ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00454.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00455.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00456.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00457.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This paper discusses and compares the systems for the delivery of health care services to indigenous peoples in the United States and Australia; both are poor minorities in wealthy countries and many live in remote locations. Three necessary conditions that have shaped the relative success of the Indian Health Service in the United States are relevant to the Australian situation: federal government administration; the separation of the Indian Health Service from other Indian affairs; and the provision of an integrated health service. Ironically, recent policy changes in the United States by the Clinton administration are reducing the federal bureaucracy, and along with it, Indian Health Service funding. In Australia, the states have had responsibility for service delivery to Aboriginal people, there have been no treaties formalising the relationship between indigenous people and the federal government, and Aboriginal health has been switched between different departments while remaining primarily within the Aboriginal affairs (rather than the health) portfolio. Since 1993, there has been pressure to return Aboriginal health to the health portfolio, and in July 1995, funding and administration of Aboriginal health services were moved from the Aboriginal and Torres Strait Islander Commission to the Department of Human Services and Health.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00458.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This paper provides a preliminary report on the work of the Canadian Royal Commission on Aboriginal Peoples. This commission has spent the past four years undertaking a comprehensive review of all matters pertaining to indigenous people in Canada, and will publish a final report in late 1995 or early 1996. The paper provides an overview of health policy issues examined by the commission. The author was employed by the commission in various capacities to contribute to this analysis of indigenous people's health policy concerns. A disproportionate burden of illness has been suffered by indigenous peoples in Canada. Past policy has systematically undermined the capacity of indigenous communities to develop their own health care systems. Current concerns about health problems and services, as expressed by indigenous people at the commission's community hearings, describe a need for a community‐controlled and culturally appropriate approach to healing in indigenous communities. The commission's framework for developing an indigenous people's health strategy is intended to ensure that indigenous people have the capacity, the resources and the appropriate political environment in which to implement community healing. Its relevance to the Australian context may best be seen through a careful review of the commission's final repor

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00459.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Most health and substance abuse programs for indigenous peoples in Australia are funded by government. Over the past decade there have been calls for greater accountability in the conduct of these programs. Initial attempts focused on the development of standardised performance indicators, an approach that has been criticised on both political and methodological grounds. Recently, some government agencies have sought to identify culturally appropriate models for the evaluation of programs for indigenous peoples. In a comparative review of the evaluation of indigenous programs in Australia and Canada, conducted for the Western Australian Aboriginal Affairs Department, the authors were not able to identify any generally applicable models. However, this literature review and our own research and experience in working with Aboriginal community organisations have identified some principles that should be an essential part of any attempts to evaluate health and substance abuse programs for indigenous peoples. Underlying these principles is the realisation that evaluation is not a politically or ideologically neutral activity. Theoretical and mediodological considerations of the evaluation process must take into account the very real differences between the agendas of indigenous peoples and those who seek to evaluate programs for them.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00460.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Primary prevention is consistently identified as a priority in mental health and Aboriginal health planning. In both areas it has proved to be elusive. Aboriginal mental health therefore presents substantial challenges, particularly in remote Australia. In this paper, two brief case histories are used to demonstrate the limits of conventional psychiatric engagement in such settings and explore the dimensions of social disadvantage that compound psychiatric vulnerability. There are difficulties of primary prevention in mental health generally, and access to mental health services for those most at risk, including indigenous Australians, is unacceptably poor. Proceeding to primary prevention in Aboriginal mental health will, of necessity, include rectifying that situation and addressing the social precursors of mental disorders and distress. Such initiatives will require wide and sustained commitment toward long‐term goals, with a focus on children and families, and must include effective substance‐abuse strateg

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00461.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In remote Far North Queensland, evacuation for mandatory hospital births saves lives. However, morbidity and mortality for mothers and infants remain high. Results from a retrospective study of deliveries over a one‐year period showed significant differences in obstetric risk and outcomes among rural and urban Aboriginal, Torres Strait Islander and Caucasian women. Choices of birth place for remote residents were severely limited but those women with education and knowledge about how the system worked utilised options alternative to the regional public hospital. The findings from both the retrospective hospital sample and interviews among remote‐area residents of Far North Queensland confirm the need to develop community‐based perinatal services to reduce cultural and social barriers to clinical

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00462.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The people of the Torres Strait suffer a disproportionate level of diet‐related disease, especially diabetes. The Torres Strait Health Strategy identified the difficulty in obtaining healthy food, particularly fruit and vegetables, as a major problem for people living in the Torres Strait. This study examined traditional plant food supply systems and current local production of fruit and vegetables. The supply system of fruit and vegetables from mainland Australia was also examined. Traditional garden food production was seen to continue (mainly to provide food for ceremonial occasions), but had declined because of easy access to store foods, changes in the physical, social and economic environment, limited access to land and water, and quarantine restrictions on movement of garden produce. Supplies of fruit and vegetables from the Australian mainland were infrequent and the prolonged transit time meant that produce was often in poor condition on arrival and prone to continued rapid deterioration due to limited store‐level storage facilities. Demand for fresh produce exceeded sup

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1995.tb00463.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY