Introduction – The need for NACCHO
In mid 2006, the Indigenous population of Australia reached 500,000 , the number often quoted as the population prior to colonisation. The 500,000 milestone is both a symbolic and real victory for Aboriginal & Torres Strait Islander survival.
Australia now experiences an extraordinary paradox- while Aboriginal & Torres Strait Islander peoples make up more than 2.4% of the population and are a vibrant, integral part of Australian culture, there is compelling evidence of massive social and economic disadvantage experienced by Indigenous people. This disadvantage makes the excess morbidity and mortality of Aboriginal & Torres Strait Islander peoples utterly predictable. What Aboriginal & Torres Strait Islander people have always known – that racism and health are inexorably linked – is now supported by a number of research findings on the social determinants of health.
This has provided a significant body of evidence about how health is moulded by neighbourhoods, family and social connections, social marginalisation, and actual or perceived control over one’s life and workplace.
The unequal distribution of negative health-related behaviours adversely affects the already disadvantaged. Racially and ethnically biased clinical decision making has also been shown to contribute to poorer health care and outcomes.
Australia is alone among comparable developed nations in its failure to make significant inroads into the health status of its Indigenous population over the past 30 years. In particular, the massive excess of mortality among Aboriginal people in middle age is without comparison.
The evidence from North America and New Zealand is that a great deal can be achieved over relatively short periods of time. The fact that Aboriginal & Torres Strait Islander peoples comprise only 2.4 % of the population means that the necessary measures are eminently affordable.
Aboriginal community controlled health services and self determination
The first Aboriginal Medical Service (AMS) established at Redfern in 1971, following hot on the heels of the local service, was in part a reflection of the aspirations of Aboriginal people for self-determination in the intense, melting-pot environment of Redfern intellectual life.
Predating, Medibank, it was also a response to the urgent need to provide decent, accessible health services for the swelling and largely medically uninsured Aboriginal population of Redfern.
Aboriginal medical services (now known as Aboriginal Community Controlled Health Services’s to distinguish them from state government controlled services) are controlled by the local Aboriginal community via elected boards of management.
The primary health care approach adopted by Redfern and other early ACCHS’s was innovative. It mirrored international aspirations at the time for accessible, effective and appropriate needs-based health care with a focus on prevention and social justice (foreshadowing the 1978 WHO Alma-Ata Declaration on Primary Health Care).
The impact of ACCHS’s in the Aboriginal community came to be more than just an effective health service provision; through employment, education of staff, engagement, empowerment and social action, ACCHS’s became key strategic sites for Aboriginal community development.
The following goes some way to explaining their significance:
“Thing is that we own the bloody thing and it is something that we can’t, I can’t explain – about the ownership and the pride that it actually brings… we used to be blamed for being the same as the mainstream, well , I can tell you, the ACCHS service activity reporting has reflected that we’re nowhere near the same as mainstream. Mainstream would love to do some of this stuff, but they can’t. I don’t know why, but that’s why we’re here…”