Editorial

Abstract

There are two factors which will be absolutely critical if we are to truly make progress in improving Indigenous health. They are, in my view, the most important steps we can take to closing the gap between Indigenous and non-Indigenous health indicators, and our success or otherwise in achieving these two things will ultimately determine how we will be judged by future generations.The fi rst is increasing the number of Indigenous health professionals, but particularly nurses and midwives.Primary health care is the backbone of the health system and nurses and midwives are major contributors to primary health care. Indigenous health professionals are clearly best placed to provide high quality primary care to Indigenous people. They have the expertise and experience in Indigenous health issues as well as deep understanding of cultural, spiritual and community needs.The second most important way we can improve health outcomes for Indigenous people is to increase our understanding of how health care needs are best interpreted and met for each Indigenous person seeking health care.To turn to the fi rst point, we have a daunting task. Indigenous nurses constitute 0.8% of all nurses in Australia, while Indigenous Australians make up 2.4% of the population. To make these numbers 'even', we should ideally aim to triple the number of Indigenous nurses and midwives.While our job may be daunting it is not impossible. Our medical colleagues are proving it can be done. Between 1997 and 2010, Indigenous doctor numbers have increased from 15 to approximately 150 - a 1000% increase!There are many ways we can work together to raise the numbers of Indigenous nurses and midwives, but generally speaking these involve policy and structural changes which need to be implemented at least initially at the level of the system.My second point involving the interpretation of individual health needs is one which can be addressed locally at the health service level and by every one of us.At the outset I should note that I am referring to regional and urban centres as well as rural and remote communities given that only 25% of Indigenous Australians live remotely. Sydneybased Professor Behrendt (2011) reminds us:I am often asked, 'How often do you visit Aboriginal communities?' And I reply, 'Every day, when I go home'.le are correct when they say that government and other leaders need to take responsibility to close the gap. They absolutely do. But I believe that if we are to truly make a difference then it's up to each and every one of us as health professionals to take responsibility to do what we can.Taking responsibility is essential because the 'gap', while deplorable, is only the surface of the story. It is symptom, if you like, of much deeper disorder.We know that the difference in health indicators between Indigenous and non-Indigenous people refl ects profound and long-standing issues, and we must always remember that any measures which address the gap must take into account broader cultural and social factors. Professor Behrendt (2009) again:... this is not just a simple matter of 'closing the gap', as the popular political catch-phrase describes it. Equality, I would argue, is not simply matching the socioeconomic statistics and giving Aboriginal people and their children the same opportunities, it also includes ensuring that the space is given to ensure that Aboriginal culture and Aboriginal communities remain vibrant and strong and that Aboriginal identity and history is given space in Australia's national story. …