Researchers from the University of Queensland have previously shared in Croakey their ongoing study on pandemic preparedness in urban Indigenous communities in Brisbane, Australia.
In a collection of articles they outlined how they 1) used a systems thinking methodology to produce a visual map that conceptualised issues relating to pandemic responses; 2) documented six themes that state, federal, and community-based stakeholder participants identified as impacting COVID-19 risks; and 3) focused on how conspiracies and misinformation were increasing risks associated with COVID-19.
Here, the research team reflects on some of their findings, in the context of plans to develop an Emergency Public Health Framework for First Nations’ peoples in Australia.
Bronwyn Fredericks, Abraham Bradfield, James Ward, Sue McAvoy, Shea Spierings, Troy Combo and Agnes Toth-Peter write:
Since we commenced our 2021 rapid-fire study to better understand the dynamics that shape responses to COVID-19 in an urban health system, all Australian states and territories have reopened and lifted most pandemic restrictions.
For many members of the public the severity of the pandemic, which was once at the forefront of mind, now remains but a memory.
This is despite COVID-19 continuing to circulate, people continuing to die from infections, Aboriginal and Torres Strait Islander people remaining at high risk due to social and historical determinants of health, and that the country is fast approaching what is predicted to be a particularly severe winter in terms of the spread of influenza – a potentially deadly combination when contracted with COVID-19.
Here we re-visit six themes identified in our research, and which were visually depicted by Dr Sue Pillars during an Australian Partnerships for Preparedness Research on Infection Disease Emergencies (APPRISE) symposium held in March 2023 (see feature image above).
The themes include COVID-19’s impact on young people; vaccine uptake; households and workforce; family and community; and media and misinformation.
We’ll share what stakeholders identified as potential touchpoints where health and policy interventions could be implemented to ensure effective responses and assist in preparations for future pandemics.
These can be used to help develop a Public Health Emergency Response Framework for First Nations communities, an agenda currently being pursued by APPRISE.
Touchpoint 1: Minimise mobility
Stakeholders expressed that developing strategies to minimise a person’s mobility if they become infected, or when infection susceptibility is high within communities, was essential.
The importance of ‘relationality’ for Indigenous peoples was raised during most discussions, particularly in relation to elders and young people.
Stakeholders spoke of how relationality needed to be built into health policy and responses.
Designating a family member to run household errands and liaise with service providers, for example, was presented as one way to mitigate face-to-face contact and reduce risk of exposure.
Touchpoint 2: Incentivise protective behaviours
Awareness campaigns and effective use of media run by and for Indigenous people, such as the work of Deadly Choices, significantly contributed to Indigenous peoples’ awareness of COVID-19 and provided credible sources of information.
ACCHOs and/or Indigenous organisations were unanimously identified by stakeholders as having the greatest potential to encourage protective behaviours.
While we recognise that ACCHOs should not be expected to address or present all the solutions to the risks associated with COVID-19, they should nonetheless be adequately resourced, financed, and consulted during the conception and implementation of policies relating to Indigenous health. This must always occur, not just during pandemics.
Touchpoint 3: Coordinating responses
The formation of the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 demonstrated that meaningful partnerships and lines of communication between governments, service providers, and communities are possible.
Stakeholders believed that coordinated responses and networks amongst service providers and community organisations could counter siloed approaches to healthcare and direct resources where they are most needed.
Stakeholders expressed that developing a streamlined step-by-step action plan – which identified key actions and networks – could provide guidance on how best to respond to future health crises as well as share best practices.
Such action plans could mitigate siloed approaches by raising awareness of the interconnection between the six themes that collectively influence health outcomes.
Touchpoint 4: Address burnout
The Indigenous workforce (health workers especially) experienced numerous pressures when responding to the challenges associated with COVID-19.
This involved responding to the cultural and social needs of Indigenous communities; countering misinformation, hesitancy, and mistrust; and navigating workplaces that are not always culturally safe.
These pressures often resulted in fatigue and burnout. Stakeholders expressed that immediate action through the remuneration of overtime, implementation of flexible work arrangements, and recognising the cultural needs of both the workforce and patients were needed.
Long term interventions are also needed to create safe workspaces and build the numbers and capacity of the Indigenous workforce whilst also building the cultural competency of non-Indigenous people to counter racism.
Touchpoint 5: Housing
Many of the health challenges faced by Indigenous peoples during COVID-19 (but also generally), can be attributed to housing availability, inadequate infrastructure, and overcrowding.
Long-term solutions to housing can reduce overcrowding and potentially help curb the spread of virus.
However, stakeholders also identified the need for immediate responses including access to temporary housing and provision of adequate accommodation, support, and culturally appropriate care should self-isolation be needed.
Envisioning a Public Health Emergency Response Framework
Indigenous communities, organisations, and representative bodies such as ACCHOs are best placed to respond to future pandemics as they have longstanding and trusted relationships with Indigenous peoples and are operated by members of Indigenous communities.
Whilst the five interventions outlined here are far from complete, they provide some actions that could potentially be built into a Public Health Emergency Response Framework. The complex challenges associated with COVID-19 has further emphasised the importance of:
- Providing targeted and trusted messaging to incentivise protective behaviours
- Integrating partnerships across sectors to encourage less siloed approaches to healthcare
- Implementing workplace reform to create culturally safe spaces for Indigenous workers and patients
- Addressing systemic issues with housing.
Additionally, as an airborne respiratory disease, COVID-19 has highlighted the need for empathetic but effective policies pertaining to social distancing and mobility during outbreaks.
What stakeholders from our study unanimously voiced was that any framework must be overseen and implemented by Indigenous peoples in accordance with local needs and directives.
Both immediate and long-term solutions are needed which address systemic disparities between Indigenous and non-Indigenous peoples and provide the resources and finance needed to respond to unforeseen events.
Any development of an Emergency Public Health Framework for First Nations’ peoples in Australia must be holistic, intersectional, but most importantly conceived and implemented by Indigenous peoples.
• References are available here.
See Croakey’s archive of articles on cultural safety
