 Preface
Welcome to “Rural
and Remote Environmental Health I”, the first in what is hoped will be
a series of books dedicated to investigating issues pertaining to rural
and remote environmental health!
This book was
written to fulfill a need for quality educational material, which is lacking
in the area of rural and remote environmental health. It is expected to
be of use to academics, researchers, students, physicians, nurses and
other health professionals, and particularly to those who plan to work
in areas with limited access to resources and significant exposure to
environmental factors. It is hoped that Master of Public Health students
will make great use of this resource as they study the subject.
The topics covered
in this book fall into the general categories of hospitals & clinics,
pests & pets, housing and health hardware, resource development operations,
disasters and refugees. Many chapters are written by experienced people
who have witnessed what they have written about. Virtually all are middle
career health professionals with experience in tropical medicine and have
a keen interest in promoting health in rural and remote areas. Some chapters
contain information that can be related to urban situations, but on the
whole, the focus has been maintained.
It is clearly
evident in global terms that all people do not enjoy the same standard
of living or level of health care and that many populations are disadvantaged.
This is also true in Australia were historically it was thought that some
humans were created more equal than others. According to the conditions
set out in the Australia Charter for Environmental Health, the general
population is close to achieving most of the responsibilities and entitlements
outlined. The gulf between the Charter and rural, remote and Indigenous
populations in Australia is, however, embarrassingly large and shows no
sign of closing in the immediate future. Indigenous populations continue
to experience a disproportionately higher rate of morbidity and mortality
than the general population, while a healthy life is easily attainable
by most Australians. To a certain extent, this is due to increased exposure
to environmental hazards and a lack of environmental health services.
Environmental
health is characterized by unbiased even-handedness and a population-based
approach to health that endeavors to improve health outcomes. Policy-makers
are now starting to realize that policies and actions are a major contributing
factor to the success of any effort in terms of health outcomes. Moves
are now afoot to include environmental health issues into all levels of
government policies, programs and activities. The only way this situation
can be remedied is for extensive collaboration to occur between all levels
of government and rural, remote and Indigenous organizations and communities.
The state of
health in Australia’s Indigenous communities has been compared to that
in developing countries because the burdens of disease and mortality are
typically borne by those in younger age groups and overall rates are much
higher than for the general population.
Social justice
from the environmental health perspective usually includes the following
categories:
- Socially and economically disadvantaged populations
- Children
- Indigenous Australians
- Sustainable development
Since 1973, mandates
from the Federal and State Governments have recognized and attempted to
address the social justice issues inherent in the gulf between Indigenous
and general population health. In 1999, Queensland Health further recognized
the necessity of developing a national strategy to address this problem
through planning.
It is envisaged
that a health risk assessment approach will be used to address the priority
areas affecting Indigenous health. The Tropical Public Health Unit of
Queensland Health is currently developing a risk assessment and review
program specifically for environmental health in Indigenous communities.
This is in reality is not a risk assessment program, but a risk management
program which is a best-practice tool used for prioritizing risks and
informing decision makers so that management plans contain the best strategies
and most appropriate programs.
In 1998, the
National Indigenous Environmental Health Workshop was held in Cairns from
which emerged several important points concerning collaboration. It was
agreed upon that a successful environmental health management program
should include the following additional components:
- Provision of effective environmental health services and programs
- Provision of community environmental health education programs
- Community involvement in environmental health system development
- Provision of training to initiate and maintain environmental health
systems
- Provision of a supportive infrastructure for environmental health
systems
- Provision of adequate relevant information on and for Indigenous communities
- Provision of opportunities for economic development
- Reduce cultural barriers that affect behavior and communication
- Community control of environmental health systems
Efforts by government
to date have not produced the expected results. This has been blamed on
failure to provide these items fully and appropriately as outlined below.
- Fragmented approaches between agencies to managing Indigenous environmental
health.
- No mechanisms in place to monitor or evaluate the impact of environmental
health programs.
- Absence of local full-time Indigenous environmental health services
throughout the State of Queensland.
- Communication breakdown through cross-cultural barriers and misconceptions.
- Inadequate infrastructure maintenance programs.
- Decision making without effective community involvement.
- Excessive cost resulting from isolation and the absence of road infrastructure.
- Lack of consultation between funding agencies.
It must be admitted
though, that provision of some of these items is a big ask. On the one
hand, provision of general and specific health education is unquestionable.
On the other, provision of economic development opportunities is impossible
without adequate social cohesion and structure for support. There is but
one item on the list that indicates flexibility and willingness to give
in addition to take – reduction of cultural barriers – however, this has
also clearly failed to materialize. The primary over-riding factor is
still access to and penetration of adequate and appropriate primary and
secondary education. Once this has been achieved, communities will have
the ability and social cohesion required to initiate and maintain most
environmental health systems.
The Queensland
Aboriginal and Torres Strait Islander Environmental Health Strategy will
be a demonstration of the distance that we have come in addressing these
issues and is based on five essential components:
- An integrated approach to community development (land, housing, water,
sanitation, income, employment, education).
- Aboriginal and Islander control of decision-making.
- Implementation of effective prevention and treatment health services
for the major health problems.
- Provision of resources for health services at least equal to the rest
of the population, as well as additional resources required to address
the higher burden of illness and consequently higher use of services
by the Aboriginal and Torres Strait Islander populations.
- Progressive improvement in the skill levels of health workers providing
services to Aboriginal and Torres Strait Islander communities.
Dr. Deon V. Canyon (Editor)
James Cook University, Australia
|
THE
AUSTRALASIAN COLLEGE
