So far in this report we have taken the ‘big’ view of the effects of primary health care on the health of Indigenous populations. We have looked at the strongest evidence (life expectancy, mortality rates) at the level of nations or (in Australia) States and Territories. The results show strong evidence internationally for the positive effect of primary health care, but weaker evidence within Australia.
We suggest that – despite the increased investment in Indigenous primary health care over the last ten years and some positive changes in the health status of the Aboriginal and Torres Strait Islander population – the relative weakness of the evidence in this country is primarily a result of the only modestly increased investment in primary health care and the continuing negative pressure of the social determinants of health.
The relative weakness of the evidence at the national / jurisdictional level, however, must be counter-posed to local evidence, from numerous sources, of the positive effects of primary health care in Aboriginal and Torres Strait Islander communities.
Some of this evidence includes outcome measures, including mortality. A selection of these is presented as case studies below.
However, there are a number of other services and approaches to which our attention was drawn during the consultations for this review. The data supporting the effectiveness of these services are backed by the opinion and experience of practitioners with a long history in the field, and are positive examples of Indigenous primary health care practice.
Central Australian Aboriginal Congress, Alice Springs119Congress is one of the oldest and largest Aboriginal community-controlled health services in the country, providing a wide range of clinical and other health services. Their excellent data on service provision feeds into a continuous quality improvement cycle. Some key points about their service delivery model include:
- very high access rates, with nearly all Aboriginal people living in the catchment area being seen each year;
- a male health program to encourage (especially young) men to attend the clinic and to provide them with social and emotional well-being support;
- women’s health and maternal care provided through Congress Alukura;
- a life-course approach to health care, beginning with maternal health and child health, youth health (including primary prevention and early intervention services), adult health checks (with a concentration on effective clinical management of chronic disease), and support for older people;
- strong partnerships with other communities, including providing management and staffing support to a number of remote community health services in Central Australia;
- public advocacy on broader health issues, especially petrol sniffing and alcohol availability, and the social determinants of health; and
- strong participation at the Territory and national level in Aboriginal health policy, as well as broader issues of self-determination and community control.
Tasmanian Aboriginal Centre120The Tasmanian Aboriginal Centre has over three decades of history in advocating for the rights and health of the Aboriginal people of that State. They have a strong emphasis on the effect that racism and the colonial experience have had – and continue to have – on the health of Aboriginal communities. Aboriginal community controlled health services are seen as being essential not just as ‘neutral’ deliverers of medical services, but also as important vehicles for the self-determination and independence which are the foundations of good health for communities.
The TAC’s focus on racism as an important contributor to poor Indigenous health – and particularly to mental health problems and higher risk of behaviours such as smoking and substance abuse – is beginning to receive greater academic and research attention.121
Victorian Aboriginal Community Controlled Health Organisation122VACCHO has recently published a list of case-studies of successful primary health care interventions in the community-controlled sector in Victoria. Usefully, they identify a number of key strategies for success in their region:
- the establishment of new services, involving extensive funding, advocacy, resources, planning, partnership-building and effort by both existing health services and the community itself;
- building strong partnerships with other organisations and with Government, with each partner bringing their expertise and perspective to a project;
- the need for a flexible approach that addresses the community’s health priorities, as a fundamental component of community control
- building research and evidence, particularly to ensure that evidence’ in the form of statistical data has is available to ensure that Aboriginal health issues are addressed;
- employment and training of Aboriginal community members, especially to provide opportunities for young people to become involved in the community and the health sector.
Redfern Aboriginal Medical Service, Sydney123The oldest Aboriginal Medical Service, Redfern has played a leading role in health service delivery and Aboriginal health policy for over thirty years. In the early 1980s, long before the current concentration on child and maternal health became an accepted core part of Indigenous primary health care, AMS Redfern developed a formal comprehensive shared care ante natal program in collaboration with staff at the King George V Hospital in Newtown.
It was possibly the first ever shared care arrangement between a primary health care service and a large hospital. Under the agreement, Redfern provided routine antenatal care until the late stages of pregnancy with clients required to attend King George V for scheduled specialist consultations. Regular meetings were held between staff of the two organisations to promote clinical best practice and to encourage culturally sensitive service delivery within the Hospital’s various facilities.
The program received strong community approval and was also highly successful in delivering clinical outcomes, such that after several years of operation, full term neonatal birth weight distribution was similar to the Australian average.
119 Personal communication from Dr John Boffa, Public Health Medical Officer, Central Australian Aboriginal Congress, and Central Australian Aboriginal Congress (2007) Business Plan Report 2006/07. Unpublished PowerPoint presentation.
120 Personal communication from Ms Heather Sculthorpe, Tasmanian Aboriginal Centre; Tasmanian Aboriginal Centre (2003) Public Health Issues for Islands of Small Populations: Tasmanian Aboriginal Perspective on Aboriginal Health Issues in Tasmania. Unpublished address to the Royal Australasian College of Physicians Annual Scientific Meeting, Hobart 2003. Heather Sculthorpe, Tasmanian Aboriginal Centre.
121 Paradies, Y., Harris, R. & Anderson, I. (2008). The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda, Discussion Paper No. 4, Cooperative Research Centre for Aboriginal Health, Darwin.
122 Victorian Aboriginal Community Controlled Health Organisation (2007) Communities Working for Health and Wellbeing: Success stories from the Aboriginal Community controlled health sector in Victoria. Victorian Aboriginal Community Controlled Health Organisation and Cooperative Research Centre for Aboriginal Health.
123 Personal communication from Dr Naomi Mayers and Dr John Daniels, Redfern AMS; Redfern Aboriginal Medical Service (nd.) The Aboriginal Medical Service shared antenatal care programme: an early case study in the efficacy of comprehensive, culturally appropriate primary health care. Unpublished paper.