Are we moving towards yet “another failed experiment” in Indigenous affairs policy?

Ngiare Brown, Professor of Indigenous Health and Education at the University of Wollongong, has been appointed to the Prime Minister’s Indigenous Advisory Council.

According to a statement from Tony Abbott, the Council will meet three times a year with the PM and senior ministers, and will inform the Government’s policy implementation.

As reported previously at Croakey, Professor Brown is an advocate of taking a strengths-based cultural determinants approach to improving the health of Aboriginal and Torres Strait Islander people. She also stresses the importance of a focus on resilience, and the value of the Aboriginal Community Controlled Health sector.

Meanwhile, as journalist Marie McInerney reports below, the Closing the Credibility Gap symposium held in Melbourne last week heard concerns about the shift of Indigenous affairs to the PM’s department and about deficits-based approaches to policy.

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“Closing the Gap” entrenches a deficit focus

Marie McInerney reports:

The former co-chair of the National Congress of First Peoples is concerned that shifting control of Aboriginal and Torres Strait Islander Affairs to Prime Minister Tony Abbott’s department may turn out to be “another failed experiment” in Australian Aboriginal policy.

Jody Broun told the Closing the Credibility Gap symposium in Melbourne last week she is also concerned the Coalition Government may drop the National Aboriginal and Torres Strait Islander Health Plan developed under the Labor Government and launched in July 2013. 

Broun was co-chair of the Congress’s National Health Leadership Forum, and the Stakeholder Advisory Group that steered consultation for the National Health Plan.

The plan’s vision of the Australian health system being free of racism set a new precedent for Australian public policy, she said, going deliberately beyond words like ‘discrimination’.

“We wanted the R word to be used and actively addressed,” she said of the “formidable” group of Aboriginal and Torres Strait Islander groups involved in the plan’s development.

Broun also told the symposium she as “not a fan” of Closing the Gap as a policy lens, warning that it promoted a deficit model that defined Aboriginal and Torres Strait Islander people by deficiencies rather than strengths.

Here are extracts of the main points of her symposium speech, including insights into her own family’s experiences of health system failures for Aboriginal people.

On changes under the Coalition Government

“Of course the change in Government and new administrative arrangements for Aboriginal and Torres Strait Islander Affairs may have a negative impact on the implementation (of the National Health Plan), not least because of ‘ownership’ issues but also because the premise of the plan around social determinants requires a coordinated effort across government agencies.

“The transfer of all Indigenous programs to the Department of Prime Minister and Cabinet, I believe, will make it more difficult, not less, to effect change through mainstream agencies that are not responsible for program delivery but which have very high stakes in delivering programs that have a broad impact on the social determinants.

“Of course there is sufficient authority in Prime Minister and Cabinet as a lead agency, however I fear the clarity of purpose and dilution of the accountabilities of other agencies may well negate that strengthened authority.

“I don’t believe the shift of program delivery… ameliorates this problem; in fact this simplistic response may well prove to exacerbate it, disenfranchising mainstream service delivery agencies from their responsibility to deliver improved outcomes for Aboriginal people.

“It would be a shame if Aboriginal people are again the recipients of yet another failed experiment in government administration.”

On implementation of the National Health Plan

“(Implementation) has to be thorough, measured and measurable, engineered not only with community control and partnership central in the document, but in practice on the ground.”

The National Health Leadership Forum has outlined what would be needed:

• development of a comprehensive set of measurable targets and/or benchmarks to be achieved over 10 years
• development and implementation of a service model that will effectively and efficiently achieve those targets
• development and implementation of a national workforce strategy for existing and emerging areas of need in service provision
• formulation of a funding and resource model commensurate with health care needs and priorities in Aboriginal and Torres Strait Islander populations in the next 10 years
• clear measurable requirements for governments to work together in partnership and guidance of Aboriginal and Torres Strait Islander peoples
• structures and processes for the accountability of expenditures against targets that are independent and involve Aboriginal and Torres Strait Islander peoples.

On Closing the Gap as a policy framework

“I’m not a fan of Closing the Gap as a policy framework. This is not a positive or empowering policy; it is based on a deficit model – constantly reminding us of the ‘gap’ between us and other Australians. What began as a community driven campaign to Close the Gap in life expectancy – a national disgrace and embarrassment – has now been adopted across the whole range of our existence. We are defined by our deficiencies.

“While the advancement of our peoples in a western world may well rely on ‘closing the gap’ in health, education and employment, the use of deficit language as the basis of a policy, I think, is unfortunate in the least and detrimental to our psyche.

“I would tend to agree with Jon Altman that ‘an assumption is being made that Indigenous Australians ascribe to the mainstreaming goals of the state…and that they lack aspirations and agency to pursue alternative forms of livelihood.’

“I suggest we shouldn’t see our future through the lens of ‘Closing the Gap’ because it distorts our vision. It’s like having your beer goggles on late at night: everything looks good but you wake up in the morning sadly disappointed. It has the potential to quash the aspirations and agency referred to by Jon.

“I want our expectations to be higher than those prescribed by the COAG (Council of Australian Governments) Closing the Gap framework, and our outcomes to be higher still.

“During the round tables conducted to inform the (National) Health Plan development, it was often commented that we like the ‘gap’ between us and other Australians, particularly in the area of culture and spirituality.

“We have a lot to offer and our culture actually is what separates us and gives us strength. A subtext of ‘Closing the Gap’ is ‘be like us’ – an assimilationist goal. While we may want the benefits of western society and can and do achieve, it cannot be at the expense of culture and what makes us different. Our place in this country. Our culture. Our identity.”

“The latest COAG report on Closing the Gap shows that, while there is some improvement against targets, overall little has changed.

“One reason I suspect has been the neglect of one of the building blocks – governance. Governance is more than sending some people from remote communities on a leadership course. It has to be a philosophy where community control is expected, strengthened and valued.”

On change on the ground

Broun talked about her own family’s experience in Roeburn in Western Australia: “a fairly typical regional town – large proportion of Aboriginal people, high levels of health problems and unemployment”, despite a mining boom that has lasted several decades. The town has an Aboriginal Medical Service (AMS) supported by a larger hospital in Karratha, 50 kilometres away.

While services exist, she said they fail on many levels and through all service providers. “Let’s not imagine that our own community based providers are without fault,” she said.

She asked: “So what would and should people in the community of Roebourne expect from their health services in a post health plan world?”

“My family in Roebourne do not want to be confronted with racism when they access those health services – sadly too often our people continue to be treated poorly by mainstream health services often citing discrimination and racism as a part of that experience.

“They want effective, professional follow-up and connection between the services, the sharing of information. My mother has determined to only use the hospital now and not the AMS because she has to tell her story twice (at least) and usually have a repeat of the blood test – which is not great when your skin is paper thin, your veins are failing and you’re in pain. And this is from a woman who helped establish the AMS in Perth in the 70s. This is not a criticism of AMS, but of the lack of connections between services.

“My dying sister should be able to have follow-up in the home, her carer receiving advice and support. And there should be more than one diabetic advisor for a whole region that has a diabetic epidemic.”

“We can continue to measure poor outcomes. We can continue to be outraged by lack of progress. But improving health outcomes is up to all of us, health professionals and service providers, communities and individuals.”

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Some tweet coverage from the Symposium:

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And some Twitter discussion about the new advisory council

• Croakey’s Symposium coverage is compiled here.