HLSC120

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alternative healing systems

>post modern philosophy >aligns close to the social model of health >alternative to dominant medical model >complimentary or alternative medicine (CAM)

Primary health care are based on the following

>social justice >accessibility >public participation >intersectorial collaboration >increased emphasis on health promotion >appropriate technology >equity

PHC graduate attributes

A PHC Attitude would be one which achieves ACU Graduate Attributes 1 & 2 - #1 demonstrate respect for dignity human person & human diversity - #2 recognise responsibility to common good, environment & society

Non-pathological Factors Affecting Sleep

» Age » Environment » Emotional stress/depression » Relationships » Shift work » Illness (to name a few)

Loss of Aboriginal land through Exploration and Pastoral expansion

• Aboriginal people are methodically and rapidly dispossessed of their land, their source of food and water and religion. • Governor orders Aborigines "to be driven back from the settler's habitation by firing at them". Aboriginal resistance is immediate

Alcohol consumption leads to

• Alcohol dependence syndrome • Alcohol liver disease • High blood pressure • Stroke • Some cancers

Cherbourg Mission

Aboriginal community located in South-East Queensland. It was established in the early twentieth century by the Queensland Government under the Aboriginal Protection and Restriction of the Sale of Opium Act 1897 (Qld). This saw Aboriginal people deported against their free will to Cherbourg from different parts of Queensland. Cherbourg ,CE , 1904-86

Cherboug Mission

-there we no cots or bedding ,malnutriton lack of clothing and protection lead to deaths by 1934 one third of all Indigenous people were living in missions and settlements. Many girls sent to Service came back pregnant .

Queensland History

1797-Mathew Flinders lead expedition to Moreton Bay landed at Redcliffe.Area not settled untill 1824, as penal post 1842-lead to colonisers and Indigenous contact and extreme violence ,Including poisioning of people at Kilcoy station and attacks on Indigenous camps at Breakfast creek 1879- Thursday Island was settled and made part of Queensland by the Colonial Parliament.This achieved without consultation of Torres Islander people. 1865 -first legal removal took place under Industrial and Reformatory Schools Act .taken on grounds of neglect -Simply being Aboriginal was grounds for neglect 1859 The Queensland colony was created on 6 June. At the time of its establishment, New South Wales electoral laws, specifically the Elections Act of 1858, prevailed. Although NSW electoral provisions did not specifically exclude Indigenous people, the franchise qualifications tended to exclude them as they required voters to be male, over 21 years of age, naturalised as well as owning property valued at more than 100 pounds. 1885 Queensland enacted the Elections Act 1885. Section 6 specifically excluded Aboriginal natives from voting. These disqualifications were carried over into the Elections Act Amendment Act 1905 and the Elections Act 1915. However, Indigenous persons who could be defined as "half-caste" as opposed to "Aboriginal native" could not legally be excluded from voting. 1896- Meston,chief protector... to stop Kidnapping of Indigenous children suggested Missions Away from Non -indigenous society Chief protector Bleakey , stated" Its only by complete separation of the two races that we can save him(the Aborigine )from hopeless contamination ans eventual extinction,as well as safe guard the purity of our own blood "

Queensland Timeline

1904 The Queensland government establishes Cherbourg, an Aboriginal community, about 30 km from Gympie. Torres Strait Islanders become subject to the Queensland Aboriginal Protection Act.

Assimilation and Integration 1950s-1972

1948 Universal Declaration of Human Rights adopted by UN signed by Australia Govt. policies aimed to improve housing, health and education and integrate Aboriginal people into white society. "all Aboriginal people shall attain the same manner of living as other Australians enjoying the same rights and privileges..." "Australian Citizenship" includes Aborigines 1950s Aboriginal children assimilated into public schools. 1962 Electoral Act gives Aboriginal people right to vote, however vote not compulsory 1967 Aboriginal people gain citizen rights 1967Aborigines included in the National census 16 1965 Freedom rides ‐ 30 black and white activists toured northern and western NSW to protest against racism. They exposed high levels of racism where Indigenous people were often denied service in shops, separated from whites in cinemas, banned from hotels and clubs and excluded from swimming pools being used by white people. 1969 Aboriginal delegation presents a statement on Australian Aborigines to the UN Aboriginal stockmen and women strike against working conditions and wages and demand the return of their traditional lands. Larrakia people protest against theft of their land. 1972 National Aborigines Day there are Australia wide strikes and marches by Aboriginal people. 1972 the 'Aboriginal Tent Embassy' at Parliament House in Canberra established, demonstrating for land rights. Distrust and suspicion of whites and their institutions continues Passive resistance continues Growing anger at white society Academic achievement (Charles Perkins) Aboriginal activism recommences Movement for self‐determination

What is G*d practice?

A recognised set of sound procedures and practices within an industry Good Practice is linked to the successful achievement of outcomes Good practice is also about inclusive and respectful interpersonal behaviour

1991 National Aboriginal health strategy

A social approach It considered:‐ The role of Government The changes needed in the health system Role of inter sectoral collaboration in promoting Indigenous health The range of specific health issues Indigenous health research and evaluation

Segregation 1890-1950

Aboriginal Protection Boards are established in all states and are empowered; To remove Aboriginal children from their families To remove Aboriginal people onto reserves Become the legal guardian of all aboriginal children whether or not they are living with their parents Justification to protect 'dying race'. The stolen generation

5 Essential parts to any strategy developed to improve indigenous health are :

An integrated approach to community development (infrastructure, employment, ) education) Indigenous control of decision making Implement effective prevention and treatment health services for the major health problems Provide adequate resources to services Improve skill levels of Indigenous workforce.

Historical context Aboriginals

Before time Since the Dreamtime, the Australian continent has been - and continues to be the traditional country - its land, seas and waterways - of Indigenous peoples. 1770 Captain Cook 'claimed' the Australian continent for Britain. 1788 European settlement of Australia commenced under the legal doctrine of terra nullius (meaning land of no-one). This doctrine allowed colonists settling the 'unoccupied' land to impose their own laws. Traditional Aboriginal systems of tribal land ownership were neither recognised nor acknowledged.

Bethesda (Mission)

BethesdawasthefirstmissiontobesetupintheseparatecolonyofQueensland.It was one of the very few missionary ventures in Queensland during the 1870s. BethesdawasaLutheranmissionestablishedneartheAlbertRiverin1866bythe Rev. J.G. Haussmann, one of the German missionaries from Zion Hill, following his resignation as the Pastor of the Nazareth Lutheran Church at South Brisbane

Stolen Generation

Between 1910 and 1970 up to 100,000 Aboriginal children were taken forcibly or under duress from their families by police or welfare officers. Most were under 5 years old. There was rarely any judicial process. To be Aboriginal was enough. They are known as the 'Stolen Generations'. The main motive was to 'assimilate' Aboriginal children into European society over one or two generations by denying and destroying their Aboriginality. Speaking their languages and practising their ceremonies was forbidden They were taken miles from their country, some overseas Parents were not told where their children were and could not trace them Children were told that they were orphans Family visits were discouraged or forbidden; letters were destroyed.

Bloomfield River mission

BloomfieldRivermissionintheDaintreecommencedasawell-fundedgovernment initiative during a period of rapid settlement in the Cooktown region. It was then devolved into Lutheran care

Pre-Invasion

Boundaries - geographical, language The Dreaming Spirituality Is LAND /SEA centered Structure of society - community Hunter - gatherer Nutrition differences Health

Before you make contact with the aboriginals

Build your knowledge of the community you are working with. Get to know people before 'doing business' Don't assume the person wants you to refer them on to an Aboriginal Service, but if they do make sure you follow through that request Make sure you know the name of the person who gave you the referral and why

Problems with access to mainstream services

Cultural chasm between clients and providers Impersonal nature of clinics Presence of large numbers of non‐ Indigenous people Rules of convenience, not client benefit Providers ‐ judgmental / authoritarian Paternalistic / racist attitudes of providers

Revision of

Dreaming Cultural competence / cultural safety Terra nullius Policy‐protection era Assimilation Reconciliation Native title "Mabo" decision, Bringing them home report,Deaths in custody report Social engineering Primary health care‐ NACCHO /AMS Role Health workers

Missions and Missionaries

First started as a means of controlling the original owners of the land by restricting their movements and making it easier for white settlers to move in and take over. Places in which often Aboriginal people lost almost all of their cultural heritage. Was paternalistic. Many missionaries would not allow Aboriginal languages to be used, initiations to take place or heritage to be passed onto children. Some missionaries helped Aboriginal people maintain their culture while acquiring skills valued by white society. Colonial administrations frequently saw missions as agencies to which government responsibilities for Aboriginal people could be delegated and mission stations often became the distribution points through which government supplies and rations were handed out, medical aid dispensed and children educated.

European occupation

Frontier conflict - diseases Protection - mission stations / reserves Institutionalisation - Assimilation policy De-regulation - 1967 Referendum Self determination & Self management Reconciliation? - Northern Territory Emergency Intervention The Apology to the Stolen Generation Stolen generation continues.....

Historical Timelines Australia

Frontier conflict ‐ diseases Protection ‐ mission stations / reserves Institutionalisation ‐ Assimilation policy Deregulation ‐ 1967 Referendum Stolen generation continued 2007 - Northern Territory Intervention 2008 ‐ Apology to the "Stolen Generation"

Cultural Skills to develop

In order to work more effectively as a professional in cross cultural contexts.

Gaining trust with aboriginals

Keep confidentiality at all times Do not act or speak in a superior manner Avoid using jargon Be open and transparent It may be useful to share your own experiences Do not generalise about stereotypes Listen to the person's needs

Why is it important to nursing?

Life expectancy was 20 years but may be 11 to 17 years less now depending on the ABS methodology used Use more hospital services All disease categories are higher Death rates are 4 times higher Low numbers accessing health services Why?

Sacred Sites

Localising the sacred to a geographical landscape. Can be secret - where only the fully initiated can visit. Or have a mythical significance

Primary Health Care

New focus on primary health care in Australia Plan to increase GPS and community clinics Mix of private and public

Mythology of Aboriginals

Myths containing significant truths expressed in a variety of settings ranging form stories, information about everyday life and occasions for entertainment and drama to secret importance. Aboriginal culture relied on oral transmission supplemented with material representations, art and graphic designs, music and dramatic enactments. DREAMING - all the myths were included in the creative era of the Dreaming (the sacred eternal time sometimes called the Dreamtime. Emphasis is on spiritual continuity as against the visible cycles of growth and decay in physical aspects in the everyday time. Myths told in narrative form have a story form with a sequence and climax. If told in song style they would have a single out episodes, characters and imagery perhaps in a sacred context. Can change

The Black Wars 1788 - 1890's

Pemulwuy and his son Tedbury were famous Aboriginal resistance leaders in the Sydney area guerrilla warfare

Government involvement and aboriginals

People forced to live outside their land / country. Loss of rights. Did not allow 'mixed marriages'. Children were transferred elsewhere to be trained and assimilated into the general community Forced resettlement (withdrew rations etc) Large numbers on reserves, poor living conditions. Removed access to traditional foods Social structure rapidly changed (males v females) Forced culture change (prevented speaking their languages and going to sacred places)

Rituals of Aboriginals

Religious enactment prescribed by tradition. Participants believe that they contact the supernatural world and renew a spirituality which derives from that world (especially from the Dreaming). Deal with creation or modification of the world./ also fertility (NT)/ men's and women's business / cooperative event May involve physical marking eg scariation on the arms and back or removing a tooth / circumcision. Involves seeing sacred objects or visiting sacred sites. Important social and learning events. Which bolster emotional support, bonds of kinship and a sense of belonging together for all participants. Changes over time. In determining how a ritual should be performed people refer to that body of traditional oral knowledge often called "the LAW"

If the aboriginal doesn't answer the phone?

Say hello, who you are, who gave you their number and why you are calling Don't assume you will be meeting clients at their home or at your workplace Ask where they are comfortable to meet you ‐ at your office, their home, a coffee shop or local Indigenous Organisation?

Meeting the aboriginal for the first time

Sit and chat with the client first. Find a connection - then relate your own experiences to it It may take time to get to why you are there - but you will. You may not get all the information you need - but that will come with trust If you are not sure about something - ask the client. Be honest and up front

Phone contact with aboriginals

Some Indigenous people may be shy or apprehensive about dealing with government staff. Some may also be nervous about the phone If clients do not answer the phone - leave a message saying who you are, who gave you their phone number and leave your number as well Say you will ring back if you don't hear back from them today Tone is important. Keep your voice happy and down to earth

Introduction of Christianity to Aboriginals

Some missionaries helped Aboriginal people maintain their culture while acquiring skills valued by white society. Many missionaries would not allow Aboriginal languages to be used, initiations to take place or heritage to be passed onto children.

Building trust with aboriginals

Some people may be unsure about your motivations, due to a history of negative interactions in missions and with government. It may take a while to build trust. A breach of trust, such as sharing confidential information with another service provider, government, community member etc., apart from being unethical and unprofessional will get back to the client. This applies to all health workers Indigenous and non‐Indigenous

Referrals with aboriginals

Some people may need to be directed to the appropriate service Ask if they would like you to do this and follow through with it Do not leave clients 'high and dry' Don't assume Yes means Yes Admit if you don't know - don't promise anything you cant deliver

Functions of Sleep

Sorting and discarding neuro-physiological data Character reinforcement and adaptation Restoration/preparation Growth & repair Conservation of energy supply Maintenance of the immune system Problem-solving

Social Context- Aboriginals

Structure of Society - Community Hunter / Gatherer Nutrition differences Health Quality of life Determined all aspects of life, including control over their physical environment, of dignity, of community self-esteem, and of justice.

Native Police 1842 'divide and rule'

The establishment of the notorious Native Police force. Lead by European officers, and comprising Aborigines recruited from distant tribes. The force played a significant role in ruthlessly 'settling' hostilities Reports of squatters poisoning Aboriginal waterholes and giving gifts of flour laced with strychnine. 1836 - 1837 the British House of Commons said that Aborigines had a "plain right and sacred right" to their land. The committee reports genocide is happening in the colonies. Terra nullius meant no peace treaty was attempted.

Filling out forms for aboriginals

Think about how questions on your forms are written - how will they be received? If you feel the question may be too intrusive for your first meeting, then don't ask it If you must ask - find another way of asking the question

Aboriginal Rituals Dance

Transcends every life concerns. RITUALS incorporate songs and dances transmitted from Creator Beings who are tied to particular geographical sites and localities. For those who won the dance it closes the time gap between past and present. Body marking is relevant in some areas Dances occur in secret men's business. Today - public performances Women have a supportive role Dance space / time is organised so that everyone has a chance to perform. Bran Nue Dae - contemporary dance production originating in Broome Intergenerational link - reviving culture

what does the federal government defines an aboriginal person as?

is of Aboriginal descent identifies as an Aboriginal person, and is accepted as an Aboriginal person by the community in which he or she lives.

NACCHO's definition of Aboriginal health

"Aboriginal health" means not just the physical well‐ being of an individual but refers to the social, emotional and cultural well‐being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well‐being of their Community. It is a whole of life view and includes the cyclical concept of life‐death‐life.

Cultural safety with aboriginals

"Cultural Safety is nursing practice which Respects Supports and Empowers the cultural identity and wellbeing of an individual. AND empowers him/her to EXPRESS that identity AND have her/his CULTURAL NEEDS MET"

Health Inequities

"Disparities in health and healthcare that are systemic and avoidable and considered unfair or unjust." Troutman (2006) • Not all health disparities are unfair: • Youngeradultsarehealthierthantheelderly • Femaleshavelowerbirthweights • Maleshavehigherbirthweight-specificmortality • Clear examples of inequities: • Lowerimmunizationratesandhighermalnutrition&mortality among girls in some countries

health-WHO

"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"

• What is equity (in health)?

- Broadly about the distribution of goods and services usually on the basis of need - May incorporate concept of social justice and fairness

Passive smoking and aboriginals

- Increased rates lung cancer and heart disease in adults - Asthma and lower respiratory tract infections in children » Pneumonia » Bronchitis

What is inequity (in health)?

- The way people experience those conditions or factors that determine health

SOCIAL JUSTICE (health inequalities)

- While equal opportunity rights are applicable to everyone, social justice targets the marginalised groups of people in society - it focuses on the disadvantaged. - Social justice recognises that there are situations where application of same rules to unequal groups can generate unequal results. Social justice provides a framework to implement and assess the impact of policies and practices (affirmative action).

Parsons the sick role

-Represents illness as a 'failure' to maintain normal social roles [Gerhardt, 1989, in Gray, 2006]; Characterised by passivity, helplessness and emotional disturbance - seen as failure in society that values activity, competency and emotional self-control; When ill, a person has access to the sick role - legitimate status designed to provide them with a temporary refuge from normal social commitments

World Health Assembly Social Determinants of Health

-The social determinants of health are the HEALTH - 2013 conditions in which people are born, grow, live, work and age, including the health system. ➢ These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries

European reprisals

1804Colonistsareauthorized toshootAborigines in Tasmania in response to Aboriginal resistance. 1816 attacks on farms on the edge of Sydney. The 76th Regiment kill 14 Aborigines. There are large scale killings of Aboriginal people as conflict over dispossession of land and erosion of hunting rights continue.

Aboriginal resistance fails

1. Alienation of land meant destruction of livelihood and food supply 2. Undermining of their social organisation through disease, war, dispersal of groups onto reserves, and removal of children. 3. Disintegration of their spiritual and cultural world view through activity of missions, combined with 1 and 2 above.

what are the major components of culture?

1. SYMBOLS 2. LANGUAGE 3. VALUES AND BELIEFS 4. NORMS 5. MATERIAL CULTURE

Terra Nullius (empty land)

1. Terra nullius applied to 'uncultivated' land. As the indigenous people were not (in European views) using the land, those who could cultivate the land had a right to claim it as theirs. 2. Land that was unclaimed by a sovereign state recognized by European powers. 3. Gave legal force to the settlement of lands occupied by "backward" people, where no system of laws or ownership of property was held to exist. in 1992 an Aboriginal rights case known as Mabo, the High Court of Australia overturned terra nullius.

Aboriginals first contact with the europeans

1606 Earliest recorded contact between Europeans and Aborigines 1616 Dutchman Dirk Hartog landed on the Western coast of Australia 1642 DutchmanAbelTasmanreachedTasmaniaand claimed it for Holland, called it Van Dieman's Land 1770 Lieutenant James Cook claims Australia at Possession Island off Cape York Peninsula

Fraser Island

1871 a Primitive Methodist lay preacher, Edward Fuller with little success,mission was moved to the Noosa River in 1872. In 1897 another attempt at establishing a mission on Fraser Island was made by Archibald Meston. An Aboriginal reserve near Bogimbah on Fraser Island was gazetted on the 7th of December 1901. Fifty one Aboriginal people from Maryborough were brought to the Island. In 1902 the mission was placed under the control of the Anglican Board of Missions. In 1904 the mission was closed and the remainder of the inhabitants moved to Yarrabah.

Medicare

>Access by all eligible Australian residents to free or low cost medical , optometric and public hostpial care >Individual financial contribution based on their taxable income >Admission to public hospital and aftercare is free >Most public hospital medical care is provided by salaried doctors

Theory of Biomedical Model of Illness

>All diseases arise form a cause (cellular) >Health is the absence of disease >Mind/body dichotomy

Categories of CAM

>Alternative medical systems -homeopathy -naturopathy -traditional chinese medicines >Mind-body interventions -prayer, meditation, art, music , dance >Biologically based therapies -use substances (herbs, foods, vitamins) from nature e.g shark cartilage to treat cancer >Manipulative and body based, e.g chiropractic >Energy therapies; magnetic fields

Modern Society- Idea of community/tradition

>Expanded oppurtunity for travel, community expanded, national and international identity >Cultural and structural change embraced >More complex society

Social Determinants of Health Factors

>Health inequities arise from the societal conditions in which people are born, grow , live , work and age >housing >employment >education >environment >access to effective systems of preventing and treating ill health

Primarily Health Care Principles

>Social justice >Equity >Community participation >Social acceptability >Holistic approach >Cultural safety >Trust >Accountability

Sleep

A cyclical, non-pathological state of unconsciousness which is readily reversed by normal sensory stimuli and alternates with long periods of wakefulness.

Why do we need indigenous health workers?

Aboriginal Health Workers assist to 'Bridge The Gap' in healthcare facilities by supporting Aboriginal and Torres Strait Islander People through the hospital system. They assist in helping health care professionals communicate to Aboriginal and Torres Strait Islander People in a language and in terms that they understand, they help them feel comfortable accessing the services offered and to feel confident in the care that they are receiving.

Qualifications to work with aboriginals

Aboriginal health workers may complete Certificate III. A Certificate IV in Aboriginal Primary Health Care Work is a prerequisite before a Diploma in Aboriginal Primary Health Care Practice may be commenced. Undergraduate courses include an Associate Degree in Aboriginal Health and a Bachelor of Applied Science - Indigenous Health.

What is CAM?

Alternative Natural Folk Holistic Complimentary CAM is socially constructed and what might be mainstream in one culture may be alternative in another

structure- agency debate quote

An individual 'contributes, however minutely, to the shaping of this society and to the course of its history, even as (s)he is made by society and by its historical push and shove

Aurukun (1904-78) Mission

AurukunontheArcherRiverwasamissionmarkedbytroubleduringitsfirsttenyears under the German Moravian pastor Richter who strongly relied on 'native assistants' to mediate contact with indigenous communities that remained aloof

Premodern Aspects

Authority PRE-MODERN Church/monarchy - closely bound Sources of Knowledge Traditional - rarely challenged Health Focus on pathology - Illness associated with fate, will of the gods, community healers provide health care Perception of the Individual Fate set - externalised control - set position in society Material/ Industrial base Feudal - agricultural - labour based Perception of community

Post Modern Aspects

Authority Political - rise of democracy - UN - fading monarchical power Sources of Knowledge Rational thought - science - dominant paradigms - the sovereignty of science challenged Health Beyond the absence of disease - holistic views - establishment of sophisticated health systems - health professions expansion

Modern Aspects

Authority Political/Industrial Sources of Knowledge Rational thought - science - dominant social paradigms Health Pathology based but now diseases curable - panacea - beginnings of state based health care systems Perception of the Individual Some control over future- positions in society not

Totemism

Belief and practices that incorporate the relationship between people or groups of people and natural species, objects or phenomena. People seen themselves associated with these natural species etc. Not worshipping - they are symbols of a relationship Clan totems - viewed as relationships with members to each other, to their ancestors and the past and to particular places o sites.

Problems within current health care system

Bed shortage Staff shortage, medical , nursing , allied health Hospitals need to be upgraded Increasing technology- increased costs and expectations of access to that technology Lack of funding Lack of rural services Reduced number of GPS who bulk-bill Duplication of funding and poor coordination Does not include any CAM therapies

Indigenous History

British occupation of Australia begins 1788 The first 100 years of foreign settlement 1788-1880s Australian government policies Segregation 1890s-1950s Assimilation and integration 1950s-1972 Self-determination and self management 1972-1996 ?Today ? reconciliation ? economic rationalism

Stigmatization Model Link and Phelan

Bruce Link and Jo Phelan propose that stigma exists when four specific components converge: 1. Individuals differentiate and label human variations. 2. Prevailing cultural beliefs tie those labelled to 3. Labelled individuals are placed in distinguished groups that serve to establish a sense of disconnection between "us" and "them." 4. Labelled individuals experience "status loss and discrimination" that leads to unequal circumstances.

Main problems with Aboriginals

Cardiovascular disease Diabetes Chronic respiratory disease Cancer mental disorders

Bio-medical approach

Cause : a reductionist approach Individual approach to diagnoses and therapy. The social/physical is seen as outside the professionals realm Surgical / medical interventions- health professionals have the knowledge

Sociology Theories and Health : Feminist Multiple theorists Gender equality

Cause of Disease : Carrying out the social role enforced on women by patriarchal men; the medicalization of a woman around her reproductive life cycle Role of the medical profession: To enforce conformity with patriarchal norms of femininity and motherhood

Sociology Theories and Health ; Parsonian Talcott Parsons [1902-1979] Structural functionalism Sick Role Theory

Cause of Disease : Social strain caused by meeting the demands of social roles Role of the medical profession: to rehabilitate individuals to carry out their social roles

Sociology Theories and Health; Foucauldian (1926-1984)

Cause of Disease: Diseases are labels used to sort and segregate the population to make it easier to control Role of the medical profession: to enforce compliance with 'normal' social roles and to ensure that we internalise these norms

Indigenous Approach

Cause of disease is a result of the breaking of taboos or of supernatural The sick individual is seen in the context of the social and spiritual i.e public Therapy : bush medicine, priority 1 or 2 members of community with special knowledge

Sociology Theories and Health; Marxist (1818-1883)

Cause of disease: putting profit ahead of health Role of medical profession: to discipline and control the working class, and provide individualised explanations of disease

Aboriginals and smoking

Causes, • Lowbirthweight • Coronary heart disease • Stroke • Chronic respiratory tract disease • Cancer - Lung, Cervical, Bladder and Pancreatic

Modern Society- Material Base

Changes in means of production-industrialisation Rise of capitalism

Modern Society- View of History

Changes of inevitable Focus on time Optimism about the future

Material culture

Chinese eating with chop sticks, british eating with forks and knifes , middle easterns eating with fingers ➢ Represent class distinction ➢ Implies cultural patterns are readily accessible to some but not all members of a society [Macionis & Plummer, 2008, pp. 138-9].

The indigenous definition of 'community control'

Client of that service has a large say in how the service operates • Community identifies the needs and then works together to address these needs • Community has ownership and is wholly involved in planning and decision‐making • Strong influence from the grass roots up •Community does things in its own time and at its own pace • Accountability to the community is the guiding principle

What is closing the gap?

Closing the gap is the term recently adopted to refer to reducing the gap in equalities that exist between aboriginal and Torres Strait Islander and non-indeginous Australians. When the Close the Gap campaign was launched in 2008 (Kevin Rudd Labour Government), the gap in life expectancy between Aboriginal and Torres Strait Islander an experimental estimates, and estimated the gap in life expectancy to be approximately 17 years (20 years). Closing the life expectancy gap within a generation (by 2033) Halving the gap in mortality rates for Indigenous children under five within a decade (by 2018)

Target 1 of closing the gap

Closing the life expectancy

Postmodern society- material base

Consumerism Communication based Global markets

Roles of States and Territories ; health care in Australia

Delivery and management of public health services Joint responsibility for funding and provision of public hospitals Community care for aged/people with disabilites

Premodern Society - Perception of the Individual

Destiny pre-ordained

Health care funding aggreements

Determine level of Federal grants given to States/Territories for public hospital funding Negotiated every 5 years

Quality of Life

Determines all aspects of life, including control over their physical environment , of dignity, of community self-esteem and of justice

Cultrual Relativism

Different cultures represent the legitimate adaptation of different peoples to various historical, natural, socio-economic and political environments. Do not abandon your own traditions or philosophies Do suspend judgement Constantly question your own predisposition to seek security in the things we feel we 'know' about other groups.

DISCRIMINATION

Discrimination is a sociological term referring to the treatment taken toward or against a person of a certain group in consideration based solely on class or category. • Discrimination is the actual behaviour towards another group. It involves excluding or restricting members of one group from opportunities that are available to other groups.

The first 100 years of European settlement 1788-1880s

Disease - smallpox Terra Nullius - 'empty land' Rapid dispossession of land - loss of hunter gatherer lifestyle - loss of food and water sources - loss of health

Criticisms of Biomedical further

Disease focus leads to lack of preventive efforts Reductionist ignores complexity of health and illness Fails to take into account social origins of health and illness Medical opinions can reinforce victim blaming

Health care within Australia facts

Divided between federal and state governments Mix of public , non government and private sector providers Informal Providers , family , friends , community networks

Doomadgee

Doomadgee mission was originally founded in 1933 and was situated at Dumaji on the Bayley Point Reserve. The mission was administered by members of the Christian Brethren who had previously established a missionary home at Burketown in 1931. In 1935 it was decided that the mission site was unsuitable and following a cyclone in 1936 the mission 'was shifted to its present site on the Nicholson River'. In November 1936 90 square miles of land were gazetted as an Aboriginal reserve. The Bayley Point Reserve became known as Old Doomadgee.

Australian health care system : historical context

Early years of settlement: 3 influencing factors for today Ability of medical practitioners to gain prominence and political influence Responsibility of governments in provision of health and welfare The way the HCS developed with acute care services (hospitals) at its center

Social Exclusion

Encompasses individuals and groups who experience persistent social disadvantage from a range of causes - poverty, unemployment, poor housing, social isolation etc (Germov, 2009, p. 91) UK Social Inclusion Unit defines social exclusion as: '...what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low income, poor housing, high crime environments, bad health and family breakdown'

Health (week three)

Health is socially constructed. Health is a resource that permits people to lead an individually, socially and economically productive life. It is a positive concept emphasising social and personal resources as well as physical capabilities (Keleher & MacDougall, 2011, p. 3 Health is a product of reciprocal interactions between an individual and their environment

EQUAL OPPORTUNITY

Equal Opportunity - concentrates on treating all people equally and providing people with equal rights. - Basically, it is about giving everyone a 'fair go'. However, since inequality still exists in society treating everyone the same does not necessarily mean fairness of treatment. - The provision of equality of opportunity must be combined with social justice principles to provide substantive equality to marginalis

Federal and State government and Mental Illness

Federal & State governments have come together to formulate a National approach to improve the lives of people with mental illness and to take an active approach in the mental health promotion - National Mental Health Policy 2008 Fourth National Mental Health Plan: an agenda for collaborative government action in mental health 2009- 2014 National action plan on mental health (2006-2011).

Inequality or inequity?

Example: the disproportionate numbers of poor and minority citizens that do not have adequate access to health care • Is it a health inequality? - Yes,sincethereisadifferenceinratesofaccesstohealthcare amongst segments of the population • Is it a health inequity? - Dependsonwhetheryourideaofjusticeinvolves"therightto health care"; if so, then yes, it is unfair and unjust that there are differences in this fundamental right, the right to health care

Postmodern Society-Knowledge and power

Expansion of knowledge , multiple sources Varied perceptions of truth Corporate power rivals political power Political tension- terrorism

Gestational Diabetes and aboriginals

Few reports have been published about gestational diabetes mellitus (GDM), but information from the Northern Territory Midwives' Collection found that around 6.3% of Indigenous women in the Territory developed GDM, compared with 4.1% of non‐ Indigenous women

Criticisms of Biomedical Model

Focus on illness Reductionist (cell pathology single cause) Ignores holistic / environmental / social / housing Ignores/de-emphasises promotion of health Dominant -politically powerful -focus on the professional , especially autonomy -expert professional v passive recipient -lack of shared decision making / partnership -victim blaming

Post modern society- view of history

Focus on the present History not important or relevant History as fiction

social institutions

Formal structures within society - such as health care, government, education, religion, and the media - that are organised to address identified social needs

Globalisation-Friendman

Friedman (columnist): G. is the inexorable integration of markets, nation-states, and technologies to a degree never witnessed before. It is an international system.

Health care System Funding in Australia

Funding responsibilities Federal (about 67%) -medical services -pharmaceuticals -assistance to public hosptials , residential aged care, community care for aged State/ territory -Most acute and psychiatric hospital services -community and public health services (school,dental,maternal,child health) Local -water , garbage control, health inspections, immunisation programs

Globalisation- Stiglitz

G. is the removal of barriers to free trade and the closer integration of national economies.

Globalisation-Robertson

Globalisation - is a process by which we come to experience, or become aware of, the world as a single place.

What is PHC?

Health care based on the following principles (see WHO Alma Ata Declaration 1978) ➢ Social justice ➢ Accessibility ➢ Public participation ➢ Intersectorial collaboration ➢ Increased emphasis on health promotion ➢ Appropriate technology ➢ Equity

New public health (social model of health)

Health is a process of interaction with their environments Incorporates medical concepts and does not negate medical treatment Focus on the social determinants of health

More on Illness

Illness is an outlook that understands a specific malady, whatever it's particular causes, as created in the convergences between biology and culture (Morris, 1998, p. 76).

A balanced System of :

Illness treatment Disease prevention health promotion

Modern Society- Description of the Individual

Individual Freedom Control of own destiny

Social versus biomedical

Individual focus Health and illness are objective biological states Individual responsibility for health Illness cause gene defects and microorganisms , trauma , lifestyle Cure: surgery, medications, modification, health , education , immunisation VS Societal focus health and illness are social constructions Social responsibility for health Social inequality lllness cause: political , economic factors, employment , cultural , structural factors, Cure: public policy, alleviate health and social inequalities, comity participation, lobbying, benefits address social determinants of health and illness

Postmodern world ; Levelling of hierarchies

Individual rights and freedoms predominate

Private Health Care in Australia

Inpatient services: >Private hospitals provide about 1/3rd of all hospital beds in Australia >Visiting medical officers provide private medical services to patients in a private hospital Non-inpatient services Private medical practitioners provide most out of hospital medical services Most dental and allied health services are provided by private practitioners

Acupuncture

Intially considered part of the complimentary (non essential) health offerings Accepted as a mainstream treatment , acupuncturists issued with provider numbers, stamp of legitimacy , still although requires a referal from medical system

Three elements of Cultural competency

Knowledge, Values , Skills to develop

Mapoon Mission

Mapoon was established in 1891 at the mouth of the Batavia River. The Mission was run by Moravian missionaries on behalf of the Presbyterian Church of Australia, with the Queensland Government also providing financial assistance

Australian Health Care system , pharmaceutical

Medicare funds pharmaceutical benefits under the Pharmaceutical Benefits Scheme which provides subsidy for agreed prescribed medications Copayment Scheme , commonwealth pays 83% and the patient pays balance Pharmaceutical Safety net , to ensure cover for people who require high level medication expenses

Sociological Analysis - Modernism

Modernism is generally referenced to the period 1650 - 1950s

Ottawa Charter

Move towards a new public health ➢ Building healthy public policy ➢ Creating supportive environments ➢ Strengthening community action ➢ Developing personal skills ➢ Reorientating health services ➢ Ottawa Charter goals = social /holistic model of health

Postmodern society- perception of the individual

Multiple interpretations Changeable Increased agency

NACCHO

National Aboriginal Community Health Organizations

CAM (complimentary or alternative medicine)

Needs to comply with the therapeutic good administration (TGA) , regulatory authority -Focus on safety not efficiacy

Health and cultural diversity: Mortality and morbidity

No community is mono-cultural Immigrants healthy on arrival then adopt lifestyle diet -example diabetes mellitus increased rates Mental health issues- higher in refugees due to experiences (trauma, loss of social networks) PTSD Cultural concepts of health and illness

Vision of health

Not just the physical well being of individual but the social emotional and cultural well-being of the whole community. This is a whole-of-life view and it also includes the cyclical concept of life-death-life

The iceberg effect of Culture

Observable: Behaviours , appearance, language, habits, dress, customs Non-observable ; beliefs, norms, expectations, perceptions

Ottawa Charter Health Definition

Old" public health (history and structure) ➢ Refers to philosophy/practices/systems of health prior to 1978 generated within biomedical model ➢ Tracked epidemics and or potential epidemics ➢ ensured government regulation & monitoring illness ➢ McMurray (2007) claims old public health achieved only 10% of improvements in health

Postmodern world focuses

On global rather than national

culture quote

Only humans generate and then rely on culture rather than instinct to ensure the survival of their kind

Stigma comes in three forms:

Overt or external deformations Deviations in personal traits Tribal stigmas

Role of Federal Government and Health care in Australia

Policy making National issues, public heath, research, information management Funding most medical services that occur of hospitals Regulation of health professionals

World Health Assembly Social Determinants of Health 2

Promoting world health HEALTH - 2013 ➢ Reducing health inequities through action on the social determinants of health - three overarching recommendations - ➢ To improve daily living conditions; ➢ To tackle the inequitable distribution of power, money and resources; ➢ To measure and understand the problem and assess the impact of action > conditions in which people are born, grow, live, work and age, referred to as social determinants of health. ➢ early years' experiences, ➢ education, ➢ economic status, ➢ employment, ➢ decent work, ➢ housing, ➢ environment,

What to do when working with aboriginals?

Provide cultural support to Patients. Provide cultural awareness training to Staff. Provide clinical support (BP's, temp, pulse, resps, BSL's, baby weighs etc.). Provide education to Patients. Assist Patients with forms (Centrelink, Birth Registration etc.). Arranging, confirming and changing appointment times. Providing a cultural link between the community and hospital facility. Collating data and presenting reports. Working closely with both the patient and the health care team, they may act as interpreters to ensure that the healthcare practitioner is clear about the patient's symptoms, medical and personal history and that the patient has a good understanding of the diagnosis, treatment and health care advice.

Parons the sick role - The two responsibilities

Pt must acknowledge state of illness as inherently undesirable - must want to get well and refrain from enjoying too much privileges (secondary gains) that may accrue from sickness. Pt obligated to seek competent medical help and cooperate in recovery process [Gray, 2006].

Taboos Aboriginals

Refers to categories of forbidden conduct which if practised are through to bring ritual uncleanliness or harm upon the people involved. Relates to food, names, modes of address, place of residence, kinship and social contact, sexual functions, initiation and sacred objects and sites. Taboos links these. Eg food taboos are observes at various stages of an individuals life cycle eg initiation, menstruation and pregnancy. - You must abstain from particular classes of food. Also taboos regarding mortuary practices. Eg in disposing the body, conduct of the mourners, their location during the funeral ceremonies, the foods they may eat, the disposal of the deceased's habitation and personal effects and the use of the deceased's name. Taboos can lapse when the period of danger has passed except when concerning relations between certain categories of kin - these are permanent.

social construction (week three)

Refers to the socially created characteristics of human life based on the idea that people actively construct reality (Keleher & MacDougall, 2011). A theory exploring how knowledge and interpretation of meaning results from social interaction, exercise of power and the broader social environment (Willis & Elmer, 2011)

Respiratory and aboriginals

Respiratory disease refers to a number of conditions that affect the lungs or their components; each of these conditions is characterised by some level of impairment of the lungs in performing the essential function of gas exchange Respiratory disorders,problems (which may or may not start in the lungs), are generally divided into two basic categories: Acute respiratory infections Chronic respiratory disorders.

Biomedical Model of Illness

Rudolph Ludwig Karl Virchow - founder of concept of cell pathology Louis Pasteur - germ theory of disease Robert Koch- doctrine of specific etiology

Parsons - The sick role , The two rights

Sick person exempted from normal duties [degree of exemption related to nature/degree of illness]; Sick person not held responsible for condition - can request assistance from others - has right to some degree of medical assistance and others deal with patient's usual tasks [Gray, 2006].

Structure of Biomedical Model of Illness

Social Structure- medicine as an institution Dominance in western world - almost all aspects of life (e.g birth and death) assumed by biomedical model Governments fund biomedical model and the illness system (funding attached to illness/diagnosis) Rejects intuitive ideas, agency, and social and cultural factors in health and in illness Associated with compliance / non compliance with therapeutic recommendations -denotes a power over someone , an unequal partnership , element of control -cultural diversity can be affect levels of compliance

Sociological Imagination

Sociological Analysis >Historical >Structural >Critical >Cultural

Modern World provided

Stability, security , predictability

Globalisation-Steger

Steger (political theorist): G. refers to a multidimensional set of social processes that create, multiply, stretch, and intensify worldwide social interdependencies and exchanges while at the same time fostering in people a growing awareness of deepening connections between the local and the distant.

Their role to work with aboriginals

The Aboriginal and Torres Strait Islander Health Workers role is varied (depending on where the IHW is working) and involves many elements. Their role is to: Often based in Community health services. • Support Patients at all appointments (MWC, Dr's, ANDAS etc.) • Advocate for Patients. • Assist Health Professionals to communicate with Patients.

Social Inclusion Priorities (mental health)

Supporting children at greatest risk of long term disadvantage - health, education and family relationship services • Helping jobless families with children - unemployed into sustainable employment and children to a good start in life • Focusing on locations at greatest disadvantage - tailoring place based approaches in partnership with the community • Assisting the employment of people with disability or mental illness - creating employment opportunities and building community support services • Closing the gap for indigenous Australians - with respect to life expectancy, child mortality, access to early childhood education, educational achievement and employment outcomes

What can be done with Mental Illness?

The Australian Government's vision of a socially inclusive society is one in which all Australians feel valued and have the opportunity to participate fully in the life of our society. Achieving this vision means that all Australians will have the resources, opportunities and capability to: - Learnbyparticipatingineducationandtraining - Workbyparticipatinginemployment,involuntaryworkandin family and caring - Engagebyconnectingwithpeopleandusingtheirlocalcommunity's resources and - Have a voice so that they can influence decisions that affect them.

Burdekin Report - 1993

The Report of the National Inquiry into the Human Rights of People with Mental Illness was tabled in Parliament and publicly released on 20 October, 1993 • Findings of the Inquiry included: - People affected by mental illness are among the most vulnerable and disadvantaged in our community. They suffer from widespread systemic discrimination and are consistently denied the rights and services to which they are entitled. - Individuals with special needs - children and adolescents, the elderly, the homeless, women, Aboriginal and Torres Strait Islander people, people from non-English speaking backgrounds, those with dual or multiple disabilities, people in rural and isolated areas and prisoners - bear the burden of double disadvantage and seriously inadequate specialist services. - The level of ignorance and discrimination still associated with mental illness and psychiatric disability in the 1990s is unacceptable and must be addressed.

Mental Illness

The Victorian Mental Health Act defines mental illness as: "a person is mentally ill if he or she has a mental illness, being a medical condition that is characterised by a significant disturbance of: - Thought, - Mood, - Perception or - Memory "

agency

The ability of people, individually and collectively, to influence their own lives and the society in which they live

Illness

The concept of illness is socially constructed. Illness is a highly personal state in which the person's physical, emotional, intellectual, social, developmental or spiritual functioning is thought to be diminished. It is not synonymous with disease and may or may not be related to disease. Illness is highly subjective; only the individual person can say he or she is ill (Stanley, 2012, p. 351).

The social detriments of health

The economic, social and cultural factors that directly and indirectly influence individual and population health (Germov & Freij, 2009, p. 350)

Aboriginals and Diabetes

The first case ‐ Indigenous people, Adelaide in 1923 . Prior time Indigenous people were fit, lean, and did not suffer from any form of metabolic condition, which were largely believed to be a characteristic of European populations 1960s. Subsequent studies found a significant correlation between the development of a 'westernised' lifestyle and the levels of type 2 diabetes in the Indigenous population Type 2 diabetes has been recognised as one of the most important health problems for Indigenous populations across Australia, with the overall prevalence likely to be around four times that of the general population

Who has private insurance

The government subsidies private health care costs and provides incentives for people to maintain private insurance -deduction in annual fee to join if <30 years old and maintain insurance Levy exists for people with high income who do not have private insurance People with low income cannot afford private health care

social structure

The recurring patterns of social interaction through which people are related to each other, such as social institutions and social groups

Bribie Island

TheBribieIslandreservewasneverofficiallygazettedbutreservedbyaCabinet decision on 20 May 1877. Thomas Petrie recommended in a letter to the Minister for Lands in April 1877 that a "fishing establishment" be formed on the island for Aboriginal people. By 1878 he reported that most of the Aboriginal people on the island had left. InJanuary1891JohnAdams,theHonorarySecretary of the Aboriginal Protection Association of Queensland, wrote to the Colonial Secretary suggesting Tin Can Bay or Tewantin as potential sites for a reserve to replace the mission station at Bribie Island. This did not eventuate and in November 1892 the Aboriginal Protection Association advised the Colonial Secretary that a number of Aboriginal people had been removed from the Bribie Island Mission Station and taken to Peel Island as a temporary place of residence, awaiting completion of buildings to be erected on the new mission station (Myora) at Stradbroke Island. Brisbane-AboriginalGirlsHome InMarch1904theAboriginalGirlsHomeinSouthBrisbanewasproclaimedareserve for the benefit of the Aboriginal inhabitants of the state. The home was established around 1899 for the purposes of accommodating Aboriginal women and girls going into domestic service. . The Magdalen Asylum at Wooloowin in Brisbane was also used to accommodate Aboriginal women.

Upper or Ruling Class

Those who own or manage economic resources (capital) such as raw materials, technology, workplaces (owners of production) • Employ others • Sometimes includes senior executives who may not own a company but have access to the company's profit through ownership of shares or profit sharing arrangements • For example owners of TV or radio stations or newspaper owners • 15 % of the Australian population.

What is the very essence of these bodies for aboriginals?

To be independent and community controlled (self determined and self managed) 'Run by people for people'; according to the needs. Client has the control In harmony with their wholistic view of health The decision-making base has shifted from the medical professions to community elected boards of directors A response to the appalling Aboriginal health statistics

Post modern society - idea of community/tradition

Tradition less valued Worldwide community Focus on the surface , appearances are paramount

Criticisms of Social

Utopian goal of equality leads to unfeasible attempts to change society Over emphasis on harmful side effects biomedicine Proposed solutions can be complex and difficult to implement in short term Sociological opinions can underestimate individual responsibility and psychological factors

Ethnocentrism

Viewing others from one's own cultural perspective, with an implied sense of cultural superiority based on an inability to understand or accept the practices and beliefs of other cultures

Post modern world; break down of structures

What served society well in the past no longer delivers

The challenge for aboriginals

With the general shortage of health professionals in Australia, increased recruitment efforts will NOT be sufficient to address the health needs of Australian/QLD Aboriginal communities. (N)ACCHO is committed to pursuing strategies for the future which include a collaborative effort across government, the health sector and the community to explore training, innovative practice models, practice support, infrastructure requirements and A greater investment in programs to address the current and emerging health challenges faced by community members.

"Tribal stigmas"

are traits, imagined or real, of ethnic groups, nationalities, or religions that are deemed to constitute a deviation from what is perceived to be the prevailing normative ethnicity, nationality or religion.

Postmodern world ; Lack of trust

authority, organisations, political power

Ayurverdic Medicine (Indian)

balance between structure and force in the cosmos (aromatherapy, diet, acupuncture, massage and meditation)

Cultural Knowledge

broad understanding of The specific cultural and historical patterns which have structured Aboriginal & Torres Strait Islander lives past and present, as well as give guidance to the future. The implications of culture for understanding human behaviour

Challenges to the HCS

chronic disease Increased costs in health care Workforce shortages

Postmodern world provided

fragmented, confusing, uncertainity

Sociological Analysis-Post Modernism

generally refers to the period from the 1950s to the current date

Post modern world ; blurring of boundaries

geographic, personal , roles , gender

Cultural Values

i.e. an awareness by professionals of their personal values and beliefs and being able to move away from them Anawarenessofthevalues,biasesandbeliefs being part of the practitioners' profession.

Deviations in personal traits

including mental illness, drug addiction, alcoholism, and criminal backgrounds are stigmatized in this way.

Sociological Analysis - Premodernism

is mostly referenced from the beginnings of sedentary life (Mesopotamia - Sumer, Babylonian, Akkadian and Assyrian empires) to 1650 - beginning of the Age of Enlightenment

Social Determinants of Health : Education barriers affecting the Indigenous population

lack of relevance of the curriculum racism and discrimination poor health levels of incarceration access availability of suitable teachers attendance levels financial constraints community expectation

Prescriptive Norms

mandate what we SHOULD DO

Proscriptive Norms

mandate what we should NOT do

TGA classifies complimentary medicine as

medicinal products that contain herbs, certain vitamins or minerals nutritional supplements homeopathic medicines certain aromatherapy products traditional medicines such as traditional Chinese medicines, ayurvedic medicines , and Australian Indigenous medicines

Cultural Competency with aboriginals

ocuses on: (1) the capacity of the professional to work efficiently with individuals / organizations within the cultural beliefs, practices and needs presented. (2) the capacity of the health care system to improve health and wellbeing by integrating culture into the delivery of health services.

Overt or External deformations

such as scars, physical manifestations of anorexia nervosa, leprosy (leprosy stigma), or of a physical disability or social disability, such as obesity.

Indigenous people and alcohol

• By comparison with non‐Aboriginal people, a large proportion of Aboriginal people do not drink alcohol at all and, in some Aboriginal communities, alcohol consumption has been banned by the residents • Up to 35% of Aboriginal men do not drink alcohol compared with 12% of non‐Aboriginal men • 40% to 80% of Aboriginal women do not drink alcohol compared with 19% to 25% of non‐Aboriginal women • In the Northern Territory, it has been estimated that 75% of Aboriginal people do not drink alcohol at all • Research published in 1991 by Associate Professor Wayne Hall and Dr Randolph Spargo found no evidence of truth in the "fire water theory" which maintains that Aboriginal people are biologically less able to handle alcohol

Health Disparities

• Health disparities • population-specific differences in the presence of disease • health outcomes • access to health care • eg differences between populations in measures of health

Inequities within countries & between countries

• In all countries where data is documented there are inequities between groups based on socio-economic status • Those countries with more equal distributions of income have better population health status • Wealthier countries have better health outcomes and longer life expectancies than poorer countries.

Why discuss the concept of class?

• In order to begin to understand how and why differences exist • We must also begin to understand the difference between equity and equality, inequity and inequality. • In order to change or work with any system it is easier if you understand it

People with mental illness

• In the past people with mental illness were admitted, detained and treated in large psychiatric institutions. • Today care and treatment of people experiencing mental illness predominately takes place in the community • Mental health services are divided between CAMHS, Adult & Aged Care and are conducted on a continuum of acute to long term rehabilitation

High Prevalence Disorders-Mental Illness

• Include disorders such as Anxiety, Depression & Substance Abuse • Depression & Anxiety are currently considered to be akin to an epidemic in Western Countries.

Low Prevalence Disorders

• Include disorders such as Psychosis , Schizophrenia and people with long term serious mental illness

Why are there disparities

• Inequalities • Inequities

The death of class

• Like most theories and concepts the concept of class is evolving and changing. • Germov (2009) points out that some believe that class is dead. • He suggests that whilst the boundaries may be blurred and there are added dimension such as gender, race and ethnicity the persistence of class based patterns of illness and health - related behavior suggests both objective and subjective dimension of class are central to any analysis of health inequality (Germov, 2009, p. 91)

MARGINALISATION

• Marginalise -to relegate to the fringes, out of the mainstream; make seem unimportant • Marginalisation -relates to stigma, prejudice and discrimination. Marginalised groups have been associated with poorer health outcomes. -research has consistently concluded that these groups have poorer health outcomes on many markers including obesity, illicit drug use, physical activity and cigarette smoking • Vulnerable & Marginalised Groups -'Vulnerable' and 'marginalised' are loose terms encompassing many different individuals and groups deprived of their rights.

Impact of Dysfunctional Sleep

• Memory loss • Emotionalinstability • Confusion • Poorjudgement • Impairedhealing • Increasedinfections • Loweredpainthreshold • Tremors • Weightgain

Malnutrition leads to

• Osteoporosis • Dental caries • Gall Bladder disease • Nutritional anaemias • Digestive tract disorders • Diet related cancers

Middle Class

• Possess some form of qualification and skill which gives ability to access higher wages and better working conditions than unskilled people • Teachers, HCW's, small business owners and self employed • 47% of the Australian population

Otitis Media

• Rates (OM) in some Aboriginal communities are among the highest in the world with patterns similar to those seen among disadvantaged populations in developing countries Hearing loss • Hearing loss is significantly worse in Indigenous communities than in the wider population. When it occurs in the first few years of life ‐ a critical period of child development ‐ it has major implications for speech and language development and learning.

Equity and Inequity

• So then... health equity or inequity refers to the achievement or not, of fair health status, or to the allocation of resources that permit equal or unequal access to health care or to broader economic allocations of goods and resources that underpin good health such as education and social welfare. • Concept with political and social justice dimensions • Involve relations of equal and unequal power (political, social, economic) as well as justice

What is Class? (week five)

• Sociological analysis of class focuses on the underlying factors that produce and reproduce societal difference. Original concept from Marxist theory • Simplified model based on Marxist and Weberian ideas. Defined according to three characteristics: • Ownership and control of scarce economic resources • Ownership of marketable skills and qualifications • Wage labour

Stigma

• Stigma is generally based on stereotypical and uninformed impressions or characterizations of a given subject. • Although the specific social categories that become stigmatized can vary across times and places, and is found in most cultures and time periods.

Government and Mental Illness

• Today people experiencing mental illness may receive treatment and care against their will. • Each State or Territory has a specific Act which governs the care and treatment of people with mental illness. • Within these Acts specific requirements are set out to protect the rights of people with mental illness. • However, people with mental illness still experience stigma, exclusion and physical ill health compared to the rest of the population.

Working Class

• Unskilled, manual and non manual labour • Gain employment by selling their labour power • 38% of Australian Population

Other risk factors for chronic otitits media include

• • overcrowding and inadequate housing • • inadequate or unavailable health care • •inadequatenutrition • •poverty • •attendanceatchildcare • •bottlefeedingratherthanbreastfeeding • • exposure to cigarette smoke • • a family history of the disease

WHO-PHC

➢ A philosophy; a strategy; a model/practice ➢ Relevant to health care provision everywhere ➢ Philosophically attuned with cultural competence

Western Beliefs

➢ Age of the enlightenment - values of rationality, science and progress from 18th C philosophers ➢ People believed they could make own future - could exert rational control over world - make it a better place. ➢ Centred on Judaeo-Christian values, culture and identity. ➢ Development of nation states - belief in 'citizenship' - core values about being a good Englishman, a good Scot, a German. ➢ Hierarchical - recognise superiors and inferiors - deep roots in values of a feudal and aristocratic system - class system. ➢ Strong individualism.

Premodern Society- Material Base

➢ Agricultural based society ➢ Feudal based - elite landholders owned the means of production and serfs sold their labour and worked the land in return for food and shelter

Sociological Imagination template

➢ Analysis of complex systems is assisted by the use of models which contain all the key elements and the relationships between them ➢ Wills (1916-1962) and cited in Germov (2009) on page 6 proposed a template for sociological analysis

Cultural Safety

➢ Begins with a reflection on your own cultural identity ➢ Acknowledging the impact of you own cultural values and beliefs on clinical practice ➢ Being culturally unsafe means any act that diminishes the cultural identity of the individual ➢ Being culturally unsafe means to disempower individuals

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