Possible Public Health approaches to increase the School Attendance Rate of Indigenous students in Mataranka, Northern Territory, Australia

Table of content

Background
The early aboriginal history
The health in our modern 21st century
The preferred approach
Conclusion

Health Plan
Health Plan – The history of the first nation people
Health Plan – Aboriginal life in modern Australia
Why should we focus on the school attendance rate? – The role of the social determinants of health
How many Students don’t go to school?
Why don’t the students go to school?
The Indigenous community of Mataranka

The Health Plan
The analysis of the current situation
Important organizations
Health approaches
Health Plan
The restructuring of classes
Cultural awareness and the anti-bullying campaign
The educational campaign
The reduction of alcohol use

Conclusion

Appendix

Background

The early aboriginal history

It is approximately 50.000 years ago that the first humans settled down in this part of the world. Scientists and archaeologists assume that the first aboriginal people moved from the Indonesian archipelago down to Australia. The sea level was significantly lower than today and the ancestors of the native Australians could move to the country in small boats. Ancient Australia was an inhospitable and harsh place to live. However, the indigenous population was able to colonize the continent, but sparse (1). Scientists estimated the maximum population to be 900.000 people. Their culture was shaped by a strong spirituality, which is still important for today’s aboriginal peoples. The first European discoverers arrived in the 17th century. On the 22nd August 1770, Captain James Cook declared the east coast of Australia to be a British colony (2,3). Over the next few years, the European settlers started to take the

This figure was deleted by the editors due to copyright issues

Figure 1: Scarce German lithography depicting an aboriginal family at a camp, painted 1891 by Gustav Ludwig Heinrich Mutzel (https://www.pinterest.com.au/pin/4191163090742584 09/ access date: 18.03.2020)

land from the aboriginals and create a western nation, while the number of indigenous people was reduced significantly. Since those days, integration and protection programs were launched to increase the health and life of the so called first-nation people (2). Although, key factors like the child mortality or the life expectancy are still significantly different in indigenous and non- indigenous communities. To reduce those differences, the Australian government started the “Closing-the-Gap” initiative, created in 2008. The main target is to close the gap in life expectancy between indigenous and non-indigenous people within one generation (4). The data is annually published in the “Closing-the-Gap” – report. Those reports show also which of the targets are on track and which are not on track.

The health in our modern 21st century

In the past, health was simply the absence of diseases or injuries. But that definition has been changed rapidly during recent years. Today, we know that health is affected by different physiological, psychological and other factors. In one of the “more older” modern papers, health is defined as “a state characterized by anatomic, physiologic and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological and social stress” (5). One of the first persons who described the influence of social determinants on the health was the German anthropologist and politician Rudolf Virchow. Today, he is known as the founder of the modern pathology and plays an important role in health science.

In 1848, he researched an ongoing typhus outbreak in upper Silesia, which is now Poland. In the course of his research, Virchow hypothesised that the outbreak was connected with poor and bad living standards in the region. In his report to the Prussia government, he recommended the support of the population with medicine and food as well as the introduction of a democratic system (6). His ideas were not implemented by the government. Nevertheless, the influence of social determents has a great impact on our modern medicine and health.

A very important man, who opened our mind for the social determinants which influenced health is Professor Sir Michael Marmot. The British professor for epidemiology and public health assumed, that the social status and living conditions have a direct influence on the health of the people (7,8). In the year 2014, at the annually symposium WORLD.MINDS in Zürich, Sir Michael Marmot described those social determinants and showed that the life expectancy can differ significantly even in the same cities (9).

Aboriginal communities are also influenced by those determinants. Archaeological studies revealed that the population of indigenous Australians decreased significantly after the first settlers appeared (10). The traditional lifestyle of the indigenous populations was very healthy. Researchers often compare it with the lifestyle of the ancient Greeks, with healthy food and sport. Then the settlers arrived in Australia, they begun to adapt their unhealthy lifestyle in the colony and to take over the land, which lead to the decreasing number, influenced by new diseases, introduced by the settlers, but also by social violence like racism, violent treatment, aggressive land takeover (often with the use of alcohol) and cultural disruption (11). Those changes reduced the number and the life expectancy of the indigenous population.

The preferred approach

To protect the indigenous population and increase the health and life expectancy, the government introduced the “Closing-the-Gap” – Initiative. The initiative started in the year 2008, with the aim to close the gap between indigenous and non-indigenous Australians in different targets within different time frames (4). The main target is to close the life expectancy in one generation (12) and includes targets like “Halve the gap in mortality rates for Indigenous children under five within a decade” or “95 per cent of all Indigenous four year-olds enrolled in early childhood education” (12).

To increase the health of young aboriginals, a multi-part approach is necessary. In 2018, the indigenous child mortality rate was 141 per 100,000 – twice as high as the rate for non-Indigenous group (67 per 100,000). The childhood mortality is closely linked to the mother´s health. The main cause was perinatal conditions, like birth trauma, foetal birth disorders etc. But social determinants play an important role, like smoking during pregnancy or other risk factors (12). Remoteness also influences the health and early childhood mortality. In remote areas, the medical infrastructure is worse than in urban areas.

Another important part is health promotion and education of both the mothers and the children. As an example, mothers must be educated and informed about the risks of medicine, which can easily pass through the mother’s blood to the placenta and to the unborn baby where it can harm the foetus. To reduce the risk, medicine is put into 5 categories. Table 1 gives an overview about the different categories. Medical practitioners must inform pregnant women about that risk (13).

Table 1: Overview about the different medicine classes and their effect on the pregnant patients.

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School education is also very important. Good school education is not only linked with a better health but also the entry to a better job and a better career, which is also connected with a better life and health. Low attendance rates have several school or familiar reasons (14). Table 2 gives some examples.

Table 2: Overview about the different factors why students don’t attend at school classes.

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There are many different ways to increase the school attendance rates for children. One of the best, and probably one of the easiest ways is to create a good and healthy school culture, where the students want to be and to learn.

This figure was deleted by the editors due to copyright issues

Figure 2: An overview of targets of the "Because I am a Girl" – campaign from Canada. The aim of that campaign is to increase the safety of girls in schools all over the world. But the targets can be transfer to other vulnerable populations like indigenous populations or other minorities. (https://www.pinterest.com.au/pin/437834394997942488/ access date: 28.04.2020)

One example of how to improve school culture is the Canadian “Because I am a Girl” – campaign, started by the Canadian government in 2007. Figure 2 shows the aims of that global campaign, which sets a focus on the education of girls. But the targets can be easily transferred on Indigenous students and other groups (15).

Another approach is to change the structure of the education system and make it more interesting for younger children. The German astrophysicist and natural philosopher Professor Harald Lesch belongs to the greatest critics of the German school system (16,17). In his opinion, the schools must set a greater focus on art subjects and should teach classes like natural science and mathematics more practical (16,18). His main aim is to make the school more interesting for young students and avoid stress related diseases like burnout that keep increasing (19). If we can create a more effective system with a safe and positive school culture, the school attendance rate should be increasing. Indigenous students should then be able to receive better degrees and following better jobs, that lead to a better and healthier life (20).

Another problem that influences not only the school attendance rate but also other health factors is the difference between urban, regional and remote areas. Australia is famous for its remote outback. But the influence on the health care system is enormous. As an example, the closest hospital at the Uluru resort Yulara is in Alice Springs, 460 kilometres away. Compared with urban regions, the population in remote and rural regions experience greater morbidity and mortality (21). Aboriginal communities are threatened by several communicable diseases. Particularly children are affected by skin, eye and respiratory infections (21). Another threat is a parasitic infection with the nematode Strongyloides stercoralis, which is a very dangerous infection (22). Studies revealed that communicable diseases, include Strongyloides infections, are associated with a bad hygiene and bad education. Education plays a very important role in medicine (21,23). Another problem is the infrastructure. Remote areas are hard to reach. Australian answer that problem with telemedicine and its Royal Flying Doctor Service, founded in 1928 (24).

Conclusion

The health of aboriginal populations is influenced by several social determinants, like racism, inequity, bad education and living in remote areas. To improve health in those populations, a multi-step approach is necessary. The risk of children’s health is often associated with a bad education. So, it is mandatory to increase the education of children, because that influences the health not only direct (knowledge about diseases and behaviour) but also indirect (access to better jobs, more money, which is associated with better living conditions). Australia´s associations like the Royal Flying Doctor Service are able to reduce the health risks in remote areas.

Health Plan

Health Plan – The history of the first nation people

It is approximately 50.000 years ago that the first humans settled down in this part of the world. Scientists and archaeologists assume that the first Aboriginal people moved from the Indonesian archipelago down to Australia. The sea level was significantly lower than today and the ancestors of the native Australians could move to the country in small boats. Ancient Australia was an inhospitable and harsh place to live. However, the Indigenous population was able to colonize the continent, but sparse (1). Scientists estimated the maximum population to be 900.1 people. Their culture was shaped by a strong spirituality, which is still important for today’s Aboriginal peoples. This influence of spirituality is also very important for Aboriginal health. Scientists compared the traditional life style of Indigenous Australians with the life style of the ancient Greeks, which was strongly influenced by healthy food and sporting competitions (11). This life style was heavily influenced by the arrival of the European settlers in the 17th century (2).

Health Plan – Aboriginal life in modern Australia

After the first Europeans arrived in Australia, Captain James Cook declared the east coast of Australia to British territory on the 22nd August 1770 (2). In the following years, the settlers started to create a western nation. That process influenced the traditional lifestyle of the Indigenous people direct. There is a wide gap between Indigenous and non-Indigenous health today.

Why should we focus on the school attendance rate? – The role of the social determinants of health

In the past, health was just the absence of sickness or injuries. But this definition has changed significantly in the last years. Today we know that health is very complex and influenced by psychological, physiological and social factors. As an example, people with a good and safe job are healthier than people with a less safe job. The entry to a good and safe job is a good school education. But to receive a good school degree, a constant school attendance is very important. A constant attendance also increases the physical and mental health (20).

How many Students don’t go to school?

To develop activities and approaches to increase the attendance rate, it is important to know the actual data and how many students do not attend school lessons. The Closing-the-Gap report compiles that important data. The main sources are the Australian Bureau of Statistics and the Australian Assessment and Reporting Authority (12).

Graph 1: Student attendance rates in semester 1, years 1-10, 2014-2019.

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The first graph compares the student attendance rate of Indigenous and non-Indigenous students. It becomes clear, that the gap between Indigenous and non-Indigenous attendance rate is great. The target of the Closing-the-Gap agenda is not met.

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Graph 2 shows, that the rate is decreasing in the higher years. Thereby, the gap in the higher, more important years is greater than in earlier education years.

Graph 3: Indigenous student attendance rates, by jurisdiction, semester 1 2014-2019.

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The third graph compares the attendance rates of the different jurisdictions and years. The graph shows, that the overall attendance rate is degreasing from 2014 to 2019. More rural and remote states have a lower attendance rate than more urban states. The Northern Territory had the lowest attendance rate of Indigenous students, followed by Western Australia. Tasmania and Victoria had the highest rate. The following graphs (4 and 5) compare the attendance rate of Indigenous and non-Indigenous students and the demographic of Indigenous and non- Indigenous people sorted by remoteness. It becomes clear, that Aboriginal students are more present in very remote areas than non-Indigenous students. Their attendance rate is also lower.

Graph 4: Indigenous and non-indigenous attendance rates by remoteness, Semester 1 2016-2019.

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Graph 5: Indigenous and non-indigenous Population by remoteness, 5-16 years, 2016.

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