Sociology

In current decades, there has been heightened awareness of the predominance of the middle ear disease, also known as otitis media (OM), as the most common antecedent of auditory or hearing loss among Native Australians. OM is an infection of the middle ear that presents itself in diverse forms. It is elicited by bacterial or viral contamination and is a complication of a simpler malady (such as a cold). OM commonly precipitates conductive hearing loss that is mild to moderate in intensity, and may be sporadic or persistent depending on the form of OM. Without effective medical care and follow-up, OM may become very serious and incurable, increasing the chance of total hearing loss. Sadly, the compelling repercussions of hearing loss  has its effect on the ability to communicate, to participate in schooling, attain advancing skills, and form connections among other people. This recognized the need for further examination in a range of areas concerning health, mainly Indigenous hearing health.
Prototypes and degrees of OM and hearing loss commence differently in Indigenous and non-Indigenous people, resulting in more serious aftermaths and necessitating different aid and services for the Indigenous population. Lack of information within the mainstream

Hearing Impairment in Australian Islanders   
health and education strata of the Indigenous ear health and hearing analysis being different is likely to have added to the limited understanding and rendering of existing knowledge, and prompted the development of appropriate policy and applications in the Indigenous context. Studies overseen in provincial and remote Aboriginal communities account that otitis media often occurs in infants within weeks of birth, which is usually undetected and untreated due to lack of health care, and repeated occurrences commonly lead to a chronic disease that carries on into adolescence and adulthood. It has been assessed that an Indigenous child experiences combined occurrences of OM that total about two-and-a-half years, in contrast with three months for a non-Indigenous child in Australias general population.

Otitis media is blamed for much of the hearing loss happening to the Indigenous people of all ages in Australia. Stages of otitis media (OM) and hearing loss differs across Indigenous communities throughout Australia, but are indicatively worse than those reported in non-Indigenous populace. The true extent of the point of issue remains unclear, but probing studies, large-scale surveys, and hospitalization abstracts provide awareness into levels of OM and hearing loss within the Indigenous communities. It is beyond the scope of this paper to consider shifts in levels of Indigenous OM and hearing loss over time, but reports from research studies conducted in the last two decades emphasize the endemic nature of ear disease, which means that it is a disease that is invariably present to a greater or lesser degree in people of a certain class or in people living in a particular area. Hearing loss in the Indigenous populace, and recent surveys and hospitalization abstracts point to the continued affliction of ear disease and hearing loss experienced by Indigenous Australians.

Factors That Have Resulted in a Disproportionate Incidence of Hearing Impairment and Deafness in the Population of Aboriginal and Torres Strait Islander Peoples

Compared to the General Community
The Productivity Commission, the Australian Governments autonomous research and advisory body on the sphere of economic, social and environmental concerns involving the welfare of Australians, has marked that high rates of chronic ear infections have a direct link to poverty, crowded housing circumstances, insufficient access to clean water and operative sewerage systems, dietary issues and limited access to health care experienced by the Aboriginal and Torres Strait Islander communities.

Poverty in indigenous tribes
World Bank has upheld Australia as one of the richest countries of the world in 1995. The country has one of the most booming economies in the world which is mirrored in the lifestyle of most of its people. Its urban cities such as Sydney and Melbourne has a very prosperous and dynamic lifestyle. But although the standard of living in Australia is relatively higher than in other countries of the world, there is still an imbalance among the settlers of Australia pertaining to living standards. Australia is also an abode to a number of Aboriginals who have been, over the years, relegated to a lower social standing by the European settlers. This traces back to Australias history about the conflict between Aboriginal people and European settlers in Australia that goes back to 18th century, 1788 to be exact. This was when the first group of European migrants arrived in Australia and was confronted by the Aborigines already owning the land. Misunderstandings and conflicts led to a marginalization that has resulted in a huge contrast between the living standards of the Europeans and the indigenous communities evident in this present time.

The poverty being faced today by the Aboriginal and Torres Strait Islander peoples of Australia is a fruit of history. One of its present-day offsprings is the high incidence of hearing impairment and deafness in the population of Aboriginal and Torres Strait Islander tribes.

The lack of financial capacity can restrict the adequacy of families to provide sanitary and healthful environments, especially in terms of diet and habitation, which in turn puts family members, particularly the young ones and teenagers, at increased danger of contracting diseases. Poverty in Australia is as bitter as it is in developing countries, and its Aboriginal and Torres Strait Islander peoples, about half a million Australians, who are among the most impoverished. Dispossession, deprivation, racism and discrimination for more than 200 years have left Indigenous Australians with the lowest levels of education, the highest levels of unemployment, the poorest health and the most appalling housing conditions.
       
But whose fault is it really Should the Australian government take full blame for the plight of the Aboriginal and Torres Strait Islander peoples Why cant the government help them out of their poverty
 We all know that education opens a wide avenue of opportunity for everyone. But in the opinion of Coombs (1994), the Australian education system is still discerned by some members of Aboriginal society today as an instrument of assimilation children are there to be changed to be weaned away from the loyalties that have made them Aboriginal (p. 87). Education has been undertaken as a solution to what has been termed Australias Aboriginal problem for almost 200 years now. As an institution, school has been used, among other purposes to promote racial integration and stimulate Aboriginal self-determination (Fletcher, 1989). According to what has been stated then, is it the native communities deeply-seated immovable schema of education that is hindering them from moving on to progress A negative impact on educational achievement can have further negative life repercussions as educational achievement has been found to be linked with progress and advancement.

Overcrowded Housing
Overcrowding, poor housing frameworks, and limited access to affordable and suitable shelters in Aboriginal and Torres Strait Islander communities is still a big challenge to the Australian government and service providers. Ameliorating and increasing current housing stock is compulsory if Australia is to narrow the gap between economic conditions of the disadvantaged population of Aboriginal and Torres Strait Islander peoples and the general community of the country.

Congestion or overcrowding in places of habitation may contribute to poor hygiene and subjects the children especially, to the dangers of getting infected by other family members if there is already an ear infection epidemic in the home. Indigenous people living in remote areas abide in temporary dwellings, including tin sheds, caravans and humpies.  Having too many people confined to a small place also upsurges the noise level of the home area, which may result to further hearing deterioration and render hearing aids useless because of much background noise.

The place of dwelling has a huge impact on health. The components of place are the not just the infrastructure, but also the physical surroundings, availability of healthy environments and sanitation, accessibility to services, and socio-cultural elements of the locale. They are a mix of physical, social, environmental, economic, and socio-cultural influences. The actuality of these conditions is increasingly shown to have repercussions on psychosocial aspect of the individuals of that community and defines how various groups resultantly engage in health-promoting behaviors.

Indigenous communities living in areas across Northern and Central Australia who experience the most alarming living circumstances in remote Australia are the most apparent and enduring evidence of past government inadequacy. This is the exact opposite of the modern housing facilities enjoyed by the majority of the general population situated in Australias urban cities. Reconstructing economic opportunities in remote areas such as the Torres Strait Islander communities should be a major call for Australias economic participation reforms.

Insufficient Access to Clean Water
Majority of Australians abide in cities where large expenditures have been made to guarantee an adequate supply of water, even in the event of drought. An estimated 70 of Australians live in cities accommodating more than 100,000 inhabitants. These cities typify less than 1 of the area of Australia. The remaining 99 of this large area contains the other 30 of Australians. A multitude of those people live in smaller cities and communities and also have adequate water supply. On the other hand, some do not. For places not connected to main water supply, some arrangement for the supply of water is essential. This could be, for example, groundwater, stored rainwater or a junction of both.
       
However, for a number of small communities in remote parts of Australia, the provision of a satisfactory supply of water is a considerable challenge. Many of these remote areas are Aboriginal and Torres Strait Islander communities.

A number of these communities still have insufficient water supplies and some do not have a constructed water supply at all. The provision of water supply to small communities in the boondocks is particularly problematic. The remoteness makes it slow and high-priced to get materials transported. It also makes it difficult to get support teams and maintenance services on site.
Because community members chiefly lack access to the needed technical training and to the specialized services that might be required for on-going maintenance, repairs and restorations to water supply systems is difficult.

Government administration departments and agencies have come up with resolutions to improve water supplies in remote Indigenous communities. Nevertheless, it concluded that no significant betterment in Aboriginal living conditions would take place without a number of other reinforcements. These included
acknowledgment of the need for community control in decision-making assimilation of difference between cultures development of the means for communities to acquire independent scientific and technical methods identification and application of the necessary adjustments in Government policies and programs

Inadequate Sewerage Systems
Domiciles without functioning water taps and showers, or with substandard means to obtaining clean water, operational sewage and waste removal methods make subsisting with good hygiene very difficult and increase the susceptibility of children to bacteria that is responsible for ear diseases.

In a sewerage service survey in 2001 of 1,216 Indigenous communities with a population of 50 or more found that 48 had reported sewerage system overflows or leakages in the 12 months prior to the survey. Also in a 2001 report, 7 of isolated Indigenous communities, denoting 1 of the entirety of the reported residents of all such communities, reported having no systematic sewerage system. Of the 327 communities which accounted a population of 50 or more, 58 reported overflows or leakages in the prior 12 months. Flooding also occurs in the dwellings in communities of this size. But recently, according to the Australian Bureau of Statistics, between 2001 and 2006, there was a 55 growth in the count of communities conjoined to a town sewerage system as their vital form of waste disposal. This developed in a proportion of people whose community had town sewerage augmenting from 8 to 30. As a result, a reduced proportion of people depended on water-borne systems and septic tanks (38 and 28 correspondingly) in 2006 than in 2001 (50 and 36). But still, not all people in remote Indigenous communities had access to some type of functional sewerage system. The microbes from external ear infections can be passed on to exposed individuals under conditions of poor hygiene and inadequate waste disposal sewerage systems.

Nutritional and Dietary Issues
Intensified degrees of excess morbidity and mortality from diet-related ailments among Indigenous peoples compared to the non-Indigenous population implies that access to healthy, reasonably-priced foods is an important health concern for Aboriginal and Torres Strait Islander people. In a number of remote Aboriginal and Torres Strait Islander community markets there is frequently a limited variety of foods stocked compared to larger urban towns and more commercial areas. Selectively, perishable items such as dairy foods, fruits and vegetables are usually in short supply, of poor quality and are very expensive (Young 1984, Leonard et al 1994, Lee et al 1994).

Notwithstanding the cost of food in all rural areas is predominantly higher than in southern capital cities, several separate surveys have exposed that the cost of food in Indigenous rural and remote communities is even more exorbitant than those in other rural and urban areas. For instance, a Queensland survey done in urban, rural and remote areas recorded that the prices for a healthy food basket for a remote Indigenous family swung from 120 to 180 of Brisbane prices. The Torres Strait shopper can pay about 75 more for fruit and vegetables in contrast to consumers in Brisbane (Leonard et al 1994).

On the other hand, one study has pinpointed that Aboriginal women are more inclined to spend available funds on foods while the men tend to choose other goods (Rowse et al 1994). Abuse of substances such as alcohol and tobacco may also veer money away from food and other basic needs. For example, a study in remote communities of Aboriginal and Torres Strait Islander people has shown more than 50 percent of their meager income was spent on cigars and beer. This is different to less than 20 percent being spent on these commodities in the Australias general community (Lester 1994,
Hoy et al 1997).

Limited Access to Health Care
Although health care in Australia is considered one of the best in the world, the Australian Federal Government has, in effect, coursed a system in which Aboriginal and Torres Strait Islander communities receive second-rate level of service when it comes to the constancy of care than the rest of Australias general population  less on prevention, less on fundamental healthcare, less for surgery in health service institutions and less for rehabilitation. The evident of higher expenditure on hospital care is almost certainly less than it should be on a needs presumption, given the higher ailment levels in the indigenous groups.

Unfortunately, the Federal Government, through projects under its own direct control (i.e. Pharmaceutical Benefits Scheme Medical Benefits Scheme, aged care), budgets approximately  .70 per capita on Aboriginal and Torres Strait Islander people for every 1 spent on the rest of the general population.

The critical shortfalls are on vital basic healthcare and prevention and these are the turning points for improving Aboriginal and Torres Strait Islander health. Giving priority to early intervention in childhood to impede poor health consequences in adulthood should not be underestimated. Whats essential, most of all, is a comprehensive national program to reform Indigenous health care as a starting point heading to the improvement of health of the next generation of Indigenous Australians. Such projects should include a well-planned allocation of medical and health care staff linked with an increased advancement in health infrastructure, including basic vital healthcare and the advocacy of healthy lifestyles that can add to Aboriginal and Torres Strait Islander health equality with other Australians.

Prototypes and degrees of OM and hearing loss commence differently in Indigenous and non-Indigenous people, resulting in more serious aftermaths and necessitating different aids and services for the Indigenous population. Lack of information within the mainstream health and education strata of the Indigenous ear health and hearing analysis being different is likely to have contributed to the limited understanding and implementation of existing knowledge, and influenced the development of appropriate policy and practice in the Indigenous context. Studies conducted in rural and remote Aboriginal communities report that OM often occurs in infants a short period days from birth, and repeated occurrences frequently lead to chronic illness that persists into adolescence and adulthood.

The lack of supply and the high demand of health care professionals with the motivation to want to participate in the process of becoming culturally aware, culturally skillful, and familiar with cultural experiences with Aboriginal and Torres Strait Islander peoples, under the circumstance of receiving even lower wages compared to those working with the general population presents still another problem in health access. At present, there is a deficit of more than 400 doctors, more than 600 nurses and related shortfalls in many of Aboriginal health staff and allied health workers attending to Aboriginal and Torres Strait Islanders health services. Services such as vital primary healthcare cannot be optimally delivered without these professionals and health care staff. Current recruitment opportunities are impeded by the failure of Aboriginal-specific primary healthcare services to compensate the health workers with competitive salaries as compared to the private sector salaries in Australias major cities which are, in fact, higher.

Another point that makes it even more difficult for health professionals is their lack of cultural competence. Cultural competence is an essential constituent in rendering effective and culturally responsive assistance to culturally and ethnically diverse patients. Supernatural interposition, for instance, plays a very valuable role in the traditional health beliefs of Aboriginal people as it may support the ultimate ground why a person became sick. All health professionals interacting with Aboriginal people should have been briefed of the effects this may have on the provision of healthcare.

Concluding thought
The factors that have resulted in a disproportionate incidence of hearing impairment and deafness in the population of Aboriginal and Torres Strait Islander peoples compared to the general community as briefly described in the previous pages can merely be compared to leaves of a tree of whose texture and quality is a by product of how the tree was nourished and from whence it has originated. It is only by nourishing its roots with more nutrients can we then see greener leaves. Solving the health problems of the remote communities especially the hearing impairment leading to hearing loss, will not only untangle the maze of problems they now face, but it will, in effect, improve the lives of these people in its total framework and over all quality of living.