Aboriginal and Torres Strait Islander Peoples' Health Flashcards

Define cultural safety.

The ongoing critical reflection of practitioner knowledge, skills, attitudes, behaviours, and power differentials in delivering safe and responsive healthcare free of racism. It is determined by ATSI people and families.

What are the 6 cultural determinants of health for ATSI people (FIICCS)?

1. Family, kinship, and community

2. Indigenous beliefs and knowledge

3. Indigenous language

4. Connection to country

5. Cultural expression and continuity

6. Self-determination and leadership

Why is there no written record of life in Australia before 1788?

Aboriginal and Torres Strait Islander people passed down information and culture through oral traditions (stories and songs). Some archaeology like paintings, footprints, and rock carvings show objective evidence of life.

What is cultural fire used for?

Fuel reduction, food, fibre, medicine regeneration and management, fauna habitat protection, and the healing of Country spirit.

Describe the Wilto (Southern Cross) constellation significance.

The Aboriginal people of the Adelaide Plains have an eagle constellation called Wilto. The southern cross represents the raptor’s foot. Nations share the southern cross story as the eagle’s foot. It is viewed as a place where deceased spirits travel up to the heavens.

Define settler colonialism.

The historical process where European settlers replaced Aboriginal people on their land, attempting to eliminate culture and society through massacres, forced displacement, and disease to establish a new society that claimed land ownership, justified by ‘terra nullius’.

Define intent to replace.

Settler colonialism aimed to replace existing Indigenous populations with new settler societies unlike traditional colonialism which focused on resource extraction.

Define land dispossession.

Seizure of Indigenous land and its allocation to European settlers.

Define cultural assimilation.

Attempts to integrate Indigenous people into settler culture, through forced removal of children so their identity would be lost over time. They proposed that “full blood” children should be allowed to die out through natural elimination while “half castes” should assimilate into white culture.

What was the impact of assimilation and protection on ATSI people?

Its policies included separate education, town curfews, alcohol bans, no social security, lower wages, state guardianship over all children, segregation of living spaces, and forcible removal of children for placement in white institutions or foster homes.

Describe the Stolen Generations.

Occurred between 1910s and 1970s, disguised as child welfare. Children were placed in foster care or forcibly adopted, experiencing significant abuse and neglect.

Describe the Victorian Aboriginal Protection Act of 1869.

It allowed mixed children to be removed from reserves, forcing them to assimilate into white society. They were not allowed to speak traditional languages, participate in cultural activities, and they were forced to adopt new names and identities.

Describe the Aborigines Protection Amending Act.

Established in 1915 to give the Protection Board the authority to remove Aboriginal children without having to establish in court that the children were subject to neglect by their own families.

Describe the purpose of group homes.

Many stolen children were placed in group homes like the Cootamundra Girls Training Home where they were taught housekeeping and farm handling so they could serve white families. They experienced abuse and neglect in many forms, including physical and sexual abuse.

Describe the Aborigines Welfare Board.

Established in 1969 which resulted in all States and Territories having revoked legislation that allowed for the removal of Aboriginal children under ‘protection’ policies.

What are some immediate implications of forced removal?

Mistrust, loss of culture, lost family, lost language, psychological harm, physical injury and neglect.

What are some ongoing implications of forced removal?

Intergenerational trauma, increased likelihood of developing chronic conditions like cancer, diabetes, and heart disease, loss of identity, loss of connection to culture and land.

Describe the impacts of the Stolen Generations on survivors as they age.

Survivors are more likely to develop dementia because of their trauma. Those with dementia experience higher barriers to accessing care. Triggers include things reminding them of trauma (clinical settings resembling institutions), authoritative tones of voice, gestures, facial expressions, and general situations bringing back a feeling of a lack of control.

Define trauma-informed practice.

A strengths-based approach to healing that is responsive to the impacts of trauma, prioritising cultural, spiritual, psychological and physical safety, but does not avoid addressing sensitive and triggering issues. Providers are skilled in managing the effects of triggering conversations, and empowering people through increased understanding of their lived experiences.

Define racism.

A phenomenon that results in avoidable, unfair inequalities in power, resources, or opportunities across societal groups. It can be expressed through beliefs, prejudices, or behaviours, and can be based on race, ethnicity, culture, and religion.

Define individual racism.

Involves 2 or more people where one person expresses negative attitudes and beliefs about someone else or a specific group.

Define institutional racism.

Formal and informal, intended and unintended. Involves actions by institutions or systems that systematically privilege members of a certain racial group and disadvantage other minority groups. It reflects the cultural assumptions of the main group (seen as the norm), and is exhibited in health outcomes.

Define cultural racism.

Views minority groups as the cause of their disadvantage. Cultural context and behaviours are blamed while structural factors and institutional racism aren’t acknowledged. For example, beliefs that poverty is caused by cultural behaviours attributed to specific minority groups are assumed to prevent successful participation in contemporary society.

Define environmental racism.

Related to policies/practices that disproportionately affect certain population groups in relation to living and health. For example, inadequate living conditions (no access to clean water and electricity) negatively impact health and wellbeing. Minority groups suffer disproportionate health conditions and a lower life expectancy as a result.

Define ideological racism.

Social myths about, and representation of certain groups.

Define micro-aggressions.

Intended and unintended, like moving away from a person in a store or on public transport.

Define stereotypes.

Fixed, over-generalised beliefs about a particular group of people, inferring that a person has a range of characteristics that one assumes all members of this group have.

Define bias.

Disproportionate weight in favour of or against someone/something. While we process bias consciously or unconsciously, it can have unintended consequences or unfairly influence decision-making and thinking.

Define unconscious bias.

Refers to attitudes and patterns of perceptions held subconsciously. They influence thoughts and actions that result in the creation of unfair advantages or disadvantages without the person’s awareness. They cause negative consequences and unintended discrimination for those subject to it.

Define white privilege.

Inherent advantages possessed by a white person on the basis of their race in a society characterised by racial inequality and injustice. They are formed through society that treats white people as the racial norm. It explains that any disadvantages white people face is not because of their race.

What are some “benefits” of systemic white privilege?

Access to higher education, well paying jobs, safe neighbourhoods to live in, police protection, and other basic civil liberties.

Describe the National Aboriginal and Torres Strait Islander Health Plan.

Policy outlining a 10 year strategy to improve health outcomes for Aboriginal and Torres Strait Islander people, focuses on culturally safe/responsive healthcare, equitable access, prevention, racism-free, guides the development of all policies and programs nationally.

Describe the National Agreement on Closing the Gap.

All Australian governments signed it in 2020, built around what Aboriginal people have said is important to improve their lives, has 4 priority reforms to create new accountability measures, shared monitoring and implementation arrangements.

Describe the connection between racism and health/wellbeing.

Regular racial discrimination is associated with increased psychological distress and risk of mental illness. The suicide rate is higher due to complex influences including colonisation, trauma, racism, and disadvantage. They delay seeking health services, leave hospitals early (AMA) as a result.

What is the connection between racism and health/wellbeing for young people?

Linked to higher rates of anxiety, depression, psychological distress (particlarly causing PTSD, headaches, higher HR, muscle tension).

Describe how cultural safety is integrated into the NMBA code of conduct for nurses.

Acknowledges that Aboriginal people inhabited the land first, that it is a culturally and linguistically diverse nation, requires HCPs to understand the historic factors like colonisation and its impact on ATSI health, provides guidance for nurses/midwives in supporting the health of ATSI people.

Describe the Call it out First Nations racism register.

A secure way for people to report incidents of racism/discrimination towards Indigenous people, analysed to inform annual reports to raise awareness and drive systemic change.

Define a National Aboriginal Community Controlled Health Organisation.

National peak body, represents 146 ACCHOs, provides policy and budget advice to the government, advocates for community based solutions that improve health outcomes, representation, raises awareness, advances community-led responsive healthcare solutions to improve health/wellbeing.

Define an Aboriginal Community Controlled Health Organisation (ACCHO).

Community run, primary health service providing comprehensive and culturally informed care for ATSI people, addressing physical, emotional, social, and cultural wellbeing for individuals and communities. They emerged in response to barriers to traditional healthcare access.

Define an Aboriginal community-controlled organisation (ACCO).

It is a business/charity, not for profit organisation incorporated under state/territory legislation, has at least 51% ATSI ownership and/or directorship, operated for the benefit of Aboriginal communities.

Describe the importance of Aboriginal community-controlled organisations (ACCOs).

They increase the amount of government funding allocated for ATSI programs and services that they run, in accordance with priority reform 2 of the Close the Gap campaign (building community-controlled sectors to deliver closing the gap services).

Describe the NSW Aboriginal Health & Medical Research Council.

It is the voice on Aboriginal health, representing ACCHOs in NSW, addressing their needs and improving health outcomes. They support ACCHOs to deliver culturally safe primary health services to communities at local, state, and national levels, addressing social determinants and ensuring Aboriginal involvement in decision-making and service delivery.

Describe the ACCHO model of care.

A holistic system, grounded in lived realities, culture, law, and country, using changing structures and relationships to design culturally informed health models. This informs best policy and legislation.

Describe the declaration of Alma Ata.

The components of primary health include education concerning prevailing health problems, promotion of food/nutrition supplies, adequate supply of safe water and sanitation, maternal/child healthcare including family planning, immunisation, prevention/control of locally endemic diseases, appropriate treatment of common diseases and essential drug provision.

Describe the declaration of Astana.

Unanimously endorsed by all WHO member states making pledges in 4 areas:

1. Make bold political choices for health across all sectors

2. Build sustainable primary healthcare

3. Empower individuals and communities

4. Align stakeholder support to national policies, strategies, and plans

What are the 5 pillars of the Ottawa Charter?

1. Building healthy public policy

2. Creating supportive environments

3. Strengthening community action

4. Personal skills development

5. Reorientation of health services

Define cultural vitality.

Encompasses the maintenance and development of cultural expression, knowledge, practices, and support for essential services like education and healthcare. It promotes an ability to adapt and thrive while maintaining a unique cultural identity.

Define decolonisation.

Decolonizing the mind involves acknowledging and addressing the historical and ongoing effects of colonisation on Indigenous people, including the ways it has impacted their mental health and wellbeing.

Give examples of decolonizing healthcare in Australia.

1. Value diversity and inclusion

2. Experience positive/affirming spaces to build motivation and purpose in leading healthy and empowered lives

3. Feel personally and culturally safe

4. Connection to culture and other ATSI people

5. Immersion in culture to heal from historical/cultural loss

6. Reconstruct self care and strengthen collective care

7. ATSI leadership in health programs builds self-determination

Give some examples of ways to improve health interactions for ATSI people.

More relevant, local services, cultural competence, therapeutic relationships with HCPs, continuity of care, extended visiting hours, Indigenous staff at all levels, Indigenous-specific treatment options (non-traditional services), respecting Aboriginal kinship systems, local artwork, spaces in hospitals.

Describe the Indigenous Australian Social and Emotional Wellbeing Framework.

A developmental framework from the 1980s that is Indigenous driven. It is a preferred term to describe their understanding and experiences of their relationships to mental health aspects which is important since perceptions of mental health/illness come from western models of health.

Describe a holistic framework and the 7 domains of wellbeing.

It acknowledges the historical and social context of Indigenous people including their connections to land, family, community, and the personal choices they make. Wellbeing is determined by relationships between 7 domains: Body, mind/emotions, family/relationships, community, culture, country, spirituality.

Describe Indigenous connection to body.

Refers to physical health, felling healthy and strong, individuals can participate in life as fully as possible.

Describe Indigenous connection to mind and emotions.

Refers to mental health, individuals can manage their thoughts and feelings, maintain a positive mental health, cognitive emotional and psychological wellbeing.

Describe Indigenous connection to family and kinship.

Central to the functioning of Indigenous societies. A strong family and kinship system provides a sense of belonging, identity, security and stability.

Describe Indigenous connection to culture.

Maintaining a secure sense of cultural identity by participating in cultural practices (language, traditional law, men and womens’ business).

Describe Indigenous connection to community.

Provides opportunities for individuals and families to connect, support each other, and work together.

Describe Indigenous connection to spirituality.

Provides a sense of purpose and meaning. Mental health and emotional wellbeing is influenced by relationship, traditional beliefs, and the metaphysical world (Dreamtime and totems).

Describe Indigenous connection to country.

Underpins identity and a sense of belonging, refers to an area where Indigenous people have a tradition and spiritual association. It is viewed as a living entity that provides nourishment for the body, mind and spirit.

Describe culture bound syndromes.

A combination of psychiatric and somatic symptoms considered to be a recognisable disease only within a specific culture. For example, Aboriginal people don’t believe that they get sick from within their body, they believe that they get sick because of someone else and their intentions.

Describe the WHO’s definition of mental health.

A state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to their community.

Define mental illness.

Disorders that affect cognition, mood, and/or behaviour, diagnosed clinically according to the DSM-5 or the international classification of diseases.

Define psychological distress.

Worry, restlessness, and sadness in response to stressful or difficult circumstances.

Define resilience.

The capacity to bounce back following adversity.

What are some risk factors impacting on social and emotional wellbeing?

Discrimination, racism, widespread grief and loss, child removals, unresolved trauma, life stress, social exclusion, economic and social disadvantage, incarceration, juvenile justice supervision, violence, substance use, and physical health problems.

What are some strategies to enhance social and emotional wellbeing?

Social justice and societal reconciliation, collaboration between ACCHOs and governments, culturally appropriate therapies, narrative therapies, development of culturally competent healthcare assessments, community development/empowerment, policy initiatives/frameworks, family wellbeing programs.

What are some protective factors for social and emotional wellbeing?

Connection to land, culture, community, spirituality, ancestry, kinship, self-determination, community governance and cultural continuity.

Describe the Close the Gap Campaign.

Started in 2008 where the government apologised to the Stolen Generations and set policy goals to close the gap regarding Indigenous disadvantage in education, employment, and health. There are 7 targets, none of which are currently on track to closing the gap.

What are the 7 targets of the Closing the Gap Campaign?

Child mortality, early childhood education, school attendance, literacy and numeracy, year 12 attainment, employment, and life expectancy.

Describe the 2021 National Agreement.

It replaces the National Indigenous Reform Agreement, setting out a strategy to close the gap based on ATSI priorities with 4 priority reforms:

1. Developing/strengthening structures to ensure full involvement of ATSI people in decision-making

2. Building a formal ATSI community-controlled services sector to deliver services/programs in agreed focus areas

3. Ensuring government institutions undertake systemic change to contribute to closing gaps, improve accountability

4. Ensuring ATSI people have access to, and the capability to use locally relevant data to monitor the implementation of these reforms, closing the gap targets, and drive local priorities

What are some areas where closing the gap progress has been made?

Babies are born healthy and strong, early childhood education has been provided, and there is greater economic participation.

What are some areas for further progress in closing the gap?

Longer life expectancy, children thriving more, greater student learning potential, more education pathways, youth engagement, housing, criminal and youth justice, child protection, family safety, social and emotional wellbeing, thriving culture/languages, and greater access to information.

What are the 5 main causes of death for Aboriginal people?

Circulatory disease, cancer, injury/poisoning (including self harm and suicide), respiratory disease, and endocrine disease.

What are some contributing factors to poorer health outcomes?

Many Aboriginal people are unemployed, have no post school qualifications, no household internet connection, low weekly household income, rent, live in multi-family households, reside in dwellings with 6 more people compared to non-Aboriginal people.

What are some benefits of effective communication?

Increased likelihood of establishing beneficial relationships, increased confidence and self empowerment, reduced misunderstandings, reduced rates of non compliance and DAMAs, improved reputation.

What are reconciliation action plans (RAPs)?

They are ways for organisations to communicate with Aboriginal people and communities about how they aim to provide a more welcoming and culturally safe environment for them when accessing services.

What is a cultural interface?

A term describing a place to find common ground and innovation between Aboriginal and non-Aboriginal people. Higher knowledge levels contribute to a cultural interface, minimising the gap and cultural differences between groups.

What are the 5 principles of cultural safety?

1. Protocols - Show respect, get consent, seek cultural knowledge

2. Personal knowledge - Consciousness of social location/power

3. Partnerships - Engage in authentic encounters/relationships

4. Process - Ensure equity and dignity, negotiate goals

5. Positive purpose - Build on strengths, confidentiality, accountability

Define cultural humility.

A lifelong commitment to self reflection, self-critique, and learning about yours and other peoples’ cultures. It requires openness to other beliefs, customs, and values, honouring these differences. It is essential to recognising and addressing power imbalances to balance them.

What are some benefits of cultural humility?

Smoother collaboration, teamwork, increased sense of belonging, growth with dignity and integrity, and a greater ability to recognise the strengths of other people.

Provide some ways to be an ally to Aboriginal communities.

Listen to/follow the community when working with them, know the historical and cultural context, never show up empty-handed (use your skills, labour, and resources to help), always seek consent/permission, know when to step back, stand in solidarity (not performative), do no harm to the community, and be mindful of the time and energy of others.

Define Aboriginal community control.

A process allowing the Aboriginal community to be involved in community affairs in accordance with any protocols/procedures determined by the community.

Define the Dreaming.

A sacred, timeless concept that explains the origins of the world, people, and natural phenomena. It isn’t just a past event, but an ongoing, living narrative connecting the past, present, and future.

Define Aboriginal Spirituality.

Expressed by people connecting through kinship, relationships, and identity, living their beliefs through creation stories, practicing culture, and ceremonies, and caring for/nurturing creation through country, skies, waterways, and animals.

Define ancestral beings.

Stores and beliefs about mythical creator figures who shaped the land and established the rules of living.

Define totemic relationships.

People are connected to specific animals, plants, or natural features through totemic relationships, which define their identity and personal responsibilities.

Describe harmony and balance.

Aboriginal spirituality emphasizes living in harmony with nature and maintaining balance in the natural world, which includes taking only what is needed and respecting all living things.

Describe oral tradition.

Stories, songs, and ceremonies are used to transmit knowledge, history, and spiritual teachings between generations.

Define interconnectedness.

Everything is seen as interconnected in Aboriginal spirituality, including people, the land, and the natural world.

Define culture.

A system of values that individuals determine as their way of life. It is a shared set of beliefs in how individuals think, react, communicate, and behave. It evolves over many years and is built up by many individuals, passed between generations.