NACCHO Congratulates #Lowitja @LowitjaInstitut 20 years of making a difference in Aboriginal health and wellbeing

 “It has been 20 years since I was asked to be the inaugural Chairperson of the Cooperative Research Centre for Aboriginal and Tropical Health.

One of my fundamental objectives as a Chairperson was to work towards reconciliation between Aboriginal and Torres Strait Islander and Western perspectives of health and wellbeing and encourage a different way of doing research.

That meant bringing the academics and the researchers together with those who are qualified to know what’s needed on the ground. I wanted practical people to investigate the changes that need to be made in Aboriginal and Torres Strait Islander communities to bring about the change we all want to see for our peoples.

I told them that I wanted them to be a courageous organisation committed to social justice and equity for Aboriginal and Torres Strait Islander people, to match words to action, to achieve real, tangible outcomes. “

Dr Lowitja O’Donoghue AC CBE DSG august 2017

 “When these ( ACCHO ) services are set up, it was very clear that the mainstream system was failing us.

So we decided we had to set up our own services… those original AMSs, Redfern and Congress and all the others that followed… were… hotbeds of political activism as well.

We were flexing our muscles in terms of, not only self-management, but self-determination.”

Pat Anderson Lowitja Chair and former NACCHO Chair Interview , 14 November 2014)

 ” Honoured to be marking 20 years of the two decades of Aboriginal-led excellence in research and making a difference.”

The Hon Ken Wyatt Minister for Indigenous Health launching the report  

Paul House welcomes the audience above to country at launch of report Changing the Narrative in ATSI Health Research. Improving our wellbeing

In 2017 Lowitja is celebrating 20 years of Aboriginal and Torres Strait Islander led and focused health research – recognising the journey of the Lowitja Institute and the four associated Cooperative Research Centres (CRCs).

To mark this anniversary they released at Parliament House in Canberra on Wednesday 9 August 2017 a publication titled

 

Changing the Narrative in Aboriginal and Torres Strait Islander Health Research


Four Cooperative Research Centres and the Lowitja Institute: The story so far

Download a copy here  LOWITJA Changing-the-narrative

Changing the Narrative outlines the journey and the successes of the Institute and the CRCs, and showcases how their cumulative efforts have pioneered a new way of conducting  health research in Aboriginal and Torres Strait Islander communities.

It maps the evolution of a new, collaborative and culturally appropriate way of carrying out health research.

It’s an approach driven by Aboriginal and Torres Strait Islander priorities – an approach developed by the CRCs, and embodied in the Institute.

Each of the CRCs and the Institute has progressed the work to develop health research expertise and processes to achieve lasting reform. Efforts are based on key principles of Aboriginal and Torres Strait Islander control of the research agenda, a broader understanding of health that incorporates wellbeing, and the need for research to have a clear and positive impact.

The Lowitja Institute commissioned the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) to write a brief history of our organisation – including audiovisual recordings that highlight the vision of influential individuals.

In addition, the writing, editorial and production work of the Lowitja Institute team have created the hard copy Changing the Narrative publication, and a companion e-book which will be available soon.

Extracts from Report ( for references see report )

Background Aboriginal Community Controlled Health

While this sense of outrage at inequality was being expressed at the universities and in the big cities, little change was occurring in the rural and remote areas of Australia where services for Aboriginal and Torres Strait Islander people were limited.

Those that did exist were segregated and hidden in Aboriginal and Torres Strait Islander welfare departments, missions, reserves and pastoral stations.

In the 1970s, however, there was a significant increase in Aboriginal and Torres Strait Islander health research.11 The results of much of this research confirmed that Aboriginal and Torres Strait Islander life expectancy was lower, and morbidity higher, than for other Australians. In the Northern Territory, these statistics were worse than they had been for non-Indigenous Australians at the turn of the twentieth century.12 Other indicators – such as living conditions, maternal and infant health and chronic disease – highlighted a huge gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

This crucial time of activism followed the 1967 referendum to allow amendments to the Australian Constitution that would give the Commonwealth Government the right to make laws affecting Aboriginal affairs and to include Aboriginal peoples in the national Census.13 It was a movement that was ‘most symbolically expressed through the land rights campaigns, but first gained concrete organisational form through the establishment of the Aboriginal legal aid and health services’.14

Change would not happen until the 1970s. The first Aboriginal Community Controlled Health Service (ACCHS) was established in Sydney’s Redfern in 1971, with the Victorian Aboriginal Health Service in Melbourne’s Fitzroy and the Central Australian Aboriginal Congress (CAAC) in Alice Springs two years later.15 The CAAC prides itself today as ‘the voice of Aboriginal health’, from its beginnings in the early 1970s and on its foundation objective that ‘Aboriginal health must be in Aboriginal hands’.16

However, it was not until 1991 that Darwin’s Danila Dilba Biluru Butji Binnilutlum17 and smaller services like18 Miwatj in East Arnhem Land the following year.19 A noticeable exception was Utopia’s Urapuntja Health Service, which opened in 1977.20

When these services are set up, it was very clear that the mainstream system was failing us. So we decided we had to set up our own services… those original AMSs, Redfern and Congress and all the others that followed… were… hotbeds of political activism as well. We were flexing our muscles in terms of, not only self-management, but self-determination. (Pat Anderson Interview 3, 14 November 2014)

Pat Anderson drew attention to the sense of ‘struggle’ against inefficient government control and past polices and the desperately poor health situation for Aboriginal and Torres Strait Islander peoples that framed their thinking in setting up these Northern Territory community controlled health services.

There was a whole range of Aboriginal national bodies that was set up around that time, but in particular with the health services, that was a very conscious decision to be able to be part of the struggle. We used to sign letters in those days, ‘Yours in the Struggle’, with a capital ‘S’. (Pat Anderson Interview 1, 23 October 2014)

The independence of the ACCHSs was enabled by a wide range of people from within the medical profession in Alice Springs and Darwin:

… When we decided that we were going to set up our own organisation, not a government initiative, doctors and nurses and a whole lot of people, as well as Aboriginal people… worked for nothing in those days. They would donate some of their time. The doctors, for instance, when they finished their shifts, they would come to the AMS and they did that for quite a while… NACCHO remains because it came out of the Aboriginal and Torres Strait Islander local communities. (Pat Anderson interview 3, 14 November 2014)

Aboriginal Health Strategy

The other thread that provides crucial background to the establishment of the CRCATH and changes to the Aboriginal and Torres Strait Islander health research landscape that began to emerge at this time was the 1989 National Aboriginal Health Strategy (NAHS).21

It aimed at developing mechanisms to achieve improvements in Aboriginal and Torres Strait Islander health; in particular it focused on taking into account ‘specific health issues, health service provisions, Aboriginal and Torres Strait Islander participation, research and data collection and ongoing monitoring’. It also aimed at maximising the involvement of Aboriginal and Torres Strait Islander people in their own health care.22

A Working Party was established in 1987, which included stakeholders from across a number of sectors involved in Aboriginal and Torres Strait Islander health, including government, communities and the Aboriginal controlled health sector. Its Chairperson was Dr Naomi Mayers, Director of the Redfern Aboriginal Medical Service. Other members of the group included Associate Professor Ted Wilkes and Professor Shane Houston, both of whom would go on to serve on the Board of the CRCAH. The Working Party carried out consultations with interested parties from across all Australian jurisdictions and received approximately 120 submissions for its consideration.23

The Working Party’s report highlighted many of the Aboriginal and Torres Strait Islander community’s concerns regarding the nature of health research. It noted that research was too often imposed on communities, with the communities having little control or redress, and seldom of actual benefit to them. The report also acknowledged that the pervasive nature of the existing Western-centric approach to research needed to be questioned and re-examined.24 The Working Party called for reform of the research processes in Aboriginal and Torres Strait Islander health and, in particular, for more involvement by Aboriginal and Torres Strait Islander people:

… The community should be involved in framing the questions so that the research is relevant to their needs. The Aboriginal community must actively participate in the research process, be kept fully informed, and have some say in how research findings are publicised and used. Only when research projects are subject to Aboriginal community influence, will they be both relevant and of benefit to the community.25

Shane Houston described the Working Party as ‘visionary’ to ‘embrace this notion that good data and good research could be the bedrock or the springboard on which we built really quite an innovative model and approach to Aboriginal health and research’. This was in spite of the fact that, up to that point, ‘appalling relationships [existed] between Aboriginal communities and researchers’ resulting from ‘countless examples’ of research failing to engage in ethical and effective ways with Aboriginal and Torres Strait Islander communities (Shane Houston interview, 1 December 2014).

Shane Houston was critical of what he saw as the dilution of the recommendations of the Working Party in the final report.26 Nevertheless, he later also recognised that it helped reshape the discussions around some of the most important issues regarding Aboriginal and Torres Strait Islander health and continued to be influential 25 years later. He pointed out that the NAHS was a breakthrough for policymakers and for Aboriginal and Torres Strait Islander community controlled health services, as it carried the debates beyond blaming researchers for their self-interest, and grasped the idea of influencing good and ethical research to create better data.

The report talked about intersectoral collaboration before people were talking in this country about the social determinants of health. It argued the case that housing affected health, that education affected health, that education affected housing. And it did so in a really coherent [way] that both government and communities agreed with. It argued for a reform to the style of service delivery in communities. It argued for more collaborative planning – ongoing planning, joint planning by state, territory and Aboriginal communities in the Aboriginal health arena…

And I think, looking back on it, it was one of those key turning points in the Aboriginal health movement across the country that just flipped the debate, that created a new way of talking about, a new way of engaging [with] and a new way of solving the challenges that we confronted. It was never going to be a panacea that would solve every problem. But it gave us the experience and the tools to approach problems in a new way. (Shane Houston Interview, 1 December 2016 )

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