RACMA THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS

Transcription

1 RACMA THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS POSITION PAPER Management of Healthcare Services for Indigenous populations in Australia and New Zealand Approved by the RACMA Board July 2011 Scope This position pap e r entitled Management of Healthcare Services for Indigenous populations in Australia and New Zealand is the first to be published in a series of st ate me nt s pertaining to the issue of Cultural Competence amongst various populations. The Royal Australasian College of Medical Administrators (RACMA) is committed to improving the health status of the Indigenous peoples of Australia and New Zealand by educating and supporting our Candidates, Fellows, Associate Fellows and Affiliates to provide a health care environment that is culturally appropriate, sensitive and inclusive. The College will facilitate t his by delivering Cultural Competence education through their fellowship training programs, Continuing Education Program and involving s t a k e h o l d e r representatives on committees, and encouraging inclusion within the Candidate i n t ak e. Cultural Competence is the ability to interact effectively with all people who possess cultures and belief systems different to your own 1. A medical manager must lead and influence at every level (systemic, organisational, professional and individual 2 ) in order to institute change and drive quality improvement toward greater Cultural Competence. Medical managers establish organisational priorities; direct financial allocations; and lead change from their positions of authority and influence. Therefore they are well positioned to advocate and institute change. Cultural Competence at an individual level involves the practitioner s: Knowledge about the c ause s o f and the resulting solutions to inequity Skills associated with identification and then rectification of inequity Relationships with patients, families and populations Behaviour and attitudes to health professionals and other members of the health care team At a professional level it involves the overall experience of the patients, their families and community. At an organisational and systemic level it includes the performance of the health care organisation and system as a whole.

2 Cultural Competence is based on the recognition that we are all immersed in social, educational and organisational cultures. These cultures shape our assumptions, beliefs, values and behaviours. Within a medical management and leadership setting, the challenges introduced by cross cultural personal and professional interactions m u s t b e addressed if equitable, appropriate and accessible services are to be provided 1. Conversely Cultural Competence at an individual or professional level is underpinned by systemic and organisational commitment and capacity 2. While Cultural Competence focuses on the capacity of the health worker and system to improve the health care outcomes of the patient, Cultural Safety concentrates on the experiences of the patient 3. R A C M A uses t h e t e r m C u l t u r a l Competence or Com p et ency in order to comply with the New Zealand Health Practitioners Competence Assurance Act. The goal of Cultural Competence includes the drive to eliminate inequity. This involves consideration of the determinants of health, as well as the provision of acceptable, accessible, competent health care of an equal standard to that available to non indigenous members of the same community. Determinants of health are often outside the health system, but those in positions of medical leadership are often in a position to advocate, directly or indirectly, for changes that will support better health outcomes. Wherever possible and appropriate, RACMA members should extend their roles as advocates beyond the health sector, or support others in a better position to do this. Although RACMA recognises the importance of acknowledging and accommodating other non Indigenous, multicultural groups and their differing cultural perspectives, beliefs and backgrounds; this position paper is primarily focussed on the state of A b o ri g inal and Torres Strait Islander health and health c a re in Australia, and Maori h e a l t h and health care in N e w Zealand. Background Aboriginal and Torres Strait Islander people Colonisation impacted on the health of the first peoples of Australia in many ways. Colonists introduced a range of infectious diseases such as smallpox, sexually transmitted infections, tuberculosis, influenza, measles, scarlet fever and whooping cough, to which Indigenous populations had no immunity. Non Indigenous populations rapidly distributed themselves across the country and devalued Indigenous culture by destroying traditional food bases, separating families, causing broad scale mortality, and dispossessing whole communities from their traditional lands. A trail of dispossession, disempowerment, demoralisation and poor health was left in their wake 4. Social determinants of health such as education, employment, income, housing, access to services, isolation, racism, socialisation, and incarceration a l l adversely a f fe c t the health of Indigenous Australians. The precision of the Aboriginal and Torres Strait Islander health status estimates are influenced by the systematic inaccuracies in identifying ethnicity when recording births, deaths and health events. D e s p it e t hese inaccuracies the disparity between Indigenous and non Indigenous health remains g re at 4.

3 T o d ay Indigenous Australians c o m p a r e d w i t h n o n Indigenous Aust ralians experience: A death rate 2-4 times higher. Birth rates 21.7 % higher. Maternal mortality three times higher. Male life expectancy 11.5 years lower. Female life expectancy 10 years lower. Twice as likely to feel high or very high levels of psychological distress. E x t rem e ly high rates of suicide in young people. Increased incidence of cardiovascul a r, re n a l, l iv er and respiratory disease. Poor eye, ear and oral health, 4 and A higher incidence of substance abuse, incarceration, homelessness and childhood mortalities. Maori people On the 6 t h of February 1840, Captain William Hobson, several English residents and 43 M ao r i Rangatira o r Northland Chiefs signed an English and Maori version of the Treaty of Waitangi, at Waitangi in the Bay of Islands. This was circulated further to include 532 Maori chief signatures, including 13 women. This Treaty re p r esents an agreement in which Maori gave the Crown rights to govern and to develop British settlement, while the Crown guaranteed Maori full protection of their interests and status, and full citizenship rights 5. The treaty guarantees Maori equal access to n a t io n a l resources, and can be seen to require the government to ensure that Maori have at least the same l e v e l o f h e a l t h a s n o n -M ao r i 6. Despite the Treaty s legal status, it was ignored throughout most of the nineteenth and twentieth centuries; during which the rights of the Maori population were violated. In 1975 the New Zealand Government established the Waitangi Tribunal in order to address the C ro w n s n e g lec t o f it s responsibility. Embedded within the Treaty are three principles that apply to Maori h e a lt h and wellbeing. These are: Partnership developing strategies for the community s health care in partnership with the Maori communities c o n c e r n e d. P a r t ic i p a t io n planning and delivery of healthcare services must have Maori involvement. Protection Equity in health care access and quality, and ensuring Maori cultural concepts, values and practices are respected and adhered to. Despite the Treaty of Waitangi and then Waitangi Tribunal enshrining the right of Indigenous New Zealanders, M ao r i h ave encountered consistent cultural and social barriers that have adversely affected their health. Maori, who represent 14.7 per cent of the New Zealand population, experience the poorest health. T o d ay M ao r i in comparison with non Indigenous New Zealanders experience: A higher mortality rate and higher rate of illness and disability. Breast, cervical and lung cancer several times higher in women. 5% higher incidence of diabetes, with an earlier onset of 12 years. Reduced access to many health services. Lesser quality or intensity of care when health services are actually accessed. Life expectancy 8-10 years lower, and Disproportionate rates of incarceration, unemployment, violence, poverty, mental ill health and discrimination.

4 These disparities remain despite adjusting for socioeconomic status, education and geographic location. Position R A C M A and its members are in the professional position to be able to influence and facilitate Cultural Competence at the national, state, regional, organisational and departmental level. The Royal Australasian College of Medical Administrators: Context Acknowledges that the term Cultural Competence includes consideration, respect and accommodation of a range of groups such as the Indigenous populations of Australia and New Zealand, and the transient and permanent multicultural populations of both countries. Recognises the disadvantage experienced by Indigenous peoples of Australia and New Zealand. Acknowledges that Indigenous Australian and New Zealander people are entitled to equitable and accessible health care which is appropriate to their cultural, social and medical needs, a n d provides outcomes similar to those experienced by non Indigenous people in the same communities. Acknowledges the different ways in which Indigenous peoples view health and how this is a holistic perspective interconnected to land, environment, family, spirituality, history, physical body, community, relationships and law. Acknowledges that the issues and historical context of the Indig e n o u s Australians is different to that experienced by the M aor i population in New Zealand. Training and education for RACMA members Is committed to developing and delivering a suite of Cultural Competence resource materials for use in the Fellowship Training Program and Continuing Education Program, available to all Australian and New Zealand members. Is committed to ensuring the Fellowship Training Program and Continuing Education Program curriculum is representative of Indigenous issues and views and will deliver this program within each of the CanMEDs roles. Is committed to ensuring Candidates demonstrate an appropriate level of Cultural Competence before Fellowship is granted. Is dedicated to providing financial and human resources to developing an effective Cultural Competence training program for the Fellowship Training Program and Continuing Education Program of the College. Acknowledges that this is a constantly evolving area and will stay abreast of developments, publications, studies, policies, projects that will influence relevance and accuracy of the College s educational programs, policies and position statements; and revise them accordingly. Formulate a Cultural Competence Working Party that is comprised of informed Fellows, Candidates and Indigenous community representatives; to advise the Curriculum Steering Committee regarding educational and policy developments. Will actively include Indigenous health topics and invite appropriate speakers to participate at College conferences. Will internalise its awareness of Indigenous health inequalities to such a degree that it becomes a consideration in all areas of RACMA activity.

5 Community education Is committed to liaising with external stakeholder experts in the development of Cultural Competence or Indigenous Health educational programs for our members. Is committed to collaborative and cross disciplinary research and project opportunities presented by partnerships with Indigenous health organisations, primary healthcare organisations, governments and other medical colleges. Health care infrastructure Understands that recognition and acceptance of cultural differences is imperative to the safe and effective management of health care systems and services. Strives for equity of access to and through health services for all populations, Indigenous and non-indigenous. Understands that assessing access to and use of services will take account of many factors including the population number and incidence rate of disorders within communities. A d v o c a c y Recognises the disparity in access to all health services experienced by Indigenous people and will advocate and support specialist medical administrators with particular emphasis on rural communities. Strives to lead change in improving the social determinants of health to m a ke p ro g r ess to w ar d equity of health outcomes for all Indigenous Australian and New Zealanders. Is pursuing avenues to encourage and support increased Indigenous representation amo n g s t our Candidate intake and extended membership. Publicly advocates for the rights of the Indigenous populations through: Representation on t h e Indigenous Health Sub Committee of the Committee of Presidents of Medical Colleges. Representation on a variety of Indigenous health fora. Providing evidence based responses to Government instituted policies and procedures on Indigenous h e a l t h i s s u e s. Supporting the RACMA members to raise issues in the public domain when appropriate. References 1. New So uth Wales Health Departme nt, Cultural Co mpetence, May v.au/multicultural_healt h_se rvice/culturalco mp.asp 2. Natio nal Health and Medical Resear ch Co uncil, Cultural Co mpetency in Health: a guide for policy, partnersh ips an d participatio n, December T he Ro yal Australasian Co llege o f Physicians and th e Austral ian Indig en o us Doctors Association, An intro ductio n to Cultural Competency, November Retrieved 20 th December 2010 from x.cfm?o bjectid=cfb7dfe5-0dc4-4b64-7b6e11673ae00b7f 4. Thomson N, MacRae A, Burns J, Catto M, Debuyst O, Krom I, Midford R, Potter C, Ride K, Stumpers S, Urquhart B (2010). Overview of Australian Indig eno us healt h status, A pril Retrieved 20 th December 2010 from net.ecu.edu.au/health-facts/overviews 5. Treaty of Waitangi, February Medical Council of New Zealand, Best Health Outcomes for Maori: Practice implications, December The Royal Australasian College of Physicians, Policy statement on Aboriginal and Torres Strait Islander Health, September 2003.