NUR342 Evidence Based Health Research And Practice 3

Introduction

This paper gives a detailed description of the health disparities experienced between Australians of indigenous descent and their non-indigenous counterparts. Pieces of evidence reveal that Aboriginal and Torres Strait Islanders in Australia experience unfavorable health outcomes as compared to their non-aboriginal counterparts. This paper, therefore, aims to answer the clinical question regarding the factors that contribute to these health disproportions between the Aboriginal and non-Aboriginal Australians. The significance of this clinical question in the health care setting cannot be overstated. The clinical question helps in understanding the reason for health inequalities and finding ways of closing the gap in the health outcomes between Aboriginals and non-Aboriginals.

Annotations

1. Alston et al. (2017) report that ischaemic heart disease is one of the most common forms of cardiovascular diseases in Australia. The prevalence of ischaemic heart disease can be affected by an individual’s place of residence; rural or urban residence. Using a quantitative study design, Alston et al. (2017) aimed to identify existing differences in the burden of ischaemic heart disease between rural and metropolitan communities in Australia. The authors suggest that the rural-urban inequalities in health outcomes regarding ischaemic heart disease can be found with the Aboriginal and Torres Strait Islanders. This is because Aboriginals are more likely to reside in rural areas. Therefore, they experience socio-economic disadvantages, poor access to healthcare, and clinical risk factors.

Alton et al. performed a systematic review of peer-reviewed journals that had been published between 1990 and 2014 to determine the basis of the health inequalities. The journals were Australian-based to comprehensively understand the depth of this problem within the rural and metropolitan communities in Australia. The authors performed their study from research databases, which included Medline, EMBASE, CINAHL, and Health and Society Database.

From the study, the authors established that the mortality rates due to ischaemic heart disease were higher in rural areas than in major cities across Australia. Alston et al. (2017) further determined that the mortality rates as a result of ischaemic heart disease among the Aboriginal and Torres Strait Islanders increased based on remoteness in Queensland. The study findings also established that health literacy in remote areas, thus leading to a low prevalence of self-reported ischaemic heart disease.  Apart from poor access to health care services in rural communities, the authors also determined that smoking, obesity, and alcohol abuse among the Aboriginal and Torres Strait Islanders contributed to high rates of ischaemic heart disease in rural communities. These findings can be very significant in clinical practice because they can help in understanding the differences in disease burden between Australians in rural and metropolitan communities. As a result, effective interventions and policies can be developed to address the problem of health inequalities.

2. Banham et al. (2017) also attempted to understand health disparities that exist between Aboriginal and non-Aboriginal Australians. In their study, the authors aimed to explore differences in cancer staging and stage-specific survival of indigenous and non-indigenous Australians. Banham et al. (2017) used a qualitative study design to explore how the area of residence affected cancer staging and survival. The chances of survival among cancer patients are significantly reduced due to advanced staging. Aboriginals are more likely to have advanced stages of cancer, thus contributing to higher mortality rates as compared to non-aboriginals. The situation worse among Aboriginals living in rural areas (Banham et al., 2017).

The authors in this research performed a study on 950 Aboriginal Australians in addition to other several cases recorded on the cancer registry in South Australia between 1977 and 2010. This was a retrospective study that involved the staging of cancer from data obtained from the cancer registry. This study, according to the authors was very important in determining cancer disparities among Aboriginals and non-Aboriginals. The findings of the study revealed that at diagnosis, Aboriginal cases were younger by 10 years. Additionally, most Aboriginals in the study were residents of remote areas. Banham et al. (2017) established that the advanced staging of cancer was associated with high risks of death. The authors further established that Aboriginal Australians had advanced cancer stages at the time of diagnosis; their conditions were found to have spread to secondary sites at the time of diagnosis. From these findings, it was evident that the rate of cancer-related deaths was lower among non-Aboriginal Australians, thus helping to answer the question about existing health disparities among Aboriginals and non-Aboriginals. Overall, this article gives an additional outline and description regarding inequalities in health and health outcomes among Australians of indigenous descent and their non-indigenous counterparts, thus providing a good basis for bridging the gap in health and health care access.

3. Crowshoe et al. (2019) also used a qualitative study design and attempted to address the social barriers that affect indigenous people suffering from type 2 diabetes. In this study, the authors aimed to determine ways of addressing social barriers that affect indigenous populations with diabetic conditions. Crowshoe et al. (2019) presented a framework called education for equity to address the problem of health inequity and inequalities experienced by indigenous people. It is worth noting that one common factor that influences the prevalence of diabetes among indigenous people is colonization.

The researchers, in their attempt to establish disparities in health care among diabetic patients in Canada performed literature reviews on best treatment practices for type 2 diabetes, indigenous health inequality, and social inequities of diabetes especially among indigenous groups. From their research, Crowshoe et al. (2019) found that social inequities had serious implications on the biology and causes of disease.

From the research, the authors identified that colonization was a serious social health determinant for diabetes among indigenous Canadians. Crowshoe et al. (2019) established that the psychological and social impacts of colonization affected the resilience of indigenous Canadians, thus leading to negative health outcomes due to ongoing institutional racism, inescapable poverty, and hostile life expectancies. Additionally, the authors suggested that there was ongoing discrimination against indigenous Canadians, thus leading to low social status and psychological effects, which impacted their health.

According to Crowshoe et al. (2019), the education for equity framework can help in ensuring appropriate management of diabetes among indigenous Canadians. The principles of this framework included colonization, equity in health care, empowerment, and culture. Empowering patients and respecting their cultural beliefs can help in managing type 2 diabetes better among indigenous Canadians. This study is important in the clinical context because it contributes to the ongoing study regarding health disparities between indigenous and non-indigenous populations globally. Therefore, it forms a good basis for designing appropriate interventions, which can help in addressing health inequalities.

4. In a different study to further understand the health disparities between Aboriginal and non-Aboriginal people, Crowshoe et al. (2018) aimed to understand the prevalence of diabetes among Aboriginals living in Canada by conducting a qualitative research. The authors established that several indigenous families had people living with diabetes. According to Crowshoe et al. (2018), globally, indigenous populations are affected disproportionately with diabetes. The researchers found out that the prevalence of diabetes was higher among members of the First Nation and the Metis as compared to the general Canadian population. This is an indication that more indigenous Canadians are at an increased risk of developing any type of diabetes as compared to their non-indigenous counterparts.

Additionally, Crowshoe et al. (2018) established that indigenous Canadians were being diagnosed with diabetes at a very young age, and they were at more risk of developing diabetes-related complications due to poor treatments that contributed to poor health outcomes. The authors also argued that the most common factor in the prevalence of diabetes among indigenous populations across the world was colonization. Stress and poverty is another problem experienced by most indigenous populations. Poverty affects access to basic needs and health resources, thus increasing the prevalence of diabetes among indigenous Canadians. Some social barriers to improved health outcomes among indigenous Canadians include disparities in social and economic resources, the buildup of adverse life experiences, inequity, and colonization.

According to Crowshoe et al. (2018), it is important to collaborate with community leaders, health care practitioners, indigenous people living with diabetes, and all stakeholders to enhance diabetes screening and reduce incidences of diabetes among indigenous Canadians. Primary prevention programs targeting diabetic Canadians should also be developed to address the common risk factors of diabetes such as obesity, unhealthy diets, and sedentary lifestyles among indigenous people. The management of diabetes among indigenous Canadians should also focus on the cultural and social contexts of the Aboriginal communities to realize positive health outcomes. This study helped in revealing the importance of understanding disparities in diabetes prevalence so that effective interventions can be developed to address health inequalities.

Conclusion

The articles evaluated and analyzed in this paper examined whether indigenous communities in Australia and Canada experienced health inequalities. The article by Alston et al. (2018) reported differences in health outcomes between Australians living in rural and metropolitan communities regarding ischaemic heart disease. However, this study was limited because it only a direct relationship between urban and rural communities regarding health inequalities. Therefore, the actual level of disparity could not be appropriately determined. The study by Banham et al. (2017) also established health disparities in cancer staging among Aboriginal and non-Aboriginal people. Their findings demonstrated that, indeed, more Aboriginals were at a higher risk of cancer-related deaths due to advanced cancer staging and inequalities in healthcare. This study was, however, limited because the research did not consider recent data. Crowshoe et al. (2019) and Crowshoe et al. (2018) also studied the relationship between diabetes incidences and ethnicity. According to these two articles, indigenous individuals are at a higher risk of developing diabetes and diabetic-related complications as opposed to their non-indigenous counterparts. These are however limited because they do not clearly specify the age group of the participants, thus making it difficult to understand the actual prevalence by age among indigenous people.

References

Alston, L., Allender, S., Peterson, K., Jacobs, J., & Nichols, M. (2017). Rural inequalities in the Australian burden of ischaemic heart disease: a systematic review. Heart, Lung and Circulation, 26(2), 122-133.

Banham, D., Roder, D., Keefe, D., Farshid, G., Eckert, M., Cargo, M., & Brown, A. (2017). Disparities in cancer stage at diagnosis and survival of Aboriginal and non-Aboriginal South Australians. Cancer epidemiology, 48, 131-139.

Crowshoe, L. L., Henderson, R., Jacklin, K., Calam, B., Walker, L., & Green, M. E. (2019). Educating for Equity Care Framework: Addressing social barriers of Indigenous patients with type 2 diabetes. Canadian Family Physician, 65(1), 25-33.

Crowshoe, L., Dannenbaum, D., Green, M., Henderson, R., Hayward, M. N., & Toth, E. (2018). Type 2 diabetes and Indigenous peoples. Canadian journal of diabetes, 42, S296-S306.