Introduction
‘Closing the Gap’ initiative of the Australian government focuses on reducing the life expectancy and health gap among Indigenous Australians, the Aboriginal, and Torres Strait Islander people, to achieve health equality. Initially started as a social justice campaign, the initiative now presents a national strategy with a range of different socioeconomic targets. In addition to targets in the area of population health and wellbeing, the initiative also aims to improve issues with social determinants of health and provide more education and employment opportunities for First Nation people. The strategy also focuses on improving housing conditions and protecting the spiritual and economic connection of Aboriginal and Torres Strait Islander people with their land and waters. Taking a closer look at the strategy defines registered nurse practitioners’ role in improving First Nation people’s health by raising awareness about health disparity, developing cultural competence, and implementing cultural safety practices.
Indigenous Health and Wellbeing
Firstly, understanding the reasons behind health disparity for First Nation Peoples is required to develop an appreciation of the initiative in novice registered nurse practitioners. The main concerns which became the basis for the development of the initiative were high death rates and low life expectancy index among the Aboriginal and Torres Strait Islander people. Furthermore, it was determined that in most cases, the leading cause of death in the Australian Indigenous population was a chronic disease, such as diabetes, heart disease, kidney disease, and cancer (Australian Institute of Health and Welfare, 2022). While preventing mortality outcomes in patients affected by chronic diseases is possible with appropriate health resources, in this case addressing the issue required a complex approach to eliminating socioeconomic barriers to access to health services.
Next, the condition of a patient affected by the chronic disease is highly dependent on socioeconomic factors because they determine the patient’s social and emotional wellbeing. As a part of the governmental assimilation program, which wrongly assumed that improving the lives of First Nations people was possible through integration into white society, many Indigenous Australians were forcefully removed from their families. The Indigenous children forcefully removed from their families during that period are commonly referred to as the Stolen Generations. Emotional wellbeing is strongly associated with positive family relationships and support from family members. Considering that there are nearly thirty thousand Stolen Generations survivors, a significant portion of Indigenous Australians may experience mental issues from their inability to feel a sense of belonging and loss of cultural identity (Australian Institute of Health and Welfare, 2022). Therefore, the previous experience of unsuccessful policy draws attention to the issue of choosing culturally safe practices in addressing health disparities.
In addition, the disadvantage can persist through generations, resulting in poor emotional wellbeing in Stolen Generations’ descendants. Lastly, suicide and self-harm also present a significant part of mortality cases among Indigenous Australians. It is estimated that suicide rates are two times higher among Indigenous Australians than non-Indigenous Australians, and the difference is more apparent among younger people (Australian Institute of Health and Welfare, 2022). The issue signals a lack of activities in the healthcare system focused on support of the population’s mental health. Therefore, addressing the issue and shifting the focus to more accessible mental health treatment options will require additional efforts from the healthcare system.
Furthermore, the equality in the health of First Nation people is affected by low education and employment opportunities for the population in remote areas, poor housing conditions, and the inability to engage in healthy behavior activities. Employment and education are closely connected with the health status of Australian Indigenous people. Insufficient employment opportunities have a negative effect on individuals’ quality of life by limiting their access to oral and hearing health services. According to the Australian Institute of Health and Welfare (2022), ear infections such as otitis media can often result in hearing loss in children if they are not examined and treated in time. Furthermore, hearing impairment can affect children’s academic progress, reducing their educational opportunities. Next, a significant portion of Aboriginal and Torres Strait Islander people experience hearing and vision problems from a lack of proper care and timely inspection (Australian Institute of Health and Welfare, 2022). Hearing and vision problems furthermore reduce the quality of life of the population by limiting their possible actions.
Thus, exploring the health disparity experienced by First Nation Peoples demonstrates the importance of the ‘Closing the Gap’ initiative. Furthermore, the registered nursing practitioners’ knowledge of First Nation people’s health needs is essential for understating the role of cultural competence and cultural safety in the healthcare system. Registered nursing practitioners have access to regular direct communication with patients; therefore, they must use the interactions to increase the population’s awareness of the topic. Moreover, students transitioning to registered nursing partitioners must develop the necessary cultural competence to ensure their ability to participate in the initiative by using culturally safe practices.
Cultural Competency and Cultural Safety
Next, considering the theme of cultural competency and cultural safety, both aspects are acknowledged as necessary in eliminating inequities in ethnic health. However, some experts perceive cultural safety as a more practical approach to cultural competency and prioritize it over cultural competency in professional requirements. The difference between cultural safety and cultural competency is mainly explained by the healthcare professional’s willingness to challenge his own culture and cultural system. According to Curtis et al. (2019), the issue of ethnic health inequality also involves institutionalized racism, implicit bias, and unfair distribution of resources acknowledged as social determinants of health. Therefore, prioritizing cultural competency in addressing the needs of the Indigenous population is less likely to contribute to the overall system change than cultural safety policies. Thus, in the context of contributing to the ‘Closing the Gap’ initiative, healthcare professionals’ cultural competence is less efficient than implementing cultural safety practices.
The definition of the concept of cultural safety can vary across different countries, but it always emphasizes the power dynamic in ethnic health inequality. In particular, the concept prioritizes patients’ rights and eliminates the power imbalance between the patient and the healthcare provider. Thus, the cultural safety approach rejects the idea of learning the cultural customs of an ethnic group because it emphasizes the power of healthcare providers over patients. Instead, cultural safety focuses on transforming the existing healthcare system to be more accessible for indigenous populations. According to Curtis et al. (2019), cultural safety shifts the focus from changing the patients’ culture to changing the culture of the clinical environment. Therefore, registered nursing professionals have more opportunities to contribute to the ‘Closing the Gap’ initiative by utilizing cultural safety practices.
Next, while individual-level implementation of culturally safe practices in healthcare professionals is limited to their abilities and influence, the positive impact of cultural safety is evident when applied at the organizational level. According to Curtis et al. (2019), implementing culturally safe practices in healthcare organizations results in more transparent relationships between healthcare practitioners and patients, increased patient involvement, and higher patient safety. Furthermore, evidence of cultural safe practices’ efficiency also includes the elimination of biases, stereotypes, and prejudice in healthcare professionals, which increases the quality of services (Curtis et al., 2019). On the other hand, while cultural competency attempts to achieve similar outcomes, it risks oversimplifying the understanding of culture to the point of cultural essentialism, which will eventually result in lowered quality of care.
Lastly, considering the role of students transitioning to novice registered nurse practitioners in the initiative, several individual-level strategies are recommended to address the issue of health disparity for First Nation Peoples. Firstly, even though cultural competence presents a more common requirement for healthcare professionals, their activity should not be limited to the approach utilized in the cultural competence concept. Thus, all nurse practitioners should employ a wider understanding of their role in addressing ethnic health inequity by implementing cultural safety practices. Next, all healthcare professionals must implement cultural safety on individual and organizational levels and change the power dynamics between patients and healthcare providers by respecting patients’ rights. Lastly, novice registered nurse practitioners must develop appropriate skills to address the existing bias and stereotypes in the healthcare system and make each patient feel equal to the healthcare provider.
Conclusion
In conclusion, this essay explored the issue of ethnic health inequalities through the prism of the novice registered nurse practitioner’s role. The essay explained the major health concerns of Aboriginal and Torres Strait Islander people and described how the Australian government plans to address them through the ‘Closing the Gap” initiative. Gaining knowledge about health disparity for First Nation Peoples is very important for novice registered nurse practitioners because it allows them to understand the issue and raise the public’s awareness of the problem. The essay also explored the differences between cultural competence and cultural safety and explained how cultural safety is more important for healthcare professionals because it utilizes a more comprehensive approach with an emphasis on decolonization. Lastly, the essay provided several individual-level cultural safety strategies to address ethnic health disparity, which can be implemented in novice registered nurse practitioners’ activities.
References
Australian Institute of Health and Welfare. (2022). Indigenous health and wellbeing.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health, 18, 1-17.