Aboriginal or indigenous Australians are obviously the earliest people to live in Australia. The term "Aboriginal", stands for the earliest occupants of a given geographical location. In this sense, Aboriginal Australians are the original inhabitants of Australia and their descendants. Evidence shows that Aboriginal Australians have a higher burden of oral diseases than non-indigenous Australians (Parker & Jamieson, 2010). This is orchestrated by factors such as their belief, accessibility to medical services and so forth. This report takes a look at historical events, racism in oral healthcare services and cultural competency relating to Aboriginal Australians and also the appropriate recommendations that can be leveraged to remedy the conditions of Indigenous Australians today.
RACGP, (2012) also outlined that the colonists spread slow and steadily across the aboriginal land on their arrival. This was accompanied by a sudden outbreak of diseases across the aboriginal land. The aboriginals have no immunity against these diseases and, as a result, there was widespread death and consequent decline in the population of the people. Obviously, colonization of the indigenous Australians brought with it diseases of all kinds and death.
Colonization adversely impacted the health of indigenous Australians because it resulted to the loss of hunter-gatherer lifestyle of the people as it led to the loss of lands or formation of fixed settlements. This led to poor nutrition that consequently resulted to poor health conditions such as low birth weight, diabetes mellitus, hypertension, cardiovascular diseases and so forth. Indigenous Australians were marginalized from the white society and also denied of good communication systems. The discrimination led to poverty, poor education and unemployment which consequently resulted to alcohol and substance abuse as well as domestic violence, accident, and death. The aboriginals were confined to fixed settlements, fringed camps, and urban ghettos. This was because poor housing, unhygienic conditions, overcrowding and infectious diseases. Hence, these resulted to untold diseases including ear diseases, respiratory diseases, renal diseases, and rheumatic heart diseases.
Assimilation and other policies brought by the colonists also had a great toll on the aboriginals. This integration was targeted at ensuring that the aboriginals would lose their identity and culture, but it also brought about lots of diseases. A lot of children were forced to separate from their parents and sent to training homes where they are trained as laborers in the farms. The human rights of aboriginals were greatly abused during assimilation, and this brought about untold psychological harm, poverty and also poor health and early death.
According to Public Health Australia, (2010), the persisting poor state of indigenous health in Australia truly have complicated causes. However, the continuing consequence of colonial experience is a major factor in causing these poor health conditions or statuses. Essentially, the consequences of colonization in Australia are ongoing and as a result it has an ongoing effect on health and wellbeing of Indigenous Australians.
Cultural Competency Standard in Dentistry
Dentistry, as well as other medical practices, must ensure cultural competency standard in order to meet the needs of locals such as indigenous Australians effectively. In effect, the traditional health beliefs of Aboriginals should be well understood for effective health service. According to Maher (1999) it is imperative to appreciate really the aboriginal models on causes of illness. The aboriginal models may look awkward with respect to Western models, but it does have its peculiarity. For years, aboriginals have held on to these models, and it forms the core of their beliefs and tradition.
Cultural competence is an important aspect that encompass the relationship between helper and the person being helped. It can be defined as a set of attitudes, behaviors and policies in agreement in a system, agency or among professionals. Thus, it enables the system, agency or professionals to work effectively in cross-cultural settings (The Royal Australian College of Physicians, 2004). Cultural competence involves five cross-cultural capabilities that include self-reflection, cultural understanding, context, communication, and collaboration. These capabilities are expressed as a series of transitions. The experts argue that cultural competency should begin with self-reflection and self-awareness.
The impacts of cultural competency are far reaching as it impacts both clients and staff. Cultural competency is designed to ensure that a health system would be able to respond to the diversity in clients and staff. Queensland Government reveals that patients who do not able to speak the language of health care professionals were at higher risk of receiving less care compared to those who speak their language (Queensland Health, 2012). Here, cultural competency comes in handy in order to foster and improve the relationship between patients and healthcare professionals.
Moreover, cultural competence will not only help the patients, it will also help the staff in the context of health professionals. Workforce diversity is one of the important issues that cultural competency can tackle. Of course, cultural competence involves the relationship between the healthcare professionals and the patient. Hence, it would be relevant in dealing with issues of misunderstanding and intercultural conflicts and so forth.
Cultural competence is also very vital in the current status of the average health of indigenous Australians. Improving the health of indigenous Australians would require a strong appropriation of these standards. This is because integrating these standards and cultural safety will not only buttressing cultural differences but it will essentially reduce the barriers placed on indigenous Australian's access to health services. More so, cultural competence is practically oriented, or evidence-based. This is because it cannot be said to be achieved if health gains are not maximized. To build cultural competence, it is important for individual medical practitioners to have a positive reflection on their own cultural identity and identify the impacts of their culture on their medical profession and practice. It is essential to implement policies and practices that meet patients’ language, cultural and social needs in order to promote the health outcome of the indigenes.
It is important to take advantage of the already outlined culturally safe and sensitive practices in Australian dentistry to boost indigenous health. Essentially, it is imperative to be aware of the cultural needs of the patients. Firstly, this involves having good knowledge of sensitivity and respect for the cultural needs. It also involves knowing the economic, cultural, social, historic and behavioral factors that influence individuals and population health. Furthermore, it also involves bringing in practices that would help to improve the engagement with patients or clients and healthcare outcomes. Cultural competency standards in Australian dentistry require understanding of the influence that practitioners' culture and beliefs have on their interactions with clients.
The aforementioned standards, however, wonderful are not enough. Obviously, if they are enough, the gap in an average Australian’s dental health would not be quite obvious. Thus, to improve the dental health of an average Australian, it would be important to improve these standards.
Aboriginals Health Belief System
Before colonization, aboriginals enjoyed good health enhanced by their traditional health belief systems but these changed with colonization. The disparity between Western health belief system and that of the aboriginals is the major reason due to which western health professionals experience difficulties in delivering health services to Aboriginals. The Aboriginal model of causation relates to different aspects of their lives. These include religion, kinship obligations, and land. According to Maher (1999), the emphasis is placed on social and spiritual dysfunction as the primary cause of illness, this is in line with their sociomedical system of health beliefs. The belief system asserts that the effective discharge of obligations to society and the land itself is the major determinant of individuals’ wellbeing and health condition. It is to be observed that in this model, the social relationships of individuals are given great priority. This is because the model states that the social responsibilities and obligations of an individual can determine their health conditions.
Indirect supernatural illnesses are attributed to sorcery and could be caused by boning, singing or painting. This ailment could result to serious injury, congenital defects, as well as physical malformation and so on. There are also illnesses classified as emergent or western. These are illnesses that were known to the aboriginals since colonization. The aboriginals rely on the power of traditional healers who use different means to heal sick folks. Essentially, aboriginals believe that sicknesses or diseases from solid objects in a person's body that resembles a piece of wood. That treatment method usually involves removal of this particular piece of a solid object from the sufferers' body. After the solid is removed, they use suction by the mouth to remove the final part of the rubbish. This is collected where the illness is located, and the rubbish is disposed of into the wind (Tjilari & Peter 2003). The aboriginals are common in their beliefs, and they usually resort to bush medicines for medication and treatments.
Aboriginals and Oral Health Today
Australians living in rural, as well as remote areas, have access to poorer dental care than those who live in urban cities (Kruger, Perera & Tennant, 2010). More so, (Williams, Jamieson, MacRae & Gray (2011) stated that indigenous Australians suffer from more caries, periodontal diseases and tooth loss than non-indigenous people. Tooth decay in indigenous people often goes untreated and end up in tooth extraction. The prevalence of oral diseases in indigenous communities is largely caused by the limited accessibility of healthcare services. Ware (2013) defined accessible health services as those health services that are physically available, affordable, appropriate and also acceptable.
The racism in healthcare is also predominant, and it is one of the reasons for the low accessibility of dental health services by Indigenous Australians. Racism, as defined by Hampton & Toombs (2013), is the idea or belief that each identifiable group of people or race possesses with specific cultural, individual characteristics and abilities that distinguish them. Aboriginal Australians had their adequate experience due to the activities of colonial masters like most of the other races in the world. Consequently, racism exerted an ill effect on the health of ingenious Australian. This demands to minimize inequities, creating awareness and structural reforms (Awofeso, N. (2015).
Obviously, the overall oral health of Indigenous Australians would not be improved if the issue of accessibility of dental services is not fixed. One way of dispensing with this issue is to adopt mitigation strategies that give room to cultural competency and safety at the individual, organizational and systemic levels.
One of the important attributes of the ability of the dentist to understand the cultural needs in the contexts of different patients to obtain good health outcomes. It includes being sensitive and respecting the cultural needs of the Aboriginal Australians and studying the factors influencing the health of the individuals (Australian Dental Council, 2010).
Moreover, colonization, assimilation, race, and racism had and are still having a great toll on Indigenous Australian health. Cultural competence standards that involve the relationship between health practitioners and patients are essential in improving the health of Australians. However, the already outlined cultural competence standards in Dental Board of Australia code of conduct are not enough. Thus, this report showed the overall dental condition of indigenous Australians, citing from a historical perspective the Aboriginal health beliefs and how it affects them today. Of course, the aboriginals are deeply religious people and their religion and culture affect virtually everything they do. To deliver effective dental service to them, it is important to acknowledge, appreciate and respect the culture, else it would be impossible to communicate western healing process to the local people.
It is important to address the issue of cultural competence and, of course, this is necessary to deal with the accessibility of dental healthcare services among Indigenous Australians.
Moreover, cultural competence and accessibility can be resolved by employing indigenous health professionals and workers in order to promote culturally safe service delivery (Ware, 2013). This will go a long way to encourage acceptance of dental services by the indigenous people because the services will be communicated in their language styles.
The aboriginals already have their system of health beliefs, and the better result might be achieved by building on their health belief model. This is in line with the report by Tjilari, & Peter (2003). Encouraging and building on their health practice would not only help in solving the health issues among Aboriginal Australians but it might provide alternatives or solutions to various ailments in the world today.
Australian Dental Council, (2010). Professional Attributes and Competencies of the Newly Qualified Dentist. Australian Dental Council, Melbourne Victoria Australia
Awofeso, N. (2015). Racism: a major impediment to optimal Indigenous health and health care in Australia. Australian Indigenous Health Bulletin, [online] 11(3). Available at: http://healthbulletin.org.au/wp-content/uploads/2011/07/bulletin_review_awofeso_2011.pdf [Accessed 25 Apr. 2015].
Hampton, R. & Toombs, M., (2013). Chapter Two: Racism, colonization/colonialism and impacts on indigenous people. In indigenous Australians and health: The Wombat in the room. South Melbourne: Oxford University Press.
Kruger, E., Perera, I., & Tennant, M. (2010). Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia. Australian Journal of Primary Health, 16(4), 291.
Maher, P., (1999). A review of traditional Aboriginal health beliefs. Australian Journal of Rural Health. Vol. 7, pp 229-236
Parker, E., & Jamieson, L. (2010). Associations between Indigenous Australian oral health literacy and self-reported oral health outcomes. BMC Oral Health, 10(1), 3.
Public Health Association of Australia, (2015). Policy-at-a-glance – Indigenous Health Policy. [Online] Available at: http://www.phaa.net.au/documents/policy/101215_Indigenous%20Health-The%20Continuing%20Consequences%20of%20Colonisation%20Policy.pdf [Accessed 24 Apr. 2015].
Queensland Health. (2012). Cross Cultural Capabilities: For clinical staff and non-clinical staff: Background paper. Division of the Chief Health Officer, Queensland Health. Brisbane. Available at: http://www.health.qld.gov.au/multicultural/health_workers/CCC-bkgrnd.pdf [Accessed 25 Apr. 2015].
RACGP, (2012). An introduction to Aboriginal and Torres Strait Islander health cultural protocols and perspectives. 1st ed. [Online] Melbourne, Victoria: The Royal Australian College of General Practitioners. Available at: http://www.ntgpe.org/workingwell/pdf/racgp_cultural_protocols.pdf [Accessed 25 Apr. 2015].
Tjilari, A. & Peter, R. (2003). Introduction. In Ngangkari work – Anangu Way: Traditional healers of central Australia. (pp. 18-21). Alice Springs, NT: Ngaanyatjarra Pitjantjtjara Yankunytjatjara Women’s Council Aboriginal Corporation.
The Royal Australasian College of Physicians, (2006). An Introduction to Cultural Competency Policy Statement on Aboriginal and Torres Strait Islander Health. [Online] Racp.edu.au. Available at: https://www.racp.edu.au/index.cfm?objectid=FCBB0411-9DFF-0474-A0B250ACA0737BF8 [Accessed 26 Apr. 2015].
Ware V.A. (2013). Closing the gap: Improving the accessibility of health services in urban and regional settings for Indigenous people. Retrieved April 20, 2015 from www.aihw.gov.au/closingthegap
Williams S, Jamieson L, MacRae A, Gray C (2011) Review of Indigenous oral health. Retrieved April, 17 2015 from http://www.healthinfonet.ecu.edu.au/oral_review