” Achieving health equality for Aboriginal and Torres Strait Islander people will be impossible without a sincere, committed effort to understand and address racism in this country. That is why the Close the Gap Campaign continues to call for a national inquiry into the prevalence of racism and its impact.
The old cliché about persisting with the same failure in the hope of a different outcome is sadly the lived reality of much of the government policies regarding our people.
It is time to do something different.”
NACCHO CEO Pat Turner AM and Co- Chair Close the Gap Campaign
Opinion editorial 16 March see below in full ” It’s time to re-think Aboriginal and Torres Strait Islander health
“Closing the gap in health equality between Aboriginal and Torres Strait Islander people and other Australians is an agreed national priority but governments are failing to meet nearly every key measure. This has to change.”
That’s the blunt assessment delivered by Close the Gap Campaign co-chairs, Jackie Huggins and Patricia Turner :
Dr Huggins, who is also co-chair of the National Congress of Australia’s First Peoples, and Ms Turner, who is chief executive of the National Aboriginal Community Controlled Health Organisation, released the Close the Gap Campaign 2017 Progress and Priorities Report in Sydney today ( 16 March ) to mark National Close the Gap Day.
Download the report HERE CTG Report 2017
CTG 2017 report : 15 Recommendations : “We have the Solutions “
New Engagement ( The remaining 12 below )
- The Federal, State and Territory governments renew the relationship with Aboriginal and Torres Strait Islander peoples, by engaging with sector leaders on the series of calls in the Redfern Statement, and that they participate in a National Summit with Aboriginal and Torres Strait Islander leaders in 2017, to forge a new path forward together.
- The Federal Government restore previous funding levels to the National Congress of Australia’s First Peoples as the national representative body for Aboriginal and Torres Strait Islander peoples, and work closely with Congress and the Statement signatories to progress the calls in the Redfern Statement.
- The Federal Government hold a national inquiry into racism and institutional racism in health care settings, and hospitals in particular, and its contribution to Aboriginal and Torres Strait Islander inequality, and the findings be incorporated by the Department of Health in its actioning of the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
It’s time to re-think Aboriginal and Torres Strait Islander health
Op-ed by Patricia Turner, CEO, National Aboriginal Community Controlled Health Organisation and co-chair of the Close the Gap Campaign.
Today [16 March 2017] is National Close the Gap Day. It is a day to acknowledge our resilience and a day to focus attention on the significant gap in health equality between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
The facts are indisputable. Governments at all levels are failing Australia’s First Peoples. We have shorter lifespans and we are sicker and poorer than the average non-Indigenous Australian.
The Close the Gap Campaign began in 2006. One of the Campaign’s first accomplishments was to convince the Federal Government of the need to plan and set targets to improve health equality for Aboriginal and Torres Strait Islander people.
We’ve now had almost a decade of Closing the Gap Strategy by successive federal governments. Prime Minister Malcolm Turnbull’s most recent report to Parliament, in February 2017, was not good news. Most of the Closing the Gap targets are unlikely to be met by 2030. Frustratingly, child mortality rates are going backwards.
Today, the Close the Gap Campaign’s Progress and Priorities Report 2017 reflects on the continuing failure of the Government’s Closing the Gap Strategy and outlines a series of recommendations that can begin to turn the tide.
As a co-chair of Close the Gap Campaign and CEO of the National Aboriginal Community Controlled Health Organisation, I see the impact of a lack of coordination between federal, state and territory governments on addressing Aboriginal and Torres Strait Islander health.
The Federal Government’s recent announcement to refresh the strategy is timely and a dialogue should begin with Aboriginal and Torres Strait Islander peak health organisations on how to address the health challenges our people face.
We expect much more from the state and territory governments. The Federal Government has a clear leadership role but the states are simply not doing enough to address inequality in their jurisdictions.
New arrangements between state, territory and federal governments must begin with a clear focus on addressing the social and cultural determinants of health.
Aboriginal and Torres Strait Islander affairs should not be managed in siloes. Instead, we need to take account of the factors that contribute to good health: housing, education, employment and access to justice. Aboriginal and Torres Strait Islander leaders from across these sectors are already working together to make these policy connections – governments must follow suit.
Cultural determinants matter. There is abundant evidence about the importance of self-determination, freedom from the grind of casual and systemic racism, discrimination and poverty. For over 200 years we have been burdened with laws, systems and institutes that perpetuate disadvantage.
But our cultures and traditions still endure; we remain the traditional custodians of the land you walk on.
Last year, 140 Aboriginal community-controlled health organisations (ACCHOs) provided nearly 3 million episodes of care to over 340,000 clients by more than 3,000 Indigenous staff. It is clear that putting Aboriginal health in Aboriginal hands works.
Recently, Flinders University highlighted the success of the Central Australian Aboriginal Congress in Alice Springs, noting its ability to provide a one stop-shop with outreach services, free medicine and advocacy.
The benefits of having Aboriginal health in Aboriginal hands are evident in other case studies which show reductions in the numbers of young smokers, increased immunisations rates, and increased numbers of child health checks in our local communities.
The Federal Government’s rhetoric about economic empowerment and opportunity should be replaced with significant public policy initiatives and the delivery of specific outcomes. Politicians often speak about the optimism, resilience and determination of our people but how about speaking today, right now, about meaningful actions, engagement and self-determination for us all.
CTG 2017 report 15 Recommendations : “We have the Solutions “
” Prime Minister, and all Members of Parliament I say to you that Aboriginal and Torres Strait Islander people have the solutions to the difficulties we face.
Consider for a moment the 2.5 million episodes of care delivered to our people by Aboriginal Community Controlled Heath Organisations each year.
This community-controlled work is echoed by many of our organisations here today, and amplified by countless individual and community efforts working for change.
Imagine this work stretching out over decades as it has.
We need a new relationship that respects and harnesses this expertise, and recognises our right to be involved in decisions being made about us.
A new relationship where we have a seat at the table when policies are developed.”
Dr Jackie Huggins Redfern Statement Parliamentary Event, 14 February 2017
|Reinvigorating the national approach to health inequality
4. State and Territory governments recommit to the Close the Gap Statement of Intent, and develop and implement formal partnerships with the Federal Government with agreed roles, funding and accountability with the provision of annual reports on their efforts to close the gap from each jurisdiction.
|5. The Federal, State and Territory governments work together to develop a National Aboriginal and Torres Strait Islander Health Workforce Strategy to meet the vision of the National Health Plan.
Social and Cultural Determinants of Health
6. The Federal Government develop a long-term National Aboriginal and Torres Strait Islander Social and Cultural Determinants of Health Strategy.
The Implementation Plan is a major commitment by the Federal Government and must be adequately resourced for its application and operation. As such, the Government should:
7. Identify geographic areas with both high levels of preventable illnesses and deaths and inadequate services, and development of a capacity-building plan for Aboriginal Community Controlled Health Organisations (ACCHOs) in those areas.
8. Fund the process required to develop the core services model and the associated workforce, infrastructure, information management and funding strategies required.
9. Ensure Aboriginal and Torres Strait Islander health funding is maintained at least at current levels until the core services, workforce and funding work is finalised, when funding should be linked directly with the Implementation Plan.
10. Ensure the timely evaluation and renewal of related frameworks upon which the Implementation Plan relies.
|11. Finalise and resource the National Plan for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing. This plan should incorporate and synthesise the existing health, mental health, suicide and drugs policies and plans – and should be an immediate priority of all governments.
12. Ensure that the consultation process for the next iteration of the Implementation Plan be based on genuine partnership with Aboriginal and Torres Strait Islander people, in a way that is representative and properly funded so that First Peoples can be full and equal development partners.
Primary Health Networks
13. The Federal Government mandate formal agreements between Primary Health Networks (PHNs) and ACCHOs in each region that:
a. specify Aboriginal and Torres Strait Islander leadership on Indigenous issues and identify the specific roles and responsibilities of both the PHNs and the ACCHOs.
b. include workforce targets for Aboriginal and Torres Strait Islander health professionals and include mandatory Aboriginal and Torres Strait Islander representation on the clinical committees of every PHN.
14. The Federal Government mandate ACCHOs as preferred providers of health services for Aboriginal and Torres Strait Islander people provided through PHNs.
15. The Federal Government develop and implement agreed accountability, evaluation and reporting arrangements to support the provision of primary health care for Aboriginal and Torres Strait Islander peoples in each PHN area.[i]
The Campaign believes that the PHN program has the potential to make a significant positive difference in health outcomes for all Australians if they are culturally safe and properly engaged with the Aboriginal and Torres Strait Islander community within their network area.
The ability of PHNs to deliver culturally safe, high-quality primary health care for Aboriginal and Torres Strait Islander people will be seen in the lived experience of the people.
It is essential that Federal Government ensure that the PHNs are engaging with ACCHOs to ensure the best primary health care is afforded to Aboriginal and Torres Strait Islander people, as well as the broader community. Competitive tendering processes for PHNs that award contracts to organisations that are able to write the best proposal may well be at the expense of organisations that can provide the best services in terms of access, quality and outcomes.
However, formal partnerships between PHNs and ACCHOs should reduce rather than exacerbate current funding inequities and inefficiencies.
It is the Campaign’s view that ACCHOs must be considered the ‘preferred providers’ for health services for Aboriginal and Torres Strait Islander people.
Where there is either no existing ACCHO or insufficient ACCHO services, capacity should be built by the establishment of new ACCHOs or within existing ACCHOs (or have capacity development of existing ACCHOs) within the PHN area to extend their services to the identified areas of need.
Where it is appropriate for mainstream providers to deliver a service, they should be looking to partner with ACCHOs to better reach the communities in need.[i]
The Campaign welcomes the collaboration between the Department of Health and the National Aboriginal Community Controlled Health Organisation to develop the Primary Health Networks (PHNS) and Aboriginal Community Controlled Health Organisations (ACCHOS) – Guiding Principles which are intended to provide:
…guidance for actions to be taken by each party across six key domains: Closing the Gap; cultural competency; commissioning; engagement and representation; accountability, data and reporting; service delivery; and research.[ii]
Having a shared understanding of the key domains of focus and the principles of engagement and collaboration are a good start, however, more can be done to formalise the relationship between PHNs and ACCHOs.
The need for culturally safe services, with safe spaces that support the holistic concept of health is well established.
ACCHOs continue to be the exemplar for cultural safety standards as they are, by their very existence, best placed to respond to the health needs of the community based on implicit cultural understanding.[iii]
Again, it is encouraging to see some indications that the PHNs are looking to incorporate culturally safe practices as evidenced by the Guiding Principles document between PHNs and ACCHOs. The Guiding Principles state:
‘An understanding of Aboriginal and Torres Strait Islander culture is important to partners who wish to engage with Aboriginal and Torres Strait Islander people effectively and as equals.
Underpinning the Guiding Principles is a shared knowledge that will ensure:
- respectful culturally sensitive consultation
- recognition that Aboriginal and Torres Strait Islander health outcomes will be achieved when Aboriginal and Torres Strait Islander people control them, and
- that commissioned service delivery will be a strengths-based approach reflecting the United Nations Declaration on the Rights of Indigenous Peoples.’[iv]
Respect of culture must be embedded in all PHN practice and management, from formalised cooperation with ACCHOs, the delivery of services and the investments made in the non-Indigenous workforces so that they understand and value Cultural Safety and its importance for Aboriginal and Torres Strait Islander people seeking care.
The Close the Gap Campaign
Close the Gap Campaign co-chair Jackie Huggins highlighted the resilience of Indigenous people and cautioned against feeling disheartened by the slow pace of change.
“When Tom Calma started the Close the Gap Campaign in 2006, he set a 25-year goal to achieve health equality between Aboriginal and Torres Strait Islander peoples and non-Indigenous peoples,” Dr Huggins said.
“This was an intentionally ambitious time frame. Nevertheless, Tom and the other early Campaign members knew that every inch the gap closed between First Australians and non-Indigenous Australians translated into lives saved and lives improved.
“The Australian community agreed. Since then more than 220,000 Australians have signed the close the gap pledge for change.
“Despite the significant challenges we face to make health equality a reality in this country, it is the commitment of the hundreds of thousands of people that have pledged their support to closing the gap that give us courage and strength to press on.
“In communities across Australia we are seeing more and more of our people rising above the obstacles of institutional racism, generational trauma and low expectations to become nurses, doctors, social workers, youth workers, health workers, administrators, teachers and community leaders.
“Our people, with the support of the many non-Indigenous people committed to health equality, are best placed to lead the changes needed today, tomorrow and over the next decade,” Dr Huggins said.