NACCHO Aboriginal Health News ALERT : @CREATE_NHMRC Resource Launch – Aboriginal Community Controlled Health Organisations in Practice: Sharing ways of working from the ACCHO sector

NACCHO Aboriginal Health Resources Alert : Download @HealthInfoNet Overview of Aboriginal and Torres Strait Islander health status 2019 : Continuing to show important positive developments for our mob

In the Overview we strive to provide an accurate and informative summary of the current health and well-being of Aboriginal and Torres Strait Islander people.

In doing so, we want to acknowledge the importance of adopting a strengths-based approach, and to recognise the increasingly important area of data sovereignty.

To this end, we have reduced our reliance on comparative data in favour of exploring the broad context of the lived experience of Aboriginal and Torres Strait islander people and how this may impact their health journey “

HealthInfoNet Director, Professor Neil Drew

The Overview of Aboriginal and Torres Strait Islander health status (Overview) aims to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander people.

Download HERE 


The annual Overview contains updated information across many health conditions.

It shows there has been a range of positive signs including a decrease in death rates, infant mortality rates and a decline in death rates from avoidable causes as well as a reduction in the proportion of Aboriginal and Torres Strait Islander people who smoke.

It has also been found that fewer mothers are smoking and drinking alcohol during pregnancy meaning that babies have a better start to life.

The initial sections of the Overview provide information about:

  • the context of Aboriginal and Torres Strait Islander health
  • social determinants including education, employment and income
  • the Aboriginal and Torres Strait Islander population
  • measures of population health status including births, mortality and hospitalisation.

The remaining sections are about selected health conditions and risk and protective factors that contribute to the overall health of Aboriginal and Torres Strait Islander people.

These sections include an introduction and evidence of the extent of the condition or risk/protective factor. Information is provided for state and territories and for demographics such as sex and age when it is available and appropriate.

The Overview is a resource relevant for the health workforce, students and others requiring access to up-to-date information about the health of Aboriginal and Torres Strait Islander people.

This year, the focus will be mainly on the Aboriginal and Torres Strait Islander data and presentation is within the framework of the strength based approach and data sovereignty (where information is available).

As a data driven organisation, the HealthInfoNet has a publicly declared commitment to working with Aboriginal and Torres Strait Islander leaders to advance our understanding of data sovereignty and governance consistent with the principles and aspirations of the Maiam nayri Wingara Data Sovereignty Collective (

As we have done in previous years, we continue our strong commitment to developing strengths based approaches to assessing and reporting the health of Aboriginal and Torres Strait Islander people and communities.

It is difficult to make comparisons between Aboriginal and Torres Strait Islander people and non- Indigenous Australian populations without consideration of the cultural and social contexts within which people live their lives.

As in past versions, we still provide information on the cultural context and social determinants for the Aboriginal and Torres Strait Islander population.

However, for the selected health topics and risk/protective factors we have removed many of the comparisons between the two populations and focused on the analysis of the Aboriginal and Torres Strait Islander data only.

In an attempt to respond to the challenge issued by Professor Craig Ritchie at the 2019 AIATSIS conference to say more about the ‘how’ and the ‘why’ not just the ‘what’ where comparisons are made and if there is evidence available, we have provided a brief explanation for the differences observed.

Accompanying the Overview is a set of PowerPoint slides designed to help lecturers and others provide up-to-date information.

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islander.
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities.
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Download the PowerPoint HERE


NACCHO Aboriginal Health Research News : Download @LowitjaInstitut and @ourANU Aboriginal Health and Wellbeing Services – Putting community-driven, strengths-based approaches into practice

From the wide range of health and wellbeing practitioners we spoke to – which included nurses, midwives, Aboriginal health workers, therapists, caseworkers and more – there was clear sentiment that in a context of post- colonial power imbalance, Aboriginal people often experience inappropriate treatment in mainstream services.

There was agreement that community-driven, holistic and person-centred approaches are key to delivering better services, yet, increasingly, restrictive and metrics-focus funding regimes constrain what works. ” 

From Aboriginal Health and Wellbeing Services – Putting community-driven, strengths-based approaches into practice Report

Download 80 Page PDF here


” Laynhapuy Health is responsive to a set of distinctly localised, Yolŋu ways of setting goals and priorities. The Traditional Owners, in combination with the local health workers, are effectively the ‘bosses’ of the Laynhapuy Health service.

They make broad decisions about the nature and pace of health delivery, in keeping with the broader self-determined ethos of the homelands movement (see the section on Laynhapuy Homelands self-determination movement).

The Aboriginal health workers, meanwhile, are responsible for the clinics in their communities (see the section Aboriginal health and wellbeing professionals).

Difficult decisions about local health are made in the first instance through adherence to Yolŋu conventions of reciprocity, relational obligation, custodianship and clan-based understandings of the right way to do things.

In the second instance, decision making in Laynhapuy Health is intercultural. The Laynha Health manager (and a range of other staff) regularly meet with community leaders, health workers and a wide range of community members on routine community visits, and the communities are the manager’s first point of contact for discussing new ideas or directions.

This is not always an easy task as it relies on subtleties beyond formal governance. The community needs to trust that the staff and clinicians of Laynhapuy Health will respect and adhere to the decisions made at a homeland level.

At the same time, the manager must ensure power in decision-making continues to reside with the Traditional Owners and the community, while also adhering to the clinical and bureaucratic conventions of biomedical systems.

As we explore here, time, communication and trust are crucial elements in making this work. However, at the heart of Laynhapuy Health’s model is a belief that the people of the homelands are best placed to make decisions about their own health care; in short, Yolŋu concepts of health create healthy Yolŋu.”

From page 32 Laynhapuy Health is an Aboriginal Community Controlled Health Service (ACCHS) operating in East Arnhem Land, Northern Territory (NT). It delivers comprehensive primary health care (CPHC) to Yolŋu people across the remote Laynhapuy Homelands

Executive summary 

This report explores strengths-based, bottom-up approaches to delivering Aboriginal health and wellbeing services.

It focuses on three case study organisations across two sites, all of which have reputations for maintaining highly positive relationships with their communities:

  • Laynhapuy Health is an Aboriginal Community Controlled Health Service (ACCHS) operating in East Arnhem Land, Northern Territory (NT). It delivers comprehensive primary health care (CPHC) to Yolŋu people across the remote Laynhapuy Homelands (see
  • Waminda is an ACCHS that provides a range of health and wellbeing services to Aboriginal women and their families in the Shoalhaven region of New South Wales (NSW) and beyond. This includes general practice, antenatal and postnatal care, lifestyle programs, justice support, social enterprise programs and more (see

  • Noah’s is a community-based, not-for-profit organisation catering to children and young people with special needs and their families across the Shoalhaven. Their work includes National Disability Insurance Scheme (NDIS) services, childhood education, playgroups, and behaviour Noah’s has several programs specifically for Aboriginal clients (see

Despite the substantial differences between the two field sites and the scope of the three organisations, there were strong commonalities between them in the approaches and challenges they raised.

For all three organisations, strengths-based approaches are inseparable from their community-driven, holistic design. The linking elements are their understandings of power structures and neo-liberal trends in a cross-cultural context in the Australian health and wellbeing sector.

This highlights that strengths always need to be understood in relation to constraints. For example, a narrow focus on strengths risks portraying individuals and communities as responsible for their situations, shading out wider relations of power and socio-economic inequality.

We found that all three organisations strike an important balance between confidence in the strengths of the communities they serve and represent, and consciousness of the constraints on their (and their clients’) room for manoeuvre in a post-colonial and increasingly neoliberal nation-state.

In many ways large and small, the organisations keep working at pushing those boundaries a little further – creating more room for autonomy and for strengths.

This report explores these dynamics, and, in the process, details the three organisations’ approaches and successes. This brings us back to many of the core issues that are well documented in relation to Aboriginal health and wellbeing, including the importance of community-driven design, holism, the social determinants of health, and person- and family-centred approaches.

This allows us to celebrate the organisations’ strengths and successes – highlighting ‘beautiful, big, positive’ stories, as one of our interviewees put it.

Throughout this report we have followed the terminologies of our case study organisations, participants, and/or source materials in our use of the terms ‘Aboriginal’, ‘Aboriginal and Torres Strait Islander’ and ‘Indigenous’.

The main section of the report details the organisations’ understandings of effective approaches in the sector, as they have sought to implement them. Although there is much overlap, we have divided this into three areas of focus:

Under the section What Works: Bottom-up approaches we explore broad, organisational issues relating to governance, program design and staffing.

  • Community-driven program design is fundamental to ensuring This requires building long- term relationships with communities that go well beyond superficial consultation.
  • Relationship building goes hand-in-hand with long-term learning based on local histories, culture and socio-economic
  • From these relationships and learning, innovative place-based services that are responsive to community needs and aspirations can
  • Crucial to these processes is having staff who are part of the community, but drawing on expertise and support from staff with a diversity of backgrounds can also help build robust structures and services and provide clients with a wider

Under the section What Works: Holism and wellbeing we then look at how the organisations think about health and wellbeing and what they incorporate within the scope of their work.

  • Much of the health sector treats illness in Aboriginal people, rather than promoting health and
  • Holistic health that addresses social determinants is preventative and protective. It can include supporting culture and language, connection to Country, spirituality, belonging and identity, strength of community and family, and empowerment and control.
  • Holistic health may seem broad, and therefore difficult to implement. However, because the organisations are in tune with community needs and aspirations, it is often clear to them which health-promoting services are most relevant in their context. For example, for one health organisation, enabling people to live and thrive in remote homelands communities is at the core of their work, while another explicitly promotes fitness, nutrition and career pathways among other things.

Under the section What Works: Delivering person- and community-centred care we narrow to a focus on effective approaches at the ‘clinical interface’ of the organisations’ work.

  • Much top-down intervention in the health care sector and beyond relies on externally identifying and seeking to fix Often systems operate based on practitioners’ ‘expert’ values and terms.
  • Person-centred care shifts the power balance and places clients’ needs, desires, goals, values and circumstances at the centre of the care
  • Related strengths-based approaches seek to shift the emphasis away from problems and negative labels through which a person’s or community’s identity can become defined, to instead recognising positive capabilities, goals and
  • All the case study organisations stressed the importance of their services being accessible on a regular and consistent basis. This was closely linked with making a long-term commitment to a place and a population, and building peoples’ familiarity with the service and their trust over
  • Consistency in service provision must be balanced with flexibility, adaptability and responsiveness based on community and client needs. In other words, consistently ‘being there’ for clients is important, but the form this takes need not be prescribed, rigid or
  • Brief consultation times, which are standard in the health care sector, are particularly sub-optimal in the context of Aboriginal health care for a range of reasons we detail. For example, building trust is essential,particularly in light of traumatic histories with institutional services and the prevalence of negative experiences in the health and wellbeing sector. However, building trust and rapport takes time.
  • All the case study organisations see brokering, advocacy and coordination of care as central to their work and success. This ranges from explaining to people the available services and talking them through what to expect, to (in the case of one organisation) escorting them on major hospital visits and translating between

While many of these themes are well-established ‘best practice’ in the health and wellbeing sector, the organisations had remarkably similar Challenges and Constraints in marrying bottom-up, holistic and person-centred approaches with top-down funding regimes.

  • Funding is typically for a specific purpose, falls within a siloed sector or assumes a certain set of realities. The purpose and scope of the funding is decided from the top down and it often assumes a compartmentalised approach to health and
  • Project and programme grants are also often relatively short-term. But, as noted, genuine community relationships take time to build, and many programs that address the social determinants of health are unlikely to show results in such timeframes. Even initiatives with a strong and consistent record of positive results over the long term can be defunded at short notice with little or no This is a threat to the consistency and regularity of services (factors that our participants identified as being so important). It is also a threat to staffing in a context where the organisations have strived to build up Aboriginal staff capacity and cross-cultural understandings, as it can result in the loss of long-term institutional knowledge and produce employment precarity.
  • The organisations are required to report on key performance indicators (KPIs). These are typically determined from the top down and are often strongly metrics-focused. There are frequent disconnects between what KPIs measure and what local organisations value, as well as frustrations that KPIs measure the ‘wrong’ things or fail to capture important successful activity. This is part of a broader international trend toward standardised statistical indicators, despite evidence that they often do not produce the desired

Drawing on the findings throughout the report, we make a range of recommendations for ways forward. These are targeted at funders, policy makers and associated stakeholders seeking to enable non- government organisations (NGOs) in the Aboriginal health and wellbeing field to work more effectively.

Funding that embraces holism, innovation and responsiveness

  • A prevalence of narrow, sector-specific funding may be impeding holistic health and wellbeing approaches, and those driven by community needs, values and More funding streams that allow organisations to define and respond to holistic health and wellbeing in their context are needed.
  • Designing bottom-up, holistic health and wellbeing services sometimes means innovating and taking risks. Funding streams that embrace innovation, but do not force it where it is unneeded, would benefit the

Longer term funding cycles

The availability of more long-term funding options will better allow organisations to design projects and programs from the bottom up. This includes organisations’ efforts to prioritise relationship building;

to address the social determinants of health; to ensure there is leeway for strategies to be tried and, if necessary, amended; to provide consistency of presence over time; and to help build a more skilled and stable workforce that includes training, learning and career development opportunities for Aboriginal and non-Aboriginal staff.

Co-designed KPIs

  • Funding providers should allow organisations the capacity to design or negotiate KPIs according to local realities and community-based aspirations, thereby allowing for greater local relevance, responsiveness and
  • Co-design of KPIs should be an ongoing, reflexive process, allowing for the mitigation of unintended consequences.

Narrative-based reporting

  • Reporting formats need to allow funding recipients the option and scope to detail progress, issues and outcomes in narrative/descriptive form. This may mean incorporating more open-ended questions in report
  • The capacity to integrate or attach multi-media (including videos, audio and photographs) is also merited.
  • Public servants and program managers need professional development in valuing and using qualitative information, and in the dangers of privileging statistical

Reducing over-reporting

  • It is incumbent on funding providers to ensure that reporting requirements and processes are efficient. This includes thinking carefully about how often reports fall due, how user-friendly the reporting templates are to complete, and whether the extent of what they ask applicants to produce is

Relationship building between funders and recipients

  • Policy makers and funders can gain a better understanding of the realities on the ground by talking directly to those implementing services in that Staff at funding institutions should be encouraged to view the funding relationship as a partnership, rather than as a hierarchicalrelationship in which the funder holds the power. It is, after all, usually the service provider that best understands the realities, needs and aspirations of the communities with which they work.
  • Organisations can feel that submitting reports on expended funding is like feeding information into a black hole; there is typically no engagement or feedback from the funding organisation and it is often unclear if or how the submitted information is (or might in future be) used. More transparency around the use of requested information is important, as is engagement with submitted reports.

Career public servants and time for learning

  • The Australian Public Service encourages professional mobility among its staff, but understanding Aboriginal Affairs requires relationship building, substantial cross-cultural knowledge, and comprehension of a range of complex and interrelated historical, socio-economic and political As such, there is strong merit in encouraging public servant stability and specialisation in Aboriginal Affairs.
  • Because knowledge of best practice, and cross-cultural understanding, are central to effective Aboriginal health and wellbeing policy, public servants need time for There is a vast amount of high-quality and accessible research and guidance material on these topics, as well as a plethora of other learning avenues such as courses and cultural immersions. It would be of enormous benefit for public servants to be encouraged to read such materials and to undertake learning opportunities on-the-job with allocated time to do so.

NACCHO Aboriginal Health Research #ourculturescount #HaveYourSayCTG : Download @Mayi_Kuwayu and @LowitjaInstitut Defining the Indefinable: Descriptors of Aboriginal and Torres Strait Islander peoples’ culture and their links to health and wellbeing

“In recent years, interest in understanding the relationship between Aboriginal and Torres Strait Islander peoples’ cultures and how culture relates to health and wellbeing has been growing. The first step in understanding this relationship is to identify what is described in the literature as ‘culture’ and then to describe how the literature reports the relationship between culture and health and wellbeing.

Some people argue that culture is not definable or that it is intangible. However, all people are born into and grow, work and live within a culture or cultures. Cultures are maintained or modified when they are passed on and are reinforced and practised in both specific and general situations.

The many definitions encompass culture- specific knowledge, attitudes, beliefs and behaviours (including within cultural variations according to rules), and all human life is culturally bound.

Much work in epidemiology and public health focuses on the presence (or absence) of disease and not on the culture within which illness and wellbeing manifest.

We need to understand both wellbeing and culture to have effective public health. “

From the publication Mayi_Kuwayu and Lowitja Institute Defining the Indefinable : Continued Part 1

Download HERE


In Australia, limited data establish or define the relationship between health, wellbeing and culture and the mechanisms through which Aboriginal and Torres Strait Islander cultural determinants impact health and wellbeing.

There is increasing attention on the relationship between culture, health and wellbeing in this population.

The authors conducted this literature review as preliminary work for the Mayi Kuwayu Study—Mayi Kuwayu broadly means “to follow Aboriginal people over a long time” in Ngiyampaa language (language of the Wongaibon people of New South Wales, Australia).

Survey Website 

The aim was to help us understand the cultural factors that are important to Aboriginal and Torres Strait Islander peoples and how these factors relate to health and wellbeing.

The authors examined the Australian literature, as well as literature from countries that have experienced colonisation events similar to those of Australia— primarily Aotearoa (New Zealand), Canada and the United States.

 Part 1 Introduction continued from opening 

This work stems from the desire of many Aboriginal and Torres Strait Islander people to achieve that understanding in order to improve our health. Culture (the maintenance, revitalising, embracing, nurturing and growth of it) is important to our happiness and wellbeing and for improving health outcomes.

This review provides insights into what Indigenous peoples across the world describe as culture. However, much more knowledge is likely to be held by cultural leaders and others who have not engaged in what is often non-

Indigenous-led research. This also means that what is described as culture is largely viewed through the lens of people from non-Indigenous cultures. The content of this review is not intended to be a tool to measure indigeneity or cultural proficiency for individuals or groups and should not be read or interpreted as such.

The Lowitja Institute Aboriginal and Torres Strait Islander Health CRC funded this review under project 16- SDH-0503. Our aims were to identify from the literature the broad domains (and additional sub-domains) of Indigenous peoples’ cultures and describe how these relate to health and, more broadly, wellbeing.

We mainly restricted our review to literature published between 1990 and 2017 and used an iterative search process that initially returned many thousands of results from five online databases and through hand searching. We included grey literature to ensure as much material as possible was included.

We identified six broad, frequently cited cultural domains or themes, each with a number of sub-domains (see ‘Summary of cultural indicators’ at the end of Chapter 3). The broad domains were:

  • Connection to Country
  • Indigenous beliefs and knowledge
  • Indigenous language
  • Family, kinship and community
  • Cultural expression and continuity
  • Self-determination and

This revised edition of the literature review has been published by the Lowitja Institute as part of the project completion process.

Part 2 : The Conclusion

We have highlighted the often complex and overlapping factors that affect Aboriginal and Torres Strait Islander culture and wellbeing.

These factors can operate at the individual or community level. Importantly, we have identified that, while some practices, processes and beliefs are different in the context of Aboriginal and Torres Strait Islander culture, there are some universal elements across Australia and internationally.

We have highlighted in this review that health and more broadly wellbeing appear to be enhanced when cultural elements and culture more broadly is learnt, practiced and incorporated into people’s lives.

While we have likely not produced a succinct definition of culture, as a result of this review we have a better understanding of what things constitute the varying parts of culture for Aboriginal and Torres Strait Islander peoples and how these relate to health and wellbeing.

The authors acknowledge that this review may not include some elements of Indigenous peoples culture however this paper, has for the first time, put in one place the range of factors describing Aboriginal and Torres Strait Islander culture from an Australian and international perspective.

As a result of the extensive search we have been able to list broad domains of culture and a range of sub themes under each broad cultural domain. This is the first time to our knowledge this has been done.

Through the review we have been able to identify quantitative cultural measures that did not currently exist and this enabled the research team identify areas for data development – the creation of new measures for Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing.

This review also assisted in informing the modification of existing measures for inclusion in the Study. The Mayi Kuwayu Study commenced data collection in October 2018.

The report was prepared by Minette Salmon, Kate Doery, Phyll Dance, Jan Chapman, Ruth Gilbert, Rob Williams & Ray Lovett

 Part 3 Have your say about what is needed to make real change in the lives of Aboriginal and Torres Strait Islander people  #HaveYourSay about #closingthegapCTG

Aboriginal and Torres Strait Islander people know what works best for us.

We need to make sure Aboriginal and Torres Strait Islander youth voices are reflected and expertise is recognised in every way at every step on efforts to close the gap in life outcomes between Aboriginal and Torres Strait Islander people and other Australians.’

‘The Coalition of Peaks is leading the face to face discussions, not governments.

The Peaks are asking Aboriginal and Torres Strait Islander youth to tell us what should be included in a new Closing the Gap agreement and we will take this to the negotiating table.’

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

NACCHO Aboriginal Health and Health Literacy Research : Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care.

” Enhancing health literacy can empower individuals and communities to take control over their health as well as improve safety and quality in healthcare.

However, Indigenous health studies have repeatedly suggested that conceptualisations of health literacy are confined to Western knowledge, paradigms, and practices. The exploratory qualitative research design selected for this study used an inductive content analysis approach and systematic iterative analysis.

Publicly available health literacy-related policy and practice documents originating from Australia, Canada, and New Zealand were analysed to explore the extent to which and the ways in which Indigenous knowledges are recognised, acknowledged, and promoted.

 Findings suggest that active promotion of Indigenous-specific health knowledges and approaches is limited and guidance to support recognition of such knowledges in practice is rare.

Given that health services play a pivotal role in enhancing health literacy, policies and guidelines need to ensure that health services appropriately address and increase awareness of the diverse strengths and needs of Indigenous Peoples.

The provision of constructive support, resources, and training opportunities is essential for Indigenous knowledges to be recognised and promoted within health services.

Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care. “

Gordon Robert Boot and Anne Lowell Charles Darwin University, Australia

Download full copy of research 

Health Literacy

Image above from Menzies study : The aim of this study was to understand the interplay between health literacy, gender and cultural identity among young Aboriginal and Torres Strait Islander males living in the Northern Territory.

The health promotion sector is increasingly recognising that developing and improving individual, population, and provider health literacy (HL) is an important and effective strategy to enhance health and wellbeing, as well as to improve safety and quality in healthcare (Australian Commission on Safety and Quality in Health Care [ACSQH], 2014; Centre for Literacy, 2011; Johnson, 2014).

Integral to HL is the capability of individuals and the wider community to take active control and participate in addressing their healthcare needs (ACSQH, 2014, Johnson, 2014, Nutbeam, 2008).

Health outcomes can be improved through HL competencies that enable self-care and self-advocacy, development of mutual trusting relationships with health professionals, more effective access to and navigation of the healthcare system, as well as the ability of service providers to communicate effectively (Paasche-Orlow & Wolf, 2007, Sørensen et al., 2012).

Recent studies have highlighted that inclusion and promotion of Indigenous health knowledges within health promotion practices can enhance overall Indigenous health outcomes through mutual recognition of differing worldviews (Smylie, Kaplan-Myrth, McShane & Métis Nation of Ontario-Ottawa, 2008; Vass, Mitchell, & Dhurrkay, 2011), improved health communication (Lowell et al., 2012), and through strengthening cultural safety within culturally diverse healthcare systems (Rowan et al., 2013; Nielsen, Alice Stuart & Gorman, 2014).

However, representation of Indigenous health knowledges and practices within health literacy-related policy and practice documents does not appear to have been investigated in previous research.

The overall purpose of this paper is to present selected findings of a larger study (Boot, 2016), which has sought to address this knowledge gap by exploring the extent and means by which Indigenous knowledges, paradigms, and practices are recognised, acknowledged, and promoted within HL-related documents across Australia, Canada, and New Zealand.

This article focuses on two themes from the findings that have particular relevance: acknowledging cultural beliefs, practices, and norms, and promotion of Indigenous cultural health knowledges, paradigms, and practices (Boot, 2016).

The next section of this article explores definitions and context encompassing Indigenous health and health literacy. The Methods section describes in detail the exploratory research approach, document selection, and content analysis process.

The Findings section illustrates prominent examples from within the two themes that are represented within this article. The relevance and implications of these findings are further explored in the concluding discussion, and recommendations for future research are presented.


Many countries, including Australia, Canada, and New Zealand, are considered to have world-class healthcare systems (Organisation for Economic Co-operation and Development, 2017).

Extensive efforts are made by governments and the health promotion sector to improve overall health and quality of life outcomes within these populations (Organisation for Economic Co-operation and Development, 2017).

The majority of people living within these countries have reasonably good health and enjoy an average life expectancy of 78 to 82 years of age (Australian Bureau of Statistics [ABS], 2015b; Statistics Canada, 2015; Statistics New Zealand, 2015).

All three countries have a similarly rich history of Indigenous cultures, knowledges, and languages, but life expectancy for many Indigenous people within these countries remains significantly lower, ranging from 69 to 80 years of age, in comparison with the national average (ABS, 2015a; Statistics Canada, 2015; Statistics New Zealand, 2015).

The health inequities Indigenous people experience today are predominantly linked to the effects of colonisation and persistently unfavourable social determinants (Dudgeon, Milroy & Walker, 2014; Griffiths, Coleman, Lee & Madden, 2016; Sherwood, 2013).

Governments and frontline health services aim to overcome these inequities by developing and implementing a variety of policies, strategies, and evidence-based approaches.

Defining Health Literacy 

The concept of health literacy originates from the field of education and has in recent years expanded to include a wide range of skills and knowledges. Health literacy is commonly defined as the abilities and skills of an individual or community to access, appraise, and communicate health-related information, to navigate and engage with the healthcare system, and to advocate and maintain personal and community health and wellbeing (Centre for Literacy, 2011; Nutbeam, 2000; Sørensen et al., 2012; World Health Organisation, 2016a).

Governments and scholars advocate that developing and enhancing HL within populations supports the process of empowerment thereby enabling the individual, community, and society to take control over their healthcare needs and engage in collective action to promote health (ACSQH, 2014; Estacio, 2013; Freedman et al., 2009; Johnson, 2014; Kickbusch, 2009; Ministry of Health, 2015; Mitic & Rootman, 2012; Nutbeam, 2008; Sykes, Wills, Rowlands, & Popple, 2013).

Health literacy skills develop across the lifespan, are context specific, and influenced by social, cultural, and political contexts (Centre for Literacy, 2011; Kickbusch, Wait, & Maag 2006; Mitic & Rootman, 2012; Paasche-Orlow & Wolf, 2007; Vass et al., 2011; Zarcadoolas, Pleasant, & Greer, 2005).

Zarcadoolas et al. (2005), for example, asserted that cultural health literacy needs to be inherent within health literacy models. This is defined as having “the ability to recognize and use collective beliefs, customs, world-view and social identity in order to interpret and act on health information” (p. 197).

In addition, Ewen (2011) argued that health professionals need to obtain and effectively utilise cultural literacy skills in order for them to be culturally competent in their service delivery.

Cultural literacy is considered a skill-set that encompasses awareness, respect, and responsiveness to cultural differences and needs (Ewen, 2011). These abilities become critical within culturally diverse healthcare environments where worldviews, values, approaches to communication, and conceptualisations of health and wellbeing differ significantly from those endorsed by the dominant culture.

More recent conceptualisations of HL are increasingly recognising the significance and complexity of the health literacy environment: That is, “the infrastructure, policies, processes, materials, people and relationships that make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services” (ACSQH, 2014, p. 10). The Global Conference on Health Promotion in Shanghai in 2016 also identified HL as a critical social determinant of health that needs to be developed and strengthened within populations (World Health Organisation, 2016b). Enhancing HL skills within Indigenous populations, however, requires sophisticated cultural literacy and a collaborative, comprehensive, and empathetic approach due to the diversity in worldviews, perceptions of health and wellbeing, as well as complex sociocultural factors (Ewen, 2011; Smylie, Williams & Cooper, 2006; Vass et al., 2011).

Indigenous Concepts of Health and Wellbeing

Indigenous populations across and within each of the three countries that are the focus of this article

(Australia, Canada, and New Zealand) are diverse in terms of languages and their physical environment (urban, rural, level of remoteness, and climate), as well as political and social relationships, ancestral heritage, and cultural knowledges and practices (Dudgeon et al., 2014; Greaves, Houkamau & Sibley, 2015; Stephenson, 1995). Although Indigenous Peoples share some common health beliefs, their health knowledges and healing practices are diverse due to the unique social, cultural, political, and environmental circumstances within which they have developed and continue to exist (Dudgeon et al., 2014; Durie, 1994).

Despite this diversity, Indigenous people across all three countries tend to regard health and wellbeing as a holistic, multidimensional, and interconnected concept that cannot be separated from other aspects or fragmented into distinguishable individual units (Durie, 1994; Morgan, Slade & Morgan, 1997; Stephens, Porter, Nettleton & Willis, 2006). Health and wellbeing incorporates physical, psychological, social, ecological, spiritual, and cultural aspects and is sustained by nurturing and attending to all these relational aspects regularly in an appropriate and meaningful manner (Campbell, 2002; Durie, 1994; Morgan et al., 1997; Vukic, Gregory, Martin-Misener & Etowa, 2011; Wilson, 2008). Individual studies within all three countries similarly highlight how positive strengthening and maintaining of those interrelated aspects can provide preventative and long-lasting health benefits (Colles, Maypilama & Brimblecombe, 2014; Dockery, 2010; Hopkirk & Wilson, 2014; Lambert et al., 2014; Lowell, Kildea, Liddle, Cox & Paterson, 2015; Smylie et al., 2008; Wilson, 2008).

Previous research addressing Indigenous health concerns have identified HL-related barriers and challenges including racism, communication and language barriers, poor relationships, and culturally associated misconceptions (Durey & Thompson, 2012; Lambert et al., 2014; Lowell et al., 2015; Vass et al., 2011). Such challenges can significantly obstruct access to and provision of effective primary healthcare services, inevitably influencing health outcomes (Lambert et al., 2014). The need for healthcare systems to adequately acknowledge and incorporate Indigenous health knowledges within health promotion practices has also been identified (Hopkirk & Wilson, 2014; Liaw et al., 2011; Lowell et al., 2015; Nielsen et al., 2014; Priest, MacKean, Davis, Briggs & Waters, 2012; Rowan et al., 2013; Vass et al., 2011).

Incorporating and promoting Indigenous knowledges within an Indigenous healthcare environment has the potential to strengthen culturally safe practices and opportunities for self-determination, enhance health communication, and to foster relationships that are built on trust and mutual respect (Colles et al., 2014; Dockery, 2010, Hopkirk & Wilson, 2014; Lambert et al., 2014, Lowell et al., 2015). However, the majority of current conceptualisations of HL are commonly confined to Western pedagogies and paradigms. As such, they frequently disregard the significance of Indigenous cultures, languages, and knowledges as strengths, with potential health benefits (Akena, 2012; Barwin, 2012; Durey & Thompson, 2012; Lambert et al., 2014; Priest et al., 2012; Sherwood, 2013; Smylie et al., 2006; Vass et al., 2011).

Ingleby (2012) suggested that every person has some form of HL that is intrinsic to their personal and cultural beliefs. Enhancing HL within diverse populations can therefore only be achieved when distinctive personal and cultural beliefs are taken into account and appropriately acted upon (Ingleby, 2012). Indigenous concepts of holistic health and associated knowledges and practices have developed over millennia, ensuring individual and community survival, health, and well-being prior to colonisation and beyond. For example, Indigenous-specific HL includes knowledges and practices related to bush medicines and sourcing traditional food (Ewen, 2011) and the interconnectedness of language, physical, emotional, environmental, and spiritual aspects that as a whole contribute to health and wellbeing among First Nation people (Smylie et al., 2006).


NACCHO Aboriginal Research Health News : New @NHMRC project to implement and evaluate 715 annual health checks interventions designed to help Close the Gap

 “The prevalence of most chronic diseases increases with age and affects not only physical health, but also the broader contributors to the well-being of older Aboriginal people, including participation in family, community and cultural leadership roles and connection with community networks.

Aboriginal people often receive a diagnosis at a more advanced stage of chronic disease, which means there’s less opportunity to prevent their condition and health deteriorating “

Professor Sanson-Fisher said chronic diseases continue to be a major contributor to unhealthy ageing among Aboriginal and Torres Strait Islander people. Timely diagnosis and appropriate management was vital to improving health outcomes for Aboriginal and Torres Strait Islander people. See Website

Consider these facts

  • In 2016-2017 just 27 per cent of Indigenous adults aged 15 to 24 had an annual health assessment.
  • Only 30 per cent of 25-to 54-year-olds, and 41 per cent of Indigenous adults over 55 had one.
  • Around 37 per cent of the burden of disease in Aboriginal people could be prevented by reducing risk factors

Read previous NACCHO 715 Health Check Articles

Download resources to boost the rates of the 715 health check. Information available for patients and health professionals!

An intervention designed to help Close the Gap, by increasing the number of Aboriginal and Torres Strait Islander people who receive an annual health check by their GP, will be implemented and evaluated by a new National Health and Medical Research Council (NHMRC) project.

Renowned population health researcher, Laureate Professor Rob Sanson-Fisher of the University of Newcastle and Hunter Medical Research Institute, will lead a team of expert Aboriginal and non-Aboriginal researchers in the five-year research project – which was awarded $745,056 following a Targeted Call for Research** for Healthy Ageing of Aboriginal and Torres Strait Islander People.

Indigenous people die about eight years earlier than non-Indigenous Australians. For Aboriginal and Torres Strait Islander Australians born in 2015-17, the life expectancy is 71.6 years for men and 75.6 years for women – about 8.6 and 7.8 years less than non-Aboriginal men and women respectively.

Twenty-two mainstream general practice clinics within the central Coast and New England regions will participate in the research project.

The intervention package will comprise strategies such as continuing medical education, recall and reminder systems, and mailed invitations to patients.

The project will also test whether the intervention increases doctors’ adherence to best practice care and improves patient outcomes.

More than 60 per cent of Indigenous people regularly visit mainstream general practice services – a key opportunity to deliver an annual ‘715’ health assessment, which forms an integral part of the Australian Government’s Closing the Gap commitment.

The aim of the Aboriginal and Torres Strait Islander Health Assessment (Medicare Benefits Schedule item 715) is to help ensure Indigenous Australians receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early death.

The health assessment is an annual service and covers the full age spectrum..

Key contributing chronic conditions include cardiovascular diseases (19 per cent of the chronic disease prevalence gap), mental and substance use disorders (14 per cent), cancer (9 per cent), chronic kidney disease, diabetes, vision loss, hearing loss and respiratory, musculoskeletal, neurological and congenital disorders.

Around 37 per cent of the burden of disease in Aboriginal people could be prevented by reducing risk factors.

The risk factors causing the most burden are tobacco use (12 per cent of the total burden), alcohol use (8 per cent), high body mass (8 per cent), physical inactivity (6 per cent), high blood pressure (5 per cent) and high blood glucose levels (5 per cent).

“Mainstream general practice is a crucial setting to impact on prevention, timely diagnosis and appropriate management of chronic disease for Aboriginal people, which is imperative to help Close the Gap,” Professor Sanson-Fisher said.


NACCHO Aboriginal Health #ClosingTheGap #NAIDOC2019 : @AIHW Key results report 2017-18 Aboriginal and Torres Strait Islander health organisations:

Findings from this report:

  • Just under half (45%) of organisations provide services in Remote or Very remote areas

  • In 2017–18, around 483,000 clients received 3.6 million episodes of care

  • Nearly 8,000 full-time equivalent staff are employed in these organisations and 4,695 (59%) are health staff

  • Organisations reported 445 vacant positions in June 2018 with health vacancies representing 366 (82%) of these
  • In 2017–18, nearly 200 organisations provided a range of primary health services to around 483,000 clients, 81% of whom were Indigenous.
  • Around 3.6 million episodes of care were provided, nearly 3.1 million of these (85%) by Aboriginal Community Controlled Health Services.

See AIHW detailed Interactive site locations map HERE

In 2017–18, Indigenous primary health services were delivered from 383 sites (Table 3). Most sites provided clinical services such as the diagnosis and treatment of chronic illnesses (88%), mental health and counselling services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

Most organisations provided access to a doctor (86%) and just over half (54%) delivered a wide range of services, including all of the following during usual opening hours: the diagnosis and treatment of illness and disease; antenatal care; maternal and child health care; social and emotional wellbeing/counselling services; substance use programs; and on‑site or off-site access to specialist, allied health and dental care services.

Most organisations (95%) also provided group activities as part of their health promotion and prevention work. For example, in 2017–18, these organisations provided around:

  • 8,400 physical activity/healthy weight sessions
  • 3,700 living skills sessions
  • 4,600 chronic disease client support sessions
  • 4,100 tobacco-use treatment and prevention sessions.

In addition to the services they provide, organisations were asked to report on service gaps and challenges they faced and could list up to 5 of each from predefined lists. In 2017–18, around two-thirds of organisations (68%) reported mental health/social and emotional health and wellbeing services as a gap faced by the community they served.

This was followed by youth services (54%). Over two-thirds of organisations (71%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

Read full report and all data HERE

This is the tenth national report on organisations funded by the Australian Government to provide health services to Aboriginal and Torres Strait Islander people.

Indigenous primary health services

Primary health services play a critical role in helping to improve health outcomes for Aboriginal and Torres Strait Islander people. Indigenous Australians may access mainstream or Indigenous primary health services funded by the Australian and state and territory governments.

Information on organisations funded by the Australian Government under its Indigenous Australians’ health programme (IAHP) is available through two data collections: the Online Services Report (OSR) and the national Key Performance Indicators (nKPIs). Most of the organisations funded under the IAHP contribute to both collections (Table 1).

The OSR collects information on the services organisations provide, client numbers, client contacts, episodes of care and staffing levels. Contextual information about each organisation is also collected. The nKPIs collect information on a set of process of care and health outcome indicators for Indigenous Australians.

There are 24 indicators that focus on maternal and child health, preventative health and chronic disease management. Information from the nKPI and OSR collections help monitor progress against the Council of Australian Governments (COAG) Closing the Gap targets, and supports the national health goals set out in the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

Detailed information on the policy context and background to these collections are available in previous national reports, including the Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17 and National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017.

At a glance

This tenth national OSR report presents information on organisations funded by the Australian Government to provide primary health services to Aboriginal and Torres Strait Islander people. It includes a profile of these organisations and information on the services they provide, client numbers, client contacts, episodes of care and staffing levels. Interactive data visualisations using OSR data for 5 reporting periods, from 2013–14 to 2017–18, are presented for the first time.

Key messages

  1. A wide range of primary health services are provided to Aboriginal and Torres Strait Islander people. In 2017–18:
  • 198 organisations provided primary health services to around 483,000 clients, most of whom were Aboriginal and Torres Strait Islander (81%).
  • These organisations provided around 3.6 million episodes of care, with nearly 3.1 million (85%) delivered by Aboriginal Community Controlled Health Services (ACCHSs).
  • More than two-thirds of organisations (71%) were ACCHSs. The rest included government-run organisations and other non-government-run organisations.
  • Nearly half of organisations (45%) provided services in Remoteand Very remote
  • Services were delivered from 383 sites across Australia. Most sites provided the diagnosis and treatment of chronic illnesses (88%), social and emotional wellbeing services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

See this AIHW detailed Interactive site locations map HERE

  1. Organisations made on average nearly 13 contacts per client

In 2017–18, organisations providing Indigenous primary health services made around 6.1 million client contacts, an average of nearly 13 contacts per client (Table 2). Over half of all client contacts (58%) were made by nurses and midwives (1.8 million contacts) and doctors (1.7 million contacts). Contacts by nurses and midwives represented half (49%) of all client contacts in Very remote areas compared with 29% overall.

  1. Organisations employed nearly 8,000 full-time equivalent (FTE) staff

At 30 June 2018, organisations providing Indigenous primary health services employed nearly 8,000 FTE staff and over half of these (54%) were Aboriginal or Torres Strait Islander. These organisations were assisted by around 270 visiting staff not paid for by the organisations themselves, making a total workforce of around 8,200 FTE staff.

Nurses and midwives were the most common type of health worker (14% of employed staff), followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (22%).

  1. Social and emotional health and wellbeing services are the most commonly reported service gap

Organisations can report up to 5 service gaps faced by the community they serve from a predefined list of gaps. Since this question was introduced in 2012–13, the most commonly reported gap has been for mental health and social and emotional health and wellbeing services. In 2017–18, this was reported as a gap by 68% of organisations.


NACCHO Aboriginal Health and #ClosingTheGap @nhmrc and @UniCanberra Project : Commissioning stronger evaluations of Indigenous health and wellbeing programs

 ” Billions of dollars are spent annually on Indigenous programs, services and initiatives yet, despite the need, there is limited evidence on what programs are effective for improving Indigenous health outcomes.

The Productivity Commission has called for ‘more and better’ evaluations of Indigenous programs and commissioning processes that engage Indigenous communities, organisations and leaders.

The commissioning of evaluations plays a significant role in the way program evaluations are carried out. It is through the commissioning process that the budget is set, the evaluators are identified, the aims and objectives of the evaluation are set, and many other aspects of the evaluation are determined.” 

See University of Canberra website 

This National Health and Medical Research Council funded project (GNT1165913) responds to a call from Indigenous leaders for opportunities to influence decision-making processes within the health system and across sectors for the commissioning of health programs to reflect their needs, priorities and views on program design, delivery and evaluation.

This project aims to identify how government (federal, state/ territory) and non-government (not-for-profit, corporate, foundation, philanthropic) commissioning practices can better support Indigenous engagement and leadership in the evaluation of health and wellbeing programs in Australia.

To achieve this aim, this project will address the following objectives:

  1. To characterise the spectrum of commissioning practices of government and non-government organisations in contracting evaluations for health and wellbeing programs particularly the role of Indigenous engagement and leadership during, and resulting from, the commissioning process.
  2. To identify the issues, challenges and opportunities for Indigenous engagement and leadership across the spectrum of commissioning practices from the perspectives of: (a) commissioners/policy makers; (b) service providers; and (c) the Indigenous community.
  3. To translate the findings into resources to support Indigenous engagement and leadership in the commissioning of program evaluations.

The project will be supported by an advisory group, chaired by Professor Tom Calma AO.

The project is funded until October 2022.

Research team


For more information on the project, please contact Margaret Cargo at

NACCHO Aboriginal Health and #IndigenousEvaluationStrategy : The Australian Government has asked the @ozprodcom to develop a whole-of-government evaluation strategy for policies and programs affecting Indigenous Australians

 ” We are developing an evaluation strategy for Australian Government policies and programs affecting Aboriginal and Torres Strait Islander people.

 Better evidence about what works and why is needed to improve policies and programs.

The strategy will cover both Indigenous‑specific and mainstream policies and programs.”

 Romlie Mokak, Commissioner, Productivity Commission

Download the brochure HERE


Great ideas, engagement and interest in #IndigenousEvaluationStrategy workshop at #LowitjaConf2019 facilitated by Commissioner @RMokak and team members. Strong indicator of need for more attention on policy and program development and evaluation.

Evaluation can help policy-makers and communities determine:

  • whether government policies and programs are achieving their objectives
  • what influences whether government policies and programs are effective
  • how government policies and programs can be improved

We will engage widely across metropolitan, regional and remote locations.

We want to hear from individuals, communities and organisations.

  • How can Aboriginal and Torres Strait Islander knowledge, priorities and values be better integrated into policy and program evaluation?
  • What principles should guide Australian Government agencies’ evaluation efforts?
  • What should be the priority policy areas for future Australian Government evaluation efforts?
  • How can evaluation results be better used in policy and program design and implementation?

We are particularly keen to get input and advice from Aboriginal and Torres Strait Islander people, communities and organisations.

An issues paper will be released in June 2019.

Learn more about the project, or register your interest or call 1800 020 083

Indigenous Evaluation Strategy

Letter of Direction

Evaluation of policies and programs impacting on Indigenous Australians

I, Josh Frydenberg, Treasurer, pursuant to Parts 2 and 4 of the Productivity Commission Act 1998 hereby request the Productivity Commission to develop a whole-of-government evaluation strategy for policies and programs affecting Indigenous Australians. The Commission will also review the performance of agencies against the strategy over time, focusing on potential improvements and on lessons that may have broader application for all governments.


A number of high profile reports have highlighted the need for more evaluation of policies and programs that have an impact on Indigenous Australians. For example, the Commission’s Overcoming Indigenous Disadvantage Report 2016found that only a relatively small number of programs have been rigorously evaluated.

Improving outcomes for Indigenous Australians depends on agencies with responsibility for policies and programs affecting Indigenous Australians undertaking meaningful evaluations. The Commission is to develop a strategy to guide that evaluation effort.


The Commission should develop an evaluation strategy for policies and programs affecting Indigenous Australians, to be utilised by all Australian Government agencies. As part of the strategy, the Commission should:

  • establish a principles based framework for the evaluation of policies and programs affecting Indigenous Australians
  • identify priorities for evaluation
  • set out its approach for reviewing agencies’ conduct of evaluations against the strategy.

In developing the strategy, the Commission should consider:

  • how to engage Indigenous communities and incorporate Indigenous knowledge and perspectives
  • ethical approaches to evaluations
  • evaluation experience in Australia and overseas
  • relevant current or recent reviews commissioned or undertaken by Australian, state, territory or local government agencies
  • the availability and use of existing data, and the further development of other required data and information
  • areas in which there may be value in the Productivity Commission undertaking evaluation
  • how to translate evidence into practice and to embed evaluation in policy and program delivery.


The Commission should consult widely on the strategy, in particular with Indigenous people, communities and organisations (such as the Empowered Community regions), and with all levels of government. It should also consult with non-Indigenous organisations, and individuals responsible for administering and delivering relevant policies and programs.

The Commission should adopt a variety of consultation methods including seeking public submissions.

The Commission should provide the evaluation strategy and forward work program to Government within 15 months of commencement.

The Hon Josh Frydenberg MP

[10 April 2019]


NACCHO Aboriginal Health and #SuicidePrevention @cbpatsisp The #WISPC18 #NISPC18Conference Report, released this week, confirms the urgent need for action in colonised countries throughout the world

Our people know the solutions, as is evidenced in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), Solutions that work: What the evidence and our people tell us along with countless other reports and bodies of work. It’s time for all parties to work together, and with us on co-designing and implementing clinically proven culturally driven solutions.”

Professor Pat Dudgeon, a Psychologist and Project Director at the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP), has found intergenerational trauma and suicide to be a legacy of colonisation for Indigenous peoples the world over.

Download the Report


Read over 140 Aboriginal Health and SUicide Prevention articles published by NACCHO in past 7 years 

Indigenous suicide is a global concern. The 2nd National and World Indigenous Suicide Prevention Conferences in Perth WA in November 2018 brought together Indigenous peoples from Australia, Canada, United States of America and New Zealand. The Conference Report, released today, confirms the urgent need for action in colonised countries throughout the world.

Suicide rates have been increasing worldwide and are especially high amongst Indigenous peoples. The critical importance of identifying and implementing effective suicide prevention strategies in Indigenous communities was highlighted by a report Global Overview: Indigenous Suicide Rates. Prepared for and launched at the Conferences, the report details the consistently higher rates of suicide amongst Indigenous compared to non-Indigenous people and demonstrates the urgency for action.

Indigenous Elders, policy makers, researchers and community members representing LGBTIQ+SB, Youth, and Lived Experience participants came together at the Conferences to recognise the impacts of colonisation and subsequent trauma, disadvantage, marginalisation and lack of action by government on Indigenous issues and the need for healing and recovery processes for suicide prevention.

Professor Pat Dudgeon, a Psychologist and Project Director at the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP), has found intergenerational trauma and suicide to be a legacy of colonisation for Indigenous peoples the world over.

There’s an emerging story about people who have been colonised. Usually the takeover of their lands has been quite brutal. There were genocides and people removed from country and treated like second-class citizens, which in itself is traumatic.

Professor Dudgeon cited the work of psychologists Professor Michael Chandler and Professor Christopher Lalonde as pointing a way forward in preventing suicide in Aboriginal and Torres Strait Islander communities.

They looked at Canadian First Nation tribes and found that some communities had no suicide and others were right off the scale. So they examined the communities that had no or low suicide rates and coined the term ‘cultural continuity’. Translated into plain English, those communities had good self-determination. They had their own councils, they were in charge, they had agency over their community and their lives.

Another factor was that they were doing cultural reclamation activities. These could be simple things like building a long house or ensuring you had your cultural ceremonies happening. These issues corresponded directly to suicide rates.

Recovery from colonisation is our globally shared agenda and the conference enabled delegates to examine issues and identify solutions that are needed. Indigenous peoples from all countries who attended the conferences are calling upon their respective governments to recognise the Indigenous Rights declaration, the right to self-determination and the right for data sovereignty.

Recommendations included a dedicated National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and Implementation Plan; allocation of greater levels of program funds for Aboriginal and Torres Strait Islander communities; and an Elders call on all levels of government for an immediate response to unacceptable rates of suicides of young people, including a Royal Commission or ‘Truth and Reconciliation’ as the basis for healing and moving forward, programs and services to recognise and support the restoration and maintenance of culture and identity for the younger generation.

As Professor Dudgeon says:

Our people know the solutions, as is evidenced in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), Solutions that work: What the evidence and our people tell us along with countless other reports and bodies of work. It’s time for all parties to work together, and with us on co-designing and implementing clinically proven culturally driven solutions.

The next Conference will continue the legacy of the Calls to Actions and Recommendations. Ms Carla Cochrane who is the Regional Research Coordinator for the First Nations Health and Social Secretariat of Manitoba is coordinating and planning the 3rd World Suicide Prevention Suicide Prevention Conference that will take place in Winnipeg, Manitoba, Canada in August 2020.

Ms Cochrane stated:

The 2018 Conference allowed us to share our stories and to connect on all levels, including spirit, with the promotion of life.  Even though we come from different regions, our experiences and history are very similar and so is our strength, perseverance and resiliency to overcome the challenges we may face. Our connection to who we are as Indigenous people, our connection to the land and our languages set this foundation and this was highlighted at the conference.

Our focus at the 2020 Conference will be on continuing the legacy of the Calls to Actions and Recommendations from the 2018 Conference and on strengthening our communities through sharing our stories and our Knowledge.

  • Lifeline: 131 114
  • Kids Helpline: 1800 551 800
  • Mensline: 1300 78 99 78
  • Suicide Call Back Service 1300 659 467
  • Open Arms Veterans and Families Counselling 1800 011 046
  • Qlife – 1800 184 527
  • National Indigenous Critical Response Service 1800 805 801

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