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Australia's Rural, Remote and Indigenous Health - eBook

Australia's Rural, Remote and Indigenous Health - eBook

Janie Dade Smith

(2016)

Additional Information

Book Details

Abstract

Australia’s Rural, Remote and Indigenous Health 3e is a practical guide to the delivery of health care in rural and remote Australia. Drawing on personal experiences of rural and remote practitioners, historical accounts, literature analysis and epidemiology, this frank and engaging text examines the economic, social and political forces that shape healthcare in rural and remote Australia.

With limited current resources to support studies in rural and remote healthcare, this title bridges the gap by offering valuable insights into Indigenous life and social determinants of health through the use of storytelling. It is the perfect guide for anyone working in or planning to work in rural, remote or Indeginous Australia; and for those undertaking culturual studies, or social policy.

  • Only text covering both rural and remote health in Australia
  • Placement preparation with StudentConsult video interviews of experienced rural and remote practitioners providing first-hand experience of rural and remote practice
  • Pause and Think questions provide a frame
  • Pause and think question boxes train the reader to critically assess and apply concepts to practical situations.
  • New Chapter: Working with Indigenous Australians – Written by Shannon Springer, describes how to consult with Indigenous patients and draws on his experience in clinical practice. It offers consultation signposts and practical principles for working with Indigenous Australians.
  • New Chapter: Remote health practice – Written by Sue Lenthall, this chapter examines the differences and commonalities between the remote communities and then applies this information to a case study on 'a day in the life of a remote area nurse'. It presents a remote client consultation model and a StudentConsult audio consultation between a nurse and a distant doctor, as well as tips for working in remote practice. The audio consultation gives a first-hand account of the experience of a remote area nurse managing an emergency case.
  • Video and audio content – video interviews of experienced rural, remote and Indigenous health practioners as well as students. The videos contain first-hand experience of rural and remote practice as well as tips to help prepare those new to rural or remote practice.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Australia's Rural, Remote and Indigenous Health: A Social Determinant Perspective i
Copyright Page iv
Table Of Contents v
Video Contents vii
Preface viii
Foreword x
Acknowledgements xi
List of Reviewers xii
Dedication xiii
About the Author xiv
About the Contributing Authors xv
Introduction xvii
Commonly Used Terms xviii
1 Setting the Scene 1
1 Advance rural Australia 1
Who lives in rural Australia? 2
The first inhabitants 3
‘Settling’ the country: 1788–1900 4
Growing the state differences 6
Prostitution 8
Mateship 8
Rural Australia: 1900–2000s 10
Saving the country souls 11
Volunteering rural women 12
Migration 13
Rural decline 14
‘Country-mindedness’ 14
Leaving the country 15
Rural political forces: enter Hansonism 16
Rural Australia today 17
Conclusion 19
References 20
2 Defining rural and remote Australia 23
Urban Australia 24
Non-urban Australia 25
What does inner regional Australia look like? 28
What does outer regional or rural Australia look like? 29
Remote Australia 30
What does remote look like? 31
Isolated 32
Why define regional, rural and remote? 32
Classifying for urban, regional and remote regions 33
The three main classification systems used in health 34
Applying the classification to practice in very remote Australia 37
Providing health services in very remote areas 38
Classifying for disadvantage 40
Conclusion 41
References 42
3 Culture and health 45
What is culture? 46
What is worldview? 48
Understanding health culture 49
Recognising difference 50
International perspectives 50
Rites and rituals 50
Australian culture 52
Typical Aussies 52
Rural culture 53
Medical culture 55
Cultural safety 55
Principles of cultural safety 56
How do you achieve cultural safety? 57
Cultural awareness domain 57
Cultural sensitivity domain 58
Cultural safety domain 58
Cultural safety in Australia 59
What does a culturally safe health care environment look like? 59
Power, authority and health care outcomes 61
Racism 66
What is racism? 66
Stereotyping 67
Prejudice 67
Discrimination 67
Types of racism 67
Institutional racism 67
Cultural racism or ethnocentrism 68
Individual racism 68
Overt and covert racism 68
Dealing with racism – building resilience 69
Social justice 69
Conclusion – It’s a matter of respect 71
References 72
2 Indigenous Australians' Health 76
4 Indigenous Australia 76
Setting the scene 77
Who are Indigenous Australians? 77
Colonising the world 79
British colonisation of Australia 81
Australian policies of the day 82
Policy 1 – Colonisation: European settlement 1788–1880 82
Policy 2 – The White Australia Policy: 1850s–1973 83
Policy 3 – ‘Protection’ through segregation: 1890s–1950s 83
Policy 4 – Assimilation: 1950s–1960s 84
Policy 5 – Integration: 1967–1972 84
Policy 6 – Self-determination: 1972–1975 84
Policy 7 – Self-management 1: 1975–1988 84
Policy 8 – Self-management 2: 1988–2004 84
Policy 9 – Shared responsibility: 2004–2014 85
Policy 10 – Indigenous Advancement Strategy 2014–current 85
Health policy timeline: 1967–2016 86
Indigenous stereotyping 97
Conclusion 98
References 99
5 Putting Indigenous policy into practice – the double whammy 104
Putting policy into practice 107
Wages policy 108
The outcome 115
Was it genocide? 117
Assimilation policy 117
‘Sorry’ seems to have been the hardest word 120
Conclusion – Reconciliation 120
References 122
6 Working with Indigenous people 124
What is good health? 125
Looking back and going forward 126
Why so many funerals for our mob? 128
What are the causes of the health gap? 131
Improving Indigenous health and wellbeing 133
Risky behaviours for chronic disease 134
Tobacco smoking 135
Obesity 135
Physical inactivity 136
Government and organisational leadership 137
Providing access to appropriate health services 138
Imagine this situation 138
Aboriginal community controlled services 139
Accessing appropriate safe care 141
Effective communication in Indigenous health care 143
The consultation 143
Useful communication tips 146
Twelve principles for working effectively with Australian Indigenous peoples 148
Principle 1: Stand back, be quiet, listen, hear and wait 148
Principle 2: Get to know the local community 148
Principle 3: Be respectful at all times 148
Principle 4: Find a local cultural mentor for advice and guidance 148
Principle 5: Have an open heart 149
Principle 6: Don’t assume you know because you are experienced 149
Principle 7: Communication in practice is King 149
Principle 8: Don’t participate in racist behaviour 149
Principle 9: Learn to laugh at yourself and with others at you 149
Principle 10: The health status 150
Principle 11: Community control 150
Principle 12: Be cognisant of the cycle of staffing 150
Conclusion 150
References 151
7 Remote Indigenous health 155
Indigenous health 157
Remote infrastructure: The facts 159
FACT: Housing 159
FACT: Water 159
FACT: Electricity 159
FACT: Sewerage 159
FACT: Basic maintenance 159
Employment, food and grog: The facts 161
FACT: Unemployment 161
FACT: CDEP or RJCP 161
FACT: Access to food 161
FACT: Cost of food 161
FACT: Alcohol consumption 161
FACT: Violence against women 161
Lifestyle and education: The facts 163
FACT: Overcrowding 163
FACT: Life expectancy 163
FACT: Cardiovascular disease 163
FACT: Family violence 163
FACT: Access to education 164
FACT: Maternal education 164
FACT: Internet access in remote communities 164
Diseases of poverty: The facts 165
FACT: Income 165
FACT: Diabetes 165
FACT: Renal disease 165
Birth, lifestyle and death: the facts 167
FACT: Maternal mortality 167
FACT: Premature birth incidence 167
FACT: Smoking incidence 167
FACT: Substance abuse 167
FACT: Detention 167
FACT: Suicide 167
Spinning out of control 169
Health expenditure 171
International comparison 172
Mortality rates 174
Infant mortality 174
Breaking the poverty cycle 176
Indigenous statistics 177
Good remote stories 178
Conclusion 179
References 182
3 The Rural Health Landscape 188
8 Determining health 188
Health perspectives 189
An international perspective 189
A rural perspective 190
An Indigenous perspective 192
Patient-centred care 193
Contemporary views of health 194
What makes us healthy? 195
Health indicators 196
National health priority areas 196
The determinants of health 197
Determining indigenous Australians’ health 199
Australian colonial determinants of health 202
The cycle of poverty 203
Conclusion 204
References 206
9 Rural people’s health 209
Healthy Australians 210
The health of rural Australians 211
The triple whammy 211
Age discrimination 213
Older people 213
Young people 214
Cultural discrimination 214
Geographical discrimination 215
Diabetes and the triple whammy 216
Rural culture 217
Providing rural health services 217
Government blame-shifting processes 218
Prioritising rural people’s health 219
Conclusion 224
References 225
10 Caring for the population 228
Upstream, midstream and downstream approaches to health 230
Public health approach 231
Population health approach 232
What does this mean for the rural and remote primary health care practitioner? 234
‘Acute’ model versus ‘chronic’ model of care 234
Chronic care 235
Health promotion 237
Principles for health promotion 238
Health promotion should be everyone’s business 239
Primary health care approach 240
Applying the principles of primary health care 241
Yvonne’s and Julie’s different approaches to health 244
Yvonne – The biomedical approach 244
Julie – The primary health care approach 245
Community-controlled health service approach 246
Conclusion 248
References 249
4 Providing Health Care Services 251
11 Providing health services – the workforce 251
International workforce perspectives 253
The australian health workforce 253
The rural and remote health workforce 255
The nursing workforce 255
Geographical nursing distribution 256
Rural and remote nurses 256
Rural nurses 256
Remote area nurses 258
Nursing workforce trends 260
Nursing workforce shortages 260
Ageing workforce 261
The medical workforce 262
Geographical distribution 263
Medical specialists 264
Rural medical generalism 264
Remote medical practice 264
Medical workforce trends 265
Cultural change 266
Medical indemnity insurance 266
Feminisation of the medical workforce 266
International medical graduates 267
Indigenous health practitioner workforce 268
Role of the Indigenous health worker 269
Allied health workforce 270
Rural pharmacy workforce 271
Geographical distribution 272
Age and gender profile 272
Pharmacist rural roles 272
Supporting the rural and remote workforce 272
Why do they go and why do they stay? 273
Who goes? 273
Recruitment and retention 274
Why they leave 275
Are we in the right forest? 276
National data-collecting systems 277
Conclusion 277
References 279
12 Remote health practice 285
Professional roles 287
Scope of practice 287
Key remote health factors 288
The context 288
Common context 289
The common content 291
Remote practice as a separate discipline 293
The remote area nurse 294
RANs – who are they? 294
Where are they? 295
Who do they work for? 295
What do they do? 295
How do they do it? – The RAN Model of Client Consultation 301
Occupational stress 305
Tips in preparing for remote health practice 306
Implications for funders, managers and educational designers 309
Common learning – Interprofessional 309
Interdisciplinary approaches in remote Australia 311
Conclusion 311
References 313
13 A rural future 316
Social capital 317
Key factors for social capital 319
Trust 319
Business and civic-mindedness … ‘bloody banks’ 320
Volunteering 321
Rural community building 321
Growing health services 322
The rural health movement: two decades of action 322
Planting the organisational seeds 323
Growing the infrastructure 323
Advancing rural Australia’s health 325
A framework for the future 326
Barriers to ‘just’ health services 326
Retarding rural health 326
Appropriate education 327
Conquering the stigma 327
Conclusion – Advance rural Australia 328
References 329
Index 334
A 334
B 335
C 335
D 336
E 337
F 337
G 337
H 338
I 339
J 340
K 340
L 340
M 340
N 341
O 342
P 342
Q 343
R 343
S 344
T 345
U 345
V 346
W 346
X 346
Y 346