Introduction
As healthcare becomes increasingly complicated and technologically sophisticated, its efficacy and application need to be re-evaluated. Modern medicine’s reach is not infinite, and medical workers are not infallible. Sometimes the healthcare system may not be effective, especially when dealing with remote, socially disadvantaged, or otherwise notable groups of people. It has long been the case that Indigenous Australian and Torres Strait population is more likely to suffer and die from Type 2 diabetes. While the medical diagnostic measures and treatments may have advanced, their application may have remained lacking. The situation of the Indigenous and Torres Strait population can potentially be improved by implementing integrated healthcare. Before any conclusions regarding its efficacy can be made, this paper will present a discussion on Type 2 diabetes, the socioeconomic factors that influence the Indigenous population, the Social Determinants of Health, the Chronic Care Model, the Principles of Primary Health Care, and the integrated healthcare.
Indigenous Health and Social Determinants
Health problems do not appear out of the blue and strike at people indiscriminately. The social nature of humans, with all the complexities and inequalities inherent to it, has a profound influence on how people live their lives and what adversity they may face throughout. In practice, that means that health is dependent on social factors as well as biological ones. Examining these dependencies leads to the Social Determinants of Health, which are broad overlapping aspects of human life that can influence the person’s health and overall wellbeing (Clendon and Munns 7). These Social Determinants feature such things as child development, emotional support networks, education, and employment. Social inequalities experienced by the Indigenous and Torres Strait population create a divide in Social Determinants of Health in the Australian public.
A survey conducted in 2012-13 has found that 13% of Indigenous and Torres Strait adults had diabetes. Female respondents were slightly more likely to have diabetes than male respondents. Overall, the Indigenous population was 3.5 times more likely to have diabetes than non-Indigenous Australian adults (Burns 35). Of the Indigenous people, those living in the remote areas were twice as likely to have the condition than those who lived in non-remote areas, driving the disparity between Indigenous and non-Indigenous populations even higher. Curiously, the incidence of Type 1 diabetes is slightly lower in Indigenous Australians than in non-Indigenous Australians. Type 2 diabetes is the most prevalent type among the Indigenous and Torres Strait people and comprised 92% of all diabetes cases. Diabetes is the second leading cause of death for that group; on average, they were twice as likely to die from diabetes than non-Indigenous Australians.
There is evidence of ethnic differences in Type 2 diabetes incidence in other countries too. Minority youths in the United States of America have shown an increase in Type 2 diabetes incidence. Approximately 80% of all young people with that diagnosis belonged to ethnic minority groups (Butler 2). There are notable negative trends in the Social Determinants of Health of these groups. These youths belonged to households that had relatively low income and socioeconomic status, with their parents having attained low education. Suffering from Type 2 diabetes often coincided with experiencing major life stressors regularly.
These negative Social Determinants of Health are also experienced by the Indigenous Australian population, which may explain why they suffer from diabetes to such a disproportionate degree. According to Colagiuri, there are such socioeconomic disparities as lower educational attainment rates, lower employment, lower household income, and higher homelessness (156). Apart from the Social Determinants of Health, the Indigenous populations face a number of unique challenges when it comes to engaging with the healthcare system. Particularly, Indigenous women cited lack of transport, lack of comprehensive information, negative emotions brought by medical information, lack of control, and culturally unfriendly healthcare services (Campbell 559). Some of these barriers stem from living in remote areas and having relatively low income, consistent with the Social Determinants. In contrast, some stem from the healthcare system being unable to adapt to the particular needs of that ethnic group.
Unfortunately, diabetes is not a disorder that can be cured by a single procedure once and forever, it requires follow-ups and lifestyle changes. The negative Social Determinants of Health in the Indigenous and Torres Strait population indisputably play a role in the lifestyles available to them, which may not always facilitate wellness and regular medical evaluations. Profound structural changes should be made to improve the outcomes of the group and the way the healthcare system treats that population.
Principles of Primary Healthcare, Chronic Care, and Integrated Care
The Principles of Primary Healthcare underpin the practice of facilitating care from a social standpoint. These principles are oriented at providing accessible, scientifically sound care, which treats communities and cultures with respect, and, at the same time, promotes long-term wellness in individual patients (Clendon and Munns 13). Accessible care, appropriate technology, and health promotion are a given for any effective healthcare system. However, several of the principles are especially important for dealing with Indigenous communities.
The first crucial principle is intersectoral collaboration, which dictates that various communal sectors should cooperate and communicate to ensure that community members live healthy lives. This collaboration reduces structural inefficiencies, improves the quality of activities, and, ideally, tailors them to particular communities through decentralized management (Clendon and Munns 15). That would ensure small-scale action that is mindful of the local structures, which would engage the limited resources and people who know the most about the Indigenous Australians. Another essential principle, which stems from that local action, is cultural sensitivity and safety. Indigenous people responded much better to treatments that were designed specifically for them, involving members of their group (Gwynne 318). Similarly, a lack of cultural awareness alienated the Indigenous patients and decreased their follow-up rates (Campbell 559). Being intimately familiar with the Indigenous culture appears to be a necessity for an effective healthcare system.
As diabetes is a disorder that requires long-time management, Chronic Care Model could prove especially useful. The model features several core components and many building blocks, which serve to facilitate productive change in how healthcare systems deal with chronic patients. An especially important component of the model is community resources and policies, which include building up local infrastructure and health-oriented programs and events to promote wellness. Another crucial component is self-management support, which entails teaching the patient to live with the diagnosis and make beneficial lifestyle changes using the resources they have (Bodenheimer and Willard-Grace 90). Other components feature significant institutional changes that can reorganize facility personnel, introduce digital solutions, and improve access to disadvantaged groups. Reynolds et al. have found that including even a small number of these components can create tangible change (11). Introducing digital solutions was found to improve outcomes even in the research not concerned with the Chronic Care Model (Li 5). Creating a healthier environment and educating the Indigenous population about their health will serve to improve their outcomes and may even positively influence their Social Determinants of Health by creating a stronger community.
Integrated care is coordination of multiple healthcare systems, levels of care, stakeholders, and methods in order to create a holistic and comprehensive uninterrupted process of healthcare that promotes lifelong wellness and provides support to the patient throughout their lifespan. Integrated care incorporates disease prevention, treatment, rehabilitation, and palliative care, where information about the patient is managed and shared, and their health and wellness are considered from multiple angles (Goodwin). Integration can happen across several axes and areas of healthcare, with various intensity, complexity, or breadth. Effective integration creates a patient-centered approach that engages local resources that are mindful of the local culture, which is particularly important for the Indigenous and Torres Strait population. As integrated care is oriented to delivering lifelong holistic help, it could help manage a chronic condition like Type 2 diabetes for a long time. Moreover, that approach could develop the local infrastructure and create healthcare facilities in remote regions that are more convenient for the locals. Optimistically, that could improve the Social Determinants of Indigenous Health, helping prevent diabetes rather than treat and manage it.
Conclusion
While difficult and, most likely, very costly to introduce, integrated care delivery can help provide better service to the Indigenous and Torres Strait population and manage their various needs. A high-quality local-level healthcare system, which also engages community resources, can directly improve the Social Determinants of Health in the population. That approach combines the Chronic Care Model and integrated care delivery in accordance with the Principles of Primary Care to improve the health and wellbeing of the most vulnerable part of the Australian population.
References
Bodenheimer, Thomas, and Rachel Willard-Grace. “The Chronic Care Model and the Transformation of Primary Care.” Lifestyle Medicine, edited by Jeffrey I. Mechanick and Robert E. Kushner, Springer, 2016, pp. 89–96.
Burns, Jane, et al. Overview of Aboriginal and Torres Strait Islander health status 2018. 2019. Web.
Butler, Ashley M. “Social Determinants of Health and Racial/Ethnic Disparities in Type 2 Diabetes in Youth.” Current Diabetes Reports, vol. 17, no. 8, 2017. Web.
Campbell, Sandra, et al. “Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes.” Primary Health Care Research & Development, vol. 18, no. 6, 2017, pp. 549–562.
Clendon, Jill, and Ailsa Munns. Community Health and Wellness: Principles of primary health care. Elsevier Health Sciences, 2018.
Colagiuri, Stephen. “Diabetes in Indigenous Australians and Other Underserved Communities in Australia.” Diabetes Mellitus in Developing Countries and Underserved Communities, edited by Sam Dagogo-Jack, Springer, 2017, pp. 151–163.
Goodwin, Nick. “Understanding Integrated Care.” International Journal of Integrated Care, vol. 16, no. 4, 2016. Web.
Gwynne, Kylie, et al. “Improving the efficacy of healthcare services for Aboriginal Australians.” Australian Health Review, vol. 43, no. 3, 2018, pp. 314-322.
Li, Shu Qin, et al. “Does delay in planned diabetes care influence outcomes for aboriginal Australians? A study of quality in health care.”BMC Health Services Research, Vol. 19, 2019. Web.
Reynolds, Rebecca, et al. “A systematic review of chronic disease management interventions in primary care.”BMC Family Practice, vol. 19, 2018. Web.