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New solutions, new hope
Author: By Tom Calma, Aboriginal and Torres Strait Islander Social Justice Commissioner
Publication: The Australian, Page 10 (Sat 29 Aug 2009)
Any move to end the ignominy of indigenous health must empower community leaders to make decisions about resource allocation and program design, says TOM CALMA, Chair of the Close the Gap Campaign for indigenous Health Equality
THE long-standing health crisis and the yawning life expectation gap suffered by indigenous Australians is an utterly unacceptable situation for Australia to tolerate. Addressing this issue is more than within the realms of possibility-we have a moral imperative to do so.
The Close the Gap Campaign for indigenous Health Equality believes what's needed is a dose of rigorous honesty about the causes of the indigenous health equality gap-including a look at why we have failed in the past- and a willingness to embrace a new paradigm around indigenous health.
The foundation for this new approach is a genuine partnership between Australian governments and indigenous peoples and their representatives.
Genuine partnership means a break from the past of rolling out policies developed by Canberra bureaucrats to new ways of working.
It means power-sharing and allowing indigenous Australians and their representatives to take the lead and make decisions about resource allocation and program design.
Only indigenous Australians, their representatives and community leaders, can know what is really going on in our communities and the best ways to address health issues.
The Aboriginal Community Controlled Health Services operate at the frontline and are ideal partners for rolling out tailored and comprehensive primary health care. They see hundreds of thousands of Aboriginal patients across the country every year. They know what is going on in health terms. They also have decades of experience in addressing these issues.
But beyond this, if we are to see the changes necessary in key related areas, such as rates of smoking in indigenous communities, the way housing is managed, or the range of behavioural changes needed in relation to diet and exercise, it stands to reason that working together is unavoidable.
These partnerships must take place in the context of mutual respect and empowerment.
The Close the Gap Campaign also proposes a second dose of medicine: the development and implementation of a properly resourced, measurable national plan for achieving indigenous health equality by 2030. That is, a plan that encompasses all the determinants of poorer indigenous health, from smoking and poor diet through to infant health, law and order issues, unemployment, and even the impact of racism.
Such a plan should, at its core, aim to ensure that indigenous Australians have the same opportunities to make the same choices to be as healthy as other Australians.
Many Australians take these health choices for granted: whether to eat fresh fruit or not, whether to visit a doctor or not, whether to drink fresh, healthy water or not. But for indigenous Australians, such choices are not always there. Indigenous Australians often turn up at hospitals with advanced conditions because we have significantly less access to primary health care than other Australians.
For this reason, a vital element of the plan we propose is a Capacity Building Plan for the Aboriginal Community Controlled Health Services, which the evidence base shows are the most effective ways of delivering primary health care services to indigenous Australians.
It is vital that indigenous Australians have access to these services wherever possible and that opportunities to that end are maximised through the implementation of the $1.6billion COAG National Partnership Agreement on Closing the Gap in indigenous Health Outcomes.
We should also not forget the responsibility of the rest of the health sector-including those parts responsible for mental health, social and emotional well-being and oral heath. Comprehensive primary care, particularly through Aboriginal Community Controlled Health Services must be strengthened as the priority, but mainstream primary health care services, secondary and tertiary services and private practitioners also have a role to play in contributing to improving health outcomes. All must work in a coordinated fashion to that end.
Empowering Aboriginal people to be able to make the same choices for health as other Australians by providing the services and other infrastructure they need is central to achieving indigenous health equality.
Finally, we must embrace ambitious targets for indigenous health.
Here, there are positive developments. The Australian Government has, to a large extent, done this-committing to achieving indigenous health equality by 2030.
No-one is saying that this will be easy. Indeed many have stepped forward to say the target is unachievable.
Our approach is built on evidence that shows that significant improvements in the health of indigenous peoples can be achieved within short time frames. Similar new approaches and investment caused mortality rates for indigenous peoples in New Zealand, Canada and the US to drop by 30 per cent in less than 10 years.
Back here in Australia, we know the death rates among Aboriginal people from pneumonia have dropped by 40 per cent since the roll-out of pneumococcal vaccinations in 1996.
Similarly, the Strong Babies, Strong Culture maternal health program in the Northern Territory has led to significant reductions in the number of low birth weight babies within a matter of years.
With partnership, planning and ambitious targets, we can be the last generation to witness the ignominy of indigenous health inequality that stains our national reputation and translates to unnecessary suffering and early death for our people. If we want a reconciled nation, if we want to walk hand in hand into a proud future, we must address this issue head on. Working together, we are absolutely convinced that indigenous health equality can be achieved by 2030.
