There has never been a better time for non-Indigenous Australia to learn from the experience of Aboriginal and Torres Strait Islander communities in combating serious threats to the health and well-being of their communities.
The Close the Gap Campaign on Thursday warned that only systemic reform will make up for the “harrowing failure” of the last 12 years of government policy on closing the gaps in health equity, social and economic disadvantage for Aboriginal and Torres Strait Islander peoples.
As Australian governments work for the first time in genuine partnership with Aboriginal and Torres Strait Islander organisations on a refresh of the Closing the Gap strategy, the Campaign has set out a “blueprint for change” in its 2020 Close the Gap Report – titled ‘We nurture our culture for our future, and our culture nurtures us’.
The report focuses on the protective factors of Aboriginal and Torres Strait Islander cultures for health and wellbeing and makes important recommendations to address self-determination, Indigenous data sovereignty, racism in health care and climate justice.
Below, Dr Janine Mohamed, CEO of the Lowitja Institute, discusses the report and its lessons for our response to the coronavirus epidemic; a video of her discussing many of these issues can be viewed here.
Janine Mohamed writes:
The need to establish a Voice to Parliament, embed Indigenous data sovereignty in health care and research, address racism in health care, and tackle climate justice are at the heart of Aboriginal and Torres Strait Islander people’s recommendations to Close the Gap.
The Close the Gap Campaign, made up of peak Indigenous and non-Indigenous health bodies, NGOs and human rights organisations, including the Lowitja Institute, released its 2020 report today in response to the Federal Government’s once more disappointing 2020 Closing the Gap report.
It is no accident that our report does not focus on the statistics and deficits that signal why the Closing the Gap agenda, the response by Australian Governments to the call for action from Aboriginal and Torres Strait Islander peoples 12 years ago, has failed.
Instead it focuses on what we can learn from the survival, adaption and resilience of Aboriginal and Torres Strait Islander peoples. It calls on government and mainstream health services to look at their deficits, from devastating funding cuts to culturally unsafe health care, leading to preventable deaths.
In contrast, the 2020 Close the Gap Report highlights that, through a strengths-based approach, we not only reframe how we see the challenges we are facing, but importantly, we also reframe the solutions, and how we develop and implement them.
Learning from Aboriginal and Torres Strait Islander peoples and communities
As we all grapple with the challenges of the COVID-19 outbreak and measures such as social distancing and lack of medicines and other essential supplies, it is critical that we take a lead from the knowledge and expertise of Aboriginal and Torres Strait Islander peoples and communities.
We have a long history of making personal sacrifices for the greater good of our communities and the generations to come. The current closure of communities in response to the pandemic is us determining our health and wellbeing responses, and exercising the sovereignty of our borders as many diverse nations – not dissimilar to what other nations are doing across the globe.
The 2020 Close the Gap Report – titled ‘We nurture our culture for our future, and our culture nurtures us’ – focuses on the protective factors of Aboriginal and Torres Strait Islander cultures for health and wellbeing.
It demonstrates that Aboriginal and Torres Strait Islander peoples have the solutions to ensure health and wellbeing for our future generations, and the cultural determinants of health are a critical factor that must always be considered in planning public health programs.
Culture and wellbeing are ‘inextricably linked’
As we learn in the report, culture and wellbeing are ‘inextricably linked’ for Aboriginal and Torres Strait Islander peoples (including those working in health care and research). But defining and exploring ‘cultural determinants of health’ presents many challenges at a Western academic level and is often regarded in Western research as ‘intangible’.
That lack of understanding has a cost, as stated by leading Aboriginal researcher Professor Ray Lovett in the report. It means that culture does not get factored into how policies and programs are shaped, funded, implemented, evaluated or understood.
For example, he says culture was placed at the core of the Federal Government’s National Aboriginal and Torres Strait Islander Health Plan 2013-2023, “but the document itself was silent on what culture was and how it was to be enacted”.
We know that a cultural determinants of health approach requires that we understand systemic weaknesses and failures, as evident in the challenges of high levels of chronic disease and inadequate environmental health infrastructure for Aboriginal and Torres Strait Islander peoples.
It is an assertion that culturally-centred approaches, such as culturally safe health care, can drive the systemic reform needed to create a better health system for all Australians.
Cultural determinants of health
The 2020 Close the Gap report highlights many examples to illustrate that reform agenda, that point the way to Close the Gap. They include recognising that the cultural determinants of health requires us to think both systemically and on a local level and take a place-based, Nation-building approach to recognise the diversity amongst Aboriginal and Torres Strait Islander peoples and how they determine their cultural determinants.
- The historic Partnership Agreement on Closing the Gap between the Council of Australian Governments (COAG) and the Aboriginal and Torres Strait Islander Coalition of Peaks. As NACCHO CEO Pat Turner puts it, this is “a case study in self-determination” that has set a benchmark for partnerships with Aboriginal and Torres Strait Islander peoples.
- Two outstanding Health Justice partnerships – between Law Yarn and the community controlled Wuchopperen Health Service in Queensland, and between the North Australian Aboriginal Justice Agency and the Miwatj Health Service serving the Yolngu people in East Arnhem Land. These initiatives are delivering prevention and early intervention, stopping many legal issues from escalating into criminal and health issues.
- The deadly NuunaRon group that speaks to the power of providing a safe place for community members living with disability to come together and build resilience, connect to culture, and support each other. In just a few months they created art works to showcase inclusion at the United Nations headquarters in Geneva.
- The Country Needs People campaign being rolled out amid evidence that working on Country has a strong influence on the health of people engaged in Indigenous Protected Area and Indigenous Ranger programs – and on Country itself. This comes as Aboriginal and Torres Strait Islander peoples are sounding an urgent warning on the existential threat of the climate crisis to Indigenous peoples – but also how we are also uniquely equipped to meet its impacts.
We are also proud to showcase the work we do at the Lowitja Institute in the report, where 68 per cent of our funded projects are led by Indigenous researchers. As our chair Pat Anderson says: “Our vision was always, for us – First Nations people – to stop being the subject of research but rather to set and control the research agenda”.
Indigenous Data Sovereignty
We welcome the priority in the report on putting Aboriginal and Torres Strait Islander peoples in charge of their own data and decisions, by recognising and upholding the principles of Indigenous Data Sovereignty. This is also being underscored by the landmark Mayi Kuwayu study being steered by Professor Lovett and other Aboriginal and Torres Strait Islander researchers at ANU. It is the most notable step, so far, in developing contemporary research on the role of Aboriginal and Torres Strait Islander culture and wellbeing.
The six main domains the Mayi Kuwayu study has identified to describe culture specific to Aboriginal and Torres Strait Islander peoples – asking what culture means to our people and showing how culture affects our health and wellbeing – have informed the Close the Gap report. They include:
- self-determination and leadership
- Indigenous beliefs and knowledge
- cultural expression and continuity
- connection to Country.
They are many miles and millennia away from the deficits and narrow targets that have characterised the Closing the Gap strategy, and ultimately led to its failure.
A new way ahead in Closing the Gap
As well as highlighting cultural strengths, the 2020 Close the Gap report is steeped in hope, particularly that the work being done by the Coalition of Peaks with COAG will lead to a new way ahead in Closing the Gap.
As we better understand and apply our knowledge about the cultural determinants for Aboriginal and Torres Strait Islander peoples, it is important to not view them a stand-alone pillar. They need to be understood as both foundational to health and interwoven across the social determinants of health, with which we are more familiar.
The coronavirus reminds us that this task is urgent and paramount. It also reminds us why we are vulnerable in the face of it. This is not due to our own behaviour or lack of care, but as a consequence of past policies and continuing systemic failures, including an ongoing failure of governments to listen to us and to respect our rights and knowledge.
For example, we know that when health care is not culturally safe, Aboriginal and Torres Strait Islander peoples will not seek out care. This is particularly critical in light of the COVID-19 outbreak. At this time of public health emergency, it is more important than ever that governments recognise one size does not fit all – and will not work.
Equity does not mean giving everyone the same, it means understanding peoples’ uniqueness. It means deeply listening to people and providing people with what they say they need, without judgment.
The importance of culturally safe practices
Now more than ever we need our frontline health workers to enact culturally safe practice to ensure that we acknowledge and address our bias, to ensure these biases do not impede access to health services by Aboriginal and Torres Strait Islander peoples.
Similarly, we must be extra vigilant to ensure our public health messaging and communications are reaching communities and are culturally safe and relevant. This means understanding that many Aboriginal and Torres Strait Islander communities struggle with inadequate housing and infrastructure, such as clean water, hence we need to modify messaging. We can not assume that all Aboriginal and Torres Strait Islander peoples speak or read English. It may be their second or third language.
Working with Aboriginal and Torres Strait Islander experts and organisations will help ensure information, equipment and services are culturally, socially and geographically relevant. These organisations need to be adequately resourced to ensure important messages about the pandemic reach community. The recently established COVID-19 Aboriginal and Torres Strait Islander Advisory Group, co-chaired by Department of Health and the National Aboriginal and Community Controlled Health Organisation (NACCHO), will play an important role in ensuring this happens.
We applaud the leadership of the many Aboriginal and Torres Strait Islander organisations who have acted quickly to put in place measures to prevent the spread of Coronavirus (COVID-19), including the cancellation of large public gatherings, such as conferences, at great expense and before many other organisations had begun to act.
Aboriginal and Torres Strait Islander people, along with other First Nations people around the world, know too well the very real dangers that flu and cold pandemics pose to our health, and our cultural continuity.
I recognise the sacrifice and hard work of our front-line health workers during what will be a trying time – but implore you that we must work with cultural safety at the forefront of our minds if we are to truly look after everyone.
Now is the time to learn from the survival and resilience of Aboriginal and Torres Strait Islander cultures so that we can nurture each other in these tough times, and ensure a safe and healthy future for everyone.
Janine Mohamed is a proud Narrunga Kaurna woman from South Australia, and CEO of the Lowitja Institute, Australia’s national Aboriginal and Torres Strait Islander research institute. The Lowitja Institute was proud to help produce the Close the Gap Campaign’s 2020 report.
Croakey’s cultural safety archive can be accessed here.
Disclaimer: Croakey Professional Services was involved in the writing and editing of the Close the Gap report, and Janine Mohamed is chair of Croakey Health Media.