English settlement patterns and colonial development

English Settlement

Social Marginalization and Healthcare Inequality for the Aboriginals of Australia

The quality of public healthcare is typically widely variant, with a wide array of economic and sociological factors directly implicated in a tendency in every national healthcare system toward some form of inequality. For reasons often associated with ethnic disparity, socioeconomic hierarchy and geographical disadvantage, a social phenomenon called marginalization will tend to place a specific demographic at a lesser opportunity to access proper care, education on health issues or protection from certain factors increasing individual health risk. In Australia, this is a condition which is well-known to impact the Aboriginal populations native to the continent and must displaced and exploited since the initiation of English settlement over two centuries ago. The result is that today, Aboriginals suffer both a higher health risk than do Australians and have a far lesser access to proper treatment opportunities.

The disparity between Aboriginal and Australian populations in terms of health is both severe and significantly telling of the longstanding inequality to which this former group has been subjected, even to present day. Marmot's (2005) article underscores the currency of this issue and the potentially devastating outcome of such marginalization. Marmot contends that "a particularly telling example of health inequalities within countries is the 20-year gap in life expectancy between Australian Aboriginal and Torres Strait Islander peoples -- life expectancy is 56 3 years for men and 62 8 years for women -- and the Australian average. The men in this population would look unhealthy in India (male life expectancy 60 1 years) whereas Australian life expectancy is among the highest in the world, marginally behind Iceland, Sweden, and Japan." (Marmot, 1100)

This is a troubling gap that denotes the living conditions distinguishing two separate experiences in the same nation. And unfortunately, this condition has remained thusly even as Australian policy has begun to be adopted toward a change. This is to suggest that beyond the longstanding failure of the federal healthcare system to recognize the needs of the indigenous populations throughout Australia, more recently the subject has been a matter of failed access instead. Though there have been policy steps made toward resolving the serious imbalance between indigenous and English-speaking populations, the obstruction to successful actualization of such policy demonstrates the long-term impact of marginalization. In this context, it has made it particularly difficult to penetrate historical inequalities produced by cultural, geographical and linguistic biases resultant from English settlement during the 18th century.

Indeed, as indicated by Ring & Brown, "In the 10 years 1990 -- 2000, despite improvements in some conditions, there has been little or no overall progress in the health of the Aboriginal and Torres Strait Islander populations of Australia. This is in stark contrast to the gains made in Indigenous health in other countries. The issue is one of lack of commitment to and implementation of already existing policies." (Ring & Brown, 629) Though policy initiative has changed to address these needs in recent years, it is also clear that a fair amount of resistance still permeates a nation where ethnic prejudices had initially produced this condition of marginalization. Today, the persistence of these conditions suggests that such marginalization comes inbuilt with entrenched behaviors, practices and political inclinations which must be overcome if improvements are to be achieved.

At present, the outcome of this set of conditions is a severely lacking public health situation for Aboriginals. Accordingly, McIntyre & Menzies (2005) that "the inferior health status of Indigenous Australians has been extensively reported and is linked inextricably to their ongoing social and economic disadvantage. Measures to decrease this health inequity are best focused on prevention and primary care as early in life as possible." (McIntyre & Menzies, 207)

This latter point is a useful one in point the way to contending with the health disparities that afflict these specifically excluded ethnic groups. Namely, that there is a need to begin outreach by creating more open lines of knowledge and communication between Aboriginal communities and healthcare professionals. One crucial way which the McIntyre & Menzies study asks us to consider is through the improvement of vaccination for youths. The article endorses this as an approach which is appropriate for responding to the types of conditions which are endemic to the Aboriginal populations and, further, indicative of the inherent health disadvantages associated with social or ethnic marginalization. Namely, Aboriginal populations have tended to be more likely to be experience over-crowding, squalor, high rates of infectiousness, poor nutrition and hygiene and faulty infrastructure. All of these increase vulnerability to disease, the spread of disease and the susceptibility to illness. In combination with a comparatively limited excess to healthcare professionals or healthcare facilities, this places Aboriginals at a considerably higher risk of illness and mortality.

Indeed, this vulnerability results in myriad medical conditions that prove to be ethnically affiliated. According to a study by Cook (2005), "It is well established that Aboriginal Australians suffer significantly more health and welfare problems than non-Indigenous Australians. This disproportionate suffering can be evidenced in the rising rates of end-stage renal disease." (Cook, 1) This is just one of a wide array of medical vulnerabilities that appear to be specific to the Aboriginal population and which can severely diminished mortality projections. This denotes a need for lifelong preventative measures as a way diminishing the likelihood of suffering such conditions.

The value in approach such a problem through the proliferation of vaccination, for one example, is manifold. In particular, "vaccine-preventable diseases are particularly amenable to rapid and cost-effective prevention, and targeted vaccination programs have been shown to reduce health disparities. However, delivery of these programs, like other healthcare interventions, depends on culturally appropriate health services." (McIntyre & Menzies, 270) This last point highlights a recurrent issue in this discussion, which is a distinct shortcoming of Aboriginal healthcare professionals, Aboriginal linguistic specialists and facilities in geographical proximity to Aboriginal communities. By consequence, there are genuine obstacles to surmount in simply bringing those demographics at high risk of health disparity to a place of awareness or access to those treatment options which might be available to them.

Among such obstacles, the social marginalization of Australia's Aboriginal populations has produced a number of circumstances which have been magnified by the passage of time. At present, the challenge to healthcare providers of penetrating these demographics is considerable and beset by an array of problematic symptoms. Among them, "forced relocation, urban migration, poor education, lack of employment, low income, inadequate housing, lack of environmental infrastructure and a paucity of appropriate health service provision are important social determinants of ill health for Aboriginal and Torres Strait Islander people." (Hayman et al., 604)

This points to a clear need for outreach that should first and foremost be channel through healthcare workers. A key recommendation to emerge from this research is to remove the marginalization of these demographics by both creating geographically optimal healthcare facilities and by staffing them with personnel of Aboriginal descent or ties to Aboriginal communities. In particular, these facilities would be distinguished by a priority in recruiting Aboriginal language speakers and nurses of the Aboriginal culture.