One of the lessons from the COVID-19 pandemic is that the wider health system has much to learn from the successes of the Aboriginal Community Controlled Health Organisations (ACCHO) sector and Indigenous health leadership, writes Dr Janine Mohamed, CEO of the Lowitja Institute.
Janine Mohamed writes:
Around the world, one of the critically important lessons from the pandemic is that the drivers of health inequities are being exposed and exacerbated.
Precarious working conditions, poverty and inadequate incomes, and racial and social injustices are among some of the determinants of health that are influencing our ability to control the pandemic, while also increasing the risks for some groups of people.
These times are also compounding past traumas for those of us with a collective memory of the strategies of colonisation, such as confinement on missions and curfews, stolen wages, and stigmatisation of Aboriginal and Torres Strait Islander peoples as carriers of diseases.
These are also some of the reasons why the pandemic is reminding us of the vital importance of primary healthcare, and holistic approaches to service delivery that incorporate the knowledge and strengths of communities and address the wider determinants of health.
In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) have been at the forefront of primary healthcare development and innovation for many decades, recognising the importance for health of addressing issues such as transport, justice and food security.
It should surprise no-one that the ACCHO sector has provided outstanding leadership during the first stage of the pandemic.
As Dr Summer May Finlay and Dr Mark Wenitong wrote recently in the Australian and New Zealand Journal of Public Health, ACCHOs and their peak bodies have demonstrated their capacity to deliver scientifically valid, evidence‐based and culturally centred COVID‐19 prevention messages.
Leaders in innovation
They have also been at the forefront of innovative use of social media platforms, such as TikTok and Facebook, to deliver tailored public health messages to diverse communities. And they have done this in addition to their usual service delivery and using existing funding.
At the Lowitja Institute, we have created a portal to ensure one-stop access to the wide range of resources produced by Aboriginal and Torres Strait Islander organisations during the pandemic. I encourage readers to check it out, and share these resources with your colleagues.
We know how important it is to have Aboriginal and Torres Strait Islander people and organisations leading the response because we remember what happened with the H1N1 influenza pandemic in 2009.
As Aboriginal and Torres Strait Islander researchers recently reported in The Medical Journal of Australia, the omission of First Nations Peoples from the 2009 National Action Plan for Human Influenza Pandemic not only disadvantaged those who most needed protection, but failed to identify us as a high-risk population group, which resulted in worse outcomes.
Researchers subsequently found that a “one size fits all” approach to infectious disease emergencies is unlikely to work, and recommended that First Nations peoples are appropriately engaged as active and equal participants in pandemic preparedness, responses, recovery and evaluation.
I am proud of how the Aboriginal and Torres Strait Islander health sector stepped up very early in this pandemic, to ensure that our communities were prepared and protected.
On 6 March 2020, the Australian Government’s Department of Health convened the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 to inform national policy making.
The Advisory Group works on principles of shared decision-making, power-sharing, two-way communication, self-determination, leadership and empowerment. The National Aboriginal Community Controlled Health Organisation (NACCHO) co-chairs the Advisory Group with the Department of Health, and it includes membership from the Aboriginal Community Controlled Organisation Sector, State and Territory Government representatives and Aboriginal communicable disease experts.
The Advisory Group has provided strategic input into the development of the National Management and Operational Plan for Aboriginal and Torres Strait Islander Populations, and has made significant contributions to the COVID-19 Series of National Guidelines, as well as having significant impacts on policy.
Governance matters
As the researchers wrote in The MJA, many benefits flow from privileging First Nations voices, within a culturally appropriate governance structure. When First Nations peoples define the issues, determine the priorities, and suggest solutions for culturally informed strategies that address local community needs, then we have a chance for real system change.
The researchers suggested this model has the potential to be replicated where public health agencies and First Nations practitioners and researchers have developed shared understanding.
Our recent pandemic experience is a reminder of how much the wider health system has to learn from the successes of the ACCHO sector and Indigenous health leadership.
More widely, non-Indigenous Australia could learn so much from the knowledge of tens of thousands of years of Aboriginal and Torres Strait Islander people’s custodianship of this place now called Australia.
As the author Melissa Lucashenko recently wrote in The Guardian:
It’s no accident that we have managed this pandemic as well as we have.
Survival is what we do. First we made it through the ice age. Then the catastrophe of British invasion: pox, guns, all the rest. Poverty, capitalism, ongoing child removal. Policies of attempted genocide.
Whatever history has thrown at blackfellas, we have survived. And often thrived.”
Aboriginal and Torres Strait Islander children, families, communities and health professionals are more likely to thrive when our unique knowledge and cultural strengths are properly recognised and respected by wider Australia, including by our non Indigenous health colleagues.
Dr Janine Mohamed is CEO of the Lowitja Institute, and Chair of Croakey Health Media
