanders rights for self-determination is important. Describe some initiatives or organisations that attempt to address self- determination in Health.
Learning outcome: 2, and 3

Graduate Attributes: GA1, GA2, GA4 and GA5


Answer

INDIGENOUS HEALTH AND CULTURE

Question 1

Social health determinants and impacts 

As per the case study, it has been found that Luke’s father was suffering from a complex medical problem related to type two diabetes and had deafness in the right year. According to the present case, it is seen that Luke’s father passed away when Luke was 14 years old. As per the present case, it can also be seen that Luke and his family belonged from a community of Aboriginal people. It has been found that health is not only the well-being of a particular individual but also the well-being of the community as a whole. Thereby, as per the case study, it can be stated that the death of Luke’s father due to improper treatment hampered the well-being of their community which comprised of Aboriginal peoples.

Social determinants of health service provided to aborigines

The determinants of Social Health for the Torres Strait Islander and Aboriginal people can be stated as the socio-economic status, unemployment, housing, impact due to poverty and racial discrimination. The determinants of Social Health for the Torres Strait Islander and Aboriginal people also includes the educational attainment, stressful events, trauma, exposure to various violence activities, housing and access to the community services. The other determinants of health for the society are related to the social gradient, stress, work, unemployment, social exclusion, early life, transport, addiction, food and social support. According to the present scenario, it can be stated that Luke, his community and his family suffered also suffered from social determinants related to health. The social determinants that could have affected them are early life, socio-economic status, impact due to poverty, unemployment, access towards the community resources, isolating and education insufficiency.

 Social Determinants of health services

Figure 1: Social Determinants of health services

Impact on Luke and his community

The community belonged to Aboriginal people who were lacked proper education which also led the aboriginals to suffer from unemployment that caused to rise of poverty levels. As per the case study, it can be seen that Luke's father had to pass away at an early phase of life which could have been prevented through proper health checkups. Accordingly, it can be stated that the access towards the proper community services similar to efficient health care was not available for the aboriginals. As the community of Luke belonged to the Aboriginals, who lacked proper education and housing, leading to the socio-economic status which was not up to the mark. Accordingly, due to this type of socio-economic status, they were isolated from the other communities. Moreover, as per the analysis, it is also found that the mothers from the low socio-economic areas were 30% more prone to give birth to babies of low weight.

Question 2

Providing Culturally Safe health care 

History and the Effects of Colonisation

Luke belonged from the community of Aboriginals who were colonised by the dominant culture of the Eurocentric. It can be noted that the cultural livelihood of the people has been destroyed due to the impacts of the Eurocentric dominant culture. Accordingly, it can also be stated that the well-being of the indigenous people has been affected negatively. Thereby, it is found that the indigenous people suffered from the health disparities which were not faced by the common people residing in a similar place.

It was noticed that the people were assimilated in the 1950-1960s which stated that the Indigenous people and the aboriginals were asked to leave their culture and get similar to the culture of the Anglo-Australians. Based on the previous histories, it can be stated that the protection policies included the children of the Aboriginal people were removed forcibly to the Government settlements and Christian Missions.

Culture of Torres Strait Islanders and Aboriginals

Based on the estimations, it has been found that there existed 500 various nations or clan groups with specific language, belief and culture. It was also found that all the cultures had a system comprised of health beliefs which explained the cause of illness, the process of treatment and the person responsible for the process. It was also noticed that the health beliefs of the aboriginals included belief over the scientific or supernatural phenomenon, thereby, rising to the situation of complexity. 

The aftermath of “Stolen Generation” has led children to suffer from lack of family functioning and parenting, mental and physical illness along with the alienation and disconnection from the extended country, culture, family and society. Thereby, these factors led to negative impacts which include multiple bereavements along with several other losses. The other vital and negative impact includes traumatisation, where the children see the ongoing effect of the original trauma over their family members. From the analysis of the past histories, it can be said that the traumas of the past still lay an impact on the children in the form of family dysfunction, psychological morbidity, ill health, early mortality and community violence. Thereby, from the above conditions, it can be well stated that the provision for the health service to the Torres Strait Islanders and Aboriginals were poorly utilised and delivered.

Cultural safe health care for Luke

Cultural safety is generally a process that can be related to every new type of interactions in the cross-cultural type of communication, which is a great opportunity for obtaining cultural safety. From the conducted studies, it can be stated that cultural safety is supposed to be existing on a continuum. The process that leads to cultural safety starts from cultural awareness followed by cultural sensitivity and cultural competency. Thus, based on past histories it can be stated that Luke can visit the health care services, not from that meant for the Aboriginals but for the common type of people. 

Accordingly, he can also receive better services from the health care centres made for the common people which also provides culturally safe health care. This can be stated as any type of new transactions between the cross-cultural community leads to gain cultural safety. Thereby, if Luke visits into my health service centre then he will be getting health care that is culturally safe. This is due to the fact that our organisation makes no distinction while providing health care services. The objective of this health care service centre is meant to give priority to health care services to people, based on trust and co-operation.

Question 3

Social and cultural factors and cultural safety 

The social factors and cultural factors that Luke had to encounter included poor socio-economic status, social exclusion, the early standard of life, health-related issues and a lot more. It is observed that Luke’s father suffered to death from typical medical problems in spite of visiting the medical services regularly. Luke’s father was the educator and a role model of the community where he was respected as an elder. Luke has faced the same kind of unwelcoming environment in his university. 

During the first day of the university, Luke expected to get effective help from the cultural background of his chosen university, but he got disappointed in that place too. He has also carried the pressure of being first generation Aboriginals that are to become role models for present and next generations. This was due to the fact that he found everything dissimilar and he also had to face the questions related to the issues in his community. It was also found that Luke felt ashamed when he was not able to answer any of them. Thereby, it made Luke confront situations that questioned his beliefs and culture. As per the case study, it can be seen that Luke was the first sibling from the community to study in the university. Thereby, it can be stated that Luke belonged to the community where people were not well educated. It was also noticed that Luke and his fellow mates were from the first generation aboriginals who suffered from stresses. 

Principles of Cultural Safety

The principles of cultural safety mainly deal with the keeping of peace and harmony in between the cross cultures as well as leads to the process of a fresh interaction between the other cultures. The people that are providing health services and people that are accepting services must actualise mutual trust between them. Thus, Aborigines should feel safe in trusting their health with national and local health care services. From the context of the case study, it can be stated that Luke needs to enable:

  • Self-determination within the Aboriginals
  • Equity
  • Cultural Contextuality
  • Political Bipartisanship
  • Restorative and Social Justice
  • Transparency
  • Yarning

As per the analysis, it can be stated that Luke needs to establish the aforesaid principles to practice self-determination and sensitive communication culturally. From the context, it can be stated that Luke needs to maintain proper communication and trust between him and the others through the method of Yarning. This is supposed to help him gain positive results as any type of services, especially the health care services requires proper communication and trust between the patient and the doctor. First and foremost, Luke needs to imbibe within himself the factor of self-determination that can come from mixing with open-minded people. Secondly, Luke needs to follow the principle of equity that states of the requirement of fairness in the entitlement of all to an acceptable standard and quality of living. Luke also needs to follow cultural contextuality and transparency that would help him to survive better. It is also analysed that if Luke followed Restorative and Social Justice along with political bi-partnership, then he can take certain actions for any type of injustice.

Question 4

The capability of ACCHO in addressing health inequities 

Health inequality is termed as the variation in the type of health conditions among the several social groups. The inequity of Health can be referred to as the condition that states whether the inequality in between several groups is avoidable and unfair. It has been found that all ACCHS are AMS but all AMS are not ACCHS and the AMS which are ACCHS can be the board member of NACCHO. The reason behind ACCHO or NACCHO being the primary body is to address health inequalities due to the perusal of certain strategies. The first strategy of NACCHO states that it will strengthen and maintain its position as the national based peak body for the Aboriginal wellbeing and health in Australia. The second strategy followed by NACCHO states that it will develop a framework for quality improvement which would be done continuously along with research. 

The third strategy would include the demonstration and enhancement of the value offered by the body to its members through strong leadership. The fourth strategy states that NACCHO will continue to strengthen its skill base along with governance structure. This strategy is also supposed to help the ACCHO, Territory and State Peaks to improve. The last strategy that NACCHO is supposed to advocate, shape and lead national reforms in the health policy. Accordingly, it can be stated that following the above-mentioned strategies, ACCHO is supposed to address the health inequalities through the guidance of NACCHO.

Addressing Aboriginal health care services 

In relation to community-based health care service for Torres Strait Islander and Aboriginal people, ACCHO has a scope of increasing equity factors to ensure the gaps are filled with more medical facilities. In this respect, the application of concepts such as Equity and Equality can 

Question 5

Role of Closing Gap campaign to enhance the expectation of life for Torres Strait Islanders and Aborigines

Closing the gap campaign that had been launched in 2008, aims to minimise health and wellbeing differences between Aborigines and Australian white people. In the context of the death of Luke's father at a premature age, in spite of attending AMS, deserves to review this programme. This programme has aimed to reach its goal of improving the life expectancy of Aborigines and Torres Strait Islander within 2030. 

Chart related to life expectancy during Birth, 2010


Figure 2: Chart related to life expectancy during Birth, 2010

Based on the given chart it can be seen that the life expectancy during the birth of the Indigenous men was 67% and that of the women were 73% that was far lesser than the other countries. That means that continuous degeneration of health would not only affect health standards of aboriginals but will also reduce national health standards.

Improving child and maternal health

As per the findings, it can be stated that the Aboriginals or the Torres Strait Islanders can be assisted with programs that help to tackle Indigenous smoking. This is supposed to help the aboriginals address the risks related to chronic disease and maternal and child health. The campaign related to Closing of the Gap focuses to shift the Aboriginals and the Torres Strait Islanders to a preventive footing in spite of responding to the crisis after the event.

Addressing mental health issues

The campaign is also supposed to focus on the areas of Indigenous affairs and confront them in order to impede progress. Contributing to better health services, housing facilities and social acceptance is supposed to help the Aboriginals or the Torres Strait Islanders to improve their issues related to physical as well as mental health.

Enhancing early life care and increasing immunisation

The campaign promises to look after the well-being of the Aboriginals and the Torres Strait Islanders through shifting them to a better place for preventing footing so that they may be prevented from the health crisis. The campaign focuses over providing better health services to them thus leading to enhancements in early life care. Moreover, providing them with hygienic and proper diet would also help them to enhance immunisation.

Question 6

Organisations and initiatives addressing self-determination

The principles for the self-determination that needs to be provided by the organisations to the Torres Strait Islanders and the Aboriginals are:

  • Support
  • Freedom
  • Stable policies
  • Financial responsibility
  • Knowledge

It has been found that the private organisation that primarily look after the well-being of the Aboriginals and the Torres Strait Islanders are Waltja Tjutangku, AbSec, Bungree and VACCA.

 Organisations and their initiatives for Aboriginal and Torres Strait Islander people

Figure 3: Organisations and their initiatives for Aboriginal and Torres Strait Islander people

Waltja Tjutangku mainly looks after the family services related to the community for the development of self-determination and self-management. The principles that are followed by this organisation for the Aboriginals include proximity, community and family. Services delivery can be stated as the most efficient when it happens within a broad family. On the other hand, the community deals with partnerships with those communities effectively so as to respond to the recognised needs. Proximity deals with the support and training of those communities provided by the local people.

The Victorian Aboriginal Child Care Agency is primarily a state-based Aboriginal Community Controlled Organisation that focuses on providing services to young people, children, community members and families. The organisation is found to be the largest in its type and have promoted and protected the rights of the Aboriginal families and children for more than 40 years.

Bungree is said to a Central Coast Aboriginal organisation based on providing community services to the Torres Strait Islanders and Aboriginals The organisation provides services and conducts programs for the aged, children, young disabled families and young. The organisation also caters to the homelessness people. 

The organisation named AbSec looks after the safe, thriving of the Aboriginal families. The organisation is also found to look after raising the self-determination and culture of the Aboriginals.

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