” At the request of the National Aboriginal and Torres Strait Islander Health Standing Committee, the Commission undertook a project to improve the care provided to Aboriginal and Torres Strait Islander people in health service organisations, using the framework of the National Safety and Quality Health Service (NSQHS) Standards.”
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Why have Aboriginal and Torres Strait Islander–specific actions?
The two compelling reasons to have specific actions that meet the needs of Aboriginal and Torres Strait Islander people are:
- The historical and contemporary context of Aboriginal and Torres Strait Islander health
- The unique and diverse cultures of Aboriginal and Torres Strait Islander people.
1.Historical and contemporary context of Aboriginal and Torres Strait Islander health Aboriginal and Torres Strait Islander people are among the most socially and economically disadvantaged groups in Australia.2
The current poor health and wellbeing of many Aboriginal and Torres Strait Islander people stems largely from the effects of colonial policies and their ongoing legacy. These policies have resulted in loss of land, family and community connections, and denial of free cultural expression and growth across generations. They affect the physical, emotional, social and spiritual dimensions of wellbeing for Aboriginal and Torres Strait Islander individuals and communities.
The continuing impacts on health and wellbeing are evident in the unacceptable gaps between Aboriginal and Torres Strait Islander people and other Australians in health outcomes, including infant and child mortality, disease burden, and life expectancy. Significant barriers to accessing effective and safe health care contribute to these gaps. Therefore, it is important that people experience safe and high-quality health care based on need.
Meaningful, lasting relationships with the Aboriginal and Torres Strait Islander community are integral to redressing past wrongs and moving towards an equitable healthcare system for all Australians.
The project considered the safety and quality issues typically affecting care provided to Aboriginal and Torres Strait Islander people in health services, and investigated how the NSQHS Standards could be used to leverage improvements in the safety and quality of care provided to Aboriginal and Torres Strait Islander people in mainstream health services.
We represent the oldest continuous culture in the world; we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership – to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful, and our communities thrive. (Dr Ngaire Brown, New York, 20123)
Closing the Gap4 in Aboriginal and Torres Strait Islander disadvantage is a national priority that the Australian Government and all state and territory governments are committed to addressing. It is the responsibility of all health service organisations to consider and action their part in closing the gap in health disparities experienced by Aboriginal and Torres Strait Islander people.
2.Unique and diverse cultures of Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander people have world views that differ from other Australians. Although language varies across the country, four core concepts are found consistently among Aboriginal and Torres Strait Islander communities. In the Arrernte (A), Warlpiri (W), Pitjantjatjara (P) and Luritja (L) language groups of South Australia and the Northern Territory, these concepts are:
- Altyerre (A), Jukurrpa (W), Tjukurpa (P) or Tjukurrpa (L). The religious interpretations of the profound bonding of people to one another, to their country and to the species of animals and plants inhabiting it. It is continually renewed by its expression in song, dance, verbal narratives of creation stories and re-enacted continually in ceremonial journeys.
• Walytja (L, P) or Warlalja (W). The system of extended kinship; the organisational scaffolding for social roles and authority; the pathways of distribution and communication.
• Ngura (L, P) or Ngurra (W). Country to which people belong; which they may use; always subject to the obligations of looking after it and care …; including its celebration.
• Kanyini (L, P) or Mardarni (W). Which is to have, to hold [and] to care. Kanyini is a verb which reflects a commitment, a full engagement; vitalising again and again all that went before and all that will go after.5
Aboriginal and Torres Strait Islander people have a holistic view of health that is not adequately met by the biomedical model of health care. For Aboriginal and Torres Strait Islander people, health is:
… not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of-life view and includes the cyclical concept of life–death–life.6
While there are similarities, there is also much diversity. There were more than 250 Aboriginal and Torres Strait Islander language groups across Australia, and it is estimated that 120 languages are still spoken today.5
It is important to note that each language group has its own unique values and belief systems. Therefore, if a health service organisation is to provide effective care to its local Aboriginal and Torres Strait Islander people, or the communities that regularly access care, it will need to understand the diverse cultures and values of the people in the organisation’s catchment and of the patients using its services.
The approach and results :
- Consultation with a wide range stakeholders including individuals, leaders in Aboriginal and Torres Strait Islander health, policy makers, Aboriginal and Torres Strait Islander health organisations, managers, clinicians and members of the Aboriginal and Torres Strait Islander health workforce
- Mapping the safety and quality issues for Aboriginal and Torres Strait Islander people to the NSQHS Standards
- A literature review of relevant evidence based strategies to improve the safety and quality of care for Aboriginal and Torres Strait Islander people.
Based on the findings of this project:
- Six Aboriginal and Torres Strait Islander specific actions have been included in draft version 2 of the NSQHS Standards
- A series of guides to drive best practice care for Aboriginal and Torres Strait Islander people has been developed based on the NSQHS Standards.
The next stage of this project is now underway which builds on previous work and again aims to improve the safety and quality of health care provided to Aboriginal and Torres Strait Islander people in mainstream health service organisations using version 2 of NSQHS Standards.
The objectives of this project are to:
- Raise awareness of the issues facing Aboriginal and Torres Strait Islander patients in mainstream health service organisations
- Improve the safety and quality of care for Aboriginal and Torres Strait Islander patients by supporting mainstream organisations to implement the NSQHS Standards, using resources that contain effective, evidence-based strategies to address Aboriginal and Torres Strait Islander health issues
- Improve the Aboriginal and Torres Strait Islander cultural awareness skills of the surveyor workforce whose members assess health service organisations to the NSQHS Standards.
The guides contain editable text boxes for those health service organisations who wish to include local content. Please contact the Commission’s Advice Centre on 1800 304 056 to discuss any additional changes