Introduction by Croakey: Last week, the Group of Eight universities published an independent report, titled Roadmap to Recovery. This report looked at options available as part of a COVID-19 elimination strategy or controlled adaptation strategy, or another strategy somewhere in between those two, as previously reported at Croakey.
To develop the report, the Go8 convened a taskforce of more than 100 researchers to provide independent, research-based recommendations on 11 key areas ranging from pandemic control, relaxation of social distancing measures and travel restrictions, to well-being, special considerations for vulnerable populations, and communication strategies.
One of its questions was:
What are the special considerations with regards to Aboriginal and Torres Strait Islanders and their communities through the recovery process?
Coordinated by the University of Western Australia, the responses of a group of Indigenous academics and non-Indigenous academics to that question informed a separate chapter of the report, and this expanded article below.
The authors are (alphabetically): Professor Karen Adams; Emeritus Professor Jon Altman; Dr Dawn Casey; Dr Kyllie Cripps; Professor Patricia Dudgeon; Dr Kate Derry; Professor Megan Davis; Professor Sandra Eades; Samantha Faulkner; Dr Janet Hunt; Dr Elise Klein; Dr Nikki Moodie; Professor Ian Ring; Dr Stewart Sutherland; Professor James Ward; Dr Mandy Yap.
The authors write:
In addressing the global challenges posed by pandemics, it needs to be acknowledged that Indigenous populations around the world are potentially highly vulnerable.
This vulnerability is the result of the historical and ongoing experience of disempowerment and the resulting disproportionate medium and longer term impacts of the COVID-19 response on Indigenous peoples.
In preparing our chapter for the Group of Eight’s Roadmap to Recovery report, we first noted that the disproportionate impact of pandemics on Indigenous populations in Australia and worldwide has been well documented (including here, here and here).
Secondly, we focused on the ways Australian Indigenous organisations have shown exemplary leadership in their crisis response to COVID-19.
However, we also warned that the failure of the Australian Government to act decisively will have devastating consequences, during both the crisis and recovery phases.
We argued that the COVID-19 Government response must address four key issues as a matter of priority for Indigenous people:
- workforce, and
- data monitoring and sharing.
This relies on facilitating Indigenous governance and control by providing needs-based funding and implementing strengths-based, place-based, Indigenous-led initiatives.
Self-determination in practice
Early during the COVID-19 crisis phase, self-determined measures were put in place to mitigate risks of COVID-19 for Aboriginal and Torres Strait Islander communities.
These measures have resulted in important outcomes for Australia’s First Peoples including, at the time of writing (mid-April), just under 50 cases amongst Aboriginal and Torres Strait Islander people, representing 0.7% of all Australian cases. Just over half of these cases were acquired overseas and the remaining identified as local acquisition.
A key attribute of the COVID-19 response has been the self-determination of Indigenous organisations and their strategic leadership so as to mitigate risk and protect Indigenous communities from COVID-19.
In practical terms these acts of self-determination include, for example, Land Councils protecting communities by restricting permits for non-essential travellers and developing health messages in local languages. Communities themselves have restricted travel, implemented considerable efforts to protect Elders, and found solutions to secure isolation and quarantine facilities where housing stock is limited.
The health response is also a clear demonstration of self-determination. The National Aboriginal Community Controlled Health Organisation (NACCHO), state and territory peak organisations, as well as member services all over the country have participated in a national Advisory Group directly reporting to the Chief Medical Officer.
The Advisory Group is co-chaired by NACCHO with the federal Department of Health. This group has taken the lead in developing a national Management Plan (Aboriginal and Torres Strait Islander Advisory Group on COVID-19, 2020), clinical guidelines, and specific initiatives to mitigate risk and prepare communities for COVID-19.
Together these actions were taken early in the pandemic phase and came directly from Aboriginal and Torres Strait Islander organisations, communities and leaders; self-determination in practice.
Recommendations for a roadmap
Recognising that there is some time to go and significant hurdles to overcome before the COVID-19 pandemic is over, the working group on Indigenous issues made four recommendations to the Roadmap to Recovery Go8 Taskforce that place self-determination at the front of these recovery efforts.
These focused on:
- Embedding and expanding the right to self-determination and coordination
- Expanding housing supply
- Maintaining COVID-19 public health and clinical responses
- Reviewing the Aboriginal and Torres Strait Islander health workforce.
Recommendation 1: Fund and expand self-determination and coordination
Indigenous COVID-19 taskforces have been established in a number of jurisdictions led by Aboriginal Controlled Health Services to coordinate and implement effective localised responses to the pandemic.
The report recommended the continued financial and logistical support of those taskforces and their response measures, to be expanded to all jurisdictions for the remainder of the pandemic.
This will enable a single point of engagement with health services, police, education, and family and community services. These taskforces have a ready-made, cross-jurisdictional and federal mechanism that feeds into the NACCHO-Department of Health Advisory Group.
This recommendation is based on the right of self-determination to keep our communities safe, recognition of ongoing local cultural practices, and the need for efficiency in pandemic responses.
Aboriginal and Torres Strait Islander health services are most familiar with the social determinants of our health in local areas, relevant cultural considerations, and are better equipped to advise on the allocation of funding according to local needs.
The effective allocation of resources, in light of an expected shortfall between emergency funding and community needs, is most efficiently done in partnership with Indigenous health organisations.
Supporting the expansion of jurisdictional Indigenous COVID-19 advisory groups to oversee this process during the recovery phase can mitigate the complexity of navigating the distribution of responsibilities across the federation, enabling efficient and localised engagement with relevant departments at a Commonwealth and state and territory level.
Recommendation 2: Expand housing supply
The ability of families to self-isolate and quarantine effectively has been a significant issue in crisis phase of COVID-19.
Many communities are limited by critical housing shortages in urban, regional and remote areas. The lack of adequate housing has a direct impact on the ability of local health services and communities to control the spread of the virus, as well as immediately exacerbating a complex set of interrelated issues including child and family safety, pre-existing overcrowding and ageing infrastructure.
During COVID-19 the housing shortage has been exacerbated by people returning from urban centres to Country.
Many Indigenous communities remain extremely vulnerable to COVID-19 without any ability to quarantine suspected and or confirmed cases. This is particularly acute amongst Indigenous communities located on the Victorian and NSW coast who lost houses as a result of the 2020 bushfires.
An immediate supply of alternative housing is needed in local communities to alleviate the pressure on over-crowded households and enable effective disease suppression.
Some communities have already been able to work with government and business to secure emergency and temporary housing options that keep people in their communities, but for many communities this remains a significant risk factor.
In the medium-term an urgent supply of permanent housing infrastructure and sustainable supply of utilities in locations across the country is required to ensure that future outbreaks are containable, and one of the most important social determinants of health can be addressed.
Recommendation 3: Data monitoring and sharing
The report recommended that the existing Aboriginal and Torres Strait Islander Health Advisory Group be maintained until Australia has fully recovered from COVID-19. This will ensure adequate responses are able to be implemented through the practice of self-determination.
- Availability of reports of COVID-19 cases and outcomes: Particular efforts will be required to ensure adequate monitoring of COVID-19 cases and detailed epidemiology reports are produced regularly and publicly so that proportionate responses can be enacted where necessary. Accurate data is required to support the pandemic response and support recovery.
- Public health messaging will need to be maintained throughout recovery. Timely, accurate and accessible information must be communicated regularly to the Indigenous public to support strong health literacy.
- Research into the effects of COVID-19 on community social and emotional wellbeing and mental health will be required to evaluate how Aboriginal and Torres Strait Islander peoples have fared through COVID-19 that will provide important learnings for future pandemics and crises.
Such research must be Indigenous-led and based on scholarly and cultural ethical practices. In order to conduct this research and enable rapid decision-making, issues of data quality and sharing must be addressed quickly.
Recommendation 4: Review Aboriginal and Torres Strait Islander Health Workforce
The COVID-19 pandemic has exacerbated vulnerabilities in local workforces, which are dependent on staff from interstate and even New Zealand. Long-term initiatives to build local capacity are needed.
This recommendation was made because several issues have arisen in relation to workforce, including the need to quarantine locum staff prior to arrival in community and isolation for Indigenous people aged over 50 years who themselves have a chronic disease.
It is recommended on the road to recovery that NACCHO as a lead agency instigate a Health Workforce reform process in partnership with Commonwealth and state and territory governments.
In addition to the four recommendations, the working group provided a much longer discussion of other issues impacted by the social determinants of health for Aboriginal and Torres Strait Islander people.
These included the need for:
- enhanced food security
- needs-based financial support for Aboriginal Community Controlled Health and other Indigenous organisations
- the permanent retention of the Job Seeker COVID-19 income support supplement to reduce levels of deep poverty
- addressing the negative impacts of social isolation policies, including concerns around child and family safety, over-policing and disproportionate fining
- the importance of equitable needs-based funding to address historical shortfalls and current needs.
While these recommendations apply to the entire Aboriginal and Torres Strait Islander population, the diversity within this population needs to be recognised.
In preparing the report, the authors noted that the research consistently demonstrates that strengths-based, holistic, community-led approaches to health care are the only effective ways of working with Indigenous peoples. (See hyperlinks in the article, and additional references below).
The necessity of Indigenous leadership, governance and community-controlled health services must be recognised by governments and mainstream service providers to achieve the necessary health outcomes for Indigenous peoples.
In the face of significant historical challenges, Indigenous peoples are resilient. The Indigenous social and emotional wellbeing framework has shown that connection to culture, Country, community, and spirit promote the wellbeing and resilience of Indigenous individuals and communities.
Self-determination, our communities and Elders are critical in times of crises.
At the time of writing the infection of the Aboriginal and Torres Strait Islander population by the COVID-19 pandemic has been quite remarkably contained. It remains to be seen how governments across Australia take up these recommendations, as Indigenous organisations, communities, and peoples continue to shape their own own healing journey through yet another, potentially catastrophic, health crisis.
Dudgeon P, Kelly K & Walker R 2010, Closing the Gaps in and through Indigenous Health Research: Guidelines, Processes and Practices, Australian Aboriginal Studies, 2: 81-91.
Fogarty, W., Bulloch, H., McDonnell, S. & Davis, M (2018). Deficit Discourse and Indigenous Health: How Narrative Framings of Aboriginal and Torres Strait Islander People Are Reproduced in Policy. Carlton South, VIC: Lowitja Institute.
Miller, A., Massey, P., Judd, J., Kelly, J., Durrheim, D., Clough, A., Speare, R., Saggers, S. (2015). Using a participatory action research framework to listen to Aboriginal and Torres Strait Islander people in Australia about pandemic influenza. Rural and Remote Health, 15: 1-10.