Urgent need for Indigenous health resources
Greg Phillips
By Gregory Phillips
Recently, Premier Ballieu and the Opposition signed the Close the Gap Statement of Intent. In doing so, they committed Victoria to a bipartisan approach to closing the life expectancy gap between Indigenous and non-Indigenous Australians.
That state and national leaders have signed the pledge gives me great heart as an Aboriginal person that the next logical steps post-Apology are being taken.
There have been significant investments from the Council of Australian Governments and great advances in public awareness, advocacy in the last few years. However, far more than a series of parliamentary reports, statistical analyses and door-stop press conferences are required to achieve this important goal.
There are still a few missing pieces of the puzzle.
Firstly, to achieve a goal, you have to have a plan. Australia does not have one, although it is encouraging that it is being developed now. Specific objectives should be identified, along with who is responsible for implementation, and clear timetables for how progress will be measured and publicly reported. The plan should also identify how to target investments in specific areas like chronic disease and mental health.
Secondly, if we are serious about closing the gap, we will need a workforce to do it. At present, Australia is seriously under-resourced in terms of numbers of health professionals, quality and consistency of the training that the workforce receives, structure of workforce roles, and quality of care that Indigenous patients receive in our hospitals and public health system.
It is laudable that there are now about a thousand Aboriginal and Torres Strait Islander nurses, 160 Indigenous doctors, thousands of Aboriginal Health Workers (AHWs), scores of psychologists and half a dozen dentists, yet these numbers are far below population parity. Serious investment and reform is needed.
Furthermore, we are not training nearly enough non-Indigenous health professionals in Indigenous health, nor are we ensuring the consistency and quality of culturally appropriate training from undergraduate through to pre-vocational and specialty training. Notably, some education institutions and colleges have rightly embraced significant reform, and governments have smartly invested in it, to a point. Yet there is no consistent national approach, reform or investment, and Health Workforce Australia does not have a strategic direction for Indigenous health.
Australia needs to get innovative in terms of which health professionals are responsible for which service delivery roles. Workforce shortages in other countries have given rise to clinical roles such as nurse practitioners (Europe and the US), community health aides (Alaska), and community clinical doctors (Malawi). Here, the important roles played by Aboriginal Health Workers are often devalued and viewed as second-class because they are often not allowed to perform even the most basic clinical roles. Those who choose to pursue such roles should have access to pathways programs that allow them to upskill to medicine, nursing or nurse practitioner roles. Nurses and doctors unions might fight junior clinical roles aggressively, but the reality for the workforce training system is that this kind of innovation must be a part of the mix if we are to effectively meet Indigenous health needs.
A hospital accreditation system is also needed, where providers meet cultural safety quality targets for Indigenous patients. This is about making sure the taxpayer gets more bang for their buck, and that Indigenous patients do not stay away from mainstream health providers that are often racist and disrespectful, as recent evidence has clearly shown.
Finally, to close the gap, we need clarity on who is responsible for what. Mainstream health providers should undertake initiatives to level the playing field, such as quality and cultural safety measures, improved access to opportunities/services ensuring Indigenous employment and Indigenous peoples share in decision-making about strategy, resources and operations. Indigenous health professionals and organisations should lead the delivery of services, rather than the hotch-potch of mainstream NGOs now dithering about in Aboriginal and Torres Strait Islander Australia.
Closing the gap is a worthy goal, now the details of planning, workforce reform and service delivery are on the table and in need of visionary and strategic innovation.
Gregory Phillips is a medical anthropologist and Advisor to the Dean on Indigenous health.