Improving Outcomes for Indigenous Australians

Aboriginal Health

For generations before us, Australia’s Indigenous people enjoyed a rich cultural desert lifestyle, guided by the wisdom of community Elders, whose life experiences and oral histories formed the basis of all knowledge and skills developed by the children of the community. Though children were scarce in these times, those who survived the perils of rural life were allowed a certain autonomy, considered by their families to thrive or perish in accordance with their own informed choices.

Unlike the more vertical pillar structure of the general population, the age breakdown of Australia’s Indigenous populations more typically formed an inverted pyramid shape, with a small number of children and a large number of Elders to help nurture and encourage them. Today, that pyramid has been inverted, with malnourishment, limited access to healthcare and anomie eroding the strength of these communities and destroying their cultural landscape.

“Settled life in remote communities became, in recent decades, disease-plagued life: a world of camp dogs and bad housing, of scabies sores and unfamiliar influenzas, and imported viruses and golden staph,” described Nicolas Rothwell in a Conversation feature for The Australian. “The cascade of sicknesses began to flow, and the biochemical pathway for producing small babies with underdeveloped organs was triggered repeatedly: new causes, same stress response.

“A new understanding of the long-term nature of the present crisis is critical. If we now know that today’s young bush men and women, adapting rapidly as they are to the onrush of contemporary life, are still hostage to the past’s medical consequences, that knowledge has consequences of its own.”

Indeed, research is showing more and more that the harsh environmental factors are but a small part of the whole picture yet revealed. Exploring these causes and creating relevant and powerful programmes of support for Australia’s indigenous peoples has become an endeavour of paramount importance with rapid increases in the number of reported critical health conditions affecting Australia’s Indigenous peoples including heart disease, kidney failure, diabetes, depression and suicide.

Indigenous communities have evolved, not only in terms of living conditions but also in terms of lifestyle. In recognition of these developments, many health care professionals are embracing new and innovative means of working together with these communities to achieve improved results, including new mobile health care services, creative marketing appeals, and targeted multimedia resources such as film and computer apps.

Dr Brad Murphy, representing a new Bundaberg QLD health service – and the nation’s first accredited private Indigenous health service – has begun working directly with Aboriginal Elders in an attempt to develop innovative ways of facilitating better health. “There’s a big need for doctors here in Bundaberg at the moment and about forty per cent of our patients here on the books are Aboriginal and Torres Strait Islander and we’ve started to negotiate with the Elders amongst that group to ask them, ‘well how can we do this best?’” he reported.

While it’s too soon yet to see any results from this latest push, there is certainly heightened interest across all levels of Government in ensuring that these – and other – programs are able to flourish.

Established to assist the Federal Government in refining and updating Indigenous health programs, a new advisory group met for the first time in Canberra last month to determine its priorities. Co-chairing the advisory group are Professor Pat Dudgeon, Australia’s first Indigenous psychologist, and Dr Tom Calma AO, human rights campaigner and the new chancellor of the University of Canberra. Moving forward, the group’s primary function will be to advise on practical and strategic ways of addressing and improving Indigenous mental health and social and emotional wellbeing throughout Australia.

Of heightened concern for the group at this first meeting was creating a plan for implementation of the recently released National Aboriginal and Torres Strait Islander Suicide Prevention Strategy. Additionally, the group discussed the Aboriginal and Torres Strait Islander Health Plan and the renewed Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Framework. The overarching structure to this and numerous other important Indigenous health initiatives, of course, has been the introduction and continued implementation of the Closing the Gap programme.

In 2008, the Council of Australian Governments (COAG) – Australia’s peak intergovernmental forum – brought together the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association in its creation of the $1.57 billion Closing the Gap programme, focussing on treating chronic disease in Aboriginal and Torres Strait Islander communities as well as encouraging more Indigenous people to work within the health sector. Developed as a joint funding agreement between the state and federal governments, alongside engagement and partnership with Indigenous people and communities, Closing the Gap addresses critical issues affecting indigenous life expectancy, infant mortality, education and employment.

“Underpinning Closing the Gap,” reads the FaHCSIA introduction, “is a new way of working across government and of engaging with Indigenous communities. Governments are cooperating to better coordinate their services and funding. Clear responsibilities, specific targets and rigorous reporting will help to keep governments on track.”

To this end, the COAG has been working within specific timeframes for achieving six targets relating to Indigenous life expectancy, infant mortality, early childhood development, education and employment in an effort to build upon the ideas, strengths and leadership of members of Indigenous communities in an effort to discover sustainable solutions. Furthermore, the COAG has committed an additional $4.6 billion investment in Indigenous-specific National Partnerships to be rolled out over a number of years. Originally signed back in 2008, the agreement expired 30 June, with negotiations begun in earnest the month prior.

With a Federal promise of contributions of $777 million to be used over the next four years, each state has re-signed, with the exception of Western Australia. In a surprising blow to these negotiations, Western Australia refused to re-sign the Closing the Gap Indigenous health agreement, announcing instead that it intends to go it alone and provide funding initiatives in the line of $31 million over the next year toward improving the health and wellbeing of Aboriginal people in lieu of signing. The state has not as yet guaranteed any further funding beyond the year, whereas the Closing the Gap agreement locks in four years’ worth of funding.

“Closing the Gap aims to improve the life expectancy of Aboriginal West Australians and, while much has been achieved so far, there is still much more work to be done,” WA Health Minister Kim Hames said in recent statement addressing WA’s abstention from the programme. “The $31 million the WA government has committed to today is for 2013-14 and will enable us to continue to deliver these critical services over the next year, which gives job security to those workers engaged in the delivery of these services.”

Dr Hames stated that the allocation of $31m demonstrates “our very strong commitment to the Closing the Gap program” and improving indigenous health. “While it is very likely we will sign a new agreement, it is not possible to commit to this at this stage, given we have not yet seen a final proposed agreement,” he concluded, referring to the State’s request to abstain re-signing until August.

Indigenous Health Minister Warren Snowdon spoke with The Australian, stating his belief that the delay was of great concern. “We can’t afford to delay renewing this agreement with the states and territories,” he was quoted as saying. “We have seen some steady improvements in a number of areas, like reducing child mortality rates and reducing the occurrence of the blindness causing eye disease trachoma… We will only continue seeing health outcomes improve if we work together with good programs on the ground that are backed up by solid investment across the board.”

Des Martin, on behalf of the Aboriginal Health Council, was less diplomatic in his appeal to the WA Government, stating the Council’s belief that the Premier is being reckless about a serious issue, and stands to undo all the progress the initiative has made including more than three hundred jobs established already in WA as part of the initiative. “If they don’t recommit, all the work that’s been undertaken for the past four years – it really means it’s been a waste of time,” he said.

“All the work in terms of the programmes that have been rolled out across the state, and in some cases these are new initiatives, if the State Government decides not to renew the funding for a further four years, there’s huge risks.”

Vicki O’Donnell, however, also of the Aboriginal Health Council of WA, has stated her support of Kim Hames’s announcement, adding that the funding which WA has promised will ensure the initiative continues to help Indigenous Australians. “We commend Kim Hames for pushing the issue with the current government, and we certainly welcome the evaluation they’re going to do on all the government departments and where money is being spent across Western Australia,” she said.

Ms O’Donnell at the same time praised the Closing the Gap programme, which she explained has been responsible for creating in excess of three hundred jobs over the past four years and for delivering dozens of services to Indigenous Australians. “It certainly looked at interventions for child and maternal health, and accessed the remote areas which didn’t have access to health services.”

Despite this hold-out, the federal government has reported its intention to continue programs funded through the NPA, and expects the states and territories to do the same while negotiations continue. One can only hope that the support continues in every way possible and to the best of our capabilities across the Commonwealth.

Asserts Nicolas Rothwell, “Elders in all communities are a repository of knowledge and of accumulated wealth. Early death of key older family members deprives younger community members of the benefit of accrued knowledge of culture and both financial and social support.”

Indigenous culture in some communities is eroding, as is the health and wellness of the people who live within them; we must fight to keep their rich traditions alive, indeed, by keeping the members of these communities alive and thriving.

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October 17, 2017, 9:09 AM AEDT

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