Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities

Abstract

BackgroundAboriginal and Torres Strait Islanders persistently experience a significantly lower standard of health in comparison to non-Indigenous Australians. The factors contributing to this disparity are complex and entrenched in a history of social inequality, disempowerment, poverty, dispossession and discrimination. Aboriginal medical services (AMS) provide a culturally appropriate alternative to mainstream medical services as a means to address this health disparity and also advocate for Indigenous rights and empowerment. This study provides a vignette of lay perspectives of Aboriginal and Torres Strait Islanders accessing community and government controlled AMS in Brisbane, Queensland with the intention of identifying self-perceived health determinants to inform the post-2015 international development goals.MethodsFocus group discussions and semi-structured interviews were held with clients of a government-controlled AMS and an Aboriginal community controlled health service (ACCHS) in order to identify their self-identified essential health needs. Conversations were audio recorded, transcribed verbatim and de-identified for analysis. Common themes were identified to highlight important issues around community health needs, how they can be addressed and what lessons can be extended to inform the post-2015 development goals.Findings and discussionParticipants acknowledge the complexity of health determinants faced by their peoples. Thematic analysis highlighted the pervasive influence of racism through many perceived health determinants; resulting in reduced healthcare seeking behaviour, unhealthy lifestyles and mental health issues. Participants emphasised the marked health improvements seen due to the establishment of Aboriginal medical services in their communities and the importance of the AMS’ role in addressing the negative effects of discrimination on Indigenous health.ConclusionIt is concluded from this study that AMS are crucial in addressing the negative impacts of continued discrimination on Indigenous health by providing comprehensive, culturally appropriate, community empowering health services. Such services improve Indigenous healthcare seeking rates, provide invaluable health education services and address mental health concerns in communities and must be supported in order to address health inequalities in Australia. Community driven and culturally informed health services should be encouraged globally to address health disparities.

The World We Want, leaving no one behind: did the Go4Health project represent the voices of marginalised communities into the post-2015 global health discourse?

“…What is clear from this analysis is that, while commonalities between marginalised communities are profiled, much of the particularity of experience for communities has been preserved in Go4Health accounts in the literature. The studies from Guatemala, Bangladesh, and Australia, concur that ethnicity is the common thread in self-identification, with people referring often to themselves by ethnic group, and describing themselves as having values, lifestyles and needs that are different from the dominant ethnic groups in their countries of nationality (Baba, Brolan, and Hill 2014;.…”

“…The uniqueness of each of WP2's community consultations lent an extraordinary diversity to Go4Health's output, which informed the mandate for global health while also making important contributions to wider policy discourse around the SDGs (Ibell et al 2015;Hussain 2014;Brolan et al 2014;Sheridan et al 2014;Baba, Brolan, and Hill 2014;Mulumba et al 2014 I conducted research in communities in 3 countries on behalf of BRACU: Afghanistan, Bangladesh, and the Philippines. My site selections were based on the guidance of both the Go4Health protocol as well as those of my BRACU supervisory reference group.…”

“…There are many complex determinants behind the appalling mental health indicators for Aboriginal people, but participants of this study strongly felt that every-day racism was a major cause for mental health issues, and by extension, other health conditions. (Baba et al, 2014) In their project reports Friedman and colleagues (2013) have synthesised this information, and also showcase the discrimination experienced by each of the communities consulted by the Go4Health research. They report that people feel a strong sense of personal responsibility in ensuring their health needs are met, and these meant ensuring that family members have enough to eat, put hygiene practices to use, having adequate sanitation facilities, and seeking health care services when necessary.…”

“…They report that people feel a strong sense of personal responsibility in ensuring their health needs are met, and these meant ensuring that family members have enough to eat, put hygiene practices to use, having adequate sanitation facilities, and seeking health care services when necessary. Family and community as a focus for health are a highlight of the publications (Baba et al, 2014;Mulumba et al, 2014). The failure to have needs met is attributed largely due to state apathy toward marginal groups, and at other times, due to active discrimination and structural violence, as in the cases of Guatemala and Bangladesh, where the state has forced indigenous communities to leave their original homelands (Baba, Brolan, and Hill 2014;Mulumba et al 2014;.…”

“…Family and community as a focus for health are a highlight of the publications (Baba et al, 2014;Mulumba et al, 2014). The failure to have needs met is attributed largely due to state apathy toward marginal groups, and at other times, due to active discrimination and structural violence, as in the cases of Guatemala and Bangladesh, where the state has forced indigenous communities to leave their original homelands (Baba, Brolan, and Hill 2014;Mulumba et al 2014;. That discrimination is a deep-rooted structural barrier for health is clear-it prevents people from accessing care because of the anticipated ill treatment by health care providers as reported in Baba's research (2014).…”