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Asthma is a major health issue in Australia, prevalence and death rates are high by international standards even though there has been a decline. The prevalence in children remains high however the mortality rate has reduced compared to the previous years. This paper will look at asthma in the Aboriginal and Torres Strait Islander Australians who have a high prevalence rate. Critically discuss the relevant social determinants of health and why smoking is still high in this group. In addition the paper will critically discuss the current health promotion and education activities and the evidence to support them and relevant outcomes that support these.
Asthma is the second among the illnesses that are reported by this indigenous population. The prevalence is high among the elderly, young children and people who dwell in non-remote areas. The mortality rate in this group is mostly caused by asthma, more people are hospitalised due to asthma (Marks, Poulos, Ampon & Ann-Marie, 2008).
People living in advantaged areas have a less chances of dying from asthma compared to those living in poverty-stricken areas (Valery, Chang &, Shibasaki, 2001). When one is infected with asthma their physical function is reduced dramatically. This means they are not able to engage in economical activities fully which reduces their income. Thus they are not in a position to seek medical assistance as they cannot afford it. The little money they make is used to buy food. Consequently, more people are likely to die from asthma complications in this group. Another important thing to note is that even though there is a national guideline for managing asthma that has been around for nearly twenty years few use it. This is especially true for the people living in remote localities. They have no way of accessing the guidelines. Moreover they have low immunisation levels and smoking rates are very high (Peat & Veale,1996). About 10% of adult asthma occurs because they are exposed to triggering agents in their working places. They work in poor conditions and this puts them at a greater risk of contracting the diseases. Peat and Veale Say that evidence shows that many indigenous people suffering from asthma have symptoms of an infectious nature rather than allergic origins (2009).
The indigenous populations of Australia have poor health compared to the non-indigenous population. Dawson (2004) says this is because they have less access to health services as some live far away from the health facilities. Transport is also a problem in the remote areas where most reside, some do not speak English and thus communication is hindered again there is the unavailability of same-sex indigenous health workers. The poverty rate among the indigenous populations is about three times higher than in the non-indigenous populations. In 1986 half of the children were living in poverty (Dawson, 2004)
Smoking is higher in this group the rate is almost twice that of other Australians. This means that children are exposed to passive smoke and this affects their health as they are exposed to the passive smoke before they are born and after they are born. Studies say about 11% of children suffer from asthma (Torzillo & Chang, 2001). They are said to be from homes where smoking takes place. Smoking among the people with asthma according to Marks et al (2008) remains the same as those without asthma. This is despite the peoples knowledge of the adverse effects of smoking. It triggers asthmatic symptoms and may lead to lung failure especially where there is under treatment of asthma. The smoking habit is higher in the younger people who suffer from asthma than the older people suffering from the same. This group continues to smoke because some are not aware of the effects due to their poor quality of life. Thus they lack information on important health matters.
Smoking has been found to be higher among those who live in poor areas. Jenkins (2007) observed that 40% of children with asthma live with smokers. In this indigenous group smoking rate is very high and about 50% of the adult population are smokers. More worrying is the smoking trend among pregnant women which is very high. It increases the chance of their children contracting asthma.
Asthma has both direct and nondirect costs to the community. The direct cost includes hospital services, medicines, devices and medical consultations which cost the government about $700 million years according to financial data of the year 2000-2001. The largest chunk of this money goes into treating children with asthma. The indirect costs are incurred by the community and family. People suffering from asthma have reduces social activities, they have high absenteeism rate thus reducing their productivity in their work places. The children spend a lot of time away from school and this affects their academic performance (Kritikos & Vickyn.d).
Researchers estimate that the cost of asthma could be saved by 45 %. This would go a long way in improving the life of individuals and their productivity as well as saving the community. Asthma was declared a national concern and many initiatives started to improve asthma management. The initiatives have been in asthma education, community based projects, school projects and improvement in management in hospitals as well as follow-up.
Therefore it is important that asthma is managed to avoid the negative impacts. The practice in asthma management has not achieved its objective because the practices are suboptimal and the mortality rate is still high. The challenge is higher among adolescent sufferers. They have issues of self image, they do not adhere to drugs and denial therefore self management is very vital for this group (Kritikos & Vickyn.d)). Management practices in rural areas in Australia are poor and thus mortality rate is higher compared to metropolitan areas (AIHW, 2008). There is a chronic shortage of health services and the burden lies with the primary sector. The indigenous populations must be involved in the asthma management programmes. The health care givers should educate them about asthma through proper education.
Due to the high cases of new borns being infected with asthma the NAPS Project was founded in 1998. It was a pilot project to give information to women during ante-natal care to warn them on the dangers of smoking. The information was given about how passive smoke affects the fetus and their infant life. The project was successful and more projects were initiated as phase two in July 2000 to December 2001. The success led to phase three called The Newborns Asthma and Parental Smoking Project between 2002 and 2005. The project become so successful that two more years of funding by Heathway commenced in 2005 to March 2007 (Newborns Asthma n.d).
The Indigenous Womens Project was formed and it was funded by the Health Department of the Government of Western Australia. The project gives free Brief Intervention training to health workers working with indigenous pregnant women. The project also has grants that can be used by the health professionals and other organizations (Newborns Asthma n.d).
In 2002 The Australian Centre for Asthma Monitoring was started to deal with accurate and updated records as well as publications concerning the social and economical impacts of asthma in the society. The Asthma Cycle of Care is a programme that helps health providers in dealing with the management of asthma. The caregivers are and especially the nurses need to get a chance to practice by interviewing patients and making decisions about the kind of treatment they need (Crips, Potter,&Perry, 2005: 189-205) It carries surveys on the severity of the disease, medical reviews, individual management education, and write a plan for dealing with hospitalized patients with severe or mild asthma. The project aims to improve asthma care and the lives of the infected.
The asthma Partnerships Programme was started to encourage behavior change. There is evidence that patients beliefs about diseases have a major impact on outcomes. Many studies have shown that patients have different beliefs concerning inhalers. This shows the there is a difference between self management of asthma and real behaviour. Moreover doctors have often shown to have poor view of the attitudes exhibited by patients towards treatment. This leads the physicians to think that the patients will adhere to the treatment. In case there is no commitment to the treatment the effectiveness of the treatment is undermined however good it may be.( Busse& Holgate, 2000:66-68) in the background of this, the program aims to equip the physicians with the tools necessary to win over the patient to adhere to treatment. This helps them to identify what the patients think to be able to help them change their behavior for the better. They are able to break barriers that exist between the physician and the patient. When the patient-physician relationship is established the patient gets involved in the responsibility of getting outcomes from the treatment.
Treatment of asthma should involve all the stakeholders. There is importance in changing management practices in asthma. The local people should be involved in the management so that they do not feel as if ideas are being imposed on them. The physicians should be open-minded to understand their patients and be willing to accommodate new ideas. Support should be given to the care providers to encourage them in their practice.
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