Portal de Periódicos da CAPES

Editorial

2011; Taylor & Francis; Volume: 37; Issue: 1 Linguagem: Inglês

10.1080/10376178.2011.11002488

1839-3535

Anne McMurray,

Climate Change and Health Impacts

This issue of Contemporary Nurse provides a powerful forum for Indigenous and non- Indigenous nurses to refl ect on nursing's commitment to advancing knowledge of Indigenous health. As a second edition of Advances in Indigenous Health Care (ISBN 978-1-921348- 89-1) it is an opportunity to extend the dialogue of the fi rst edition and ensure that we share what has been learned as the impetus for further understanding. My comments on Indigenous health issues are offered here from the standpoint of a non-Indigenous nurse, and my frame of reference is the social justice agenda of primary health care and nursing. At the heart of this agenda is equity. As a society, our failure to create equitable conditions within which Indigenous people can live healthy lives is a tragedy. It is also a source of professional and personal distress to nurses everywhere. The inequities embedded in Indigenous lives live in our collective conscience as moral obligations, and few nurses take this responsibility lightly. The challenges and frustrations of trying to promote equitable conditions for Indigenous people are experienced daily, especially by nurses in rural and remote areas. For others it is a subconscious dilemma, never far from the surface, creating a disquiet that leaves us to ponder how we can transcend the past and move towards a fairer future. The issues that have impeded our work with Indigenous communities are complex, yet they warrant close and ongoing perusal.One of the major problems in working towards Indigenous health is the way problems are framed. Current government policy rhetoric revolves around closing the gap in health status and life expectancy between Indigenous and non-Indigenous people. This is based on an assumption that there are deliberate health interventions that can equalise health status and life expectancy. Measuring the gap is problematic in itself. In 2008 the gap was declared to be 11 years, a reduction from the previous fi gure of 17 years. Even the statisticians from the Australian Bureau of Statistics (ABS) acknowledge that this may be an artefact of a radical change in the calculation methods rather than any real reduction (Hudson, 2009). Placing the focus on the 'gap' is as distracting as concentrating on the emissions trading scheme (ETS) in the climate change debate, rather than attending to population policy, the availability and distribution of fresh water, alternative sources of energy and how best to ensure food security (National Rural Health Alliance, 2009). The 'gap' will only shrink when there is a common commitment to inclusive social policies that work towards redistributing resources and opportunities where they are most needed. These include resources for maternal and child health care, safe, affordable and well- maintained housing, education, food and water, safe communities, and preservation of the environment. Concentrating on 'the gap' and dispatching bureaucrats and untargeted bucket funding to various Indigenous communities may make health authorities feel better, but it does not get the resources or opportunities to where they are most needed (Hudson, 2009). Equity of access can only be achieved where people are empowered to identify their needs, make decisions, and attract respect for their capacity to do so.A more progressive and accountable approach to considering the health challenges faced by Indigenous people is to focus on the source of the disparities. This is also congruent with the principles of primary health care. The WHO's commitment to Indigenous people was re-affi rmed in their 2008 report 'Primary health care: Now more than ever', which reminded health service providers that many Indigenous people continue to be disadvantaged by their remoteness and lack of health services, not their Aboriginality (World Health Organization, 2008). In Australia, Indigenous people are over-represented in the incidence of chronic illness, not only because of the diffi culties of accessing health services but because of the lack of a healthy start to life and exposure to some communicable diseases prevalent in remote communities (Australian Institute for Health and Welfare, 2008). …