Academic journal article Australian Health Review

Eye Health Programs within Remote Aboriginal Communities in Australia: A Review of the Literature

Academic journal article Australian Health Review

Eye Health Programs within Remote Aboriginal Communities in Australia: A Review of the Literature

Article excerpt

Abstract

Objective: To review the literature regarding the most sustainable and culturally appropriate ways in which to implement eye health care programs within remote Aboriginal communities in Australia from a primary health care perspective.

Data sources: The search included letters, editorials and papers (published and unpublished) from January 1955 to April 2006.

Study selection: The search revealed 1 106 758 papers, books and other related material. The relevancy of this material was determined by abstract and 378 relevant articles were reviewed in their entirety. After reading the relevant articles and the interview transcripts the themes that emerged from each source were extracted.

Conclusions: The ten areas to consider include: clinical practice and access, sustainability, regional-based programs, information technology systems, health worker training, self-determination, cultural and language barriers, funding body responsibilities, embedding specialist programs in primary care services, and other considerations. Further research needs to be undertaken within Aboriginal communities in the area of primary eye health care and barriers to the acceptance of treatment. This may be undertaken using more interactive research methods such as cooperative and narrative inquiry.

Aust Health Rev 2008: 32(4): 664-676

THE LITERATURE on eye care programs within remote Aboriginal communities seems mainly grounded in service provision. There are papers that discuss the use of telehealth,1-4 visiting specialist outreach programs,5-7 and the use of digital imaging.8-11 Each of these methods are important instruments in the promotion of eye health care within communities, but it is known that the development of Aboriginal health services is not sufficient to dramatically reduce the morbidity associated with eye conditions, or indeed the mortality associated with chronic disease. It has been previously noted "that while the past two decades have witnessed very considerable improvements in the areas of health services, the persistent health problems of Aborigines are a constant reminder that poverty, not merely inappropriate health care, is the major contributing factor." (p. 121)12

Poverty is but one of the social determinants of health that have a marked impact on the morbidity and mortality faced by remote Aboriginal communities. Other factors such as: health in early childhood; a drug free environment; poor working conditions and unemployment; social support; and access to adequate hygiene services, food and transport13 all have an impact on the capacity of these communities to develop, implement and maintain programs directed toward the amelioration of poor eye health and the systemic conditions that impact upon eye health.

Eye health as a public health issue

In May 2003, the 56th World Health Assembly passed resolution WHA56.26 on the elimination of avoidable blindness. This resolution recognised the fact that 45 million people in the world today are blind and that a further 135 million people are visually impaired.14 The resolution urged member states to develop a national Vision 2020 plan in collaboration with non-government organisations and the private sector to prevent avoidable blindness. The Vision 2020 plan has been adopted by Australia, and aims to eliminate avoidable blindness and vision loss by the year 2020.

In Australia, the main causes of blindness and vision loss are macular degeneration, cataract, glaucoma, diabetic retinopathy, uncorrected or under-corrected refractive error, eye injuries15 and trachoma. Trachoma, a conjunctivitis that leads to lid scarring and eventually blindness, represents a unique challenge to Australia as a developed nation. Australia is the only developed country in which this condition still exists and it represents the ongoing social, infrastructure and poverty inequalities that are present within remote Indigenous communities. …

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