National Aboriginal and Torres Strait Islander Health Plan 2013–2023

Strategic Framework

Page last updated: 27 June 2013

Vision

The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequalities and determinants of health, this provides the necessary platform to realise health equality by 2031.

Overarching Goal

Targeted, evidence-based action that will contribute to achieving equality of health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians by 2031 (one of the six Closing the Gap targets).

Recognition Statement

Aboriginal and Torres Strait Islanders are the first people of Australia. The culture of Aboriginal and Torres Strait Islander peoples is dynamic and continues to evolve and develop in response to historical and contemporary circumstances. The Australian Government recognises that dispossession, interruption of culture and intergenerational trauma have significantly impacted on the health and wellbeing of Aboriginal and Torres Strait Islander peoples, and that they share a continuing legacy of resilience, strength and determination.

Aboriginal and Torres Strait Islander people and communities are diverse, including gender, age, languages, backgrounds, sexual orientations, religious beliefs, family responsibilities, marriage status, life and work experiences, personality and educational levels. The Australian Government accepts and acknowledges difference and diversity among Aboriginal and Torres Strait Islander people and values the contributions that all Aboriginal and Torres Strait Islander people make to generating new ideas and innovative solutions to improve health.

The Centrality of Culture and Wellbeing in the Health of Aboriginal and Torres Strait Islander People

“We represent the oldest continuous culture in the world, we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership – to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful and our communities thrive”.1 Professor Ngiare Brown Top of page

Aboriginal and Torres Strait Islander people view health in a holistic context as reflected in the holistic definition of health contained within the National Aboriginal Health Strategy (1989):

“Aboriginal health’ means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole-of-life view and includes the cyclical concept of life-death-life”. 2

There is a wealth of evidence that supports the positive associations of health, education and employment outcomes as well as general wellbeing with language and culture. 3 Aboriginal and Torres Strait Islander languages are inseparable from culture, and form the foundation for learning and interacting productively with others.

Wellbeing for Aboriginal and Torres Strait Islander people incorporates broader issues of social justice, equity and rights. The significance of culture to wellbeing, and therefore good health, is also demonstrated by using traditional knowledge and the practices of traditional healers, which are adapted by many people for complementary use with western science in an integrated health care system.

Culture can influence Aboriginal and Torres Strait Islander people’s decisions about when and why they should seek health services, their acceptance of treatment, the likelihood of adherence to treatment and follow up, and the likely success of prevention and health promotion strategies. Ensuring that health services and providers are culturally competent will lead to more effective health service delivery and better health outcomes.

Culture, in the Aboriginal and Torres Strait Islander context, needs to be differentiated from the excessive behaviours which can have a detrimental effect on the health and wellbeing of people, their families and communities. These excessive behaviours have no basis in Aboriginal and Torres Strait Islander cultures. Indeed it is the restoration and continuation of cultures which provide both the reason for change, and the pathway for securing it.

Principles

The following principles inform the approach of this Health Plan.Top of page

Health Equality and a Human Rights Approach

The principles of the United Nations Declaration on the Rights of Indigenous Peoples and other human rights instruments support Aboriginal and Torres Strait Islander people in attaining the highest standard of physical and mental and social health.

“The right to health is not to be understood as a right to be healthy. This cannot be guaranteed by governments. A human rights-based approach to health is about providing equal opportunities to be healthy, it’s about participation and progressive realisation.” 4 Mr Mick Gooda

A rights-based approach is about providing equal opportunities for health by ensuring availability, accessibility, acceptability and quality health services. This frames both policy development and the development of goals and targets. A human rights approach helps highlight additional risks and opportunities for health and wellbeing programs before any final decisions are made. In this way, a rights-aware approach is not necessarily about more services, but about better services through better informed policy, practice and service delivery decisions, and the processes that enable Aboriginal and Torres Strait Islander people to participate in all levels of health care decision-making.

Constitutional recognition is seen by many Australians as a pivotal and desirable reform which provides the constitutional architecture upon which strategies for Aboriginal and Torres Strait Islander health gain can be mobilised. The Australian Government is committed to pursuing meaningful change in the Australian Constitution – change that unites the nation and reflects the hopes and aspirations of Aboriginal and Torres Strait Islander people.

Stewardship of health is the responsibility of each person to whom health has been entrusted. Creating the personal, environmental, and social conditions for good health is a joint responsibility—public, community, private, government, organisation and individual.

Aboriginal and Torres Strait Islander Community Control and Engagement

There is a full and ongoing participation by Aboriginal and Torres Strait Islander people and organisations in all levels of decision-making affecting their health needs.

“Health issues must be addressed at a community level. The community needs to control its health services so that they are concentrated on the important issues in that community.” 5 Alyawarr Ingkerr-wenh Aboriginal Corporation

Through community consultations, individuals and communities voiced their desire to be involved in the service planning, design and implementation of policies to support their health and wellbeing. In order to enable Aboriginal and Torres Strait Islander people to participate, Government must grow more opportunities for engagement and collaboration with individuals, Aboriginal and Torres Strait Islander community controlled health organisations and other health and related services.

Aboriginal and Torres Strait Islander community controlled health organisations provide unique contributions in delivering holistic, comprehensive and culturally appropriate health care. All services delivering primary health care at the local, regional and state levels should seek to optimise their engagement and involvement with Aboriginal and Torres Strait Islander people to improve health outcomes.

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Partnership

Partnership and shared ownership between Aboriginal and Torres Strait Islander people, Governments and service providers operates at all levels of health planning and delivery.

“We are witnessing a new and exciting era…the burgeoning of a new relationship between Indigenous and non-Indigenous Australians, including governments, based on respect and partnerships. Now is the time to capitalise on the momentum and move forward together.” 6 Dr Tom Calma, AO

Working in partnerships to remove barriers to good health and building the evidence around health interventions is critical for improving the health and wellbeing of Aboriginal and Torres Strait Islander people. Partnerships also provide a mechanism to effectively engage with communities on their goals and priorities for health.

The Australian Government will seek to partner with state and territory governments and Aboriginal and Torres Strait Islander people and their representatives to implement the priorities outlined in this Health Plan to ensure that its implementation will meet the diverse needs of Aboriginal and Torres Strait Islander Australians of all ages, backgrounds and locations. These priorities were derived from the feedback received through the consultation process, written submissions and other evidence.

Accountability

Structures are in place for the regular monitoring and review of implementation as measured against indicators of success, with processes to share knowledge on what works

“This is the future of reconciliation and it has to involve all Australians in closing the unacceptable gap in life expectancy. So let us now be prepared to focus ourselves on this task, and to be measured and accountable on the success of our efforts” 7 Professor Mick Dodson, AM

This Health Plan will direct future action. Implementation arrangements will be developed by the Australian Government and each state and territory government in the context of their targeted activity. The non-government sector will be encouraged to demonstrate their commitment to action by aligning their strategic planning to include reference to this Health Plan.

The Australian Government is committed to high quality monitoring and evaluation, and to public accountability for its efforts to close the gap in Aboriginal and Torres Strait Islander disadvantage. Progress targets for the Health Plan will be developed using best practice methods 8 which are specific, measurable, achievable, realistic and time-bound. In support of this, the Health Plan will include the development of high quality measurement systems – which align reporting systems, data development priorities and target setting with strategic priorities.

Further details on accountability and monitoring mechanisms are provided in the ‘Implementation’ section of this document. Top of page