We hear a lot about Closing the Gap, but it is also important to address the “credibility gap” in Aboriginal and Torres Strait Islander health.
This refers to the gap between what is promised and what is delivered on the ground, as well as the lag between the development and the uptake of evidence-based programs and policies.
That’s according to Professor Kerry Arabena, Chair for Indigenous Health at the University of Melbourne, and Director of the Onemda VicHealth Koori Health Unit, which will host this symposium, Closing the Credibility Gap: Implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013- 2023 next week (21-22 November).
The symposium – a free, public event – is timely given ongoing uncertainty about the Federal Government’s plans for Aboriginal and Torres Strait Islander health.
Journalist Marie McInerney will report on the symposium for the Croakey Conference Reporting Service, and previews some of the key themes in this Q and A below.
Welcome to a “festival of ideas” from Aboriginal and Torres Strait Islander leaders
Q. The symposium is focused on the way ahead for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Why have you chosen ‘Closing the Credibility Gap’ as the title, and what do you want the symposium to explore?
Kerry Arabena: The Closing the Gap campaign has been a very important focus for a whole raft of activities across government, non-government, and community controlled health organisations.
Through this campaign we have been able to get better results from collaborations and partnerships, clinical and community interventions, firmer data to build evidence based policy, and be quite exact about what works with individuals and groups of people.
Closing the Gap has helped us also consider the impact of where people live – whether urban, regional, rural or remote and what stage of life they are in to better frame health messages, health interventions and health services.
At the symposium, we will hear from Aboriginal and Torres Strait Islander leaders with practical experience, academic backgrounds and professional expertise about how we close the ‘credibility gap’ – that is, the gap between what we say we’re going to do and what’s actually done in our communities.
I think we spend a lot of time, in research particularly, describing what the problems are and the kinds of systemic issues that generate those problems. With the implementation of the new National Aboriginal and Torres Strait Islander Health Plan, the last thing we want is to have another 10 years of describing the problem, how people respond to the problem, and how individual professions can address the problem.
What we want is evidence-based interventions that work, that produce positive, measurable results.
It’s also about closing the credibility gap in public policy: after we generate a worthy piece of evidence that has been peer reviewed, that has demonstrated effectiveness, the lag time for its uptake into public policy is far too long.
An example in my own experience has been the systematic way in which we did population-based work on sexually transmitted infections. Our interventions were able to demonstrate that opportunistic testing for gonorrhoea and chlamydia generated good treatment outcomes. It took about 3 years for policy to catch up with that and resource opportunistic testing in ways that meant the health hardware was in place, and professionals were supported to use it.
We have to shorten the period of time between evidence and practice. This requires us to invest in credible health system responses to critical and complex issues.
Q. What messages do you expect to come from the symposium?
Kerry Arabena: I think we are going to hear some incredible stories of success, extraordinary stories of facing and meeting challenges often in adversity, we will hear about people who have been completely innovative because they’ve worked in chronically under-resourced sectors and others who have become entrepreneurial in the way they deal with the complexity of issues facing us.
Many of these will involve best practice – for example on health promotion with diverse and marginalised communities, and mental health and wellbeing for our young people – that can offer many lessons to mainstream communities. On implementation, we are going to hear about regionalised strategies, about person-to-person management processes, and different models of case and clinical management, from people who might be frustrated about what’s happened in the past but still hopeful about what the future holds.
There are too many highlights to mention here but one person I’m very excited to hear from is Dr Misty Jenkins, who I believe is going to be one of Australia’s national treasures. She recently won a prestigious Women in Science Fellowship for her work on cancer research and ‘killer T cells’, has studied at Oxford Uni, and been mentored by Nobel Prize winning immunologist Professor Peter Doherty. She is a young Gunditjmara woman who grew up in Ballarat, is incredibly smart, and is absolutely someone to watch in this space.
Q: At the launch of the Health Plan in July 2013, the National Aboriginal Community Controlled Health Organisation (NACCHO) said:
“Critically, the plan moves Aboriginal health from being viewed in a clinical and isolated way and instead adopts a more holistic approach – considering social and emotional wellbeing, mental health, the impacts of drug and alcohol and the importance of culture as all part of a broader health picture.”
What do you see as the main strengths and weaknesses of the plan? Can you give some concrete examples to explain why culture is important for health and wellbeing?
Kerry Arabena: Since we have had the framework for Closing the Gap in health and the commitment to meeting the targets through the Council of Australian Governments (COAG), we’ve seen an unprecedented level of investment and partnerships between government, community and the private sector which has meant, for the first time in a very long time, we actually have the resources to meet the needs that people have.
This new Aboriginal and Torres Strait Islander Health Plan took a year to develop, with a comprehensive consultation process, and it is really very bold and, I think, quite visionary. For example, I’m very pleased to note for the first time ever we will be dealing with the issue of racism through the Health Plan.
Also, as the former Chair of the Aboriginal and Torres Strait Islander Dementia Advisory Group, I’m very pleased with its focus on healthy equity and quality of life in ageing. Our Elders need our concern and our support to have good quality of life, all the way through their lives.
This plan provides a foundation for dealing with emerging issues. That speaks to not only the commitment of government to take a longer-term view but also the sophistication of Aboriginal and Torres Strait Islander health leadership: that we do take a longer-term view, that we do think inter-generationally and that we are committed to meet the challenges and to have a vision about the quality of life that we want, how we need to get there and who we need to partner with on the way to make it happen.
We are working across those well-established silos into the fields of justice, housing and environmental health services, drugs and alcohol work, in education and employment. That, I think, has been a generational shift.
Wanting a good quality of life throughout our lives does not differentiate us from the aspirations of mainstream Australians. The point of differentiation is around the positive aspects of culture and resilience that are also enacted through this Health Plan. As part of those consultations, I was able to hear one of my Elders say that ‘culture is prevention’.
There is evidence that shows, for example, that young people who have access to country and language have better health outcomes and educational participation rates than those who don’t. There are lots of ways in which the ceremonies that help mark transitions between childhood and adulthood are still important to social and emotional wellbeing, and the development of the kinship relationships in those communities that really do add to resilience, not just for individuals but also for families.
There are important roles and responsibilities that grandmothers and grandfathers play in the raising of children, there are critical moments in a person’s life where they will need support from external or extended members of family, rather than from intimate family members.
There are investments being made in people relearning language and re-engaging with custom and customary practice, which are foundational to empowering communities. So I really do see that this is a central tenet not only of this plan but of a way of living and life that a lot of Aboriginal and Torres Strait Islander people yearn for, and that a lot of mainstream people look to the positive aspects of our culture, to our extended families and feel they might be lacking, or worse that they have ‘no culture’.
The weaknesses of the Plan will come to pass in about five years time when what is said in the plan is either not well resourced, is not measured, is not evaluated. We have a strong vision, and a lack of understanding about what we are implementing, how this is being measured, what to prioritise, and what has changed as a result of the plan being in place are the risks.
Q: Prior to the September federal election, the Coalition was quoted as saying the plan was ‘another exercise in political spin’ and nothing more than ‘business as usual’. Where does the Coalition stand on the plan now? Have you had any indication of whether Warren Mundine is supportive? What would be the implications if the Government were to abandon the plan?
Kerry Arabena: I believe it’s worth being concerned that it will be abandoned, absolutely. As the Chair of the National Aboriginal and Torres Strait Islander Health Equality Council, I have not yet heard whether our group has been disbanded or not (by the new Government). Traditionally, plans that belong to one government are thrown out when a new one comes in.
However, I know there has been a heavy campaign to Warren Mundine, to Tony Abbott, to others who might put their hands up to be members of the new Indigenous Advisory Council, to recognise the value and worth of the process of developing the National Aboriginal and Torres Strait Islander Health Plan. From what I understand, there is genuine support from Warren for the Health Plan itself and there will be a number of organisations meeting with him in the coming weeks and months to speak on the value of the plan and its implementation.
Traditionally the Liberal Party has done well on implementing positive health plans for Aboriginal and Torres Strait Islander people. In my own experience, Michael Wooldridge was an excellent Health Minister (in the early Howard Government years), and genuinely committed to the health and well being of Aboriginal and Torres Strait Islander people.
Certainly when no one was else was talking about sexually transmitted infections (STIs), HIV, blood borne viruses, and needle exchanges, he was receptive to those ideas, understood the value of what it was we needed to do and, because of his efforts we were able to make systematic changes that transformed the way STIs and HIV has been dealt with in our community. I‘ll never forget that personally and I hope I see that again.
Q. What needs to happen next? Who needs to do what to ensure this plan is implemented and makes a real difference to peoples’ lives?
Kerry Arabena: We want to see a commitment to implementing it in a way that builds on successful programs, not throwing money at the ‘same old, same olds’ that describe problems but don’t generate the kinds of results we need.
So implementation needs to be focused, to be effective, and we need to be able to evaluate that effectiveness and feed it back through the health system, through communities, services, policymakers and researchers, and back into practice again.
I will be deeply saddened if the evaluation process is not taken as an opportunity to strengthen our own workforce through the plan. I would have thought there would be many Aboriginal and Torres Strait Islander people who might be able to get Masters degrees and Doctorates to do that work, whether they be in community controlled, primary health or our health system services. There is much to do.
Q: The plan aims to create a health system free of racism and inequality. It quotes one of the participants in the consultations as saying: “The failure of mainstream services and Aboriginal and Torres Strait Islander people’s ability to access mainstream services, lies at the heart of continuing health disadvantage.” When you enter a mainstream health service, what do you look for as indicators that it is welcoming and inclusive for Aboriginal and Torres Strait Islander peoples?
Kerry Arabena: That’s not an easy question. Racism can be quite overt but also quite intimate. A recent Victorian surveyfound one in three Koori people said they had experienced racism in a mainstream health service.
The big thing for us is making sure that people feel safe, not only as clients but also as practitioners in multicultural and multi-disciplinary teams. At the symposium, Professor Yin Paradies from Deakin University will be looking at what is needed for a culturally respectful and non-discriminatory health system.
Q. The plan notes that Aboriginal Community Controlled Health Organisations are central to improving the health of Aboriginal people in their communities and that participation by Aboriginal people in decisions relating to their health must be supported. A recent evaluation suggests there is wide variation in the capacity of health services to provide effective care for Indigenous patients with chronic diseases. What is needed to help improve the care provided by under-performing services in the community-controlled sector? And in the mainstream health sector?
Kerry Arabena: That’s an issue that might come up at the symposium as part of key infrastructure for implementing the National Health Plan. I honestly don’t know what will happen under the new Government with regard to the Aboriginal Medical Service organisations that are struggling with governance issues.
I do know within the sector there is a lot of support available through peak bodies like the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and Aboriginal Health and Medical Research Council (AH&MRC) to make sure none of their services go into administration. Not only do they support AMSs with governance issues, they provide professional development opportunities, practical support and advocate on behalf of organisations that often do not have the necessary resources to meet the requirements with the 50-plus contracts they often have to sign off in order to keep them solvent.
There is also additional support through organisations like Office of the Registrar of Indigenous Corporations (ORIC) and of course through units in universities like Onemda that has a history of evaluating programs for AMSs. The symposium will also be discussing a number of exemplar health initiatives and health services that really focus on community control.
Q. The plan signals the need to expand the focus on children’s health to broader issues in child development. What priorities do you want to highlight?
Kerry Arabena: I want to look at brain health and development. Again from my experience of working in the aged care sector, I know absolutely that child brain health development has enormous impact on the quality of life you have in your older years. And so maximising the opportunities for good brain development, from your preconception to the quality of nutrition that a mother has, the amount of stress she experiences while she carries you – all these kind of issues make up an important and emergent area of work.
Also I think there is enormous scope to follow up on the great work done at the University of Melbourne by Associate Professor Jane Freemantle on the ‘indigeneity’ of fathers that has identified an additional 8,000 Koori kids in Victoria because of her data linkage project which counted not only the Aboriginality of the mother but of the father, so we’ve got at least a good census about who our children are and what are their experiences in school, of nutrition, of poverty, of being cared for at home or out of home.
Programs like the Abecedarian Project in Australia which is starting to engage six-month-old children and their parents in books, looking to learn and develop literacy skills, will, I think, have measurable positive impacts that will assist our children transition into school at age 5.
And for the first time in a very long time we’ve got a workforce of Aboriginal and Torres Strait Islander people who are able to engage with children’s health and wellbeing.
Q. What do you hope the symposium achieves, particularly in terms of informing ‘the novice and the expert’ alike, as you note in your preamble?
Kerry Arabena: It will be one of those rare opportunities, a free public event, where an audience can participate, listen, learn, and see Aboriginal and Torres Strait Islander people in ways which are not well represented in the media.
Here we are, standing loud and proud talking about some excellent work that we’ve done with groups of people in our own community that others have tried and failed in.
It’s like an extension of the University of Melbourne’s Festival of Ideas, one of those opportunities to really showcase excellence, not only through the way we do our business but also in the way we can share information about what we’re doing.
Q. If you could spend a day with Tony Abbott and Peter Dutton, where would you take them? What would you want to show them, and what messages would you like them to take away from the experience?
Kerry Arabena: I would take them to the symposium! They celebrate success, they want people to be engaged in the workforce, they want people to make a contribution to the nation and I think this would be a fantastic opportunity for them to see all of us in very real ways contributing to building our nation by working within our communities.
Tony Abbott, I know, goes out and does volunteering around the country. I’m on the board for Indigenous Community Volunteers and there are many successful projects happening with local, regional and national application, and I think he could have some good ideas around that.
Minister Dutton will have a lot of people bombarding him at the moment with ideas and strategies and investments that he needs to make. I’d like to bring him into a planning workshop with some of our Aboriginal and Torres Strait Islander leaders in health, education, justice, native title, so he can really sit down and engage with us around things that are going to make a difference. He would, I’m sure, have ideas to contribute and he’d have the same right as all of us to be heard.
• Croakey’s coverage will be compiled here.