The new plan aligns with the National Agreement on Closing the Gap. It charts a new way forward for governments at all levels to work in true partnership with Aboriginal and Torres Strait Islander people, communities and organisations.
A new approach to Aboriginal and Torres Strait Islander health and wellbeing
Well, welcome everybody to the launch of the National Aboriginal and Torres Strait Islander Health Plan for 2021 to 2031 – a 10-year plan to help improve Indigenous health. And I just want to acknowledge Donna Murray, Tom Calma, Dawn Casey, Pat Turner and so many others who’ve assisted in the development of this plan. We know the challenge, Indigenous life-expectancy is still well below that of the Australian average. We know that the incidence of Health related issues is higher, but access to treatment is lower. That’s the central challenge. And the job will not be done, the gap will not be considered closed, until there’s no gap. There’s a no gap policy. That’s the only acceptable outcome - parity in health. So, the progress has been great. Whether it’s in terms of our children’s health, whether it’s reduction in smoking rates, whether it’s reduction in mortality, increase in life expectancy. But there is still a significant gap. And therefore, that’s why we need this 10-year plan, which is the result of a partnership. It has been developed by the Indigenous community for the Indigenous community, and it’s been our privilege and pleasure to assist in that process and our great responsibility to ensure that this is put into action. At the last budget, over $781 million dollars of additional funding for Indigenous health. But this plan sets out a pathway to making real differences. And it covers three broad areas, firstly, we need to recognise the social determinants of health, education, employment, housing, all of these have a profound impact on health. And health in turn, can have an impact on them. And so, it has to be a comprehensive solution for Indigenous Australians. The second thing is the health markers themselves. Of working to ensure that there is access and there are initiatives which we are taking in the coming mid-year economic forecasts, which build on the $781 million dollars that we put in place in the last budget and the work of previous years. And in particular, this is about focusing on access to doctors and the great revolution of telehealth, as well as incentives for medical professionals to operate in Indigenous Australia are so important. But the training of young Indigenous Australians as doctors, as nurses, allied health professionals, Indigenous health workers. That is indispensable, because if people come from community, they arere more likely to understand community and to come back to community. So, that workforce is such a critical and indispensable part of the task. And then lastly, there are specific initiatives. For me, working with Pat, and Dawn, and Donna, and Tom and so many others. The goals of ending avoidable Indigenous blindness by 2025, of ending avoidable Indigenous deafness by 2025, of ending rheumatic heart fever as a fatal condition by 2030. These are real, tangible, significant, not to be compromised upon. These are things for which to fight, and it’s my privilege to be able to join you in that battle around tangible specific goals, which will deliver better outcomes. There are so many things. I want to thank you and honour you for your work in developing this Aboriginal and Torres Strait Islander Health Plan for 2021 to 2031, and I am delighted to launch the Indigenous Health 10-year plan.
Ms Donna Murray and Professor Tom Calma:
Hello. I’d like to acknowledge the traditional custodians across the lands on which we’re meeting on here today, the Ngunnawal peoples of the ACT and surrounding region. I’d also like to acknowledge the traditional custodians across all of our nation groups and lands in which we have lived and looked after our waters, lands and seas for over 60,000 years. And thank our ancestors for the knowledges, the leadership, the perspectives and the strength to move forward with Aboriginal and Torres Strait Islander peoples. I’m Donna Murray, I’m the CEO Indigenous Allied Health Australia, and I’m here with Professor Tom Calma as the Chair and Deputy-chair of the Aboriginal and Torres Strait Islander Health Plan Working Group. This Health Plan could not have been achieved without Aboriginal and Torres Strait Islander people voicing their needs, aspirations and goals as determined by your families and communities. As Aboriginal and Torres Strait Islander people we know what is best for our health and wellbeing. We are the holders of our own cultural knowledges, our languages and our practices. It has been an honour to work with the Aboriginal and Torres Strait Islander health experts of the Health Plan Working Group and Implementation Plan Advisory Group. We have worked in true partnership with government to develop this Health Plan, and we have ensured that it reinforces the importance of strengths-based and rights-based approaches that imbed the cultural determinants and the social determinants of health. These approaches reflect our holistic ways of knowing and being that have continued unbroken for over 60,000 years. And this includes the fundamental role that connection to country, family, kinship and community play in our health and wellbeing. For there to be real and sustained change, health and wellbeing must be self-determined and relative to place-based needs. This means aligning new and current investment with the Health Plan to ensure that it embeds our priorities. To enable real change, government policy-making and program implementation must include Aboriginal and Torres Strait Islander self-determination, governance and leadership. We look forward to continuing to work on these partnerships with governments.
The Health Plan reflects the vision of Aboriginal and Torres Strait Islander peoples. We want to enjoy long, healthy lives centred in culture with access to services that prevention-focused, culturally-safe and responsive, equitable and free from racism and discrimination. Our people and cultures are strong and resilient, and we have continued to see change and drive efforts for self-determination in health in all levels of our lives. But without a seat at the table, we will continue to see policies and practices implemented by governments that do not realise their full potential. For change to occur, our voices must be heard and departments and governments at every level must hear us. There must be shared commitments to truth telling and systemic change. Aboriginal and Torres Strait Islander people’s health is everybody’s business. All governments and sectors, including the mainstream, must work to ensure the whole health system is responsible to the needs of Aboriginal and Torres Strait Islander Health peoples, irrespective of where we live or who we are affiliated with. The Health Plan includes a long-term vision to eliminate racism with immediate action to address racism and discrimination across the health system. The Plan compliments the National Agreement including Priority Reform Three that aims to transform government organisations to work better for and with Aboriginal and Torres Strait Islander Health peoples. The development of this Health Plan demonstrates what can be achieved and when partnerships are based on empowerment, trust and mutual respect. It is this model of co-design practice that will set the standard for inspiring change across the whole health system and beyond. We hope that areas beyond the health sector can learn from the approach and work with us to close the gaps in health and life outcomes for our peoples.
Ms Pat Turner:
Hello, my name is Pat Turner and I’m the CEO of NACCHO and the Lead convenor of the Coalition of Peaks. I want to acknowledge the traditional custodians on the lands I am speaking from today, here on Ngunnawal country. I welcome the release of the National Aboriginal and Torres Strait Islander Health Plan 2021 to 2031. This Health Plan has four key priorities, working in partnership to build the Aboriginal community controlled health sector and its workforce, a focus on preventive health care, improving the system as a whole and building the evidence base around the health of our people. The Plan embeds and integrated life-course approach to Aboriginal and Torres Strait Islander health care and prioritises our holistic model of care. Critically, the Plan recognises the significant role the Aboriginal community health sector plays within Australia’s health care architecture. Our ACCHO sector is leading the way in the delivery of comprehensive primary health care services for Aboriginal and Torres Strait Islander People. This plan will guide future health policies and programs for Aboriginal and Torres Strait Islander people. Implementation will enable ACCHOs to strengthen and grow so that they can continue to deliver integrated care and primary health care services over the next 10 years. It’s been a pleasure to work in genuine partnership with the Department of Health and other members of the advisory committee to jointly develop this strategy. This approach ensured that Aboriginal and Torres Strait Islander voices led the way and reflects the needs and aspirations of our people. I look forward to continuing to work in partnership with the Department of Health and mainstream health services to drive the change that is needed to improve the health and wellbeing outcomes for Aboriginal and Torres Strait Islander people, in alignment with the National Agreement on Closing the Gap.
Kaya Wanju - hello and welcome. Thank you for inviting me to address the launch of the National Aboriginal and Torres Strait Islander Health Plan 2021 to 2031. I’m joining you from Ngunnawal country and my pay my respects to elders past, present and emerging. I’d also like to acknowledge the traditional owners of all the lands and waters across Australia. I’m pleased to join my ministerial colleagues, and Aboriginal and Torres Strait Islander health leaders, in launching this landmark plan. The Health Plan is the culmination of strong partnerships with Aboriginal and Torres Strait Islander people, and demonstrates what can be achieved when we all work together. In fact, the Health Plan has embedded all four Priority Reforms of the National Agreement on Closing the Gap and will drive progress against its health specific targets. The Health Plan will address the Priority Reforms by continuing to have a strong focus on shared decision making and partnerships during the implementation, operating across all levels of health planning and service delivery; building the Aboriginal and Torres Strait Islander community controlled health sector to deliver high-quality comprehensive primary health care services; growing and sustaining Aboriginal and Torres Strait Islander representation and leadership across the health, disability and Aged Care workforces; improving collection, access management and use of data at the local level, giving communities ownership and control over their data. Ensuring that Indigenous Australians are leading the decisions that impact on their own health and wellbeing will accelerate progress to improvement. I am very pleased the Health Plan reflects the diversity of Aboriginal and Torres Strait Islander people as well as the importance of the cultural and social determinants of health and wellbeing. It has been in partnership that we have developed the health plan ,and it’s with our continued collective efforts that we will ensure Indigenous Australians enjoy the same health outcomes as all other Australians. Thank you and thank you for your endeavours.
Elders have a special place for Aboriginal and Torres Strait Islander people. They are the knowledge holders, caregivers, leaders and teachers. I welcome the National Aboriginal and Torres Strait Islander Health Plan for recognising the place of Elders, and the importance of living well into old age – a key focus of the Australian Government.
While Aboriginal and Torres Strait Islander people are living longer, so are all other Australians. That means the gap in life expectancy hasn’t narrowed. I am pleased to say that it is key focus of the new National Agreement, which seeks to Close the Gap in life expectancy within a generation, by 2031. The Health Plan recognises that different factors impact ageing well in different stages in life, and that we all need to work together in partnership with Aboriginal and Torres Strait Islanders to bridge the gap in life expectancy. The Health Plan has a strong focus on culturally safe and responsive aged care that supports connection to culture, Country, family and community. As heard through the Aged Care Royal Commission, this includes the need for aged care services to be delivered by Aboriginal and Torres Strait Islander providers. The Government’s aged care reform package, which responded to the Royal Commission, includes over $570 million dollars to improve the experience and care of older Aboriginal and Torres Strait Islander people. We are assisting the Aboriginal Community Controlled Health Services to expand into aged care and increasing Aboriginal and Torres Strait Islander participation in the aged care workforce. As the Minister for Sport, I welcome the whole of life approach that the Health Plan takes to ensure Aboriginal and Torres Strait Islander people remain active as long as possible and make healthy lifestyle choices, including good nutrition. We want to see Aboriginal and Torres Strait Islander people enjoy long and healthy lives, from birth, right through to their place as Elders in the oldest living culture.
Hi, almost two thirds of Aboriginal and Torres Strait Islander Australians live in inner regional, outer regional, remote or very remote areas, and these populations already have poorer health outcomes than people living in metropolitan areas, just due to their location. The National Aboriginal and Torres Strait Islander Health Plan for the decade recognises that care for Aboriginal and Torres Strait Islander people needs to be place-based and centred on the person. Health services and organisations need to respond to the different experiences across urban, regional and remote locations. The Plan includes a focus on important environmental aspects such as housing, food and water security, and risk factors such as alcohol, tobacco and other drugs which can be heightened in rural and remote areas. Aboriginal and Torres Strait Islander people living in remote areas usually access primary health care from a GP who is part of an Aboriginal Medical Service or a community clinic. And that’s why the Health Plan has a focus on extending the reach of community controlled health services into areas of unmet need. This includes a focus on sustained capacity building to improve culturally safe service coverage and access to Care on Country. It also requires the continued expansion of point-of-care testing, telehealth and other digital technologies. The Plan recognises that a placed-based approach is also critical for culturally safe responses in times of challenge, such as what we’ve seen during the COVID-19 pandemic. Finally, the Plan seeks to grow the Aboriginal and Torres Strait Islander health workforce in rural, regional and remote areas. As the Minister for Regional Health, I welcome the Plan’s vision for Aboriginal and Torres Strait Islander Australians living outside the cities.
Well I join Minister Hunt, Minister Wyatt and others in welcoming the release of the National Aboriginal and Torres Strait Islander Health Plan 2021 to 31. As in too many other areas of health, Aboriginal and Torres Strait Islander people disproportionately suffer mental ill-health and suicide. Aboriginal and Torres Strait Islander people are 2.4 times more likely to experience psychological distress than non-Indigenous adults. And tragically, the suicide rate is nearly twice the rate of non-Indigenous Australians. We all have a collective responsibility to change this, and it is something that the Australian Government is deeply committed to. The refreshed Health Plan has clear priorities for improving outcomes in mental health, suicide prevention, and social and emotional wellbeing. It includes a focus on the protective aspects of culture, spanning the relationships between individuals, families, kin and community, as well as connection to land, language, and culture. Importantly, the Health Plan ensures a wraparound approach to mental health and suicide prevention. It embeds collaboration across governments and portfolios at all levels, with mainstream health and mental health programs, private and non-profit sectors, and Aboriginal and Torres Strait Islander services and organisations. The Health Plan’s approach aligns with key policies, including the National Agreement on Closing the Gap and the National Mental Health and Suicide Prevention Plan announced in May of this year. As well as our recent $79 million dollar budget package for Indigenous Australians, which includes the establishment of culturally sensitive, co-designed aftercare services for Indigenous Australians, and a 24/7 crisis line that will be governed and delivered by Aboriginal and Torres Strait Islander peoples in partnership with Lifeline and Gayaa Dhuwi. I applaud the Health Plan for its strong focus on suicide prevention and mental wellbeing. As with other health issues addressed in the plan, Aboriginal and Torres Strait Islander-led solutions, coupled with culturally safe and responsive support services, will be vital for progress.
The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 changes the way governments work with Aboriginal and Torres Strait Islander people to achieve better health outcomes. Developed in real partnership with Aboriginal and Torres Strait Islander people, it reflects their priorities and embeds a holistic perspective of Aboriginal and Torres Strait Islander health. This perspective recognises the influence of social factors, and the strengths of culture as a protective influence on physical, social and emotional wellbeing.
The plan focuses on preventing health issues before they occur. It aims to give Aboriginal and Torres Strait Islander people and communities the skills and knowledge to:
- make healthy decisions
- effectively navigate the health system.
This includes through the delivery of health care that is:
- place based
- person centred
- culturally safe and responsive.
The plan prioritises Aboriginal and Torres Strait Islander community controlled services as they are best placed to deliver these services. It also affirms the clear responsibility of mainstream services to be culturally safe and responsive.
The plan’s focus on holistic and place-based care will provide the best opportunity for Aboriginal and Torres Strait Islander people to live long, healthy lives that are centred in culture. It enables access to services that are prevention-focused, culturally safe and responsive, equitable and free of racism.
Alignment with the new National Agreement on Closing the Gap
The new National Agreement on Closing the Gap commits all governments to a new era of partnership and shared decision-making to close the gap in life outcomes for Aboriginal and Torres Strait Islander people. It recognises Aboriginal and Torres Islander people know what is best for their people and communities. It also acknowledges that the unique strengths of Aboriginal and Torres Strait Islander knowledges and cultures are critical to driving real change.
At the centre of the national agreement are 4 priority reforms to ensure we as governments change the way we work with Aboriginal and Torres Strait Islander people. These are:
- Priority Reform 1 – Formal partnerships and shared decision making
- Priority Reform 2 – Building the community controlled sector
- Priority Reform 3 – Transforming government organisations
- Priority Reform 4 – Shared access to data and information at a regional level.
The plan aligns with the new national agreement, and is the first national health document to address the priority reforms. It embeds self-determination, partnership and shared decision making as the best way to close the gap in health outcomes for Aboriginal and Torres Strait Islander people.
The plan is also the first national health document to drive progress on the 3 health targets of the new national agreement:
- Close the gap in life expectancy within a generation by 2031.
- Increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91% by 2031.
- Achieve a significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.
Developing the new plan
We developed the plan in genuine partnership with Aboriginal and Torres Strait Islander people and communities. It shows what we can achieve when co-design is based on empowerment, trust and mutual respect. The following working groups led plan development:
- Aboriginal and Torres Strait Islander health experts of the Health Plan Working Group (HPWG)
- Implementation Plan Advisory Group (IPAG).
The plan also embeds the experiences and voices we heard through the My Life My Lead community engagement process, which taught us that:
- genuine partnerships with communities achieves the best results
- we cannot ignore the impacts of trauma on poor health outcomes
- systemic racism and a lack of cultural capability, cultural safety and cultural security remain barriers to health system access.
An approach to Aboriginal and Torres Strait Islander health based on cultural and social factors requires input from different areas. A part of developing this plan was engaging with a wide range of partners across:
- Australian Government departments, portfolios and agencies
- state and territory governments and health authorities
- mainstream health organisations and services
- Aboriginal and Torres Strait Islander peak bodies and organisations
- Aboriginal and Torres Strait Islander community controlled health sector and services.
While the existing plan is not due to expire until 2023, updating it in 2021 was a unique opportunity to strengthen this coordinated approach to Aboriginal and Torres Strait Islander health policy. We developed it alongside the:
- new National Agreement on Closing the Gap
- 10-Year Primary Health Care Plan
- 10-year Preventive Health Strategy
- 10-Year National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan.
Aligning with these new reforms means we can make better progress towards improving health and life outcomes for Aboriginal and Torres Strait Islander people.
Implementation, governance and accountability
The next step for the plan is to carry the commitment to self-determination and partnership through all aspects of implementation, governance and accountability. We will develop these mechanisms in partnership with Aboriginal and Torres Strait Islander health experts and state and territory governments over the coming months.
All mechanisms for the plan will embed Aboriginal and Torres Strait Islander leadership. Governments will partner with Aboriginal and Torres Strait Islander experts to co-design culturally safe and responsive accountability mechanisms for the plan at a national level. States and territories have the flexibility to implement the plan in the way that works best with their local policies and priorities. This ensures that delivery, monitoring and evaluation of health initiatives are adaptable and responsive to the needs and priorities of people across:
- urban, regional, rural and remote locations.
All mechanisms will be appropriate, relevant and hold the mainstream accountable to Aboriginal and Torres Strait Islander people.
Prioritising the community controlled sector
The plan recognises the vital and existing efforts of the Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) in providing care that is:
- high quality
- culturally safe
- trauma aware
- healing informed.
The plan will support and strengthen the role of ACCHSs, including expanding the reach of ACCHSs into areas of unmet need. This ensures that the sector is:
- strong and sustainable
- equipped to deliver holistic primary health care services that meet the needs of Aboriginal and Torres Strait Islander people across Australia.
The sector will continue to play a crucial role in:
- advocating for communities
- providing culturally informed advice to governments
- supporting mainstream services to establish relationships with communities and understand their needs.
The leadership of the sector in these partnerships will drive the whole health system to be more accountable, culturally safe and responsive.
Accountability of the mainstream health system
The plan will ensure the mainstream health sector is responsible and accountable for providing culturally safe and responsive care. This includes:
- measuring and responding to experiences of racism
- working in partnership with Aboriginal and Torres Strait Islander organisations to set and meet cultural safety training and accreditation standards
- working in partnership with Aboriginal and Torres Strait Islander organisation to develop and deliver person-centred care that is culturally safe, responsive, trauma-aware and healing-informed
- increasing Aboriginal and Torres Strait Islander representation at all levels of health workforce, leadership and governance.
Accountability of governments
Unlike the current 2013–2023 plan, which is Commonwealth only, the new plan is a national document that all states and territories have agreed to. This means that governments at all levels will be jointly accountable for:
- implementing the plan
- making sure it achieves progress on its priorities and objectives.
- prioritising and strengthening the Aboriginal and Torres Strait Islander community controlled health sector
- driving structural change in mainstream health to ensure it is culturally safe and responsive.
The release of the plan presents an opportunity to line up existing and future investment with its new approach to Aboriginal and Torres Strait Islander health. By capitalising on this funding, the plan can improve health outcomes by guiding policies and programs towards culturally safe and responsive care.
We look for opportunities to align our investment with the plan, including the over $1 billion annual investment through the Indigenous Australians’ Health Programme. This year we announced:
- $254 million to improve infrastructure in community-controlled health services
- $45 million to improve healthy birthweight under the National Agreement
- $781 million, predominantly for aged care and mental health.
These measures all strongly align with the priorities in the plan.
Further opportunities, including through funding reprioritisation, will be identified as we begin the important task of implementing the plan.