Editor's Note: Currently there is a greater focus in repect of Indigenous health. And about time, some would say.
Only very small pockets of the pharmacy profession have attempted to come to terms with this major problem, and they genuinely need your management assistance.
Rollo Manning could well be regarded as the pharmacy expert in indigenous health, and he vigorously defends the rights of indigenous people to enjoy good health - just like the rest of the Australian community.
Rollo's sympathetic insights reflect his long association with, and understanding of, the issues surrounding indigenous health.
Promoting health to the unhealthy –
The role of government in health promotion
It is a fact of life that people from low socio-economic groups with poor literacy and numeracy have a poor health status1
. Achieving social inclusion, overcoming issues of social justice and providing equal opportunity is a goal of governments in the western world with free economies and proud culture.
Australia, as a developed nation, has the wealth, the policies and the commitment to meet these objectives but the fact is that to this day it has not been able to overcome the extreme disadvantage of its Aboriginal people, particularly those living in remote communities across the north of the country.
Improving health, closing the gap in life expectancy and raising the standard of living for this cohort is as much about alleviating poverty as it is about managing chronic diseases. One cannot succeed without the other but for the longer term the only way to go is attacking the social determinants of ill health.
Health promotion is an arm of all health departments at the government policy level that develops and researches programs that encourage healthy living habits. The list is extensive2
with examples such as hand washing, smoking cessation, a balanced diet, exercise encouragement and the evils of being overweight.
However when houses are overcrowded to the extent of having four people in each bedroom with the facilities overstretched and broken down leading to infections, scabies and low food security the active messages being promoted are not going to have a significant impact. The reference for this statement is the government review of Indigenous disadvantage that shows after 40 years of trying things are getting worse. Improvement is just not happening.
The money that is being spent on health promotion does not have to cease – but an enormous amount of money has to be poured in to overcome the unhealthy living conditions that to children growing up today is all they now and thus becomes normal.
There comes a time when the policy makers have to face up to reality and realise that while ever the physical environment is as bad as it is the secondary and tertiary health promotion messages are going to be lost in a sea of despair brought on by a life that lurches from one crisis to another simply to stay alive.
The role of government should be to provide the infrastructure for healthy living and seed funding for local people and organisations to work up the eway to use that infrastructure is a safe way with all the indicators for health living in place.
While government mess around with the detail of community based programs no change will occur because in the words of our Prime Minister3
“one size does not fit all” and programs dreamed and devised centrally (in Canberra) have little chance of succeeding at the local level4
2. Smoking, nutrition, alcohol, physical activity (SNAP) framework for general practice. Canberra: Australian Government Department of Health and Ageing, 2002.
3. Sorry” speech. Australian Parliament. 13th February 2008
4. The Hon Fred Chaney. Give Aborigines hope. The Age. 15 August 2007