HLTHIR404D Work Effectively with Aboriginal And/Or Torres Strait Islander People

HLT07 Health Training Package

HLTHIR404D

Work effectively with

Aboriginal and/or Torres

Strait Islander people

Learner resource

Version 2

Training and Education Support Industry Skills Unit SAMPLEMeadowbank

Product Code: 5577

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Acknowledgments The TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank would like to acknowledge the support and assistance of the following people in the production of this learner resource guide:

Writers: Irene Hancock Karyn O‟Reilly TAFE NSW

Reviewers/Editor: Beryl Grant Cheryl Bradshaw Rhonda Albani Merja Debsia Liz Bougaardt Maryjane Mullarkey Amanda Culver Sherryl Dismorr TAFE NSW

Project Manager: Amanda Culver Project Coordinator Health and Aged Services TAFE NSW Acknowledgements are also given to all facilitators of the Enrolled Nurse Education Program.

Enquiries Enquiries about this and other publications can be made to: Training and Education Support Industry Skills Unit, Meadowbank Meadowbank TAFE Level 3, Building J, See Street, MEADOWBANK NSW 2114 Tel: 02-9942 SAMPLE3200 Fax: 02-9942 3257 © TAFE NSW (Training and Education Support, Industry Skills Unit Meadowbank) 2012

Copyright of this material is reserved to TAFE NSW Training and Education Support, Industry Skills Unit Meadowbank. Reproduction or transmittal in whole or in part, other than subject to the provisions of the Copyright Act, is prohibited without the written authority of TAFE NSW Training and Education Support, Industry Skills Unit Meadowbank.

ISBN 978-1-74236-314-1

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Table of contents

Introduction ...... 7

1. General introduction ...... 7

2. Using this learner guide ...... 8

3. Prior knowledge and experience ...... 10

4. Unit of competency overview ...... 10

5. Assessment ...... 11

Section 1 Aboriginal and/or Torres Strait Islander Peoples’ history/Diversity of Culture ...... 13

Section 2 Knowledge of own and other cultures ...... 31

Section 3 Cross-cultural awareness and sensitivity ...... 35

Section 4 Issues affecting communication ...... 41

Section 5 Cultural safety and respect ...... 53

Section 6 Legislation and policies ...... 63

Section 7 Collaboration with Aboriginal and/or Torres Strait Islander communities ...... 71

Section 8 Aboriginal concept of health and wellbeing...... 79

Section 9 Factors contributing to Aboriginal and/or Torres StraitSAMPLE Islander Peoples’ ill health ...... 85 Section 10 Work practices and services ...... 95

Section 11 Develop workplace relationships — Mentoring/CATSIN ...... 105

Reference list ...... 107

Resource Evaluation Form ...... 111

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Section 1 Aboriginal and/or Torres Strait Islander Peoples’ history/Diversity of Culture

Historical events Aboriginal history dates somewhere between 50,000 and 100,000 years ago. When the first settlement was established in Australia in 1788, the first people of Australia namely the Aborigines, were estimated to have numbered 300,000 to 1,000,000 people. There were around 250 languages spoken with up to 600 different dialects. The population was densest in NSW and Victoria particularly on the coast.

Activity 1

Identify an appropriate website that explains early Aboriginal culture and answer the following questions..

(i) When did the first fleet arrive?

______

(ii) The area that was to become New South Wales hosted seventy or more Aboriginal languages and dialects. Match the dialects with the areas of NSW as outlined in the reading.

Dialects Region of NSW Muruwari, Ngiyampaa, Paakantji and Yandruwandha Mathi-mathi, PaakantjiSAMPLE and Wiradjuri Gamilaraay, Muruwari, Ngiyampaa, Wangkumara, Wiradjuri and Yuwaalaraay Anewan (Nganyaywana), Birpai, Bundjalung, Dhangadi, Gadhang, Gamilaraay, Gidabul, Gumbaynggirr, Ngarrabul, Wonarua, Yaygirr In Awabakal, Bidawal, Dharawal, Dharuk, Dhurga, Gundangara, Monero, Ngarigu, Ngunawal, Walbanga, Wandandian and Yorta Yorta

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Activity 1 (continued)

(iii) How was knowledge passed on from one generation to another? ______

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(iv) Describe two initiation rites. ______

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(v) Outline the values that were taught to traditional Aboriginal society, prior to the arrival of the British. ______

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(vi) From time to time clans gathered. What was the purpose of these gatherings? ______

______

(vii) Identify Tiddalik. Write the story below. ______

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______SAMPLE______

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Page 14 of 114 © TAFE NSW (Training & Education Support, Industry Skills Unit Meadowbank) 2012

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Activity 1 (continued)

(viii) What marked the beginning of white settlement in Australia?

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(ix) How could a colony be established?

______

(x) Why was the land defined as “Terra Nullius”?

______

Over the decades many issues have arisen which have widened the gap between Indigenous and non- Indigenous Australians. Examples of these include setting up of reserves, the assimilation policy of the 1940s-1960s, children being removed from their families for education and work opportunities (the Stolen Generation), granting of citizenship as late SAMPLEas 1967, self determination policy of the Whitlam government (1972), establishment of the TENT embassy on the lawn of the original Parliament house, Federal Racial Discrimination Act (1975), land rights, Royal commission into Black Deaths in Custody (1987) and reconciliation between Indigenous and other Australians.

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Activity 2

Using an appropriate website research “Aboriginal protection”, “Aboriginal assimilation”, “Aboriginal integration” and “Aboriginal reconciliation”. Now answer the questions below.

(i) What was the purpose of the Aborigines Protection Board? ______

______

In 1909 the New South Wales Aborigines Protection Act was passed. This was to be the main legislation governing the lives of Aboriginal people for the next 60 or so years, although it was amended many times according to changing government policies. (ii) What did the Act provide for? ______

______

(iii) What was the aim of assimilation? ______SAMPLE______(iv) Outline some of the policies that impacted harshly on Indigenous people. ______

______

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Health

The arrival of European settlers in the 18th century brought dramatic changes to the Aboriginal and Torres Strait Islander Peoples way of life, with dire consequences. They found themselves “disposed of their traditional lands and eventually restricted to mission settlements. This led to the loss of their traditional lifestyle and reliance on welfare provision by the state and/or churches.” (Gray, 2006)

Exposure to diseases such as influenza, measles, smallpox and typhoid had a decimating effect on the population. Their traditional medicines were ineffective against such diseases and they had little access to the health care provided to the European settlers. “Aboriginals, who had already had their populations decimated by European diseases and violence, were now dependant on unhealthy diets and were exposed to alcohol, a drug previously unknown in their cultures. The net effect of these developments was a massive decline in the Aboriginal population and severe health problems for those who survived.” (Saggers & Gray, 1991 as quoted in Gray, 2006).

The developing health care system of the time was based on the European medical ideas and practices brought into the country by the surgeons from the first fleet and did not incorporate or acknowledge any of the traditional health practices of the Aboriginal and/or Torres Strait Islander Peoples, there is evidence however, that the early European settlers were taught how to use traditional plants to replace their dwindling medical supplies.

READING 1

(Gray 2006 pp.279-282)

“Aboriginals are the most socially and economically disadvantaged group in contemporary Australian society. Compared with the Australian population as a whole, they experience lower levels of income and education as well as higher levels of unemployment. Aboriginals are also severely disadvantaged in terms of health.

More recent data (ABS 2005a in ATSI health Perf Framework report 2006) shows slight improvement inSAMPLE ATSI life expectancy of 59.4 years and 64.8 year for females. This is still way below that of non-indigenous Australians. It is also lower than the life expectancy of indigenous people in New Zealand and Canada.

“The age-specific death rates for Aboriginals were higher than for non-Aboriginals in all categories, but especially pronounced in the 35-44 age category where it was at least four times higher than for the total population (ABS 2002a). As bad as they are, these figures may be underestimates of Aboriginal mortality.

The two main causes of death for both Aboriginals and non-Aboriginals are diseases of the circulatory system and cancer. However, Aboriginal death from external causes (accidents, assault and self-harm) are more common that among non-Aboriginals (17% v. 6%). Aboriginals are also more likely than non-Aboriginals to die from endocrine and metabolic diseases, especially type 2 diabetes (ABS 2002a).

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

For virtually every cause of death, Aboriginals die at an earlier age, especially diseases of the digestive system. Aboriginals also haven an infant mortality ratio over twice than of the non-Aboriginal population (11 per 1000 live births v. 5 per 1000 live births) (ABS 2002a).”

More recent data on infant mortality indicates no major improvement in ratios since 2002. (ATSI H.P.F.R.2006)

“Aboriginal Australians also experience substantial inequality in regard to morbidity. Although the National Health Surveys of 1995 and 2001 reported that Aboriginals have chronic and recent illness levels similar to non-Aboriginals and generally high levels of self-assessed health, this is due to the younger age structure of the Aboriginal population. Once age-specific rates are examined, another picture of Aboriginal health emerges. In particular, Aboriginals are approximately twice as likely as non-Aboriginals to report only fair or poor health. Aboriginals are also more likely to have higher rates of asthma, hypertension, diabetes, kidney disease, dental disease, injury and cancer (ABS 1999; Edwards & Madden 2001; Trewin & Madden 2003).

Diabetes is an especially serious problem (Edwards & Madden 2001; Trewin & Madden 2003). Hospital separations for Aboriginal males for diabetes are approximately four times higher than for the non-Aboriginal male population. The separation rates for diabetes are even worse among Aboriginal females, with a rate approximately six times higher than that of non-Aboriginal females (Trewin & Madden 2003). The differences in Aboriginal and non-Aboriginal rates of diabetes start at about the age of 25 and are worse for Aboriginals living in remote areas. Not surprisingly, Aboriginals are more likely to have haemodialysis, although they are less likely to receive transplants. The reason this is that Aboriginals with diabetes often have multiples illness problems that make them unsuitable for transplant surgery (Edwards & Madden 2001).

Aboriginals are also disadvantaged in terms of their access to health services. Although per capita spending on Aboriginal health is greater than that for non- Aboriginals (Edwards & Madden 2001; Trewin & Madden 2003) and special government programs exist to deal with Aboriginal health, it is doubtful that these expenditures and programs produce equitable access to health services. The higher proportion of Aboriginals living in remote areas is one reason for this problem, with the absenceSAMPLE of culturally appropriate services and native-language speakers also causing difficulties in some areas. Aboriginals are also less likely to have private health insurance than non-Aboriginals.

The pattern of health care service use among Aboriginals also suggests problems in accessing appropriate care. In particular, after adjusting for age, Aboriginals are less likely to consult dentists than non-Aboriginals and more likely to consult medical practitioners, attend hospital emergency services and day clinics and be admitted to hospital (Trewin & Madden 2003). Aboriginals also report more workdays lost to illness and injuries than non-Aboriginals. Altogether these facts present a picture of an Aboriginal population that has less access to regular health care providers and is more likely to rely on hospital services and clinics after illnesses have reached increased levels of severity.

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

Explanations for Aboriginal health inequality tend to fall into the two broad categories of material and cultural deprivation. These have also been present for some other groups experiencing health inequality (such as working class people). To a large extent, this distinction is more analytical than actual, as material and cultural explanations are not independent of each other, especially in the case of Aboriginal health inequality. Furthermore, neither explanation can be considered without reference to Aboriginal history.

The critical factor in Aboriginal health inequality is the colonisation of Australia by Europeans. Prior to that time, Aboriginals lived the relatively healthy lifestyle found among most hunter-gatherer peoples. However, with the arrival of the Europeans, Aboriginals found themselves dispossessed of their traditional lands and eventually restricted to mission statements. This led to the loss of their traditional lifestyle and reliance on welfare provision by the state and/or churches. Aboriginals, who had already had their populations decimated by European diseases and violence, were now dependent on unhealthy diets and were exposed to alcohol, a drug previously unknown in their cultures. The net effect of these developments was a massive decline in the Aboriginal population and severe health problems for those who survived (Saggers & Gray 1991). As previously discussed, despite dramatic changes in Aboriginal policy by Australian state and federal governments during the 20th century, contemporary Aboriginal health inequality – whether measured by mortality, morbidity or access to health care services – remains significant.

The material-deprivation explanation for Aboriginal health inequality emphasised the roles of social and economic disadvantages (Khoury 1998; Saggers & Gray 1991). In particular, Aboriginal Australians are more likely than other Australians to have lower levels of formal education, to be unemployed and to have lower levels of income – all factors that are commonly associated with higher levels of ill health. In addition, Aboriginals are more likely to live in remote areas with poor access to health care services, are less likely to have private insurance, and have a history of experiencing discrimination by the health care system. To some extent, the establishment of Aboriginal health care programs has addressed these problems, but they cannot be expected to substantially offset the degree of disadvantage experienced by Australians in nearly all aspects of Australian life.

Another explanation for Aboriginal health inequality is cultural deprivation. According to this argument, the various cultural changes experienced by Aboriginals since EuropeanSAMPLE settlement have produced a lifestyle that excessively exposes them to ill health (Anderson 2004; Thompson 1995). Certainly, data indicates that there are numerous health risks that have a greater prevalence among Aboriginals than non-Aboriginals. A National Health Survey indicated that Aboriginals are more likely than non-Aboriginals to smoke, drink at levels of risk, live sedentary lifestyles, eat less healthy diets and experience obesity. They are also more likely to be exposed to violence and other forms of injury Some of these health risks, especially diet, obesity and exercise can be tied directly to problems Aboriginals are more likely to experience, such as type 2 diabetes. Others, such as excessive alcohol consumption, are associated with violence and injury. As health professionals we must work to address this social inequality.

HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people

In conclusion, the health care inequalities experienced by Aboriginals are extensive. They greatly exceed those experienced by other groups in Australian society and constitute a major challenge for governments and Aboriginal communities. These health inequalities can be explained by material or cultural arguments. However, both are deeply entwined with each other and the products of a long history of social, political and economic repression. Accordingly, Aboriginal health inequality is likely to defy easy solutions and remain an important social issue for a long time to come. As health professionals we must work to address this social inequality.

Activity 3

Answer the following questions which relate to reading 1.

(i) What are the two main causes of death amongst Aboriginal and/or Torres Strait Islander Peoples?

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(ii) State three (3) critical factors for the inequality in health care for the Aboriginal and/or Torres Strait Islander Peoples. ______

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______SAMPLE______

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