First Nations Australians are diverse peoples with a variety of histories, cultures, languages and experiences.
In order to deliver appropriate and culturally competent care, it is essential to understand the care needs and health of First Nations peoples.
It is a national priority to close the gap between First Nations Australians and non-First Nations Australians in healthcare, along with other areas including housing, education and employment (Healthdirect 2020).
First Nations Australians
First Nations Australians are:
Aboriginal peoples, who are the original peoples of mainland Australia; and
Torres Strait Islander peoples, who are the original peoples of the 274 islands located in the Torres Strait above Australia.
(Common Ground 2018)
First Nations peoples have diverse histories and cultures (Narragunnawali 2017). There are more than 500 First Nations clan groups around Australia and over 250 distinct languages that have been spoken by First Nations peoples (Australians Together 2020a; Narragunnawali 2020).
The Health of First Nations Australians
The life expectancy of First Nations Australians is significantly shorter than it is for non-First Nations people:
First Nations Australians
Non-First Nations Australians
(Australians Together 2020b)
In addition, the infant mortality rate is four times higher for First Nations Australians, and the rate of maternal mortality among First Nations Australians is double that of non-First Nations people (Australians Together 2020b).
The leading causes of mortality among First Nations Australians are ischaemic heart disease, diabetes, chronic lower respiratory disease and lung (and other related) cancers. Cardiovascular disease as a whole is also prevalent among First Nations Australians and is associated with hospitalisation and mortality (HealthInfoNet 2020).
Health issues experienced by a large number of First Nations Australians include:
Mental health conditions;
Chronic kidney disease;
Injuries and poisonings.
Understanding the Health Gap
First Nations Australians experience, overall, poorer health and earlier mortality than non-First Nations Australian people (DoH 2019).
This health gap between First Nations Australians and non-First Nations people should be viewed in the context of colonisation and its ongoing impact on First Nations peoples (Australians Together 2020b).
It is important to consider the social and cultural determinants of health, i.e. the context in which First Nations Australians grow, live, work and age. Social and cultural determinants include early child development, employment, education, access to healthcare and social inclusion (HealthInfoNet 2020; AIHW 2018a). The determinants of health that may adversely affect the health of First Nations Australians include:
Dispossession from land and culture;
Racism, discrimination and vilification;
Poverty and economic exclusion;
Child removal policies;
Inherited grief and trauma;
Loss of roles, cultures and statuses;
Incarceration and culturally-determined decisions and actions by the criminal justice system;
Separation from culture and identity
Low level of education;
Lack of access to education or early childhood services;
Poor quality of housing.
(NSW DoH 2014; AIHW 2018b; Beyond Blue 2013)
In addition to adversely impacting physical and mental health and predisposition to disease, these determinants may also impede First Nations peoples’ ability to access and interact with healthcare services (NSW DoH 2016).
Social and cultural determinants and health risk factors may interact, as they are closely connected. For example, smoking (a health risk factor) is more likely to be undertaken if the individual is receiving a lower income, is less educated or is living in a lower socioeconomic area (AIHW 2018a, b).
Caring for First Nations Australians
Keep the following points in mind when caring for First Nations Australians:
First Nations Australians are not a singular group; they are diverse peoples with different cultures, languages, experiences and needs.
Consider the terminology you use when talking about and engaging with First Nations peoples. Preferred terminology may differ depending on the individual or their community. Always consult First Nations peoples directly if possible. See this resource for more information about appropriate terminology.
First Nations peoples traditionally view health holistically, taking into account physical, cultural, social, emotional and spiritual factors. Ensure your care considers each client’s individual beliefs and values.
Respect segregation between genders (men’s and women’s business), which is part of cultural practice in some First Nations communities.
Understand the social and historical implications related to healthcare that may cause First Nations peoples to feel threatened, distrustful or disempowered.
Consider the emotional stressors that First Nations peoples may experience, especially if they have travelled from a remote location.
Work with First Nations peoples’ belief systems. Document their cultural views, including their concept of health, health beliefs, and cultural and gender-specific practices.
Understand language differences between First Nations and non-First Nations people; for example, First Nations peoples may use English differently. Some First Nations peoples may find direct communication confronting.
Take note of non-verbal communication. The Queensland Department of Health’s Patient Care Guideline provides information about body language that may be used by First Nations peoples.
Establish a culturally safe environment for First Nations peoples. For example, display Aboriginal and Torres Strait Islander flags and artwork, use First Nations resources (e.g. brochures and booklets) and seek advice from relevant First Nations personnel.
Take note of any signs of pain and discuss pain management options in a culturally sensitive manner.
Ensure medication is administered correctly; take note of any communication difficulties and engage an Indigenous Hospital Liaison Officer if required.
Be mindful and respectful of cultural beliefs.
Always ensure that the client is comfortable before conducting a physical examination. Explain the need for the examination and ask if the client would like a support person to be present.
(QLD DoH 2014)
Building Rapport and Communicating Effectively With First Nations Clients
It is essential to build rapport with First Nations clients, as this may help to overcome any fears of barriers. Some First Nations peoples may not disclose information until trust has been established (QLD DoH 2014). In order to build rapport and communicate effectively:
Greet clients in a warm and friendly way;
Use non-threatening body language and tones of voice;
Ask the patient where they are from and if they have visited the service before;
Identify a common view or topic with the client;
Tell the client a bit about yourself;
Explain processes and provide general information (e.g. waiting times, directions);
Show personal interest in the client;
Provide clarity and address any concerns the client may have;
Listen, be patient and allow for silence;
Adopt a non-judgmental approach;
Speak in plain English and explain if necessary;
Avoid technical language and medical jargon;
Use open-ended questions;
Be an active listener;
Speak quietly if other people are nearby;
Simplify written material and forms if possible;
Use visual aids; and
Ensure the client understands what has been said.
(QLD DoH 2014)
Overall, First Nations peoples are more likely to access healthcare organisations that:
Engage in partnerships with local Aboriginal and Torres Strait Islander communities;
Acknowledge cultural differences;
Respect First Nations peoples’ cultural beliefs and customs; and
Are physically accessible and affordable for First Nations peoples.
Being able to care for First Nations Australians in a culturally competent and respectful manner is essential in ensuring your clients feel comfortable accessing healthcare services effectively - and is a simple step you can take in working towards closing the life expectancy gap.