Enhancement of the health status of indigenous people is considered a long-term challenge for the Australian government. A huge health inequality gap exists between the indigenous population and the rest of Australian citizens, raising concerns to human rights groups such as the United Nations Committees. Health inequalities are largely determined by elements related to social, political, and economic factors, including racial discrimination, poverty, and poor environmental conditions. Unequal access to basic health care and poor healthcare infrastructure in indigenous neighborhoods need to be addressed to meet the healthcare needs of all. Such can be achieved if the government recognizes and takes necessary actions to improve the health status of the Aboriginal and Torres Strait Islander communities.
Negative Impact of Intergenerational Trauma and Racism on Aboriginal and Torres Strait Islander Peoples’ Health
Indigenous Australians experience a higher burden of disease than the rest of the country’s population due to different factors related to political and historical events. The losses experienced by Aboriginal and Torres Strait Islander people during colonization continue to impact their health status today (ABC News In-depth). They lost their land, identity, language, and customs while experiencing a long history of racial discrimination and colonization. The policies enacted were meant to protect the whites as superiors creating a system that discriminated against indigenous people by denying them basic rights. The reactions exemplified during colonial times created conditions and stereotypes that made indigenous people experience poverty and discrimination, which is still happening (Sherwood, 2013). For instance, the documentary shows that several young people die due to neglect and poor treatment by healthcare professionals.
Starting with events that took place during the colonization of Australia, it is evident that the indigenous people are living in absolute poverty and poor neighborhoods as a result of such occurrences. Before the arrival of British colonists, the Indigenous had a healthy lifestyle due to their active life as hunters and gatherers (Sherwood, 2013). There is no documentation of widespread illness in the indigenous population before colonization, suggesting that they led a healthy lifestyle. However, events changed their health status due to actions perpetuated by colonists who wanted to enrich themselves. For instance, the legal fiction termed terra nullius was key in exposing indigenous people to unfavorable living standards. In 1788, the number of indigenous people in Australia was about 750000 as the first British people arrived at the Warrange or Sydney coastline (Sherwood, 2013). British settlers claimed land belonging to the indigenous population under the terra nullius legislation leading to the dispossession of their legally owned land. The law states that no land belonged to anyone as opposed to the evidence that early settlers and explorers had revealed that Aboriginal and Torres Strait Islander communities had established land systems and water distribution channels.
The Aboriginals did not sign any treaty with Europeans concerning land ownership, but they were evicted to other locations that were deemed non-productive. This occurrence is linked to social disadvantage, traumatic experiences, and poor health. The acts related to land dispossession amount to disempowerment which is considered a causative factor of poor health by the Royal Australian College of Physicians (Kairuz et al., 2020). To the indigenous population, ill health is not limited to physical injury or disease, but it involves other factors such as spiritual as well as emotional alienation from the legally owned land, cultural values, and families. The land is part of the identity of the indigenous population, which defines their spiritual and mental health.
Another issue that has greatly impacted Aboriginal and Torres Strait Islander communities are the history of resistance. The indigenous population actively resisted the British invasion, leading to undesirable consequences currently linked to traumatic and psychological experiences. British soldiers initiated brutal massacres to destroy the resistance, termed the “Frontier Wars.” (Miller & Berger, 2020). The killings continued up to the 1960s, leading to thousands of women and children of the Aboriginal population deaths. The resistance was also met with the assimilation policy, which involved removing children from their families into state care or non-indigenous homes. The children carried away from their families represented a stolen generation as their relatives could not find them or are still tracing their origin. Children were neglected, mistreated, and abuse physically, sexually, and psychologically. The aim was to destroy their culture, which started by changing names and language (Gibson et al., 2021). While the policy was often described as assimilation, the principal objective was to erase indigenous culture and force the children to stick to the culture of the whites.
Many Aboriginal and Torres Strait Islander people still live with the trauma of remembering the pain caused by the protection policies enacted by British rule to segregate them from other Australians. The Indigenous people were forced out of their parent’s homes and barred from attending schools and hospitals (Kairuz et al., 2020). Soldiers from Aboriginal and Torres Strait Islanders communities returned home after the horrifying experiences of World War I only to find that they were not allowed to enjoy equal rights with the rest of the population. Currently, there is discrimination in healthcare where the indigenous population is never treated or given appropriate healthcare services like the rest of the population (ABC News In-depth). It was a nightmare for the soldiers and their families as there were no settlement plans for them after the painful exposure and experiences, they underwent during the First World War.
Positive Impacts of Cultural Factors
A strong cultural identity creates stable mental health, which helps withstand life difficulties that may affect an individual’s well-being. Cultural identity can enhance resilience, self-esteem, and pro-social coping skills, which help fight mental health symptoms. The Aboriginal and Strait Islander people were subjected to protective policies that destroyed their cultural identity. This affected their self-esteem and ability to respond to negative life experiences such as stigma, trauma, and racial discrimination. According to Shepherd et al. (2018), strong cultural ties or attachment fosters an effective response to stereotyping, unequal treatment, and psychological health attributes. Dislocation of cultural practices can lead to increased suicide rates, as evidenced in the Aboriginal and Strat Islander communities due to low levels of empowerment and resilience to cope with life challenges.
Currently, the Aboriginal and Torres Strait Islander people are in the process of returning to their cultural norms that were disrupted several years by the White Australians. However, the attachment to relive their cultural identity is filled with pressing difficulties and is unlikely to be fought by people experiencing trauma and low self-esteem (Verbunt et al.., 2021). These challenges include discrimination in healthcare, poverty, and unfavorable neighborhoods. For instance, in the Four Corners documentary, it is revealed that the Aboriginals are neglected by the healthcare system and left to die from illnesses such as rheumatoid disease and heart failure, which rarely cause deaths to white Australians. Family cohesion and social support enhance personal empowerment, efficacy, and self-esteem, improving personal well-being and mental health (Gibson et al., 2021). Self-determination and association with a country’s positive activities and projects promote physical health as well as mental wellness. For Aboriginal and Torres Strait Islanders, government policies and racial discrimination make them lose the sense of ownership of their country, leading to low self-esteem and psychological trauma.
Different healthcare needs and considerations ensure patients’ preferences are met while delivering healthcare services. Regarding Australia, cultural safety can be defined as creating a safe environment for Aboriginal and Torres Strait Islander people devoid of assault, discrimination, or denial of their identity or cultural beliefs. Nurses should be able to acknowledge barriers and hindrances of clinical effectiveness that arise from fundamental imbalances in power between healthcare professionals and the patient. Cultural safety does not involve a general understanding of cultural customs associated with ethnic groups (Mitchell et al., 2022). The concept seeks to accomplish equality in care through acknowledging and understanding differences, decolonizing, focusing on power relations, pursuing evidence-based practices, and inviting the patient to contribute to the treatment process to ensure safety.
Cultural safety requires nurses to evaluate themselves and the impact of the culture on healthcare delivery. This indicates that they should question the attitudes, assumptions, conscious and unconscious biases, stereotypes, and predispositions (Mitchell et al., 2022). Evaluating these elements helps nurses understand the impact they have on the quality of care for patients. Implicit bias involves attitudes and stereotypes that unconsciously influence people’s comprehension, actions, and choices. Unconscious biases are activated without an individual’s awareness (Milligan et al., 2022). Implicit associations lead to attitudes based on traits such as ethnicity, color, and physical appearance. These biases are formed throughout life due to exposure to different people, circumstances, and media. Self-awareness is important because it helps nurses understand their weaknesses and learn how to deal with them to avoid associated influences.
Understanding oneself in terms of culture, values, assumptions, and beliefs enables nurses to communicate effectively with patients and other professionals. Self-awareness allows nurses to confidently manage challenges and offer culturally safe patient care without discrimination. It allows personal and professional development, which promotes the ability to nurses to form great therapeutic relationships with patients. The process of self-awareness enhances the ability of nurses to recognize their reactions to situations and reflect on their practices to improve areas that seem to pose a threat to cultural safety in healthcare (Younas et al., 2020). Additionally, nurses can utilize self-awareness to learn ways to prevent themselves from displaying negative emotions during their role in healthcare service delivery.
Health disparities between the indigenous people and the rest of the population are an alarming issue linked to historical, social, cultural, economic, and political actions that started during colonialism. Aboriginals and Torres Strait Islanders communities were dispossessed of their land and pushed to crowded places. Additionally, they were subjected to cruel and protectionist policies, which diminished their chances of accumulating wealth. While the government should end systemic racism that perpetuates inequality in healthcare, nurses and other healthcare professionals must fight stereotypes and biases through self-awareness. Culturally safe healthcare practices are essential in establishing strong therapeutic relationships with patients and delivering services without biases or prejudice.
ABC News In-depth. (2022). An investigation into the hidden killer in Australia’s remote Aboriginal communities | Four Corners [Video]. YouTube.
Gibson, M., Stuart, J., Leske, S., Ward, R., & Vidyattama, Y. (2021). Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples’ suicide?. Australian and New Zealand journal of public health, 45(6), 643-650.
Kairuz, C. A., Casanelia, L. M., Bennett-Brook, K., Coombes, J., & Yadav, U. N. (2020). Impact of racism and discrimination on the physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: A protocol for a scoping review. Systematic reviews, 9(1), 1-6.
Miller, J., & Berger, E. (2020). A review of school trauma-informed practice for Aboriginal and Torres Strait Islander children and youth. The Educational and Developmental Psychologist, 37(1), 39-46.
Milligan, E., West, R., Saunders, V., Bialocerkowski, A., Creedy, D., Minniss, F. R. & Vervoort, S. (2021). Achieving cultural safety for Australia’s First Peoples: A review of the Australian Health Practitioner Regulation Agency-registered health practitioners’ Codes of Conduct and Codes of Ethics. Australian Health Review.
Mitchell, A., Wade, V., Haynes, E., Katzenellenbogen, J., & Bessarab, D. (2022). “The world is so white”: improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease. Australian and New Zealand Journal of Public Health.
Sherwood, J. (2013). Colonization–It’s bad for your health: The context of Aboriginal health. Contemporary nurse, 46(1), 28-40.
Verbunt, E., Luke, J., Paradies, Y., Bamblett, M., Salamone, C., Jones, A., & Kelaher, M. (2021). Cultural determinants of health for Aboriginal and Torres Strait Islander people–a narrative overview of reviews. International Journal for Equity in Health, 20(1), 1-9.
Younas, A., Rasheed, S. P., Sundus, A., & Inayat, S. (2020). Nurses’ perspectives of self‐awareness in nursing practice: A descriptive qualitative study. Nursing & Health Sciences, 22(2), 398-405.