How can we do things differently in Aboriginal health? The same challenges seen through new eyes

Abstract

Partnership is a process that must be recognised as a fundamental part of any strategy for improving health outcomes for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians will require a sustained, coordinated and well-informed approach that works to a set of goals and targets developed with input from the Aboriginal community. Partnerships provide the most effectivemechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, effective partnerships harness the efforts of governments and the expertise of Aboriginal Community Controlled Health Services, which offer the most effective means of delivering comprehensive primary health care to Aboriginal people. Partnership is a process that must be recognised as fundamental to any strategy for improving health outcomes for Aboriginal people, both in New South Wales (NSW) and Australia as a whole. In 2011, the NSW Government reaffirmed its commitment to Aboriginal health by pledging to work with Aboriginal organisations, communities and advocates to devise a 10-year Aboriginal Health Plan for the State. In many ways NSW is at the beginning of a new era, in which a great deal of attention and energy is being directed across all sectors to close health gaps for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians, however, will require a sustained, coordinated andwell-informedapproach, one which is underpinned by long-term collaborations that work to a set of goals and targets developed in partnership with the Aboriginal community. Partnerships provide the most effective mechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, productive partnerships can effect positive change by harnessing the efforts of governments and health providers, along with the experience and expertise of Aboriginal Community Controlled Health Services (ACCHSs). ACCHSs are not only the most effective means of delivering comprehensive primary health care to Aboriginal people but are also a critical component of the overall health system. Such partnerships are designed to bring the experience and expertise of the Aboriginal community to bear at every level of the health-care system, including the identification of key issues, the development of policy solutions and the structuring and delivery of services. However, a practical approach to partnership also means recognising that all parties in a partnership are not the same, that there are different roles and responsibilities – and different accountabilities. With consultations and submissions for the development of the 10-year Aboriginal Health Plan for NSW currently underway, the Aboriginal Health and Medical Research Council of NSW (AH&MRC) believes it worthwhile to highlight in this article some of the key attributes of successful partnerships, both in general and specifically with the ACCHS sector. Advocating a partnership approach A partnership approach has long been advocated by government and ACCHSs as essential to addressing Aboriginal health inequity. In 1989, Australia developed its first National AboriginalHealth Strategy,whichwas the result of extensive consultations with Aboriginal communities and governments around the country. Before the development of this national strategy, the Commonwealth Government had no strategic approach to tackle the challenges surrounding Aboriginal health. The Strategy not only reinforced the important role of ACCHSs in improving Aboriginal health, it also criticised the ad hoc approaches to Aboriginal health which were then prevalent. With a mandate to improve coordination and achieve better health outcomes, the National Aboriginal Health Strategy strongly recommended better partnerships 48 | Vol. 23(3–4) 2012 NSW Public Health Bulletin 10.1071/NB11057 between Commonwealth and state governments, and between the Aboriginal community and government at all levels. Following the recommendations set out in the National Aboriginal Health Strategy, in 1995 theAH&MRC and the NSW Government led the country by establishing the first NSW Aboriginal Health Partnership Agreement. Guided by the principle of self-determination, the Agreement emphasises a partnership approach and the importance of intersectoral collaboration. The Agreement also recommends that the partnership model be replicated at all levels of the health-care process, down to regional and local levels. Launchedwith bipartisan support, theNSWAboriginal Health Partnership Agreement endures today and its founding principles remain unchanged. In addition to the establishment of the NSW Aboriginal Health Partnership Agreement, in 2010 the NSWGovernment signed The Statement of Intent to Achieve Equality in Health Status and Life Expectancy Between Aboriginal and Torres Strait Islander Peoples and Non-Indigenous Australians. As with the NSW Aboriginal Health Partnership Agreement, the Statement of Intent also achieved bipartisan support in committing the NSW Government to work in new, more productive partnerships with Aboriginal people and their representative organisations. Partnerships and self-determination There are sound reasons why such initiatives recommend partnerships with Aboriginal communities and their representative organisations: the benefits of adopting a partnership approach are well documented, both in Australia and internationally. Within a local context, a partnership approach that incorporates proper recognition of the right of self-determination for Aboriginal people offers a solid foundation for improving collaborative efforts in the area of Aboriginal health. The United Nations Declaration on the Rights of Indigenous Peoples lays out the principles of self-determination. Adopted in 2007, the Declaration upholds the rights of Indigenous peoples and calls on states to consult and cooperate in good faithwith the peoples concerned through their own representative institutions in order to obtain their ‘free, prior and informed consent before adopting and implementing legislative or administrative measures that may affect them.’ The Declaration defines the concept of self-determination for Indigenous peoples, in Articles 3, 4 and 5: