Introduction by Croakey: The longevity and success of the Aboriginal Community Controlled Health sector has some valuable lessons for mainstream health services, according to a panel of Indigenous health experts at the recent Giant Steps conference, hosted by Safer Care Victoria.
Below, Jennifer Doggett reports on the panel discussion for the Croakey Conference News Service.
Jennifer Doggett writes:
One of the success stories of Australia’s response to the COVID-19 pandemic has been the achievements of the Aboriginal Community Controlled Health sector in preventing the spread of infection among Indigenous communities.
At the recent Giant Steps Conference, this success was attributed by a panel of Indigenous health experts to a range of factors, including the history of this sector as a vehicle for the self-determination of Aboriginal and Torres Strait Islander people.
The panel was facilitated by Nicole McCartney, Victoria’s inaugural chief Aboriginal Health Advisor, and included Pat Turner AM, CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO), Sheree Lowe, Executive Director, Social and Emotional Wellbeing Centre of Excellence at the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and Brad Brown, director of the Victorian Aboriginal Health Service.
Turner reminded participants that Aboriginal Community Controlled Health Organisations (ACCHOs) have been part of Australia’s health landscape since before the introduction of Medibank (the precursor to Medicare) in 1975.
She stressed the innovative model of primary healthcare developed by the ACCHOs and their focus on prevention and social justice, all later adopted by World Health Organization in its Declaration of Alma-Ata in 1978.
Brad Brown described ACCHOs as a “home away from home” and discussed how the community controlled model has deep roots in Aboriginal culture.
“Aboriginal people sit around a lot and talk and yarn. We talk about how to do things better, and what our current needs are. Local people talking about their local issues are part of our culture – we know that needs are different place to place and we know how to reframe what we do to meet local priorities. Community control is part of self-determination,” Brown said.
As well as providing comprehensive primary healthcare to Indigenous Australians, the panel discussed how the ACCHO model provides some important lessons for the rest of the health system about how to deliver inclusive, community controlled and integrated care.
Moving away from a deficit model
Promoting these benefits requires moving away from a deficit view of Indigenous health to strengths-based framing, an approach that was welcomed by the panel members.
However, Turner cautioned that no matter how well the Aboriginal community controlled sector performs, it cannot close the health gap unless the health funding gap is also addressed.
“We cannot keep saying that we are all working toward closing the gap when there is a $4.4 billion per year funding gap. This equates to around $5,000 less funding per Aboriginal person per year, compared to non-Indigenous Australians,” she said.
Referencing the keynote address by Dr Kedar Mate earlier at the event, Turner discussed the experience of doctors in the US (colleagues of Dr Mate’s) who had been threatened by White supremacists after they exposed racist and discriminatory treatment of People of Colour at their hospital.
She reminded participants of the evidence in Australia that Aboriginal people don’t get the same treatment as non-Aboriginal people and said that one focus of her work as lead convenor of the Coalition of Peaks is to make governments more accountable for their actions, policies and programs.
Turner also emphasised that the COVID-19 pandemic has shown how ACHHOs and Aboriginal and Torres Strait Islander communities can lead the way in effective health responses to health threats.
Lessons from the past
One key factor driving the successful COVID-19 response from the ACCHOs was the lessons learned from the 2018-19 syphilis outbreak in Queensland. Turner described how the sector applied these lessons in the early days of the pandemic, before vaccines were available.
They included the importance of early collaboration with government, government agencies and health sector allies in co-designing a response. This involved the ACCHO sector pro-actively engaging with the Commonwealth to develop a plan of action.
Given the high rates of comorbidity among Indigenous people, Turner said the sector was extremely concerned to protect their communities after seeing Native Americans experience the highest death rate from COVID-19 of any ethnic group in the US.
“We looked after our own and maintained services. Our contact tracing abilities are a strength as we know our people – if we need to contact them quickly we can,” she said.
The panel said that due to these efforts, not one Aboriginal or Torres Strait Islander person had died from COVID-19 prior to the arrival of the Delta variant in Australia.
Turner described this as “an astounding result” given the very different outcomes for Indigenous peoples in other countries.
McCartney stated that even after Delta strain, the Victorian Aboriginal community had experienced only nine COVID deaths, while also acknowledging that each one of these deaths was a tragedy.
This outcome is not reflected in outcomes for Aboriginal and Torres Strait Islander people nationally, according to recent research from OzSage which found that Aboriginal and Torres Strait Islander people are two-to-three times more likely to end up in ICU or to die from COVID than non-Aboriginal Australians of the same age.
Lowe discussed how the ACCHOs had drawn on the strength and resilience of Aboriginal communities to face other health challenges, including providing the Royal Commission into Victoria’s Mental Health System.
She also discussed the importance of ensuring policies are translated into effective action for Indigenous communities and described how services on the ground don’t always reflect the Victorian Government’s progressive policies, such as its commitment to community consultation and a treaty with Aboriginal Victorians.
Lowe also highlighted the importance of cultural safety throughout the health system and broader community.
“If you don’t have a sense of place or safety and you can’t bring your whole self when you access a job or services then there will continue to be a gap,” she said.
Lowe urged governments and funders to listen when communities articulate their needs and then to adapt their processes to meet the communities’ needs (instead of communities having to constantly adjust to the bureaucratic systems of government).
“Often our answers don’t fit into government funding and reporting box,” she said, “It’s hard to sit at a table in a genuine partnership with government when we hear stories of racism in the health system and we know that many of our people are not able to access culturally safe care.”
The importance of self-determination
McCartney invited the panel to reflect on the importance of self-determination for improving the health status of Indigenous Australians.
Turner emphasised that the ACCHO story was all about self-determination, given that the first ACCHO was established because the mainstream health system was not working for Aboriginal people in Sydney.
She also highlighted the key role of the ACCHO sector as an employer of Aboriginal and Torres Strait Islander people, providing another important vehicle for their self-determination.
ACCHOs now employ 7,000 staff, 54 percent of whom are Aboriginal and Torres Strait Islander people, making them the largest employer of Indigenous Australians after Coles and Woolworths.
The role of the Coalition of Peaks was also discussed and Turner explained how this body was formed due to the ongoing failure to close the health and life expectancy gap between Indigenous and non-Indigenous Australians.
She described how NACCHO organised a collective rejection of the Government’s processes, and asked governments at all levels to revisit the closing the gap goals and to work with the sector in partnership with the Coalition, which now represents over 70 organisations.
At a meeting with former Prime Minister Scott Morrison, Turner said the group received some acknowledgement that there were problems with the Federal Government’s response. She welcomed the support of all nine Australian governments, which have now committed to working in partnership with sector and signed an agreement for closing the gap, the first agreement of its kind.
The role of a treaty
McCartney asked the panel how the treaty process underway in Victoria would affect health outcomes in the state.
Lowe said she welcomed the treaty discussions and what she described as the “long overdue” conversations this involved in Victoria. However, she also emphasised the deep impacts of colonisation in Victoria and the trauma that sits within that, which she said will take more than just a treaty to repair.
“We should be culturally safe care everywhere when we think about clinicians trained in a certain way, when you try to introduce a cultural overlay it’s really hard as there is some critical knowledge missing. We need to have open discussions around our hidden histories and how that filters back to our ways of work. When we treat everyone the same we don’t meet the cultural needs of Aboriginal and Torres Strait Islander people,” she said.
While there is clearly a long way to go, Lowe also emphasised the progress that has been made by Indigenous people in Australia
“We need to remember that we weren’t even citizens until after 1967 – the movement of Aboriginal people has really progressed in the past 50 years and we should be proud of what we have been able to achieve. I also like to think my kids and grandkids will be able to have a different conversation in the future,” Lowe said.
Turner discussed the significance of the Uluru Statement from the Heart and the need for a “truth telling” process as part of the process of achieving an Indigenous Voice to Parliament.
“A truth telling process is a vital component of the reconciliation journey. The Bringing them Home report made some gains but reconciliation is still incomplete – we need a truth telling commission,” she said.
Turner also warned that achieving constitutional change in Australia is very difficult without bi-partisan support, reminding participants that the 1967 referendum was a success only because both major parties encouraged a yes vote.
Improving services
The panel left participants with some advice for how non-Indigenous health workers and services could change to improve the experience of Indigenous people in the health system and support their self-determination.
Brown said that it was important to recognise that many Indigenous people had a hard journey, in particular those from the Stolen Generations , and that services often had to work hard work to regain their trust.
He highlighted the importance of service providers recognising the impact of transgenerational trauma and listening to Indigenous communities.
Lowe asked non-Indigenous service providers to “lean in” to their allyship of Indigenous people.
“Everyone has a role and we need allies and friends to be on the same page. We are three percent of the population so we need the other 97 percent to support us,” she said.
Turner stressed the importance of cultural knowledge and cultural respect when engaging with Aboriginal and Torres Strait Islander people, reminding the audience that if they act in a racist way, they would not get any engagement.
She highlighted the need for more doctors to work in this sector and thanked healthcare workers attending the conference, acknowledging how much pressure the health system is under at the moment and how this impacts both consumers and health workers.
Turner also stated that there was a lot of work needing to be done by the Coalition of Peaks to improve service delivery to Indigenous people and identified four priority reforms: 1) shared decision making, 2) building and strengthening the ACCHO sector 3) transforming mainstream agencies to become culturally safe and respectful 4) sharing of data and information about Aboriginal and Torres Strait Islanders collected by government with Indigenous people.
From Twitter
Jennifer Doggett was in virtual attendance at the #GiantSteps22 conference for the Croakey Conference News Service.
Additional coverage of the conference was provided on Twitter via @CroakeyNews and @WePublicHealth and at #GiantSteps22.
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