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Inclusion and Exclusion in Contemporary Australian Health Care

Introduction to Inclusive Healthcare

Inclusive practice in healthcare involves the idea where all individuals are provided access to healthcare services equally (Hashemi et al., 2017). The attainment of this needs certain core obligations and criteria to be fulfilled by the governments for the citizens to be able to attain the highest level of health, including equitable access to health facilities, goods, and services as well including essential drugs and healthcare services (Richardson, 2015). It will also include provision of adequate water, sanitation, housing, food and water services as well. Thus, inclusive practice in healthcare is a broad term encompassing the social, economic and political factors and determinants impacting health (Solas, 2016). This essay will look at the concept of inclusive practice in contemporary Australian healthcare along with the impact it can have on patient health outcomes.

Inclusive Practice in The Australian Context and Implications

Inclusive practice in healthcare means equitable access to health services for everyone irrespective of their caste, creed, language, gender, religion, race, social and economic status or any other barrier. It means the practice of including the universal right to be able to access and receive essential healthcare provided in 1948 (Solas, 2016). Looking at the history and development of the concept of inclusive practice in healthcare, it can be seen that a focus on the same seems to have arrived later in Australia than most developed countries, in the year 2008. Even though there existed a rich source of information around it and experiences from other developed nations as well, the response by the Australian government to the concept was fleeting, to say the least(Richardson, 2015). The Rudd Labor government established the Australian Social Inclusion Board in 2008 and supported the idea of inclusive practice in health as a broad feature but did not focus specifically on health as an important agenda. It was seen that the government in South Australia championed the idea of inclusion of health and implemented it in all policies of the state in 2010(Solas, 2016). However, the Abbott government in 2013, abolished the Australian Social Inclusion Board in 2013 and so did the idea of increased government interest and investment in inclusive healthcare practice. However, the ASIB report in 2012 declared that there were still a small yet significant number of people not included in the idea of universal access to healthcare and about 5% of the population still faced discrimination and disadvantage as well (Australian Social Inclusion Board, 2012).

Indigenous populations are said to have the poorest health. The Australian Institute of Health & Welfare in a report released in 2011said that the state of health in the Aboriginal and Torres Strait Islander people who comprise of 2.5% of the total population in the country was way below the average for the nation for people in the non-indigenous group of men, children and women. There existed a huge mortality gap of about 80% in terms of potential years of life lost that could be considered to be contributed by chronic diseases. Indigenous households in 2008 were more than 2.5 times as likely to belong to the lowest income group bracket when compared with the group of non-indigenous people and households. A lot of indigenous children were living in jobless families in 2006, around half of them, in the year 2006, which is about three times the proportion of all the children (Australian Institute of Health & Welfare report, 2011). It reflects the condition of the aboriginal population and the indigenous people and the extent and level of marginalization and vulnerability they are facing in terms of access to basic services and healthcare services as well. It gives a better understanding of the inequities faced by the indigenous population in terms of attaining the basic social determinants of health to be able to achieve good health. It reflects upon the abysmal condition and state of the health system in the country where a major section of the population of the country is left out of the idea of "inclusive healthcare practice" and is excluded by the system (Durey et al., 2016). It tells us how inclusive practice in contemporary healthcare in Australia is still far from being attained.

Even though we find that the focus of the government has shifted, inclusion still remains an established practice in health care in Australia. It requires understanding and taking a much more comprehensive and broad perspective on the determinants of care and health; that is, social, economic and political, along with enhancing the capabilities of individuals, instead of focusing on their incapacities (MacLachlan et al., 2012). More importance is given to practices and policies that have been designed to increase access to care. It necessitates the empowering of individuals to be able to utilize the services they need along with making them affordable and available. It needs the system to reach out to the people, who have found themselves amongst the disadvantaged and disenfranchised without any specific rhyme or reason (Durey et al., 2016). Two basic features in the practice of inclusive healthcare are functioning and capability, which helps in enabling people to realize their complete potential. The interest of the government and its contribution to investment towards inclusion and inclusive practices has not been uniform ever and has decreased to a much larger extent in Australia (Solas, 2016). However, this does not lead to the discouragement of the health professional to continue his/her engagement with inclusive practice.

Concept of “Inclusion” and “Exclusion” in Australian Healthcare System

Primary health care and social determinants form the basis or foundation of the existing practice of inclusive healthcare. Exclusion comes from a number of inequities and deprivations that people are made to experience across all the sections of the society, which causes reduced participation in the society leading to lesser consumption accessibility, mobility, recognition and influence in the society. Exclusion is more about marginalization, segregation, isolation, being left out, disenfranchised, rejection and being more vulnerable as well (Malatzky et al., 2018). Whereas, inclusion inculcates the ideas of more opportunity, increase in accessibility, recognition, equity and justice along with the idea of more validation for everyone. The presence or absence of determinants of health creates a continuum of inclusion and exclusion as well. It occurs due to an unjust distribution of resources and unequal or reduced access to services as well. The social determinants of health along with primary healthcare and the idea and dynamic of exclusion and inclusion form the basic structure for building a healthcare system based on inclusive healthcare practice (Richardson, 2015).

In the simplest of forms, when we look at the healthcare environment, inclusive practice consists of giving and take, where there is an exchange of information that helps in building relationships-professionally to improve the healthcare for the individual as well as the communities. The practice of inclusive healthcare helps in building a sense of belonging. Within the context of the contemporary Australian health system, excellent healthcare consists of listening and learning to understand, giving and taking, and guidance by the health care professional and the patient who needs the care and support (Mills et al., 2015). Both the ideas of providing accessibility to good health, through health care services to every individual will be termed as being the inclusive practice of healthcare in the Australian context.

A major example of this policy of inclusion and exclusion can be observed in Cairns where 10% of its local population belongs to the indigenous group –either aboriginal or Torres Strait Islander people according to the census by the government in 2016. The health parameters of the indigenous population are comparatively not as good as the health parameters of the other –non-indigenous population. It can be observed that the health outcomes for them are compromised as well in terms of chronic diseases, mental disorders and substance and drug abuse (Australian Bureau of Statistics, 2016). Major attribution of this trend could be due to the initial practices of exclusion followed against them and the lack of proper access to the various social determinants of health as well. A lack of an all-inclusive policy of health and healthcare access can be considered one of the major reasons for this. There exist separate aboriginal health service centers mostly run by the community, otherwise by the local government which leads to segregation and separation of the population from the general mainstream, thereby reducing their opportunities and exclusion. The relations of power and hierarchy embedded within the system and mainstream health services leads to exclusion of the most marginalized people from health care(Malatzky et al., 2018).

Impact on Patient Health Outcomes

Inclusive practice in healthcare helps positively in decreasing the inequity and marginalization of the vulnerable communities in the society and also positively helps in the development of a better relationship between the health care provider and the person seeking care. This leads to a positive impact on the system as well as the individual and the communities as well. It causes improvement and an increase in positive health outcomes for patients and improved quality of life and health parameters in the communities as well. Strengthening primary healthcare as a part of inclusive practice helps in the reduction of mortality and m in morbidities in people and communities, thus improving patient outcomes (Yeravdekar et al., 2013).

Conclusion on Inclusive Healthcare

The principles and idea behind the inclusive practice in healthcare were discussed along with its importance and usefulness. How the idea of exclusion has led to disadvantages and discriminatory behaviour towards the marginalized and backward population in Australia, the Aboriginals and people from Torres Strait Island was also discussed. The practice and development of inclusive health practice will improve their health status and conditions and help in the establishment of a more equitable and accessible health care system. For the creation of inclusive health systems and practices, the health practitioners are required to work towards power reduction of the historical binary relationship which gives rise to health inequity based on either/or criteria (exclusive/inclusive), into practices and systems that embrace the approach of inclusiveness to health care.

Reference for Inclusive Healthcare

Australian Institute of Health and Welfare, (2011). Australian institute of health and welfare report.

Australian Social Inclusion Board, (2012). Australian social inclusion board report.

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., &Bessarab, D. (2016).Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research16(1), 224.

Hashemi, G., Kuper, H., &Wickenden, M. (2017).SDGs, Inclusive health and the path to universal health coverage.Disability and the Global South4(1), 1088-1111.

MacLachlan, M., Khasnabis, C., &Mannan, H. (2012).Inclusive health. Tropical Medicine & International Health17(1), 139-141.

Malatzky, C., Mitchell, O., & Bourke, L. (2018). Improving inclusion in rural health services for marginalised community members: Developing a process for change. Journal of Social Inclusion9(1), 21-36.

Mills, J., &Hitchins, M. (2015). Inclusion and exclusion in contemporary Australian health care. Oxford University Press.

Richardson, F. (2015).An introduction to inclusive practice. Inclusive Practice for Health Professionals, 2-22.

Solas, J. (2016). Social and political elements of inclusive practice. Inclusive Practice for Health Professionals,107-125.

Yeravdekar, R., Yeravdekar, V. R., Tutakne, M. A., Bhatia, N. P., &Tambe, M. (2013).Strengthening of primary health care: Key to deliver inclusive health care. Indian Journal of Public Health57(2), 59.

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