There are solutions to Aboriginal health – the key is to let communities manage their affairs. Read how Aboriginal-run health services emerged and succeed.
Redfern Aboriginal Medical Service was established in 1971 as Australia's first Aboriginal community-controlled health service. [1]
"Redfern was the spark that began the movement of Aboriginal communities creating and running their own health services providing comprehensive primary health care," marvels Justin Mohamed, chairperson of the National Aboriginal Community Controlled Health Organisation (NACCHO). [1]
Back then, Medicare did not exist and the only option for most Aboriginal families living in inner Sydney was to attend an emergency department or rely on the goodwill of local general practitioners. [2]
Many Aboriginal people experienced racism in the health system and wider community, and poverty was a major barrier to attending general practice or purchasing medicines.
Initially a ‘shopfront’ volunteer service on Regent street in Redfern, Redfern Aboriginal Medical Service was staffed by non-Aboriginal doctors, nurses, nuns and students. Shirley Smith, affectionately known as Mum Shirl, was the first field officer, and the late Professor Fred Hollows was instrumental in signing up medical students, doctors and volunteers. [2]
Within a year of opening, Redfern Aboriginal Medical Service had become so popular that demand outstripped supply. The federal government made funding available in 1973 which helped the service grow into a wide range of clinics and services, including medical, dental, public health and outreach services.
Between 1971 and 2011 Aboriginal health services grew from one Aboriginal community to over 150 services run by communities. [1]
The service is free for all Aboriginal patients. The majority of its patients are local, but many come from rural and remote communities and visit the service when in Sydney to get their chronic health issues addressed.
Video: Australia's Aboriginal-controlled health services
Watch a 25-minute video where Matthew Cooke, Chair of the National Aboriginal Community-Controlled Health Organisation (NACCHO) interviews doctors, CEOs, board members, health workers and community members.
Second Aboriginal-controlled health service: Brisbane, QLD
The Aboriginal and Torres Strait Islander Community Health Service operating in Brisbane is the second Aboriginal community-controlled health service in Australia, [3] operating since the 1970s.
But there are working solutions, often unreported by the media and frequently without government support.
These are community-driven and managed programs where local Aboriginal people develop and implement solutions for their own communities. Local environments can vary greatly, and blanket solutions from governments might impede, or even prohibit, the success of local solutions.
Such programs can be effective in improving physical activity levels and nutrition among Aboriginal people. Positive results include stable diabetes rates, significant falls in smoking rates, cholesterol levels and blood pressure, "near-perfect" immunisation rates for babies, increased birth weights and fewer cases of fetal alcohol syndrome. [4][5]
Keeping communities safe during the COVID-19 pandemic
During the corona virus pandemic Aboriginal community health services shut down communities early in 2020 to prevent the spread, maintained a high level of awareness and overcame major challenges to deliver COVID-19 vaccines to Aboriginal elders. [6]
Communities broadcast countless community-specific messages and developed resources for media such as community radio and social media.
This resulted initially in an very low number of cases with no deaths nationally and no cases identified in remote Aboriginal communities. [7]
Such results are a good example for how effective it can be to empower Aboriginal peoples, organisations and communities, and to trust them to find culturally appropriate solutions.
However, by September 2021, two Aboriginal people had died, there were more than 1,000 cases in NSW alone [8] and vaccination rates lagged behind those of the general population. By November 2021, 62% of First Nations people over the age of 16 had been fully vaccinated, compared to 89% of the general population, and less than 55% of First Nations people aged 12 to 15 had received their first dose. [9]
Story:
The greatest achievement: Saving Elders
When the coronavirus pandemic hit the world, Aboriginal communities, and their Elders in particular, were among the most vulnerable groups. But eight months into the pandemic, there were no cases in remote communities and not one death among Aboriginal people. How was this possible?
It all came down to Aboriginal leadership. Communities moved quickly to close down and encourage others to follow, started social media pages and informed friends, Elders and relatives to stop visiting older people.
Successfully preventing the spread of COVID-19 into Aboriginal communities has been hailed "the greatest achievement of the year" for Aboriginal people. Their low rate of COVID-19 was the best result for any indigenous population in the world. [10]
No Aboriginal person died. Does that not tell you something about what we do?
— Vicki O’Donnell, CEO, Kimberley Aboriginal Medical Service, on the community response to COVID-19 [7]
Aboriginal peoples have the highest rate of immunisation among the Australian population. [6]
Ideally community programs should form long-term relationships with sponsors. "Strategies that have been found to work to strengthen Indigenous organisational capacity include long-term partnerships between government and Indigenous people," says Dr Fadwa Al-Yaman, spokesperson of Closing the Gap Clearinghouse, a government-funded health initiative. [4]
But reality is often different. Even award-winning organisations which have won "a swag of awards", including the Premier’s Reconciliation Award, can struggle to attract the funding they need [5] and suddenly cease operation.
When control is in our hands, when we can exercise autonomy, we succeed.
— June Oscar AO, Aboriginal and Torres Strait Islander Social Justice Commissioner [11]
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