All the non-medical factors around an individual including their age, their environment, culture,

upbringing, socioeconomic status, political and financial conditions that has impact on the health
and wellbeing of an individual are known as the social determinants of health. Some of the
examples of those determinants are education, employment, income, working and living
conditions, social and community context, and health care access (World Health Organization
[WHO], 2010).
Access to health care services is one of the important social determinants that has a huge impact
on the health outcome of an individual. Access to health care consist of four components
including health coverage, services, timeliness, and workforce (Agency for Healthcare Research
and Quality [AHRQ], 2018). Health coverage facilitates the entry to the health care system by
protecting people from high and unexpected medical cost and ease the financial access to health
care which promote the utilization of health services and result increased use of health services
leads to improved health outcome (Habib, 2016). Health care services is important for
maintaining and promoting the health and prevention and treatment of the diseases. Timeliness
of health care is important for good health outcome because delayed access to health care may
lead to increased health complication, risk of premature death, unnecessary disability having
negative effect on a health (Edwards, 2015). Culturally competent care provider can build a
positive relationship with the patient to whom they can trust as a result of which there is an
increased likelihood of the patient to seek health care having positive impact on their health
(Hole, 2015).is needed for effective delivery of the person centered care People with lack of
access to health care are more at risk of disease. Appropriate health coverage, health services,
timeliness of the services provided and the efficient health care provider is important for the
effective health outcomes. Without the appropriate access to health services, people suffering
from diseases are at a risk of premature death, suffering from unnecessary disability so, health
care access is important to health.
There are many factors that hinders the access to health care services for aboriginal and Torres
strait islander people. Indigenous people would face many challenges when accessing health care
which is why they experience difficulty. Gaining access depends on their financial, social or
cultural, geographical barrier which may limit the utilization of services (Davy et al., 2016).
Majority of the aboriginal people lives in a rural and remote areas of Australia that has no public
transport available (Australian Institute of Health and Welfare, 2019). Transportation barrier
may lead to missed appointments, delayed care or missed care and delayed or missed medication
uses. These all factors negatively impact the health outcomes for the people with chronic illness
who are in the need of prompt health care (Syed et al., 2013). Despite the need of more health
care services in rural area of Australia, there is a lack of health workforce which impact the
quality of health care living in that area (AIHW, 2019). Lack of culturally competent care makes
the aboriginal and Torres strait islander people visit the hospital less even in need with the fear of
disrespect and alienation (Hole et al, 2015). Another important factor that makes them difficult in
accessing the health services is because of their low socio-economic status which makes them
unable to afford high cost of care (Banham et al., 2017). People with poor economic status are
more likely to be uninsured and uninsured people are reluctant to receive needed medical care
which impact their health (McMaughan et al., 2020).
All those barriers in accessing health care for an indigenous people will lead to unmet health
needs, delays in an appropriate care, inability to receive preventable services, preventable
hospitalizations which has a detrimental effect on health outcomes. Indigenous Australian are
living with the high rates of chronic diseases than non-indigenous people (Gibson et al., 2015).
Despite this, if they are prevented from accessing health care services then there would be an
increased health complication leading to a poor health outcome. Health services includes
different health promotion and preventive services provided by health facility. Lack of access to
health facility prevent them from basic health promotion activities, make them devoid of
different primary and secondary disease prevention services and activities which increases the
risk of developing unhealthy behaviours and increases the risk of suffering from preventable
diseases leading to poor health outcomes(Davy et al., 2016)
Nurses can play an important role in order to address all those issues which limits the access to
health care for an aboriginal people. Effective engagement of the nurses with the aboriginal
community increases the capacity to provide culturally competent care and develop the trust of
aboriginal people which may encourage them to attend the health services (Durey et al, 2016).
Involvement of the nurses in outreach services at primary health care settings might close the gap
in delivering preventive services, screening programmes, and health promotion activities at
community locations (Gulliford, 2017). Nurses can help indigenous people to facilitate engagement
with a range of local and community services which can address the key factors causing lack of access to
health care (Royal Australian College of General Practitioners, 2020).

Reflective practice is important in primary and community nursing because it helps to develop the skills
essential for effective and person-centered care. Reflective practice helps to learn from the experiences,
knowledge and understanding and gives an idea of how the things could be done in a better way in the
future and is the best way of converting theoretical knowledge into practice (Koshy, et al 2017). This
understanding could be important to me as a practitioner because it helps me to think critically and
solve the problem practically. From my understanding of the effect of social determinants on health
outcomes of Indigenous people, I could apply this knowledge and try to address the barrier of
vulnerable people in accessing the health care. This helps me advocate for the patient to access
reasonable, quality and culturally safe care.

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