Despite the Australian government’s sustainably significant effort to ensure health equality across its population, there are still profound health inequities between non-Indigenous Australians and the Aboriginal and Torres Strait Islander people, who are identified as socially, economically and culturally disadvantaged (Li 2017). ‘Health inequities’ is defined by the World Health Organisation as avoidable inequalities in health within and between groups of people, affected by their social, historical, cultural and economic conditions in which they live, i.e. the social determinants of health. One representative example of worse health suffered by the Indigenous people is cardiovascular disease (CVD) – the major cause of premature death experienced by Aboriginal and Torres Strait Islander Australians (Brown & Kritharides 2017), with coronary heart disease (CHD) being the major reason for hospitalisation (Australian Institute of Health and Welfare 2006). CHD occurs when the coronary arteries get blocked and hence blood flow to the heart is affected (Australian Indigenous HealthInfoNet 2016). Compared to other Australians, Indigenous Australians are three times more likely to have a major coronary event which leads to heart attack, and two to three times as likely to be hospitalised for CHD and heart failure (Heart Foundation 2016). The reasons for this health inequity for the Aboriginal people are traced back to their past historical events in relation to the British engagement and the Stolen Generation’s policies, as well as linguistic and cultural differences.
The historical events of European engagement with the Aboriginal Australians have imposed enormous influences on their health, which has negatively resulted in anxiety, isolation, alcohol and tobacco abuse and hence, episodes of ill health (McMillan et al. 2018), ultimately leading to the elevation of risk factors of CVD when compared with other Australians. The arrival of the British in 1788 destroyed a large proportion of the Indigenous population through brutal slaughter and violence, introduced disease and forcibly took away their land, resources and institutionalised their traditional lifestyles (Heart Foundation 2016). The introduction of the British violated the Indigenous holistic health belief that ‘everything important in a person’s life, including land environment…’ (McMillan et al. 2018. By being taken away from their traditional land, the Aboriginal people have been put in greater risk of suffering from various diseases. Furthermore, in the 1950s, policy of assimilation and forcible removal of as many as one in three Aboriginal children from their families and communities were formally adopted by the Australian government. These children are called ‘The Stolen Generations’. The parents whom children were taken away have been suffering from emotional distress, depression associated with higher rates of smoking and alcohol, physical inactivity and poor diet, hence elevating their exposure to these risk factors that lead to CVD, in particular CHD. These risk factors raise the levels of fats (atherosclerosis lesions) and cholesterol in blood that narrow the coronary arterial walls, hence leading to CHD (Australian Institute of Health and Welfare 2006). Furthermore, the British introduction of tobaccos and pipes as a token of goodwill and conciliation soon became popular among Indigenous communities and many have become addicted to them ever since (Tobacco in Australia 2018). Not only this affects people who experience the removal themselves, but also subsequent generations in terms of their general wellbeing. (Australian Bureau of Statistics 2011).
Linguistic and cultural factors have also imposed causable effects on inequities in preventing and managing CHD among the Aboriginal people (Li 2017). Only a small proportion of the Indigenous people speak English at home, presenting linguistic and cultural differences that cause their unequal accessibility to available primary healthcare services. Physical and biological factors may further exacerbate this problem as differences in physiological characteristics; cultural beliefs about values, health and identity; religions or even origins and races hinder a friendly healthcare environment and prevent the Aboriginal people from actively participate in their treatment and willing to use mainstream healthcare facilities. This explains why some Indigenous people refuse to be treated by a Western doctor, emphasising their lack of sense of cultural safety (Li 2017). Furthermore, on-going and institutionalised racism and past policies imposed by the Australian government has resulted in lower levels of literacy and numeracy among the Indigenous communities, thereby making them feel ashamed when seeking for health advices (National Rural Health Alliance 2017). This stops them from regular medical check-up to assess their cholesterol level in blood, cardiac assessment and have their diet reviewed. Therefore, health services that are not culturally appropriate for Indigenous Australians place them at a disadvantage from getting equitable access to health services that aid in preventing and controlling their cardiovascular health. Hence, the Aboriginal people are significantly more likely to suffer from damaging cardiac consequences (McMillan et al. 2018).
Despite the Australian government’s consistent efforts to close the health gap between the Aboriginal and Torres Strait Islander people and other Australians, there are still existing factors regarding to past history, or discrepancies in culture and language that are deeply impeded and uneasy to eliminate, presenting challenges of health inequities. This places the Aboriginal communities at higher risk of cardiovascular diseases, in particular coronary heart disease. The British colonisation and the Stolen Generation’s policies that result in elevation of risk factors leading to higher incidence of coronary heart disease, as well as ineffective communication and lack of cultural safety are the two significant reasons of current health inequities for the Aboriginal communities. These should be taken into consideration when adopting interventions to overcome health inequities among the Aboriginal population.