Australian Human Rights Commission Australia and the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), Shadow report to the CERD Committee – 8 July 2010 and linguistically diverse backgrounds have adequate health literacy levels. 111. There is an established relationship between literacy and poor health outcomes. 96 Good health literacy depends on at least basic reading and writing skills sufficient to enable everyday functionality. 112. Cultural beliefs or barriers can be strong determinants of who accesses health services. Culture is strongly linked with health and well being. Culture can define how health and illness are perceived, experienced, described and managed at an individual level. 97 113. Poor English language proficiency is the most common barrier identified to accessing health information and services in Australia. People with limited English language ability may not access the health care system because they are not able to adequately explain their health complaint (or understand instructions provided by health care professionals). 98 114. The Australian Human Rights Commission notes that English language difficulty is a critical issue for new and emerging communities in particular. The limited availability of interpreters has been a persistent issue for people from migrant and refugee backgrounds in Australia. Issues that can cause limited access to interpreters include: • lack of usage, or improper usage by health services • limited number of interpreters who are able to provide adequate assistance where a complex health issue presents • excessively long waiting periods. 115. Some women from migrant and refugee backgrounds experience compounding difficulties that may delay or prevent proper access to the health system. These compounding difficulties can include: a lack of English language competency, discrimination, limited mobility and limited income. Arabic women and women from other backgrounds may choose not to access health services or may access them less frequently because they are unable to see a female doctor. 116. For reasons outlined above, the cross-cultural competence of service providers and the availability/usage of interpreters should be considered in measuring (I) the accessibility of services and (II) service outcomes. Culturally appropriate health promotion/education strategies could also be used as a measure for both accessibility and inclusion. Cross-country comparisons (for example, comparative analysis with New Zealand) can provide useful benchmarks for accessibility and inclusion. Recommendation 35: That the Australian Government gives consideration to the adoption of the Building on our Strengths Framework as part of its broader national preventative health agenda. 32