Alison Barrett writes:
Aboriginal and Torres Strait Islander leadership, self-determination and community control are critical to improving outcomes for First Nations people experiencing poverty.
“The way out of poverty is rooted in culture, in community and in Country. It lies in dignity, in recognition and in self-determination,” the National Aboriginal Community Controlled Health Organisation (NACCHO) said in their submission to the Senate inquiry into the extent and nature of poverty in Australia.
According to NACCHO and other Aboriginal and Torres Strait Islander health organisations quoted in the final inquiry report – released last week – First Nations-led employment and social services are vital to ensure cultural safety.
Additionally, the importance of Aboriginal Controlled Community Health Organisations in addressing poverty was stressed.
Because they are Aboriginal-led and culturally safe, ACCHOs can overcome some of the barriers to accessing healthcare and subsequent poor health that entrenches “the cycle of poverty” for many First Nations people, according to both NACCHO and the Aboriginal Health and Medical Research Council of NSW.
However, there are insufficient numbers of ACCHOs.
The final report – which focuses on the impacts of poverty on children and First Nations people – is the culmination of evidence from nine public hearing and 253 written submissions.
Twenty-nine recommendations in total were made – fourteen were made by the Senate Community Affairs References Committee, and committee Chair Senator Janet Rice made an additional 15 recommendations.
An interim report was published in May 2023, prior to the Federal Budget, recommending the Australian Government “take urgent action so that Australians are not living in poverty” and to prioritise policy measures targeting rising inequality and disadvantage in the May Budget.
Here are some takeaways from the final report and reflections for the health sector. We welcome your thoughts on relevant aspects not covered.
First Nations first
In addition to calls for prioritising the strengths of Aboriginal and Torres Strait Islander leadership and community control in tackling poverty, organisations – including NACCHO, Aboriginal Peak Organisations NT and NT Council of Social Service – emphasised the importance of implementing the National Agreement on Closing the Gap Priority Reforms.
NACCHO said the four Priority Reforms – which are building the community-controlled sector, transforming government organisations, formalising partnerships and shared decision making and sharing access to data and information at a regional level – “offer a roadmap to meaningfully impact structural drivers of poverty and poor outcomes”.
Daniel Morrison-Bird, CEO of Wungening Aboriginal Corporation, stressed “the need for self-determined solutions to address First Nations people’s experiences of poverty. We must see self-determination if we want to see change.”
Similarly, the Queensland Aboriginal and Islander Health Council recommended increased investment in financial counselling services designed by and for First Nations people, as well as culturally safe primary healthcare and health prevention strategies.
The committee recommends the Australian Government commit to the principles of First Nations-led co-design of all First Nations employment services, and accelerate the Community Development Program reforms (recommendation six), noting the shortcomings of the long-standing program.
The Australian Government is currently working to replace the Community Development Program with a new program developed with First Nations people, which is expected to start in the second half of 2024.
Meanwhile, an article recently published by the Institute of Public Administration Australia shares lessons on co-design and place-based approaches from Indigenous-led initiatives in Australia’s primary health sector which may be useful to Croakey readers.
Culturally safe healthcare
The committee notes that institutional racism contributes to poverty among First Nations peoples.
CEO of First Peoples Disability Network Damian Griffis said:
Since colonisation, institutionalisation, incarceration, stolen wages, removal of children and institutionalised ableism and racism in policies, programs and services across the life course and across all sectors and systems contribute to this ongoing poverty.
These experiences exist across the life course and sectors, from early childhood, housing, health, education, justice and aged care.”
While ACCHOs play a critical role in delivering culturally safe healthcare – which is noted in the final report – given the inextricable links between health and poverty, and the impact of racism in healthcare, it is noteworthy that the report did not mention the broader need to address racism in healthcare.
Place-based solutions
During the inquiry, the committee heard strong evidence for place-based approaches in “breaking the cycle of disadvantage in local communities”.
The inquiry report quoted evidence submitted by ACOSS that basic living costs are much higher in remote communities than others. Prices in remote community stores have been found to be on average 39 percent higher than major supermarkets elsewhere.
Place-based approaches are an effective way to address the complex nature of disadvantage by looking at [the] physical and social environment and local service systems, according to the Life Course Centre’s comments in the report.
An example of a place-based solution is that of the Indigenous-owned Foodworks in the remote Queensland town of Normanton. Last year, ABC reported the store had not only been responsible for reducing grocery costs, but the creation of jobs for the region. According to the ABC, Indigenous staff cover approximately 80 percent of the store’s shift hours.
Community members in Burnie and Wynyard in lutruwita/Tasmania told the committee on a site visit that to reduce poverty:
- Programs and policies need to embed an asset-based approach rather than a deficit mindset
- Grant funding for bespoke place-based approaches run by community organisations needs to be longer term and untied
- Whole-of-government coordination of services and program implementation needs to improve.
More directly related to health, the National Rural Health Alliance recommended rural-led and located research into place-based approaches, investment in rural communications infrastructure to address digital inclusion, increased access to Medicare for out-of-hospital services in rural areas, and rural multi-disciplinary health services.
As a result of the evidence for place-based approaches, the committee recommends the Australian Government, in consultation with stakeholders, continue developing funding of longer-term place-based initiatives aimed at reducing poverty and disadvantage (recommendation 14).
Health in all Policies
The inquiry into Robodebt highlighted the importance of health in all policies.
As Croakey editor-in-chief Dr Melissa Sweet wrote last year, “if ever there was an argument for structures to promote and embed health in all policies, then Robodebt must be it”.
Similarly, the final report of the Senate inquiry into poverty highlights the many interconnecting factors that can lead to poverty.
The report states:
Submitters and witnesses outlined the structural drivers of poverty that go beyond simply not having enough money. This included economic, labour market, housing, and social factors that are not personal deficits or within the control of individuals.”
Early intervention to end child poverty
The committee heard wide-ranging evidence of the effectiveness of early intervention – and place-based initiatives – to reduce the impacts of child poverty in Australia.
“It is far more preferable to invest in, and address the impacts of poverty when people are young, before living in poverty becomes entrenched into their adulthood and across generations,” the committee said.
They recommend that the Australian Government continues to invest, and considers increasing investment, in early intervention and place-based initiatives to address child poverty (recommendation 12).
Ongoing advocacy to raise the rate
The inquiry received evidence from ACOSS and UNSW that the increased income support payments during the pandemic lifted 646,000 people (including 245,000 children) out of poverty.
Additionally, contrary to common belief, the changes to income support payments during the pandemic “not only improved physical and mental wellbeing, but also increased labour market engagement and economic participation, and care and community work”.
Strong evidence was provided on the benefits of increasing income support payments, according to the report.
The committee acknowledged longstanding calls to increase income support payments – one of the additional recommendations made by Rice is for the Australian Government to lift the base rate of all income support payments to $88 a day.
See this 2018 call for the health sector to get involved in the Raise the Rate campaign here.
The final report highlights the need for health organisations and leaders to renew and/or continue their advocacy efforts in support of raising the rate.
*** At time of publication, no apparent response to the final report of the Senate inquiry into the extent and nature of poverty in Australia had been made by government departments or ministers.
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