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Strengths-based approaches and shared decision-making key to closing the gap: Productivity Commission

While significant work remained to close the gap on Aboriginal and Torres Strait Islander disadvantage across a number of critical areas, such indicators were not the full measure of wellbeing, nor did they reflect the immense capacity and strengths of Indigenous peoples drawn from their culture, or the significant role of systemic and structural barriers, discrimination and racism.

These are the findings of the Productivity Commission’s latest Overcoming Indigenous Disadvantage report, Australia’s most comprehensive overview of Aboriginal and Torres Islander wellbeing, which was first published in 2002 and last reported in 2016.

Now in its eighth iteration, the 2020 edition takes a strengths-based approach to tracking progress across a number of key indicators and strategic areas for action (52 in total), recognising and valuing Aboriginal and Torres Strait Islander people’s Cultures and placing a strong emphasis on shared decision-making. It underscores the role of racism and discrimination, and acknowledges the Uluru Statement from the Heart.

The report explains:

Three common themes identified across this Report place the outcomes reported in context.

Firstly, Aboriginal and Torres Strait Islander people and communities have strengths and capacities that comes from their cultures.

Secondly, the outcomes measured in this Report do not always fully capture the elements of wellbeing that are important for Aboriginal and Torres Strait Islander people.

Thirdly, in many areas outcomes are improving for Aboriginal and Torres Strait Islander people, but when outcomes have not improved they need to be understood with reference to the personal challenges and systemic and structural barriers that some Aboriginal and Torres Strait Islander people have experienced and continue to experience.”

The report shows mixed progress, with gains on metrics including life expectancy, child mortality, education and income, as well as valuing of Indigenous histories and cultures by the Australian community.

More expectant mothers are seeking first-trimester antenatal care, rates of smoking and alcohol use in pregnancy have declined, and the teenage birth rate is at its lowest level since reporting began. Fewer babies are being born low birthweight and child mortality — especially infant mortality — has fallen, with more young children developmentally on track, going to preschool, and long-term hearing issues declining.

More young people are finishing Year 12 or continuing their education beyond, and the number of people reporting they have or are working towards a post-secondary qualification has nearly doubled in the past two decades, with household incomes on the rise.

Tobacco use has fallen significantly, and potentially avoidable deaths have reduced, contributing to an overall reduction in mortality rates and improvement — particularly for men — in life expectancy.

The report notes little progress or a widening of the gap in critical areas including rates of children in out-of-home care (almost tripled in the past 15 years), mental health (40 percent increase in the rates of death by suicide and self-harm over the past decade) and justice (adult imprisonment rate increased 72 percent between 2000-2019 and youth detention, though improved, is still 22 times the non-Indigenous rate).

The report says it is critical to understand this in the context of intergenerational trauma, colonisation and dispossession, and decades of government policy targeting Aboriginal and Torres Strait Islander people, increasing the risk of determinants such as insecure housing, poor physical and/or mental health and socioeconomic disadvantage.

“Poorer outcomes are not due to people being Aboriginal or Torres Strait Islander, but can be attributed to the additional personal challenges and structural barriers faced by many Aboriginal and Torres Strait Islander people,” says Michael Brennan, who chaired the report steering committee.

“Removing these structural barriers is critical if the wellbeing of Aboriginal and Torres Strait Islander people is to improve.”

Focus on strengths and shared decision-making

Productivity Commissioner Romlie Mokak, a Djugun man and member of the Yawuru people, spoke with Croakey‘s Dr Summer May Finlay – a Yorta Yorta woman – about the report’s findings earlier this week, and you can listen to their full discussion here.

Mokak said the report highlighted the importance of shared decision-making in improving outcomes for Aboriginal and Torres Strait Islander peoples, and of a strengths-based approach.

“The central point of this report is that, in order for outcomes to improve, those very people who are most affected by the policies or programs that are being considered have to be – they must be – at the table, and that shared decision-making between governments and Aboriginal and Torres Strait Islander people needs to be done in earnest,” Mokak told Croakey.

“Sharing power in decision-making is fundamental; the strengths of our people, recognising that – not in a trite or simplistic way but going to the depths of those issues – and the importance of action,” he added of the report’s key messages.

Connection to culture and access to culturally safe services; addressing laws, policies and practices that negatively impact Aboriginal and Torres Strait Islander peoples; ongoing investment, collaboration and coordination from governments; and addressing racism and discrimination were also important elements, Mokak said.

Source: Overcoming Indigenous Disadvantage 2020, Productivity Commission

Reframing the discussion around solutions and strengths instead of a deficit discourse was key, as was applying a cultural determinants lens to the issues, he added.

“It’s about how we frame the sorts of issues we are looking at, what we think about what the data’s saying; thinking clearly about the context in which people live and work and play and love and operate; and to think more clearly and articulate more clearly the sorts of things that Aboriginal and Torres Strait Islander people have as strengths,” said Mokak.

“Our kinship connections, the strength of our identity, our connection to culture and Country and ancestry, all of those things that make our young people strong particularly, but a challenge in our daily interactions with others quite often.”

He added:

We understand full well that the social determinants of health is really important, and has been advocated globally for many years, but it was always deficient for us as First Peoples because it didn’t place the cultural determinants squarely at the centre of that framework as well.

The importance of culture, strong identity, going back to the strengths of our people, our culture makes us strong. It’s protective, it’s a buffer against the many other issues: the high levels of psychological distress, for example, that our people experience and reported on through the data.”

The report found that indicators had many drivers, and even a single, well-targeted intervention could have multiple, amplifying effects (see below).

Source: Overcoming Indigenous Disadvantage 2020, Productivity Commission

Delving into the data

Further detail on some of the headline data:

  • Life expectancy has increased by 4.1 years for boys (71.6 yrs) and 2.5 years for girls (75.6 years) over the past decade, though the result for girls is not statistically significant
  • Infant mortality (0-4 years) has declined significantly since 1998 (from 217 deaths per 100,000 population to 141 per 100,000), especially among the youngest (0 to <1 year), halving from 13 per 1,000 live births to five per 1,000
  • Preschool enrolment is at 92 percent and attendance at 94 percent
  • School attendance (Years 1-10) down at 82 percent from 84 percent in 2014 and compared with non-Indigenous rates of 92 percent
  • Year 12 completion up to 66 percent (45 percent a decade earlier; compared with 90 percent for non-Indigenous people)
  • Employment rate (15-64 years) up from 38 percent in 1994 to 49 percent (peaked at 54 percent in 2008 before declining, partly due to CDEP changes). 63 percent of 18-64-year-olds are now in full-time employment, compared with 55 percent in 2002
  • Proportion with a Cert III or above qualification or studying (20-64 years) at 50 percent, up from 26 percent in 2002, gap steady over the period at about 25 percentage points
  • Rate of disability little changed at 24 percent
  • Median equivalised gross weekly household income $553, an increase of about 30 percent since 2002
  • Child protection substantiations at 38 per 1000 children, compared with 28 per 1000 in 2009-10; rate of children in out of home care now 60 per 1000 children, compared with 21 per 1000 in 2004-05
  • About 16 percent (15 years or older) reported a victim of physical or threatened harm in the past 12 months, about three times the population average
  • Adult imprisonment rate increased 72 percent since 2000; youth detention (10-17 years) rate fell from 409 per 100,000 to 336 per 100,000 from 2007-08, but this remains 22 times higher than the non-Indigenous rate

The report found that service access difficulties were declining (24 percent in the past 12 months compared with 30 percent in 2008; higher in remote areas at 33 percent); revitalisation and maintenance of Indigenous languages had plateaued (11 percent were learning — including 19 percent of 3 to 14-year-olds — and 16 percent spoke an Indigenous language, though this reached 50 percent in remote areas); and recognition of and access to traditional lands had increased (74 percent compared with 70 percent in 2002; higher in remote areas at 90 percent).

On health, it reported improvements in antenatal visits, smoking, teenage births, birthweight, ear health, and child development. Potentially avoidable deaths declined by about 40 percent since 1998. Alcohol use was little changed, but substance misuse has increased over the past two decades.

Obesity had increased (74 percent of Aboriginal and Torres Strait Islander adults, compared with 69 percent in 2012-13) as had rates of high/very high psychological distress to more than twice the proportion for non-Indigenous adults (31 percent compared with 27 percent in 2004-05). The suicide death rate increased about 40 percent in the past decade, and remains about twice that of non-Indigenous people, with rates 3.5 times higher (and rising) among men compared with women.

Native title had been deemed to exist in about 40 percent of Australia (five percent in 2004), and Indigenous Land Use Agreements covered around one-third of the continent, according to the report, with 15 percent of land in Australia owned or controlled by Aboriginal and Torres Strait Islander people. Home ownership had increased to 31 percent, from 22 percent in 1994, and contrasted to declining rates among non-Indigenous people (falling from 74 percent in 2002 to 68 percent in 2017-18).

Overcrowding had fallen to 18 percent (27 percent in 2004-05) overall, and 42 percent (53 percent in 2004-05) in remote areas, while the proportion of people living in adequate housing (around 80 percent) was stable.

Access the summary and full versions of the report and a fact sheet.

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Federal Budget 2020-21
Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Health workers
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
housing
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016