Guest Editorial

On this page- Guest Editorials
Gregory Phillips The Hon Nicola Roxon MP Dr Chris Sarra  Dr Kyllie Cripps

The CRC for Aboriginal Health's newsletter has a regular guest editorial featured each edition.

 

 

Gregory Phillip

Guest Editorial -  Gregory Phillips

Gregory Phillips a Waanyi man and medical anthropologist who previously worked with Medical Deans Australia and New Zealand to develop their Indigenous health curriculum framework. Gregory currently consults in Aboriginal and Torres Strait Islander health as Executive Director of ABSTARR Consulting.

In this editorial Gregory Phillips reports on the challenges faced by Australian medical schools to increase Indigenous student enrolments and to develop curricula that will improve on non-Aboriginal graduates' understanding of Aboriginal health and their skills to address the continuing gap in health outcomes….

Indigenous health workforce development: the role of medical schools

Among the family of health disciplines, medicine is one of the most influential. While the bio-medical model does not offer a solve-all for the health issues confronting Aboriginal and Torres Strait Islander Australia, it certainly is one of the key groups that must engage with and take responsibility for ending health inequity.

Australia 's nineteen medical schools have made some significant advances in recent years in terms of Indigenous health. They have developed a nationally accredited curriculum framework, endorsed changes to accreditation standards, and signed an Agreement for Collaboration with the Australian Indigenous Doctor's Association (AIDA). But will this guarantee changes to graduates' knowledge, skills and attitudes? Will the changes guarantee a significant increase in the number of Aboriginal and Torres Strait Islander medical students and graduates? Most critically, will it have a positive impact on Indigenous health outcomes?

It is of course too early to comprehensively answer any of these questions. The impact of changes to curriculum depends very much on the capacity of a medical school and its staff to adequately implement curriculum. For example, will a senior non-Indigenous clinician in a teaching hospital themselves have the necessary knowledge, skills and attitudes to be able to teach adequately? Challenges remain in ensuring quality and consistency in this area, and it is one the medical colleges, divisions and professional organisations may need to play a role in.

Whether medical schools will be able to create innovative marketing and recruitment programs for Indigenous student intakes remain to be seen, although there are some excellent examples of note where it has been done successfully (see www.limenetwork.net.au ). It should be noted however, that these universities have often managed to increase or maintain their Indigenous student intake on meagre resources, and have some have relied, sometimes unfairly, on the extra blood, sweat and tears of their Indigenous staff. Vague commitments need to transform into action in some medical schools.

What will it take for Australia as a nation to ensure Indigenous health workforce development? Although important, leaving recruitment to medical, nursing or physiotherapy schools only is not enough. The Commonwealth and the States and Territories should seriously invest resources to ensure Indigenous students are encouraged to dream in primary school, are supported academically, financially and culturally the whole way through their education, and that education institutions reform their whole operations to be culturally inclusive, rather than relying on ticking boxes at accreditation time.

All that said, Medical Deans Australia and New Zealand as an organisation, along with some individual medical schools, have shown exemplary leadership on Indigenous health workforce development. Now is the time to drive home those commitments with specific focus and resources. As a nation we must ensure non-Indigenous health professionals are comprehensively trained, and that we recruit and graduate every Aboriginal and/or Torres Strait Islander doctor and health professional possible.

As AIDA graduates have already shown, Indigenous doctors' don't think they know it all; they work respectfully with our people to create healthier families and communities. More of them please! gregory@abstarr.com 

Guest editorial from the recently appointed Minister for Health and Ageing, the Honourable Nicola Roxon

(loaded 19.12.07)

The CRC for Aboriginal Health is proud to present the following opinion piece from the recently appointed Minister for Health and Ageing, the Honourable Nicola Roxon. The new Rudd Government has pledged to tackle the life expectancy gap between Aboriginal and other Australians "within a generation". The CRCAH notes with optimism the pledge from Prime Minister Rudd, Indigenous Affairs Minister, Jenny Macklin and Health Minister, Nicola Roxon, that Aboriginal affairs policy will be driven by evidence rather than ideology.

The Rudd Labor Government is determined to see change through policy rigour. We want to see evidence-based programs which avoid bureaucracy and are designed in partnership with Indigenous people.

The challenge that remains is a significant one. The health and wellbeing of Indigenous Australians remains dramatically worse than that of the community as a whole. Aboriginal and Torres Strait Islander Social Justice Commissioner Tom Calma has noted:

What data exists suggests that we have seen only slow improvements in some areas of health status and no progress on others over the past decade. The gains have been hard-fought. But they are too few. And the gains made are generally not of the same magnitude of the gains experienced by the non-Indigenous population, with the result that they have had a minimal impact on reducing the inequality gap between Aboriginal and Torres Strait Islander peoples and other Australians.

There are a number of disturbing trends which have entrenched health problems for Indigenous Australians including:

• high rates of infant mortality, and high rates of low birth weight among Indigenous babies

• continuing presence of third world diseases, including rheumatic fever, trachoma, and otitis media

• high rates of chronic diseases such as renal failure, cardio-vascular diseases and diabetes

• continued higher rates of poor health among Aboriginal and Torres Strait Islander infants, as well as far too common occurrence of otitis media (middle ear infection) and eye conditions such as trachoma, which can impact on educationalattainment and employment

• a continuing tendency towards poor access to primary health care, as evidenced by high rates of sexually transmitted infections and relatively high rates of HIV/AIDS prevalence, and

• high rates of unhealthy and risky behaviour, including an increased prevalence of substance abuse and alcohol and tobacco use.

This continuing concern has led Commissioner Calma, OxFam and the Australian Medical Association, among others, to call for governments to commit to closing the 17-year gap between the life expectancy of Indigenous Australians and the rest of the community within the next twenty five years.

In the fortieth year since the passing of the 1967 Referendum, a Rudd Labor Government committed to closing the gap within a generation.

We supported this commitment with a $260 million downpayment on comprehensive Indigenous child and maternal health services.

As a result of this initiative, Indigenous women will have access to proper antenatal care (including a visit to a midwife or doctor, an ultrasound, and a general health check); practical advice on parenting, breastfeeding and nutrition for their babies; and
home visit services for new Indigenous mothers and children aged 0-8 years.

The Government will be investing $10 million to tackle rheumatic fever in Indigenous kids - a condition almost unknown outside the third world, and a further $10 million for accommodation services for Indigenous women if they’re travelling from remote to urban and regional centres to have their babies.

The Government will ensure that all Indigenous children have access to health and early skills checks – hearing, sight, language – so that children are ready to learn.

We need a bipartisan national commitment to tackle the 17-year life expectancy gap between Indigenous and non-Indigenous people within a generation.

In tackling that gap, we need to develop a sensible set of targets around intermediary program level outcomes, especially those that address those preventable chronic conditions that are responsible for so much of the burden of disease borne by Aboriginal and Torres Strait Islander people.  The social determinants of health – such as education, housing, employment – require action across portfolios and across different levels of government, so we need to make sure our coordination efforts are working effectively and efficiently.

While working on prevention and on the social determinants is vital, this does not mean we do not have to increase the effectiveness of the health system itself, especially primary health care services,  and in particular those in the community-controlled sector.  Initiatives to improve access, sustainability and quality will be high on my agenda as the new minister. 

This focus on outcomes will mean that while the Rudd Labor Government is value-driven, we will not be ideologically-driven.  Where things are working well, we will look to improve them.  For example, we will be working closely with the Northern Territory Government and the Aboriginal community-controlled health sector there to ensure that the $183 million investment made by the previous government as part of its intervention, plus our own $20 million boost to health services in the NT, will be put to good use to improve access and quality of care.

We will also be looking to ensure that in Cape York the welfare reform initiatives underway there are underpinned by adequate health services and infrastructure. 

The Rudd Labor Government is committed to advancing reconciliation, and taking practical steps to improve the social and economic wellbeing of Indigenous Australians.

This will require action on many fronts – but we know that investing in the health of Aboriginal and Torres Strait islander people is one of the best investments we can make in Australia’s future.

Guest editorial by Dr Chris Sarra 

The guest editorial writer for the latest edition of CRCAH's newsletter Gwalwa-Gai is Queensland educator, Dr Chris Sarra.

Dr Sarra is the 2004 Suncorp Queenslander of the Year; 2004 QUT Chancellor's Outstanding Alumnus and Faculty of Education Outstanding Alumni Award Winner; and NAIDOC 2006 Scholar of the Year.

The youngest of 10 children Dr Sarra is from Bundaberg and has had an extensive career in education with a particular focus on pursuing his main passion; more positive and productive educational outcomes for Indigenous children.

He was the first ever Aboriginal principal of Cherbourg State School in south-east Queensland where he facilitated many positive changes that saw increasing enthusiasm for student learning through dramatically improved school attendance and increased community involvement in education. Under Chris's leadership the school became nationally acclaimed for its pursuit of the ‘Strong and Smart' philosophy.

Dr Sarra is currently Director of the Indigenous Education Leadership Institute, based in Cherbourg, and designed to pursue stronger, smarter, student outcomes for Indigenous children throughout Australia.

As an educator who has spent eight years working directly with Aboriginal children in a very complex Aboriginal community I welcome any intervention to ensure their wellbeing. If the challenge is to be attended to properly we must invest substantially and seriously in this national crisis that sees Australia's most vulnerable children exposed to harm. They didn't ask to be exposed to this. They don't ask to be continually subjected to this, yet they remain confused and hurting. They definitely deserve to be set free from this!

Let's understand this hurt and confusion; then let's just get on with the task of addressing the challenge, without feeling the need to score political points along the way.

Most of us know, as well as the Prime Minister knows, that political parties do not win votes by fixing things in Aboriginal communities. We know that political parties even run the risk of losing votes by doing so. This brings me to what I think lies at the most fundamental core of this challenge.

In order for this challenge to be seriously addressed in Australia, much of the electorate has a need for this to be done so in a way that sees Aboriginal people portrayed as completely hopeless or completely despicable. It has to be in an election year; and the government must be staring down the barrel of electoral defeat.

This need to ensure that Aborigines are thought of as a hopeless, pitiable, or despicable form of 'other', is what makes it okay for a political party to announce dramatic intervention into child abuse in Aboriginal communities.

If the electorate can have it confirmed that Aboriginal people in communities are so despicable and hopeless, then it is okay for the Prime Minister to announce such dramatic intervention, and be seen as the 'big man on the job'.

This same need is that which has made it acceptable for Aboriginal communities to wallow in third world conditions.

This same need makes it acceptable to deliver second rate education, health, and justice outcomes to Aboriginal communities.

This is the need which validates the hypocrisy with which some say ‘lest we forget', but forget about Australia 's black history.

This need allows Australian Governments and their bureaucrats to treat Aboriginal voices of outrage and expectation with contempt.

This phenomenon is so sophisticated, it even recruits Aboriginal voices to satisfy this insatiable need to see 'my' proud people typecast as helpless, pitiable, or despicable.

Notwithstanding, and sadly, this is the same need that furnishes the desire of many Aboriginal people, not all, to cling to an undignified 'victim status' as a means of survival.

Decent Australians know that we are not hopeless, pitiable, despicable and evil people.

Clearly, there are challenges for all of us here. I won't pretend for a moment that this is an easy challenge to attend to or that many Aboriginal people in communities are without blame here. But show me an Aboriginal man who says it is okay to have sex with a child, and then I will show you a man who should be in jail. I can also show you white police and white magistrates who lack the courage or commitment to deal with such matters in a way that they would in a regular community. I could also probably show you some flash white lawyer trying to sniff out some legal loophole to pretend that there is some cultural dimension to child sexual abuse.

Let me make it abundantly clear there is no cultural dimension to child sexual abuse!

While such justice service providers think they do good things to keep harmony and good relations with communities by basically ignoring or passively condoning such dysfunction, they leave communities to endure a level of dysfunctionality that would never be tolerated in a mainstream community, and worst of all; they leave Australia 's most vulnerable children exposed.

If we are to have any chance of making significant progress to eradicate such disturbing degrees of dysfunction in Aboriginal communities, then we must purge the dysfunctional mindsets of those with real authority to make change and develop real capacity to attend directly with the challenges that we contemplate. We must purge our country of the need to see Aboriginal people as hopeless, pitiable and despicable.

I am not talking here about systems, bureaucracies and policies. I am talking about the mindsets and actions of all of us as individuals that are a part of those structures and processes. Each of us must realise the power and potential for change when an individual, armed with the right mindset, decides that things can be better, and rejects absolutely, the notion that second or third rate is good enough for Aboriginal children.

For more information on the Indigenous Education Leadership Institute: www.strongersmarter.eq.edu.au

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A plea for evidence-based policy

The ninth edition of the CRCAH newsletter includes a newly introduced guest editorial. The first guest editorial writer is Dr Kyllie Cripps, a researcher at the Onemda VicHealth Koori Health Unit at The University of Melbourne. Dr Cripps' 2005 PhD thesis was entitled Enough Family Fighting: Indigenous Community Responses to Addressing Family Violence in Australia & the United States.

Dr Cripps writes on the recently announced Australian Government intervention into Northern Territory remote Aboriginal communities and questions the effectiveness of current and previous government interventions aimed at reducing violence in Aboriginal communities.

Dr Cripps makes a plea for better recording and recognition of successful community anti-violence initiatives as apart of a concerted effort to developing an evidence base of what works and does not work, something that for the past decade Indigenous communities across the country have asked for.

Recently significant attention has focussed on Indigenous family violence and child sexual abuse in the Northern Territory. This attention began in 2006 as a consequence of a very explicit and confronting interview given by Crown Prosecutor Nanette Rogers on the Lateline program in 2006. The public outcry resulting from this interview spurred the Federal Government into action, an Intergovernmental Summit on Violence and Child Abuse in Indigenous Communities, involving Ministers from the Australian Government and all States and Territories was convened and in June 2006 the Federal Government offered States and Territories $130 million over four years to address social problems in remote communities. The package included funds to:

• build police stations & police housing;
• provide drug & alcohol rehabilitation services;
• to establish ‘strike teams' to gather intelligence on Indigenous violence through the Australian Federal Police;
• provide safe houses & other support for victims;
• conduct health checks on approx 2000 children in remote communities; and
• establish a national truancy unit to monitor school attendance in Indigenous communities

This funding was conditional on all references to customary law being removed from the Crimes Act in each State and Territory.

Twelve months on and following the release of the “Little Children are Sacred” Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse prepared by Rex Wild QC and CRCAH Chairperson Pat Anderson, the Federal Government announced yet more measures to respond to what has now been deemed a national emergency - the abuse of children in Indigenous communities in the Northern Territory. The measures include:

• introducing widespread alcohol restrictions in the NT;
• introducing welfare reforms;
• enforcing school attendance by linking income support and family assistance payments to school attendance and providing meals for children at school at parents' cost;
• introducing compulsory health checks for all Aboriginal children to identify and treat health problems and any effects of abuse;
• acquiring townships prescribed by the Australian Government through five year leases;
• increasing policing levels in prescribed communities, including requesting secondments from other jurisdictions to supplement NT resources;
• improving housing and reforming community living arrangements in prescribed communities including the introduction of market based rents and normal tenancy arrangements;
• banning the possession of X-rated pornography and introducing audits of all publicly funded computers to identify illegal material;
• scrapping the permit system for common areas, road corridors and airstrips for prescribed communities on Aboriginal land, and;
• improving governance by appointing managers of all government business in prescribed communities

It is interesting to note that some of these measures are a replication of the Federal Government's 2006 announcements and it begs the question what progress has been made in implementing the 2006 interventions? A Senate Estimates hearing in February 2007 sheds light on this, revealing that six months after the Federal Government announcement of a package of $130 million to combat family violence, not one cent had been spent on the ground to prevent violence in Indigenous communities. When this is put in the context of a further Senate Estimates Hearing in May 2006 in which it was revealed that approximately $5 million, or 15 percent of the $37 million budget allocated to the problem after an Indigenous family violence roundtable convened by the Prime Minister in 2003, had not been spent it begs the further question – how serious is this government about responding to the problem of Indigenous family violence and child abuse?

Already some of the proposed initiatives have been watered down in particular the compulsory health checks which now are now voluntary and do not look for signs of sexual abuse. Legislation relating to some of the other initiatives is due to be tabled in Parliament this week – the details of which have not been made publicly available at the time this article went to press.

It has long been recognised in two decades worth of reports that family violence and child abuse in Indigenous communities is a problem in all jurisdictions across Australia. Responding to the problem requires, as Anderson & Wild stressed in their Little Children are Sacred report, the establishment of collaborative partnerships at all levels of government and service provision so that appropriate joined-up support can be provided to those affected by violence. Of critical importance to this is that “governments commit [in this process] to genuine consultation with Aboriginal people in designing initiatives for Aboriginal communities whether these are in remote, regional or urban settings”. The measures announced by the Federal Government contradict not only the Anderson and Wild report recommendations but more than a decade of recommendations of how to respond to such sensitive issues in an appropriate and coordinated manner.

As Indigenous community members we know that the answers to the problems of violence lie within our communities. These are initiatives that are guided and supported by community autonomy, capacity and development. However, they often operate outside the mainstream and remain largely unrecognised. At best such grassroots and community level programs are poorly documented in one-off newspaper, magazine and/or journal articles, and fail to be noticed in the broader context. It is now time, given the current context that a concerted effort be made by researchers and practitioners to support and promote such initiatives so that an evidence base of what works and does not work can be made available more broadly.

Dr Kyllie Cripps, an Indigenous (Palawa) woman, is a CIPHeR Post Doctoral Research Fellow in the Onemda VicHealth Koori Health Unit at The University of Melbourne. In 2005 she was awarded her PhD entitled Enough Family Fighting: Indigenous Community Responses to Addressing Family Violence in Australia & the United States. She has also been involved in the development of national policy in this area. Her current work focuses on the social context of violence and how policy/programs can support Indigenous communities in responding to the problem. kcripps@unimelb.edu.au

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