Indigenous health spotlight: Can tech help unlock better care everywhere?

Just as the pandemic has accelerated digital transformation and technology, it’s doing the same for health equity in the ANZ region. While COVID-19 has devastated many lives, it’s also provided a policy window to intervene in the social determinants (the non-medical factors that influence health outcomes) of health equity.

For the first time, policies that were considered unthinkable pre-COVID were introduced almost overnight as society dealt with the unprecedented effects of a global pandemic. The government provided financial support that enabled communities to have sufficient resources in a time of great uncertainty.

Yet despite this step in the right direction, the ANZ region still has a long way to go in fully addressing the social causes of health inequity.

So the question then is, how can innovative thinking and digital health solutions help health care become more equitable and inclusive, in order to achieve better health outcomes for all?

In a recent Wolters Kluwer webinar, Better Care Everywhere: Enhancing Health Equity Across ANZ, an expert panel discussed the region’s dire health equity problem. They delved into the challenges, shared insights, and determined ways innovation could be leveraged to cut the bias.

The expert panel included:

• Dr Tuguy Esgin, Head of Clariti Indigenous
• Sandy Gillies, Chief Executive Officer, Western Queensland Primary Health Network
• Dr Silina Motofaga, Team Leader, Clinical Services Program, Public Health Division, Pacific Community
• Nicole Turner, Chair of the Indigenous Allied Health Australia (IAHA)
• Doug Benjamin, Primary Care Manager ANZ, Philippines & Vietnam, Clinical Effectiveness at Wolters Kluwer

What does health equity mean in ANZ?

Simply put, health equity is about fairness in access to quality health care. While it’s a term that gets thrown around a lot, Nicole Turner, Chair of the Indigenous Allied Health Australia (IAHA) and proud Kamilaroi woman says, health equity is a serious matter.

“Equity means everyone gets the support they need. It’s person- and family-centred care where people don’t necessarily receive the same care, but they receive care that meets their needs, preferences and aspirations. This kind of care recognises and values their identity, and then builds upon their strengths. Health equity, to me, means culturally safe and responsive care.”

This sense of cultural safety is a concept that’s gaining momentum. An article in the International Journal for Equity in Health, highlights the growing recognition of the importance of cultural competency and safety at both individual health practitioner and organisational levels to achieve equitable health care. However, there are mixed definitions and understandings of those terms, and how to best achieve them.

Sandy Gillies, Chief Executive Officer, Western Queensland Primary Health Network summed health equity up eloquently, saying, “Health equity, from my experience, means people have the same access to high-quality care, regardless of their postcode, ethnicity, financial status, age, or gender.”

“Health equity, from my experience, means people have the same access to high-quality care, regardless of their postcode, ethnicity, financial status, age, or gender.” Sandy Gillies, Chief Executive Officer, Western Queensland Primary Health Network

The health equity problem

It’s interesting; the health of the Australian population improved vastly during the twentieth century. Infectious disease declined sharply, life expectancy at birth continued to increase, and death from heart disease and stroke also drastically reduced in the last sixty years or so. More recently, deaths from certain forms of cancers have also dropped.

Yet, despite these promising leaps forward in health care, not everyone has benefited. Since the beginning of the twenty-first century and maybe even before, there have been significant health-related inequalities among population subgroups in Australia.

“Inequality has been a part of Australia’s healthcare landscape since colonisation.” Nicole Turner, Chair of the Indigenous Allied Indigenous Allied Health Australia (IAHA)

“Inequality has been a part of Australia’s healthcare landscape since colonisation,” Turner points out. “That’s the history of this country. It’s not about blaming anyone; it’s a simple matter of learning. So when it comes to addressing the issue, we all have a moral and ethical obligation to escalate this inequity to high priority.”

Closing the gap

The disparities between the health status of Aboriginal and Torres Strait Islander people and non-Indigenous Australians are many. But closing the gap is vital to ensuring health equity in the region. To achieve this, the panel believes it takes everyone, as the problem is too deeply ingrained to be eliminated by only a select few. All Australians and New Zealanders need to take meaningful action in support of achieving health equity.

“We need investments in solutions and different ways of working to improve health and wellbeing. That brings us to prevention. Ultimately, there are plenty of opportunities to address health inequity that will benefit all Australians,” Turner says.

According to Turner, those opportunities include having an understanding of holistic health, the fostering of cultural safety and responsibility, and the introduction of a model of care in the community-control health sector. “It’s about listening and learning as much as one can about the issue and working together to find a solution,” she adds.

Dr Silina Motofaga, Team Leader, Clinical Services Program, Public Health Division, Pacific Community, agrees wholeheartedly with Turner, reaffirming that lasting change comes down to education. “It’s about educating everyone – your patients, relatives, community, the entire population,” she says.

“You have to get people to look at it through different lenses, be it from a health-service perspective or a cultural perspective. Culturally, we need to narrow the gap and decrease poverty. It can be bottom up where you educate the population, and then also from the top down, where you also need funding and the support from the government. This applies to our Pacific Island countries as well.”

Dr Tuguy Esgin, Head of Clariti Indigenous and proud Noongar/Yamatji man, has engaged in a vast array of Aboriginal community work, research, and programs that foster financial and health literacy via indigenous entrepreneurship. He believes that tackling healthcare inequities requires a new narrative. “My focus now is looking out from a strength-based approach rather than the negative-deficit model that currently exists,” he says.

“You pick up a paper published in 2022, and the first thing it talks about is the doom and gloom in Indigenous communities. It’s something we’ve all been taught when getting our PhDs – this is the kind of storytelling that will get you published.”

Now, however, Dr Esgin insists the script must be flipped to one of strength-based storytelling in the minds of colleagues, policymakers, and the general public. “Our culture is the oldest living culture in the world,” he shares. “We have not only survived colonisation, but our communities are thriving. Celebrate our wins!”

“Our culture is the oldest living culture in the world. We have not only survived colonisation, but our communities are thriving. Celebrate our wins!” Dr Tuguy Esgin, Head of Clariti Indigenous

Digital transformation: where to start?

The digital age has placed so much technology at our fingertips with new tools and innovative ways of doing things. However, it’s also been a bit of a double-edged sword. In the last two years, Benjamin says, he’s seen a massive increase in telehealth, yet the disparity in the state of health between Indigenous and non-Indigenous Australians remains.

“It’s significant,” he says. “Care providers need to have consistent resources available to assist them with clinical decisions. Yet, when people think of technology, they automatically think of items involved in the direct provision of care.

“In my mind, technology also includes social media. And I think social media technology should be used to highlight the massive differences in mortality rates between Indigenous and non-Indigenous people. I’d really like to see people stand up and do something about this.”

At the same time, Turner says that while technology offers opportunities to provide access to care, it doesn’t come without risk. “As clinicians working digitally with Aboriginal and Torres Strait Island people, it’s important to be conscious of and responsive to the preference of the person,” she says. “You have to understand the factors that can impact effective digital care like privacy, for example. Simply finding a private space at home could be an issue.”

Gillies shares how she’s witnessed several examples of how technology is being leveraged to support First Nation Queenslanders in rural and remote communities with multiple and complex health issues. “These trials are showing very positive early outcomes with an increase in patient health literacy and self management, along with a reduction in preventable hospital admissions,” she says.

Aboriginal and Torres Strait Islander people have much higher death rates from major coronary events like heart attacks than other Australians, Dr Esgin points out. He shares that an indigenous cardiac outreach program had medical equipment they could fit in a briefcase. With these easy-to-carry tools, they would go out to the Indigenous communities and measure blood pressure and check heart valves.

“Cardiovascular disease is prominent in Indigenous communities. So, to be able to go and help these communities with tools that are easily carried is fantastic,” he says. “Simple technology can make a huge difference. Exposing the community to technology that reduces risk factors  associated with non-communicable diseases is very promising.”

Leveraging tech to wipe out bias

To achieve health equity, it’s imperative that more healthcare providers have access to the right tools, systems and technology. It’s also vital for investments to be made in developing more culturally validated assessment tools for Aboriginal and Torres Strait Island people, providing an opportunity for more appropriate care, says Turner.

“We also need to focus on investment in the infrastructure of our communities,” she adds. “Digital health will continue to be a part of the health landscape, and we need to support access to affordable and reliable IT infrastructure to ensure it can be accessed equitably.”

Benjamin believes that the adoption of a national approach to health care might help. However, he admits that scenario is highly unlikely.

“Imagine what it would mean if we had a national approach to health care like we do prescription medicines,” he says. “Then individual states and territories would have their own agendas and approaches, guaranteeing that there would be huge levels of variability in care.”

A report published in 2019 highlighted that care variability is the number one controllable cost in health care. “If this can be addressed, and five or six levels of bureaucracy can be removed from the healthcare system, perhaps the revenue saved could be directed to bolstering staff levels and providing resources like UpToDate (an evidence-based, electronic clinical information resource) to assist our care providers in rural and remote areas in the ANZ region,” Benjamin says.

While delivering equitable and better access to health care remains a challenge, it’s essential. At Wolters Kluwer, we see new opportunities for innovative thinking and digital-health solutions to help advance equitable and inclusive approaches to achieve better health outcomes for all.

To gain more insights, access the free, on-demand version of the virtual event here.

About Wolters Kluwer

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