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Public Health In Australia Question: Identify an example of an inequitable distribution of health in the region or country of your choice. Discuss briefly ,how public health has explained this health inequity in the past?Then use a current public health model to show how this health inequity is produced and understood today.      Answer: Introduction: In the present world of today with the advancement of science and technology, the average health condition of people is improving, and their mortality rate is gradually decreasing. However, the situation is not the same for all and that is the reason, why the question of health inequity has become such a burning topic today. As defined by the World Health Organization,  the health inequity is defined as a situation, whereby owing to low socio-economic condition, some people of the total population of a state, are  deprived of adequate access to the basic health care systems of the country (Sadana et al., 2016) . Consequently, this deprived section of the society, in absence of adequate medical resources, become prey to chronic and fatal diseases, and eventually dies. However, apart from the difference in income, an individual’s gender, ethnic or cultural background, educational qualification, are the drivers of the inequitable distribution of health in a country (Ottersen et al. 2014). Australia, over the past few years, has exhibited a shocking and terrible tale of health inequity, as it was found out that chronic diseases such as Asthma, Diabetes, heart disease and Obesity have claimed the lives of a huge number of people, belonging to the lower strata of the society (Huo et al., 2016). According to recent reports and studies, Australia is not only a country where Diabetes is a very common problem, but also a place, where disadvantaged citizens were not being able to gain minimal access to the medical resources, resulting in high mortality rate because of Diabetes (Astell et al. 2014).    Discussion: Diabetes has become a major concern in Australia, as it is being discovered that the indigenous people are more likely to suffer from diabetes, rather than the non-indigenous ones. Although, Australia boasts of being a multi cultural nation, the minor ethnic groups  are found to be three times are more likely to suffer from Diabetes, than the non-indigenous ones. An important national survey, named National Aboriginal and Torres Strait Islander Survey, conducted a comparative study on the health condition of the indigenous population of Australia as against the non-indigenous part of the population (Randall et al. 2013). The result the study showed, was shocking. The research claimed that out of every sixteen indigenous people, at least one was suffering from Diabetes. Out of these indigenous people, those living in the remote corner of the nation, that is in the rural areas, belonging to backward classes, were more likely to develop and suffer from Diabetes (Huo et al. 2016). Another very shocking aspect of the report was that the sexual identity of the individual, was also a major determinant of the disease. In fact, it was found out that not only the indigenous people were falling victim to Diabetes more than the indigenous people, but the females of the minor ethnic community were more prone to suffer from the Diabetes problem, than their male counterparts (Gibson et al. 2015). Figure 1: Comparative Chart Suggesting the Higher Rate of Health Inequity Problem in Diabetes in Australia ( Source: Burrow et al. 2016) A large number of indigenous people usually suffer and die from Diabetes and the major reasons behind the same include poverty, lack of access to medical resources, and cultural pressures which prevent them from going to hospitals for regular medical checkup. Recent studies suggest that most of the indigenous Australians are not aware of the ill effects of diabetes, and they tend to prioritize heart diseases, kidney diseases and other major diseases (Eades et al. 2013). As a result, in the year 2003-04, the total number of instances where an indigenous Australian was found to seek admission in a hospital because of Diabetes, was 1 out of 100. A recent report on the Diabetes problem in Australia, has suggested that major part of the indigenous population of Australia, undermine the harm caused by Diabetes, who consider it far from being any serious disease. There was a lack of awareness among them, as to how serious diseases, such as Heart disease or Strokes, are directly related to Diabetes. The research also stated that two out of three people, considered themselves at no risk, after having been diagnosed with diabetes. The Diabetes Australia chief, Johnson , has also expressed much concern over the issue of ignorance of the indigenous inhabitants on the question of Diabetes.  Much has been done on part of the Australian government, to curb the ill consequence of Diabetes, through the observation of the Diabetes Week, and other campaigns and events. But the indigenous community living in the rural areas has been unaware of the same(Chamberlain et al. 2013). Diabetes has become a major issue in the last few years, as it was found to be the second major disease responsible for the death of the indigenous people of Australia. What was even more striking was the high death rate of indigenous women due to Diabetes, during their pregnancy period . Even if the mother survives in several cases, the infant born develops chronic diseases such as macrosomia, congenital abnormalities, and other diseases (Burrow et al. 2016). These indigenous women, usually do not visit the nearest medical centers for taking tests, or for preventive measures that can be adopted. A latest report submitted by the Australian government, states that most of the Australians, who are living in the rural part of the nation, belonging to the downtrodden section of the society, they have to suffer from medical inconvenience. Not only is there a huge dearth of doctors, but the patients, have to keep on waiting, when one is available (Huo et al. 2016). The report added, that out of every three people living in the remote part of the country, at least one has complained about the unavailability of physicians. In an Australian report of 2008, it was discovered that out of 335 doctors being present per 1,00,000 in big cities, only 135 physicians could be traced in the rural part of Australia (Wardle et al. 2013). The major problem here, is that the doctors who are sent to the regional and remotest areas of the country, do not get any sort of incentive, and in fact, their pay scale is the same as that of the doctors working in the cities (Australia et al. 2012). Diabetes is a challenging issue for the Australian government, because the disease has claimed a huge number of lives over the last few years. Although, Diabetes has become a problem of national interest, its effect has become all the more glaring in certain communities of Australia. The Australian government, has introduced much programs and campaigns in the backward areas of the country (Ottersen et al. 2014). There were national programs, such as, Healthy Community Initiative, which made the indigenous part of the Australian population aware of the importance of eating fresh food, physical exercise, cessation of smoking habits, for the sake of controlling Diabetes (Vita et al. 2014). However, much result has not been obtained in the recent past. According to the report submitted by the ABS authority, only 20 % of the people living in the villages of Australia could get an access to the medical resources. Further, it was discovered, that a large part of the indigenous population of the country, lives in places, which have some sort of legal or physical boundaries, for which no hospital could be constructed there. In absence of proper infrastructure, proper access to the pharmaceuticals is denied to these people. At times, the reason behind this inequity is rooted in the prejudice of the Australians as well. A major issue, that has cropped up, in the rural areas, is that many indigenous people who belong to the Stolen Generation, disdain the idea of being treated by the white Australian doctors. Hence, they usually refrain from visiting the physicians, and they are least likely to do so, when they are being diagnosed with “minor” diseases such as Diabetes (Hays et al. 2015). Most of these people are also culturally prejudiced and as a result, they prefer to use herbs, and in most cases, these are ineffective, leading to the death of the patients. According to WHO report, the inequity in the distribution of health, in a country can be caused due to multiple reasons. The Public Health Model, below describes how Diabetes, as a disease is being treated in today’s world. Figure 2: Socio-Ecological Model of Public Health (Source: Power 2015) In the primary stage, steps have to be taken so that a disease, such as, Diabetes, should not at all occur. This would require on part of the Australian government as well as different NGOs to hold campaigns and awareness creating programs, especially in the remote areas of the country. One major challenge in dealing with the indigenous people, is that they are apathetic yo the white Australians, and they hardly believe a word from them, easily. Hence, a more holistic approach to the problem is needed. The organizations, such  as UFPA, should come up and make the people, especially the young ones, aware of the danger of Diabetes (Sorensen et al. 2012). These people should be educated more and more about the ill- effects of Diabetes, and how it is associated with the damage of nerves and blood vessels, if go untreated. Greater attention has to be paid on these people, as they remain out of the cities, and hence they have no knowledge as to how diabetes can lead to heart disease, blindness, kidney failure, and other diseases. These people can be informed about the importance of healthy lifestyle, spiritual well being of their community and goodness of their traditional food, in keeping the problem of Diabetes away. If necessary, more and more people, belonging to the indigenous community should be made aware of the harm caused by Diabetes. As it has already been stated, that the indigenous Australians feel a sense of fear, mistrust and panic, being encountered with the white Australians, and hence it may become difficult for the Australians to interact with the aboriginals about the preventive measures of the disease. So, these organizations may use a traditional painting to explain the problem. Further, the government provides more incentives to the physicians for visiting the rural areas, and includes more doctors from the indigenous group of Australia, to treat these people. Finally, the government helps the affected ones financially as well as morally, to get cured completely (Burrow et al. 2016). Fear, totally guided by racial consideration, stands as a major impediment in the equitable distribution of health in the rural parts of Australia. The government of Australia, as well as the NGOs are nowadays paying greater attention to the fact that it is difficult to treat the indigenous people, until and unless they possess a strong hold over the knowledge of the  traditional beliefs and ideals of the Aboriginal society. Hence, they are more directed towards creating a suitable medical environment for the affected ones. One major issue was that the total number of Australians who were approachable for treatment was incredibly less. So, the organizations are putting greater efforts to hire doctors and medical staffs from the Aboriginal backgrounds. In fact, the report suggests that the introduction of greater number of aboriginal doctors in the regional parts of Australia substantially increased the number of Diabetes struck people checking in the medical centers for treatment (Nettleton et al. 2006). The NGOs at present are also emphasizing on the importance of communication, in providing health education on Diabetes to the indigenous people. For this reason, volunteers are relying more on the use of simple languages, signs and animated movies. Reports also claim, that much care has also being taken, to ensure the comfort of the Aboriginals (Davis et al. 2012). For this reason, the hospitals, in these areas, are hiring staffs who are culturally aware of the belief system and ideology of the indigenous people. One great advancement in this regard, was  the construction of the Royal Adelaide Hospital, which having meant to serve the Aboriginals, made use of the paintings and cultural designs depicting their ancient stories, to make the people understand that the hospital is meant solely for healing (Gulati et al. 2015). The importance of the governmental policies for curbing the spread of Diabetes in the indigenous part of Australia, cannot be overstated. An insulin pump can be effectively used to reduce the problem of Diabetes, and while most of the people, in the rural part of the country, are low- income or no income group people, the government has come forward in distributing free insulin pumps to the poor ones . In the last three years, the Australian government has spent approximately $35 million for the free distribution of 4,000 insulin pumps. The Australian government has also introduced the use of Insulin Therapy, and since the service offered by it is limited, only the indigenous and financially downtrodden ones are being considered for treatment (Dunbar et al. 2014). Research has suggested over the years, that the indigenous people, suffering from Diabetes are mostly uneducated, and suffer from a huge lack of health literacy. Until and unless they are made aware of the symptoms, causes, effects and preventive measures of Diabetes, the disease cannot be effectively uprooted from the country. Lack of health literacy has led to lack of awareness among the people, to visit the local hospitals. For this reason, several health literacy programs, have been introduced in Australia (Braveman et al. 2006). Figure 3: Health Literacy Strategy of Australia (Source: Chan et al. 2014) Diabetes is a chronic problem in the rural part of Australia, especially because major part of the population stays in a remote area, which does not have medical coverage. Not only, most of the people stay at least 100 Km away from the nearest hospitals or pharmaceuticals, but most of them belong to low income group category. As a result, the Australian government has introduced Medicare Benefit Scheme, with the aim of providing financial aid to the affected patients, suffering from Diabetes. Further, the Australian government has also used the MBS, to provide additional incentive and benefits to the doctors and medical practitioners who agree to visit the rural areas of Australia for serving the indigenous people (Giles et al. 2015).    Conclusion: Diabetes is a very serious problem in Australia, and it is all the more worse, in the indigenous areas of Australia, where the Aboriginals suffer from an inequitable distribution of health, owing to lack of access to medical resources. The government of Australia, has already taken certain measures, but the whole issue needs more focus in future. The action should focus on taking measures primarily, to reduce the possibility of Diabetes in future. Next, if it occurs, the government should be able to provide financial aid to the affected ones, introducing more of health literacy programs, to reduce the chance of Diabetes in near future. The government should provide medical treatment at low or affordable rates, and should especially take care of the areas which are located in the interior regions, and which do not enjoy transport facilities (Fenwick et al. 2016).     Reference List:  Astell-Burt, T., Feng, X., Mavoa, S., Badland, H.M. and Giles-Corti, B., 2014. Do low-income neighbourhoods have the least green space? A cross-sectional study of Australia’s most populous cities. BMC Public Health,14(1), p.292. Australia, D., 2012. Diabetes in Australia. Braveman, P., 2006. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health, 27, pp.167-194. Burrow, S. and Ride, K., 2016. Review of diabetes among Aboriginal and Torres Strait Islander people. Burrow, S. and Ride, K., 2016. Review of diabetes among Aboriginal and Torres Strait Islander people. Burrow, S. and Ride, K., 2016. Review of diabetes among Aboriginal and Torres Strait Islander people. Chamberlain, C., McNamara, B., Williams, E.D., Yore, D., Oldenburg, B., Oats, J. and Eades, S., 2013. Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States: a systematic review of the evidence for screening in early pregnancy.Diabetes/metabolism research and reviews, 29(4), pp.241-256. Chan, J.C., Cho, N.H., Tajima, N. and Shaw, J., 2014. Diabetes in the western pacific region—past, present and future. Diabetes research and clinical practice, 103(2), pp.244-255. Davis, T.M., Hunt, K., McAullay, D., Chubb, S.A., Sillars, B.A., Bruce, D.G. and Davis, W.A., 2012. Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes The Fremantle Diabetes Study. Diabetes care, 35(10), pp.2005-2011. Dunbar, J.A., Jayawardena, A., Johnson, G., Roger, K., Timoshanko, A., Versace, V.L., Shill, J., Philpot, B., Vartiainen, E., Laatikainen, T. and Best, J.D., 2014. Scaling up diabetes prevention in Victoria, Australia: policy development, implementation, and evaluation. Diabetes Care, 37(4), pp.934-942. Eades, S., Paul, C., Ishiguchi, P., Zimmet, P., Shaw, J., Forshaw, K., Koller, C., Turon, H. and Sanson-Fisher, R., 2014. Baseline evidence practice gap for type 2 diabetes care among Aboriginal Australians in a cluster randomised controlled trial. BMC Health Services Research, 14(Suppl 2), p.P33. Fenwick, E.K., Rees, G., Holmes-Truscott, E., Browne, J.L., Pouwer, F. and Speight, J., 2016. What is the best measure for assessing diabetes distress? A comparison of the Problem Areas in Diabetes and Diabetes Distress Scale: results from Diabetes MILES–Australia. Journal of health psychology, p.1359105316642006. Gibson, O.R. and Segal, L., 2015. Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review. BMC health services research, 15(1), p.1. Giles-Corti, B., Sallis, J.F., Sugiyama, T., Frank, L.D., Lowe, M. and Owen, N., 2015. Translating active living research into policy and practice: one important pathway to chronic disease prevention. Journal of public health policy, 36(2), pp.231-243. Gulati, V., Gulati, P., Harding, I.H. and Palombo, E.A., 2015. Exploring the anti-diabetic potential of Australian Aboriginal and Indian Ayurvedic plant extracts using cell-based assays. BMC complementary and alternative medicine, 15(1), p.1. Hays, R., Esterman, A. and McDermott, R., 2015. Type 2 Diabetes Mellitus Is Associated with Strongyloides stercoralis Treatment Failure in Australian Aboriginals. PLoS Negl Trop Dis, 9(8), p.e0003976. Huo, L., Shaw, J.E., Wong, E., Harding, J.L., Peeters, A. and Magliano, D.J., 2016. Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia, pp.1-9. Huo, L., Shaw, J.E., Wong, E., Harding, J.L., Peeters, A. and Magliano, D.J., 2016. Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia, pp.1-9. Huo, L., Shaw, J.E., Wong, E., Harding, J.L., Peeters, A. and Magliano, D.J., 2016. Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia, pp.1-9. Ottersen, O.P., Dasgupta, J., Blouin, C., Buss, P., Chongsuvivatwong, V., Frenk, J., Fukuda-Parr, S., Gawanas, B.P., Giacaman, R., Gyapong, J. and Leaning, J., 2014. The political origins of health inequity: prospects for change. The Lancet, 383(9917), pp.630-667. Ottersen, O.P., Dasgupta, J., Blouin, C., Buss, P., Chongsuvivatwong, V., Frenk, J., Fukuda-Parr, S., Gawanas, B.P., Giacaman, R., Gyapong, J. and Leaning, J., 2014. The political origins of health inequity: prospects for change. The Lancet, 383(9917), pp.630-667. Power, A.K., 2015. Focus on transformation: A public health model of mental health for the 21st century. Psychiatric Services. Randall, D.A., Lujic, S., Leyland, A.H. and Jorm, L.R., 2013. Statistical methods to enhance reporting of Aboriginal Australians in routine hospital records using data linkage affect estimates of health disparities. Australian and New Zealand journal of public health, 37(5), pp.442-449. Sadana, R., Blas, E., Budhwani, S., Koller, T. and Paraje, G., 2016. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity. The Gerontologist, 56(Suppl 2), pp.S178-S193. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z. and Brand, H., 2012. Health literacy and public health: a systematic review and integration of definitions and models. BMC public health, 12(1), p.1. Stephens, C., Porter, J., Nettleton, C. and Willis, R., 2006. Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide.The lancet, 367(9527), pp.2019-2028. Vita, P., Reddy, P., Timoshanko, A. and Colagiuri, S., 2014. Diabetes Prevention in Australia: The Challenges of Scaling-up and Rolling-out Programs. Global Health Perspectives in Prediabetes and Diabetes Prevention, 38, p.391. Wardle, J.L., Sibbritt, D.W. and Adams, J., 2013. Referrals to chiropractors and osteopaths: a survey of general practitioners in rural and regional New South Wales, Australia. Chiropractic & manual therapies, 21(1), p.1.

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