Ensuring our services are inclusive and addressing food allergies

1 Dec 2009

It is well established that the vulnerable groups in our society (those who need our services the most), access services the least. This was first termed the ‘inverse care law’ (Hart, 1971) in 1971 and remains true today. It is also widely accepted that these groups commonly suffer the worst outcomes, be they Aboriginal or Torres Strait Islander (Duckett, 2007), Culturally And Linguistically Diverse (CALD), or young parents (Sebastian, 2008).

It is less commonly noted that the reason these populations do not access services may well be because services are not offered to them in a way that is engaging and inclusive (Moore et al., 2001; Carbone et al., 2004). The reality for many of the parents from these populations is that they suffer judgement, discrimination and prejudice when accessing mainstream health services (Wilkinson & Marmot, 2003). ‘Hard to reach’ families have long been a factor in the provision of early childhood services. However, the validity of the term ‘hard to reach’ is increasingly being challenged (e.g. Brackertz & Meredyth, 2008).

‘Hard to reach’ can be used to mean many groups, but perhaps more critically, it locates the problem with the client or potential client and does not look at the way that services are being provided. The way that health professionals perceive parents, and are in turn perceived by those parents, can impact not only on initial access, but also on ongoing attendance and the level of client involvement in the service (Carbone et al., 2004). This paper seeks to raise your awareness of your role as a health professional to support vulnerable families accessing your service to feel safe, respected and welcome.

There is a growing consensus that, rather than thinking about certain sections of the community as being hard to reach, it is more useful to think of them as being people whom services find difficult to engage and retain. Slee (2006) argues that we need to look at ‘unequal outcomes as social injustices, rather than as products of individual dysfunction or deficit’. 


Food allergy featured as the lead article in the September 2004 edition of Community Paediatric Review, and feedback tells us that it remains topical for child and family health nurses today. Concerns regarding food allergy and/or food intolerance are still raised by parents. There may be a family history of allergies and parents may be anxious that their child may be at risk. Alternatively, parents may be concerned by stories in the media about children who have had severe anaphylactic reactions to nuts.

Often food allergy and food intolerance are discussed as interchangeable problems. However, there are differences. Food allergy is defined as a reaction that is due to an immunological mechanism, usually immunoglobulin E (IgE); the reactions maybe immediate or delayed, and mild or severe. A severe reaction may be an anaphylactic reaction. Food intolerance refers to reactions involving known or unknown non-immunological mechanisms (Wilson, 2009). 

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