The importance of tackling racism and addressing the social determinants of health are central features of the new National Aboriginal and Torres Strait Islander Health Plan 2013-2023. (Download here and read the Ministerial statement here.)

The plan takes a strengths-based approach focused on health, social and emotional wellbeing, and emphasises the centrality of culture in the health of Aboriginal and Torres Strait Islander people.

The wider health sector could take plenty of lessons from its holistic approaches, not to mention its engaging visual presentation as indicated below (click on the images to read the detail). And see the bottom of this post for details of the beautiful cover artwork, “The Culture of Healing”.


Thanks to Colin Cowell from NACCHO communications for providing a summary of the plan below, and some of the responses (including from Jody Broun from the National Congress NHLF (National Health Leadership Forum), Justin Mohamed from NACCHO (National Aboriginal Community Controlled Health Organisation), Mick Gooda from the Close the Gap Campaign, and Dr Steve Hambleton, AMA president.

His report also features key quotes from some of the many Indigenous health professionals, organisations and community members who contributed to the plan during the extensive consultation process.

As always, the critical questions will be around implementation – which starts with us all reading and reflecting upon what needs to happen for the vision to be achieved.


An overview of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023

Colin Cowell writes:

On Tuesday 23 July, whilst the Australian media gave saturation coverage to the birth of a royal baby, they virtually ignored the launch in Brisbane of NATSIHP (National Aboriginal Torres Strait Islander Health Plan 2013-23) – a plan that includes the need to expand our focus on Aboriginal children’s health to broader issues in child development.

As part of efforts to close the gap, since 2011, the Australian Government has worked with Aboriginal and Torres Strait Islander people to produce this National Aboriginal and Torres Strait Islander Health Plan, providing an opportunity to collaboratively set out a 10 year plan for the direction of Indigenous health policy.

According to the Government, no plan will succeed without a robust partnership, particularly between the Australian Government and Aboriginal and Torres Strait Islander people, Aboriginal and Torres Strait Islander community organisations and their peak bodies.

The plan has been developed in partnership with all these groups, a partnership that has been over twelve months in the making.

Importantly, in this plan the sector has signalled the need to expand our focus on children’s health to broader issues in child development. There is also much work to do in developing robust research and data systems. The plan has also resolved to tackle the difficult and distressing issues of violence, abuse and self-harm.

The plan places a priority on social and emotional wellbeing and the issues that impact on it, including alcohol and other drugs. Because health outcomes are life outcomes that are affected by a broad range of factors, there will be a comprehensive approach to tackling health inequality through each of the Closing the Gap building blocks. This Health Plan builds on that approach.

There is also a need to drive health system improvements and maintain a clear priority on primary health care system reform. Aboriginal and Torres Strait Islander community controlled health services will continue to be supported to fulfil their pivotal role in improving Aboriginal and Torres Strait Islander health outcomes. Research and data will be needed to build our evidence-based practice and policy.

The plan also provides a focus on the wellbeing of Aboriginal and Torres Strait Islander people with a disability, young people and for healthy ageing. As such, it builds on our commitment to new Closing the Gap targets, including our new target aimed at increasing access to services for Aboriginal and Torres Strait islander people with disability.

And finally the Health Plan builds on the United Nations Declaration on the Rights of Indigenous Peoples. It adopts a strengths based approach to ensure policies and programs improve health, social and emotional wellbeing, and resilience and promote positive health behaviours. It emphasises the centrality of culture in the health of Aboriginal and Torres Strait Islander people and the rights of individuals to a safe, healthy and empowered life.

The Health Plan also builds on existing strategies and planning approaches to improving Aboriginal and Torres Strait Islander health, outlined at Appendix A.

(This photo of Minister Snowdon at the launch was tweeted by @IUIH )

To help achieve this, the Australian Government undertakes to:

  • Continue working across governments and sectors to close the gap in Aboriginal and Torres Strait Islander disadvantage;
  • Invest in making health systems accessible culturally safe and appropriate, effective and responsive for all Aboriginal and Torres Strait Islander people; and
  • Support good health and wellbeing across the life course, and continue to target risk factors at key life stages.
  • The Australian Government further commits to public reporting on the Australian Government’s progress in meeting this health Plan’s policy objective, through a high level annual report to the Australian Parliament and detailed bi-annual reporting through the Aboriginal and Torres Strait islander Health Performance Framework (Health Performance Framework).


Summary of reaction (To read full responses, click on links)

Jody Broun, Co-Chair of Congress and the NHLF

Congress and the National Health Leadership Forum (NHLF) support the priorities and vision of the National Aboriginal and Torres Strait Islander Health Plan released today.

She said placing culture and community at the heart of the plan puts Aboriginal and Torres Strait Islander peoples in control of health and well-being.

“The recognition of culture as central to the health of Aboriginal and Torres Strait Islander Peoples and communities shows a deep understanding of the role culture plays in our health and wellbeing,” she said.

“The plan’s vision of the Australian health system being free of racism sets a new precedent for Australian public policy.

“Congress and the NHLF organisations were able to significantly influence the health plan to ensure recognition is given to the right to health and to the Declaration on the Rights of Indigenous Peoples,” she said.


Justin Mohamed, chair of NACCHO

The release of the National Aboriginal and Torres Strait Islander Health Plan and its commitment to support the Aboriginal community controlled health model is welcome and needs multi-partisan support across all governments, state and federal, for effective implementation.

He said the health plan for the first time incorporates the social determinants of health which the sector has long fought for.

“The Federal Government should be congratulated for delivering this plan which has been developed with the involvement of Aboriginal people and Aboriginal health authorities,” Mr Mohamed said.

“The plan accepts the evidence 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.

“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.

“It is also significant that the plan’s vision articulates a health system free of racism and inequality for the first time.

“As always though the test of the plan will be in the implementation and NACCHO looks forward to being involved in the next steps – setting performance indicators and targets to ensure the vision of the plan can be realised.”

Mr Mohamed said it was essential that the implementation of the health plan be placed above party politics.


Close the Gap campaign co-chair Mick Gooda

“This plan acknowledges the need for full participation by Aboriginal and Torres Strait Islander people in all levels of decision-making. We have been calling for this over many years,” Mr Gooda said. “These are long-term issues that require a long-term plan, so we are pleased to see a ten-year focus. Mr Gooda, who is also the Aboriginal and Torres Strait Islander Social Justice Commissioner, said the Federal Government’s commitment to consulting widely with communities is critical to the plan’s success.


AMA President, Dr Steve Hambleton

He said the National Aboriginal and Torres Strait Islander Health Plan should be a catalyst for a new era of unprecedented coordination between all Australian governments to deliver better health services and better health outcomes to Aboriginal and Torres Strait Islander people.

Dr Hambleton said that the AMA welcomes the long-awaited Plan, which was developed in partnership with Aboriginal and Torres Strait Islander people, as the first step in a coordinated approach to dramatically improve Indigenous health over the next decade.

“The next step is the development of a National Implementation Plan to set out detailed and comprehensive commitments from all stakeholders,” Dr Hambleton said.

“The Implementation Plan must specify:

  • the development of a comprehensive set of measurable targets to be achieved over the next 10 years;
  • the development and implementation of a service model that will effectively and efficiently achieve those targets;
  • the development and implementation of a national workforce strategy for existing and emerging areas of need in service provision;
  • the formulation of a funding and resource model commensurate with health care needs and priorities in Aboriginal and Torres Strait Islander populations over the next 10 years; and
  • clear, measurable requirements for governments to work together in genuine partnership and with the guidance of Indigenous health leaders and Indigenous communities.”


Some quotes featured in the report

Professor Ngiare Brown

“We represent the oldest continuous culture in the world, we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices – respect, generosity, collective benefit, collective ownership- to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful and our communities thrive.”

Mr Mick Gooda

“The right to health is not to be understood as a right to be healthy. This cannot be guaranteed by governments. A human rights based approach to health is about providing equal opportunities to be healthy, it’s about participation and progressive realisation.”

Alyawarr Ingkerr Wenh Aboriginal Corporation

“Health issues must be addressed at a community level. The community needs to control its health services so that they are concentrated on the important issues in that community.”

Dr Tom Calma, AO

“We are witnessing a new and exciting era… the burgeoning of a new relationship between Indigenous and non-Indigenous Australians, including governments, based on respect and partnerships. Now is the time to capitalise on the momentum and move forward together.”

Professor Mick Dodson, AM

“This is the future of reconciliation and it has to involve all Australians in closing the unacceptable gap in life expectancy. So let us now be prepared to focus ourselves on this task, and to be measured and accountable on the success of our efforts.”

Close the gap steering committee submission

“It is important to address the social and cultural determinants of health as there are many drivers of ill health that lie outside the direct responsibility of the health sector.”

The Lowitja Institute submission

“Discussion about racism is difficult and highly charged in the Australian community and action should be focused on the development of respectful relationships and sanctioning of discriminatory behaviour, policies and practices, including within the health system.”

Participant, Health Systems Thematic roundtable

“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.”

Menzies School of Health Research submission

“Research plays an important role in advancing Aboriginal health through investigation of emerging areas of concern, identifying protective and risk factors, developing and trialling interventions, and evaluating the implementation of programs and policy.”

Participant, Mental Health Thematic Roundtable

“Mental health above all things in the Health Plan needs a clear articulation – a lot of people might not know what health and spirituality means to us.”

National Aboriginal Community Controlled Health Organisation

“Improving the health and wellbeing outcomes for Aboriginal people can be achieved by local Aboriginal people determining and owning the process of health care delivery. Local Aboriginal community control in health is essential to the definition of Aboriginal holistic health and allows Aboriginal communities to determine their own affairs, protocols and procedures.”

National Aboriginal and Torres Strait Islander Health Equality Council

The strength of using a whole of life structure is that it encourages attention to the broader factors affecting health as people move through the stages.”

Professor Kay Sing Lo and Dr Wendy Hoy

“Birth weight is important – in a sense, it is the first outcome. It reflects the influence of a number of parental factors, is directly linked with foetal death and is the earliest indicator of proneness to ill health during childhood and to later adult diseases, such as high blood pressure.”

Participant, Early Childhood Thematic Roundtable

“Early years of a child’s development lay the foundation for the healthy adult life. Preventive action on many of the health issues faced by Aboriginal and Torres Strait Islander people needs to begin in early childhood thematic roundtable

Participant Youth Forum. National Centre for Indigenous Excellence

“Indigenous youth are the forefront of Aboriginal and Torres Strait Islander health. They represent more than half of the Indigenous population in Australia, are within the age bracket where death from disease and diabetes is still avoidable, and importantly, have a passion for improving health outcomes.”

Participant, Cairns Community consultation

“Aboriginal and Torres Strait Islander people accept that it is the norm to be suffering from chronic disease and be taking medication on a regular basis in their middle years. We need to challenge this. “

Participant, Brisbane Community Consultation

“Elders and other senior community members should be engaged as key stakeholders to champion culturally appropriate choices and approaches to health and wellbeing.”

• For more news from NACCHO, follow @NACCHOAustralia and @NACCHO_CEO.


PS from Croakey

 These look like some stories that it would be good to hear more about….

The plan also includes some case studies highlighting good practice, that might be of interest to many Croakey readers, including:

• Innovation and Evidence Based Service Delivery Model, Institute for Urban Indigenous Health, South East Queensland. IUIH has developed an evidence-based Model of Chronic Disease Care (the Model) for implementation across the Aboriginal and Torres Strait Islander community controlled health organisations in south east Queensland.

• Newly created permanent aged care jobs and training achievements of Aboriginal and Torres Strait Islander aged care workers at Imabulk Aged Care Services— Belyuen Northern Territory

• A case study of how one man’s health and wellbeing was improved by efforts to integrate and coordinate his care, by the Western NSW Medicare Local in consultation with the local Aboriginal and Torres Strait Islander community controlled health organisations, primarily the Orange Aboriginal Medical Service.

• From community crisis to community control in the Fitzroy Valley: The Marulu* Foetal Alcohol Spectrum Disorders (FASD) Strategy. Communities in the remote Fitzroy Valley of Western Australia’s Kimberley region have shown great leadership in overcoming FASD. *Marulu relates to children, and means ‘precious, worth nurturing’ in the Bunuba language.

• A cardiac rehabilitation program was jointly established by the National Heart Foundation, Derbarl Yerrigan Health Service (DYHS) and the Royal Perth Hospital (Cardiology Department) in DYHS (an Aboriginal and Torres Strait Islander community controlled health organisation) and its uptake, impact on health management and cardiovascular risk factors were documented. The name of the program, ‘Heart Health –for our people, by our people’ (Heart Health) reflected ownership by DYHS and the broader Aboriginal and Torres Strait Islander community.


The story behind the cover

And here is the background to the artwork on the report’s cover, produced by Gilimbaa, an Indigenous creative agency.

“The Creation spirit shaped and formed this country, the rivers, and the mountains from the desert to the coast, imparting the Law to each and every one. Navigating by land and sea, we are the Custodians of this place – it nurtures us, sustains us, provides for us and heals us. We are connected, we are one.

Our ancestors protect and guide us, teaching us the ways of the past, strengthening our knowledge of Culture and directing our pathways, working together towards a brighter future.

The artwork for the Department of Health and Ageing ‘The Culture of Healing’ brings together many people from Government to community all across Australia to address the theme of health and wellbeing for all Aboriginal and Torres Strait Islander peoples.

The ‘Health Plan’ is a whole of government approach, the aim of which is to initiate genuine discussion, solutions and community driven outcomes for Aboriginal and Torres Strait Islander peoples within the area of health.

The foundation of the artwork is set in a grid pattern. Each area consists of different cultural markings and motifs from the Torres Straits and across mainland Australia. These markings are the tracks left by the Rainbow Serpent, the Creation Spirit, and they represent the diversity of country. The lines that make up the grid formation are the navigational pathways and meeting places. Three stars represent these navigational pathways for Government and for Aboriginal and Torres Strait Islander peoples.

The plant and animal motifs represent traditional health and wellbeing – ‘bush tucker’. The central figures represent Aboriginal and Torres Strait ancestors who teach us the traditional ways so we can keep our culture strong today and into the future. The circular motif towards the bottom of the artwork represents Government and communities coming together in discussion, working together to create better health outcomes for Aboriginal and Torres Strait Islander peoples. The inner circle represents the Government from the Minister, to staff and other stakeholders and moving outwards to the Communities. The ‘U’ shaped motifs represent people seated in discussion, or a ‘Yarning Circle’.

The pathways that lead out from these people represent the expertise and cultural knowledge and understanding that each individual brings to the table of their family, their community and their people and how the ‘Health Plan’ can best benefit them for a happier, healthier and brighter future together.”

• Thanks to @glendat45 and @IUIH_ for your tweet-pix


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