The national peak Aboriginal health organisation today welcomed the release of the 2014 Children’s Rights Report and called for a coordinated and comprehensive focus to improve the health and rights of Aboriginal children.
Professor Ngiare Brown, National Research Manager and Senior Aboriginal Public Health Medical Officer at the National Aboriginal Community Controlled Health Organisation (NACCHO) said the report highlighted the persistent and significant issues of Aboriginal child and adolescent self-harm and suicide, and the high numbers of Aboriginal children in out-of-home care and in the juvenile justice system.
“On all these issues we see a significant disparity between Aboriginal and non-Aboriginal children and the effect on families and communities is devastating,” Professor Brown said.
“We often refer to children as our future, but they are also our present and have the right to be heard, and to be able to participate in the discourse and decision making that affects them.
“NACCHO supports a child centric approach to all aspects of social policy and service delivery, underpinned by the our roles and responsibilities as defined by the CRC and other international and domestic human rights instruments.
“There is often piecemeal and incremental approaches to these complex but fundamentally important issues for our children and collectively we need to do better.
“There are clearly articulated, evidence-based solutions in the Aboriginal community controlled health sector and from our Elders, particularly for at risk and vulnerable children and young people in regional, rural and remote communities.
“There needs to be better support for these solutions and a broader commitment to invest in primary, secondary and tertiary prevention and intervention to ensure sustainable positive change.”
Professor Brown specifically called for a greater focus on:
‘nation building’ initiatives for a society dedicated to growing happy, healthy, safe, smart children;
programs which help our children, adolescents and young people know that they are valued;
investment in prevention, and addressing modifiable risk factors at individual, family, community and population levels to reduce violence, abuse and neglect;
trauma informed care and education for children affected by violence, abuse and neglect;
immediate investment in acute care services for children, adolescents and young people affected by physical, emotional and mental health traumas;
cultural education and the acknowledgement of positive cultural practices to improve resilience and positive outcomes across the social determinants of health;
a specific focus on adolescence as a key transition period for cultural, social, physical and psychological development, to build the evidence base identifying what works to support the wellbeing of our young people.
The harsh tragedy at the centre of indigenous health in Australia is anchored to shortened life expectancy and a greater predisposition to chronic illness for Aboriginal and Torres Strait Islander people than the general population.
For indigenous men, life expectancy is 11.5 years less than someone of non-indigenous background. Women are barely 1.5 years better off, with indigenous women having 10 years less than their non-indigenous counterparts.
“The figures can vary,” said Professor Ngiare Brown, executive director of research at the National Aboriginal Community Controlled Health Organisation. “That’s because there are different methods of calculation. But it’s anywhere between 12 and 15 years and that’s an unacceptable disparity.”
Much of the disparity in life expectancy comes down to chronic disease, much of it preventable, including kidney disease, cardiovascular disease and a rise in some forms of cancer.
For younger Aboriginal and Torres Strait Islander people, there’s also a high preponderance of self harm, suicide and injuries.
“With adolescents and young people, it’s hard for them to develop a social identity, so the levels of suicide and substance abuse are very high. Dealing with that in a social and medical context is very hard,” Professor Brown said.
So if much of the difference in life expectancy comes down to preventable disease, why isn’t more being done about it? According to Joshua Creamer, a barrister and president of the Indigenous Lawyer’s Association Queensland, who has been active in indigenous health, much of the problem comes down to a lack of access to services.
Access to services
“There are many factors,” he said. “But it generally comes down to access to healthcare and health services. People are living in remote communities and there simply isn’t the same level of service that there is for people living in larger population centres.”
Professor Brown concurs. “There are real problems associated with access to health services and the prevention of disease and maintenance of good health,” she said.
There are also intergenerational factors at work, Professor Brown noted. “There is the exposure of parents and grandparents and this continues down through the generations,” she said.
“Mental health, social and emotional and cultural wellbeing are also issues,” she continued. “There are the usual pressures of family and community education and employment. Layer that with complexities [in terms of] exposure to policies, extermination, identity and cultural responsibility and indigenous health becomes a very hard area to deal with.”
Professor Brown and Mr Creamer were concerned about the effect of the recent budget on Aboriginal and Torres Strait Islander populations.
Professor Brown said a completely free system is becoming unsustainable. “It was meant to be a safety net, but people have become accustomed to completely free care,” she said.
Yet on the other hand, she noted, people who can already afford private care will use it in any case. The impact of introducing co-payments and increasing the pension age to 70, will be on people and populations that cannot already afford private primary care.
“It’s going to be a mess,” she stated. “The impact will be more on the people who cannot afford it. There needs to be detailed and careful consideration of intended and unintended consequences of fee for services [if the changes] are going to be a success and not hurt people who cannot already afford healthcare.”
In terms of the budget measures, Brown continued, the impact on indigenous people is twofold. “We are the most disadvantaged population in Australia and secondly, we have the highest burden of morbidity and mortality. Our services rely on MBS and medicare rebates to provide affordable services.
“If you reduce Medicare rebate and charge a fee, for people with multiple visits, chronic disease, children with special needs, the families will not be able to afford it.”
On a positive note, Mr Creamer said under the budget funding for Aboriginal Community Controlled Healthcare will continue and that type of healthcare remains a bright spot when it comes to dealing with the healthcare issues of Aboriginal and Torres Strait Islander people.
Professor Brown said she remains an optimist, despite the harrowing life expectancy and disease statistics. “If it was that bad, I would not continue doing what I do. I remain an optimist because community health centres are locally led responses to local priorities. In the end, however, what we need is collaboration, between policymakers and government to address indigenous health in a more integrated manner.”
“Decades of Indigenous controlled health service delivery have seen the Aboriginal community controlled health sector become a leading provider of primary health care services and a significant employer of Aboriginal and Torres Strait Islander peoples.
This sector has mature organisations with a depth of expertise and capabilities, particularly in remote and regional areas, surpassing the level of mainstream health services in some areas.
I see no reason why organisations in these positions should not be able to leverage their capabilities and positioning to provide health services more broadly, thereby expanding their ability to generate extra income and funding. Opening the door to entrepreneurship, independence and self-sufficiency could present great opportunities.”
“The Future of Aboriginal & Torres Strait Islander Health”
Pictured above with Lowitja O’Donoghue
Thank you Aunty Di Kerr for the Welcome to Country on behalf of the Wurundjeri Nation.
I too would like to acknowledge and pay respect to the traditional owners of the land on which we meet and also to acknowledge and pay respect to my own Bundjalung, Gumbaynggirr, Yuin and Irish ancestors.
I wish also to thank you the Lowitja Institute for inviting me to give the Keynote Address at this Congress and to Lowitja O’Donoghue for her introduction.
And thank you Deborah Cheetham and the Indigenous Dance Troupe, Koori Youth Will Shake Spear, for your terrific performances.
I also acknowledge the Deputy Chair of the Prime Minister’s Indigenous Advisory Council, Professor Ngiare Brown.
I am honoured to be here today addressing you.
The Future of Aboriginal & Torres Strait Islander Health? The short answer is the Prime Minister’s Indigenous Advisory Council sees a healthy and prosperous future for Aboriginal & Torres Strait Islander health. I see great leadership, innovation and vision when I look at the community controlled Aboriginal & Torres Strait Islander Medical Services and their national advocacy organisation, the National Aboriginal Community Controlled Health Organisation, and the Australian Indigenous Doctors’ Association.
As people would appreciate, after reviewing the recent “Closing the Gap” report there is much more work to be done.
To get an understanding of the Council and the work of the Council I’ll give a brief outline.
The Prime Minister’s Indigenous Advisory Council was created to provide advice to the Federal Government on Aboriginal & Torres Strait Islander Affairs, with a focus on practical changes to improve the lives of Aboriginal and Torres Strait Islander people.
The Council provides ongoing advice to the Government on emerging policy and implementation issues related to Aboriginal & Torres Strait Islander Affairs covering, but not limited to:
improving school attendance and educational attainment
creating lasting employment opportunities in the real economy
reviewing land ownership and other drivers of economic development
preserving Aboriginal and Torres Strait Islander cultures
building reconciliation and creating a new partnership between black and white Australians
empowering Aboriginal and Torres Strait Islander communities, including through more flexible and outcome-focussed programme design and delivery
building the capacity of communities, service providers and governments
promoting better evaluation to inform government decision-making
supporting greater shared responsibility and reducing dependence on government within Aboriginal and Torres Strait Islander communities
achieving constitutional recognition of Aboriginal and Torres Strait Islander people.
The Council also has another role of being the Deregulation Committee for Prime Minister and Cabinet as part of the review by Parliamentary Secretary to the Prime Minister, Josh Frydenberg into deregulation including cutting red tape and addressing the overburden of compliance costs.
The Council is supported by a Secretariat based within Prime Minister and Cabinet.
The Chair meets at least monthly with the PM, currently I have weekly conversations with the Prime Minister, the Minister for Indigenous Affairs and other Ministers. The Council meets 4 to 6 times a year. Our 3rd meeting is being held in Sydney on the 2nd April.
As you can see, the Council has a broad Terms of Reference and is an independent body that gives advice. That means we give advice whether the Government agrees or not. A good example of this is the Anti-Discrimination Act Section 18C debate. Council members didn’t agree with the policy taken to the last election by the Coalition and we gave advice to the Prime Minister of our views not to repeal Section 18C. The Government and the general public are very aware of the Council’s view on this matter.
The Council is the Prime Minister’s advisory group not an elected representative body. It is an advisory group like the Commission of Audit, the Gonski Education Review, the Henry Tax Review, the Banking Inquiry Review and many such other bodies. So, when people say we are not an elected body, we don’t represent Aboriginal and Torres Strait Islander people – I say “correct”. We are a group of people who bring a range of expertise, skills and experiences together to advise the Prime Minister and Government. Council meetings are full of robust and frank discussion and new ways of thinking and that is reflected in the advice we give to the Prime Minister.
The Prime Minister wants the Council to focus primarily on the three areas of Jobs, Education and One rule for all. The third area is essentially around upholding community standards and the rule of law in all communities. My term for this is “social stability”.
Broadly, the Council operates within a reform agenda based with an economic and commerce focus. We want to see a focus on outcomes and on the experience of the people who receiving or relying on services; we look for innovative and entrepreneurial approaches; we want service delivery that is integrated and eliminates duplication; we expect service deliverers – including States and Territories – to be accountable and we will hold them to their accountabilities; we want to see less red tape more Bang for the Buck and efficiencies in cost and delivery; we also want to see investment in Indigenous communities. Above all, we want to see simple and practical approaches that really deliver.
That is the lens through which all or our deliberations and recommendations are made and it is the lens through which I will talk about the future of Indigenous Health this morning.
* * *
In preparing this speech I received a detailed briefing with pages and pages of statistics on Indigenous health and health risk factors. And these were just a sample. I am all too familiar with the data which paints a dire picture of Indigenous health and wellbeing in Australia.
Of course, for Aboriginal and Torres Strait Islander people it’s not just about statistics; it’s about our family, friends and communities; it’s about our parents and our children and our own selves. It’s my sister who died at aged 50 from heart disease. It’s the man who was stabbed in front of me enraged with alcohol and drugs Musgrave Park when I was a youth. It’s the regular emails I receive letting me know about “sorry business”. It’s the fact that almost every Indigenous person I know over the age of 40 has Type 2 diabetes. It’s my own brush with death in 2012 from cardio-vascular disease.
Indigenous people live these statistics every day and we experience the real impact – not just on individuals and their specific health problems – but also on our communities and families who are being hollowed out by things like low life expectancy, chronic and communicable diseases, and mental health problems, alcohol related disease and assaults, Foetal Alcohol Spectrum Disorder, suicide and child mortality. These problems have an ongoing social, cultural and psychological impact on communities and families.
When it comes to Indigenous health policy and health services, the greatest challenge is bureaucracy, waste and red tape.
Health is one of the most governed of all the public services. Constitutionally, health services are provided by the States. However, the Federal government has considerable influence and control because it provides substantial funding.
Indigenous health policy and the delivery of health services to Indigenous people involves multiple administrators and decision makers at multiple levels. There are at least two portfolios – health and Indigenous affairs – in the Commonwealth and in each State and often other relevant portfolios such as community services and human services. Each portfolio has a Minister and a department and often Assistant Ministers or Parliamentary Secretaries as well. All of this is before you get to the front line health services, such as State operated hospitals and other medical services and specialised Indigenous health services such as Aboriginal community controlled health services, each of which has their own administrative staff and obligations.
The previous Federal government also had a Minister for Indigenous Health. Prime Minister Abbott chose not to continue with this portfolio and these responsibilities have been rolled into the Department of Health and the Department of the Prime Minister and Cabinet which is responsible for Indigenous affairs.
Some people criticised this, arguing that not having a dedicated Indigenous health portfolio would set back Indigenous health policy and delivery. I disagree. One of the reasons we are spending billions on Indigenous people and not achieving material improvements in closing the gap is because the funding is poorly targeted and wasted on red tape and bureaucracy. The most recent Productivity Commission indicates that the majority of funding allotted specifically to Indigenous Australians is spent on bureaucrats, advisers, contractors and the like, many of whom are non-Indigenous. Shortly after the last election Minister Scullion and I did a preliminary review of the spending figures and we estimated that at least a third of Government funding for Indigenous programs doesn’t even make it past the front doors of office buildings in Canberra and other cities.
Every additional Minister and department or other entity involved in Indigenous health results in additional reporting, handoffs and intra-government dealings. The different groups have to consult and report to each other and handle demarcation issues and duplication. Inevitably this means funding must be being consumed by bureaucratic process.
I recently saw a rerun of an episode of Yes Minister called “The Economy Drive”. In it, Sir Humphrey, Permanent Secretary of the fictional Department of Administrative Affairs, must deal with Minister Hackett wanting to eliminate waste and improve efficiency. Explaining to the more junior public servant, Bernard Woolley, why this is a bad thing, Sir Humphrey explains:
“There has to be some way to measure success in the Civil Service. British Leyland can measure success by the size of their profits, or rather they measure their failure by the size of their losses. We don’t make profits or losses so we have to measure our success by the size of our staff and our budget. By definition, Bernard, a big department is more successful than a small one.”
Even though it is fiction and satire, the scary thing about Yes Minister is that people who have worked in Government very much relate to it.
Whenever funding cuts to Indigenous services or programs are made, the vocal protest and criticism simply assumes that defunding will undoubtedly lead to bad outcomes for Indigenous people. In doing so they are measuring success by the size of budgets and staffing. But if funding to date has not had a material positive impact on Closing the Gap statistics, we can’t simply assume that a funding cut will have an adverse impact. It depends whether what is being cut is actually contributing to improvements or if it is wasted spend. Knee-jerk reactions of outrage without regard to the actual outcomes (if any) the defunded services have achieved, ultimately weaken the voice of criticism.
To me it is a very simple proposition. The success of government service delivery in Indigenous health should be measured by the outcomes achieved.
It’s not about the volume of services or who provides them or how much the Government is spending or how many people are involved or how much activity occurring on a day to day basis. It’s not about the size of the department or how many departments there are or whether we have a dedicated Minister for Indigenous Health. It’s about the outcomes and results achieved for Indigenous people.
We need to get bang for our buck. I do not want to see a single cent of funding wasted on administration, bureaucracy, reporting or other red tape that isn’t contributing to outcomes. Every cent wasted is a cent denied to Indigenous people and not being used to close the gap.
In this country we pride ourselves on our universal health system – a system where everyone gets access to top rate medical treatment in public hospitals with delivery prioritised based on health needs, not on ability to pay or other factors. No one wants to see a two-tiered health system, one for Indigenous people and one for non-Indigenous people. Our health system should deliver the world class medical services to everyone and Indigenous people should benefit from that as much as everyone else. The purpose of special Indigenous health services and policy is to close the health gaps between Indigenous and non-Indigenous people.
In the current Federal ministerial structure we have one Health Minister who is responsible for the funding and funding arrangements for health for everyone.
The job of the Department of Prime Minister & Cabinet (which houses the Indigenous Affairs portfolio) is to focus on what is needed in addition to the mainstream health system to close the gap between Indigenous and non-Indigenous health. This may involve funding additional health services or bodies. It also involves looking at the totality of different services and resources that are targeted towards, or that impact, Indigenous health – including housing, sanitation – and holding States, Territories and other bodies to account to deliver real outcomes.
Groups like the National Aboriginal Community Controlled Health Organisation are critical to delivering health services that cater to the additional needs of Indigenous people and communities to close the gap and recognise the importance of having Indigenous involvement in health policy and service delivery. The Indigenous Advisory Council’s Deputy Chair, Professor Ngiare Brown, who is a doctor, is an Executive Research Manager at NACCHO.
Decades of Indigenous controlled health service delivery have seen the Aboriginal community controlled health sector become a leading provider of primary health care services and a significant employer of Aboriginal and Torres Strait Islander peoples. This sector has mature organisations with a depth of expertise and capabilities, particularly in remote and regional areas, surpassing the level of mainstream health services in some areas. I see no reason why organisations in these positions should not be able to leverage their capabilities and positioning to provide health services more broadly, thereby expanding their ability to generate extra income and funding. Opening the door to entrepreneurship, independence and self-sufficiency could present great opportunities.
* * *
At one level, it is very easy to become overwhelmed by Indigenous health statistics, not only the data itself but also the immensely complex interconnectedness of health problems, health risk factors and social issues.
At another level, Indigenous health problems are not complex to understand at all. If you step back from the tangled web of data and statistics, what you are really looking at is poverty.
Across the world, the conditions under which people are born, grow up, live, work and age shape their health. As the World Health Organisation points out: ‘the poorest of the poor have the worst health’. Most Indigenous people of my generation, and many of those in the generations after that, grew up in poverty or not far above it. Poverty is both a cause and a consequence of poor health.
It is estimated that socioeconomic disadvantage – in things like education, employment and income – account for one-third to one-half of the health gap between Indigenous and non-Indigenous Australians.
If we only achieved two things – eliminating poverty and eliminating smoking – we would close the gap in Indigenous health for good.
It is very important to remember this as we talk about Indigenous health service provision and health policy. Both are vitally important. But even the best policy and the best service provision will not close the gap if Indigenous people continue to live in poverty, or indeed if we make choices, like the choice to smoke, which damage our health.
The solution to poverty is not a mystery. Poverty is solved by economic development and commerce. Between 1990 and 2010 the number of people living in extreme poverty globally halved. That’s one billion people lifted out of poverty in just 2 decades. Two-thirds of poverty reduction comes from economic growth. The most astonishing example is China. Since it began economic reform 30 years ago its extreme-poverty rate fell from 84% to 10%.
For economic development we need our people to be educated and get into jobs and we need social stability in our communities or people will never invest in them.
So – the reason why I talk so much about economic and commercial development, about getting kids to school, about getting Indigenous people into real jobs and about safe communities, is because these are the key to eliminating poverty and therefore they are key to closing the gap in health. And therefore they are priority areas for the Prime Minister’s Indigenous Advisory Council and for the future of Indigenous Health.
Nyunggai Warren Mundine is Executive Chairman of the Australian Indigenous Chamber of Commerce
You can hear more about Aboriginal health and Close the Gap at the NACCHO SUMMIT
The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.
The economic benefits of ACCHS has not been recognised at all.
We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.
A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.
It’s time to move away from the deficit model that is implicit in much discussion about the social determinants of health, and instead take a strengths-based cultural determinants approach to improving the health of Aboriginal and Torres Strait Islander people. This is one of the messages from Ngiare Brown, Professor of Indigenous Health and Education at the University of Wollongong.
Professor Brown also stresses the importance of a focus on resilience, and the value of the Aboriginal Community Controlled Health sector as a national network for promoting cultural revitalisation and sustainable intergenerational change.
The summary below is taken from her presentation at the recent NACCHO summit
Connections to culture and country build stronger individual and collective wellbeing
Professor Ngiare Brown writes:
Although widely accepted and broadly researched, the social determinants approach to health and wellbeing appear to reflect a deficit perspective – demonstrating poorer health outcomes for those from lower socioeconomic populations, with lower educational attainment, long term unemployment and welfare dependency and intergenerational disadvantage.
The cultural determinants of health originate from and promote a strength based perspective, acknowledging that stronger connections to culture and country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety.
Exploring and articulating the cultural determinants of health acknowledges the extensive and well-established knowledge networks that exist within communities, the Aboriginal Community Controlled Health Service movement, human rights and social justice sectors.
Consistent with the thematic approach to the Articles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), cultural determinants include, but are not limited to:
•Freedom from discrimination;
•Individual and collective rights;
•Freedom from assimilation and destruction of culture;
•Protection from removal/relocation;
•Connection to, custodianship, and utilisation of country and traditional lands;
•Reclamation, revitalisation, preservation and promotion of language and cultural practices;
•Protection and promotion of Traditional Knowledge and Indigenous Intellectual Property; and
•Understanding of lore, law and traditional roles and responsibilities.
The power of resilience
The exploration of resilience is a powerful and culturally relevant construct.
Resilience may be defined as the capacity to “cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way”, positive adaptation despite adversity or “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development”
Resilience is important because:
• It is culturally significant – we are a resilient culture, surviving and thriving;
• Resilient people/communities are better prepared for stronger, smarter, healthier, successful futures and have better outcomes across the social determinants of health (education, health, employment);
• Resilient individuals are more likely to provide a positive influence on those around them and are better able to develop and maintain positive relationships with others – family, friends, peers, colleagues;
• Resilience promotes collective benefits – social cohesion, community pride in success, economic stability, and improved health and wellbeing.
There is a developing body of international work describing cultural continuity and cultural resilience.
Scholars such as Fleming and Ledogar propose dimensions including traditional activities, traditional spirituality, traditional languages, and traditional healing.
Further, Native American educators propose cultural protective factors and cultural resources for resilience such as symbols and proverbs from common language and culture, traditional child rearing philosophies, religious leadership, counselors and Elders.
(For example, Chandler, M. J. & Lalonde, C. E. (2008). Cultural Continuity as a Protective Factor Against Suicide in First Nations Youth. Horizons –A Special Issue on Aboriginal Youth, Hope or Heartbreak: Aboriginal Youth and Canada’s Future. 10(1), 68-72; Olsson 2003, Stockholm Resilience Centre; John Fleming and Robert J Ledogar, ‘Resilience, an Evolving Concept: A Review of Literature Relevant to Aboriginal Research’, Pimatisiwin. 2008 ; 6(2): 7–23. Iris Heavyrunner et al 2003).
The cultural determinants of health and wellbeing may be seen to be wrapping around, or cutting across individual, internal, external and collective factors.
A ‘social and cultural determinants’ approach recognises that there are many drivers of ill-health that lie outside the direct responsibility of the health sector and which therefore require a collaborative, inter-sectoral approach.
There is an increasing body of evidence demonstrating that protection and promotion of traditional knowledge, family, culture and kinship contribute to community cohesion and personal resilience.
Current studies show that strong cultural links and practices improve outcomes across the social determinants of health.
There are certain services only NACCHO and ACCH sector can and should do – child protection; mental health; women’s business; and men’s health.
This is useful in assisting policy and resourcing decision-making dependent upon context, geography, demography and tailoring services to local needs and priorities
The ACCH sector provides a true national network and a vehicle for cultural revitalisation. A cultural determinants approach and cultural revitalisation drive sustainable intergenerational change.
Professor Ngiare Brown, (pictured above being interviewed for SBSTV last week at the NACCHO summit) Executive Manager of Research for NACCHO and a co-Chief Investigator of the new centre, says:
“This is an exciting opportunity to work in collaboration with leaders in their field. Translation health is often overlooked but it will be critical in helping to address the biggest priorities in the Indigenous health gap.
“This centre will build leadership and capacity in Aboriginal health and the community controlled sector, and will support the development of culturally relevant services that will lead to positive change,” she says.
The University of Adelaide has won $2.48 million to establish a new national Centre of Research Excellence, in partnership with the South Australian Health and Medical Research Institute (SAHMRI), the National Aboriginal Community Controlled Health Organisation (NACCHO) and the University of Wollongong.
The centre will use the best available evidence to prevent, manage and treat chronic disease among Indigenous people.
The funding from the National Health and Medical Research Council (NHMRC) has been awarded to the University of Adelaide’s Professor Alan Pearson AM, who is Chief Investigator of the new NHMRC Centre of Research Excellence (CRE) for Translational Research in the Management of Chronic Disease in Indigenous Populations.
“The aim of our centre is clear: to improve health outcomes among Aboriginal and Torres Strait Islander people with a chronic disease,” says Professor Pearson.
“As a population, Indigenous people have significantly poorer health than other Australians and typically die at much younger ages. We hope to save lives and improve people’s quality of life by translating science to better health practice.”
Professor Pearson has an international reputation in the field of translating evidence into policy and practice in health care. He is Head of the University of Adelaide’s School of Translational Health Science and Executive Director of the Joanna Briggs Institute.
“Our research will review existing knowledge about the prevention, management and treatment of chronic disease in Indigenous populations. Based on that information, we will conduct much-needed programs to translate and implement evidence into Indigenous health care,” Professor Pearson says.
“Importantly, to maximise outcomes, this work will be conducted in close collaboration with NACCHO and their member services.”
Professor Alex Brown, Leader of the Aboriginal Research Unit at SAHMRI and a co-Chief Investigator of the new centre, says chronic diseases such as heart disease, diabetes and kidney disease account for 80% of the life expectancy gap between Aboriginal and non-Aboriginal Australians.
“The reasons why Indigenous people suffer from high rates of chronic disease are extremely complex. Our work is aimed at making inroads into this massive problem on a clinical, policy and population level,” Professor Brown says.
Professor Ngiare Brown, Executive Manager of Research for NACCHO and a co-Chief Investigator of the new centre, says: “This is an exciting opportunity to work in collaboration with leaders in their field. Translation health is often overlooked but it will be critical in helping to address the biggest priorities in the Indigenous health gap.
“This centre will build leadership and capacity in Aboriginal health and the community controlled sector, and will support the development of culturally relevant services that will lead to positive change,” she says.
The University’s Deputy Vice-Chancellor (Research), Professor Mike Brooks, says today’s announcement is further proof of the strong research collaborations that exist in Adelaide.
“The awarding of this new Centre of Research Excellence is a major vote of confidence in the quality of research being conducted in this State, and our researchers’ ability to translate their work into real health outcomes,” Professor Brooks says.
“Congratulations to all of the partners involved in this new centre, which has the opportunity to make a significant impact on a national scale.”
Aboriginal community-controlled health organisations have entered the election fray, releasing a major plan they want political parties to commit to.
At a national summit in Adelaide, the organisations challenged both sides of politics to promise to give Aboriginal communities greater control over health programs.
Karen Ashford reports.
Trust us – that’s the message from the leaders of some 150 Aboriginal controlled health agencies, who contend a community-driven approach to Indigenous health can deliver results the mainstream can’t.
Ngiare Brown (pictured above) is research manager for the National Aboriginal Controlled Community Health Organisation, or NACCHO.
She says governments have to be prepared to try something different if Australia’s to make any headway on addressing indigenous health disadvantage.
“I think it was Albert Einstein wasn’t it that said insanity isn’t that when you do the same things over and over and expect a different result?”
NACCHO thinks it would be smarter for Australia to embrace its 40 years of community health provision that it says delivers results – and they’ve produced a ten point plan to take it further.
The plan focuses Indigenous leadership, to drive health reforms and find innovative ways of closing the gaps on Indigenous health between now and 2030.
Ngiare Brown says it’s a much-needed departure from the traditional mainstream model.
“There is an ever changing line up of politicians and bureaucracies and in systems, so we’re having the same sorts of conversations over and over again. So if we’re able to demonstrate and articulate those principals and provide the kind of evidence and structural approach to that change, it should be independent of any change of government, any change in politics, any reform of the system that’s outside of that, because we in fact are one of the most consistent leadership processes and a demonstration of community control that this country has. In fact whilst there’s the revolving door of politics, Aboriginal community control is one of our strongest and most consistent national vehicles for positive change. ”
The NACCHO plan, presented to more than 300 delegates at its inaugural Primary Health Care Summit in Adelaide comes hot on the tail of the Australian Institute of Health and Welfare report card which has given Aboriginal-controlled health organisations a big tick.
The report credited those organisations with making significant improvements in areas like diabetes management, increase child birth weights and better maternal health.
NACCHO chairman Justin Mohamed says the only thing missing is political attention, with indigenous health hardly mentioned so far in the federal election campaign.
“I think to be honest both parties at different times do talk about Aboriginal community control, do talk about Aboriginal health, but I think what we’re seeing in the election process at the moment is that I would like to see more of the parties to let us know what their platform is or what their thoughts are around Aboriginal health, not just health in general.”
Mr Mohamed argues that Aboriginal community-controlled health bodies have proven their expertise and efficiency, and whoever wins government on September 7 must show greater faith in the sector.
“I think that this is a time that things are changing. Our stakeholders and other groups that are working in health are actually saying to government that Aboriginal community controlled health works, you need to give them the keys to the vehicle and let them drive it, and results will show with that. And we’ve seen the results in recent reports that Aboriginal community control delivers results in health.”
A big slice of the conference was devoted to governance.
“You certainly need to be aware of potential risks to your operations” (fade under)
Much of the program was devoted to discussing how community health bodies could make sure they’re accountable.
Ngiare Brown says the sector is tired of paternalism and keen to prove they can be trusted with the purse strings.
“I think we’ve become far more sophisticated. So in the past it has been very much the attitude for example of politicians and departments that they’re doing us a favour by providing us with funds and resources, but we’ll still maintain that control – we are actually able to demonstrate that we’re focused on governance, we’re focused on our internal capacity to be able to lead, to understand business models, to be able to be responsible for funding and other resources, and we demonstrate that at more than 150 services across the country as well as at a national level. ”
Meanwhile, Justin Mohamed won’t say whether he believes Labor or the Coalition is leading in promises on Indigenous health, instead committing to work with whoever wins.
“We need to see results. We aren’t worried about being a political football and thrown around and showcased, or rolled out when it suits – we want to see results, and we just can’t afford to take sides, it’s about we want results and we need to have whoever is in power to give us those results and work with us.”
Press release sent out on behalf of the Aboriginal Youth Healing Centre (AYHC):
Pictured above:Two of the prominent Aboriginal supporters of this project Professor Ngiare Brown (left) and David Peachey
An Aboriginal Youth Healing Centre (AYHC) currently being planned for Western NSW will use proven techniques to reduce crime, unacceptably high incarceration rates and recidivism.
Local Aboriginal leaders are working together with local agencies, the University of Wollongong, NACCHO and the David Peachey Foundation to develop the service, which will draw together best-practice prevention methods with cultural immersion to stem the flow of young people into gaols and detention centres.
“It’s time for us to stand up and acknowledge jail doesn’t work for our young people,” said Uncle Isaac Gordon, senior Brewarrina community member and Walgett ACLO, “it doesn’t work as a deterrent and it doesn’t work as a rehabilitation or education service.”
The Centre will engage at risk and vulnerable young people; provide diversionary opportunities to help break the cycle of offending, incarceration and recidivism; build social capabilities; and ultimately improve health and social justice outcomes.
“We know from what we’ve seen in other places that when communities get active in taking care of their own kids and draw in top level professional services there is an impact. There’s an impact not only on the kids, but on the savings to taxpayers. Jail is not only ineffective, it’s expensive,” Uncle Isaac Gordon said.
The AYHC will be established on a working property in the Orana region of western NSW, delivering programs that contribute to the education and training of young Aboriginal men in a supportive family environment. It is anticipated the property will be developed into a commercial, financially sustainable venture over time, engaging house parents, property managers, drovers and other expertise to oversee the running of the station.
“The Centre is about breaking the damaging patterns we see out here and establishing new patterns, using the foundations of our culture, heritage and community to build those patterns,” Uncle Isaac said.
“National and international evidence tells us that family, culture and kinship contribute to community cohesion and personal resilience,” said University of Wollongong’s Professor Ngiare Brown, who is working with the community leaders to develop the Centre
“Current studies show that strong cultural links and practices such as extended family, access to traditional land, revitalisation of traditional languages, learning dance and story, understanding traditional roles and responsibilities – are protective factors and improve childhood and adolescent resilience against emotional and behavioural problems,” Professor Brown said.
A proposal for resourcing of the project is going to Commonwealth and NSW Government departments.