Social Justice Report 2011

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Appendix 5: Position paper on achieving Aboriginal and Torres Strait
Islander health equality within a generation

Articles 24(2) and 23 of
the United Nations Declaration on the Rights of Indigenous Peoples state:

Indigenous individuals have an equal right to the enjoyment of the highest
attainable standard of physical and mental health. States shall take the
necessary steps with a view to achieving progressively the full realization of
this right.

Indigenous peoples have the right to determine and develop priorities and
strategies for exercising their right to development. In particular, indigenous
peoples have the right to be actively involved in developing and determining
health, housing and other economic and social programmes affecting them and, as
far as possible, to administer such programmes through their own
institutions.

In relation to the achievement of Aboriginal and Torres Strait Islander
health equality within a generation, this position paper is an expression of
these rights by the following national Aboriginal and Torres Strait Islander
health peak bodies and key stakeholders:

• Aboriginal and Torres Strait Islander Social Justice Commissioner
  of the Australian Human Rights Commission;
• Australian Indigenous Doctors’ Association;
• Australian Indigenous Psychologists’ Association;
• Congress of Aboriginal and Torres Strait Islander Nurses;
• Indigenous Allied Health Australia Inc.;
• Indigenous Dentists’ Association of Australia;
• Lowitja Institute;
• National Aboriginal and Torres Strait Islander Healing Foundation;
• National Aboriginal and Torres Strait Islander Health
  Workers’ Association;
• National Aboriginal Community Controlled Health Organisation;
• National Congress of Australia’s First Peoples;
• National Coordinator, Tackling Indigenous Smoking; and
• National Indigenous Drug and Alcohol
  Committee.

These positions also reflect those agreed by the
following national workshops, hosted by the Close the Gap Campaign for
Indigenous Health Equality and attended by representatives from across the
Aboriginal and Torres Strait Islander health sector and Australian
governments:

• Close the Gap - National Indigenous Health Equality Summit,
  Canberra, March 2008;
• Close the Gap - Partnership in Action Workshop, Sydney, November
  2008; and
• Close the Gap – Making it Happen Workshop, Canberra, June
  2010.

1. Principles to underpin a national effort to achieve
Aboriginal and Torres Strait Islander health equality

• Achieving Aboriginal and Torres Strait Islander health equality
  within a generation (health equality) is a national priority.

• The Close the Gap Statement of Intent is a foundational
  document, guiding efforts to meet this aim of health equality for Aboriginal and
  Torres Strait Islander peoples.

• The Statement of Intent commitments comprise an interdependent and
  coherent framework for achieving health equality and are not to be selectively
  interpreted or implemented. Therefore, the social and cultural determinants of
  Aboriginal and Torres Strait Islander health inequality must be addressed as a
  part of a national effort to achieve health equality, and within a national
  health equality plan.

• By meeting the commitments in the Statement of Intent, Australian
  governments will:

  • adopt ‘best practice’ policy, targets and guidelines
    for achieving health equality, as supported by research findings and the
    evidence base;

  • adopt the most efficient way of achieving health equality.
    Partnership, in particular, should be considered as an efficiency measure:
    helping to maximise the health outcomes from the resources available;
    and

  • align their efforts with the human rights of Aboriginal and Torres
    Strait Islander peoples, including those set out in the United Nations
    Declaration on the Rights of Indigenous Peoples.
    
    
    
• To drive this national commitment, the Prime Minister should lead
  the effort for achieving health equality through COAG and partnership with
  Aboriginal and Torres Strait Islander peoples through their representative
  organisations. This collective leadership should enable and be accountable for
  achieving the:
  
  
  
  • vital intergovernmental and intersectoral cooperation needed to
    achieve health equality;
    
    
    
  • public sector to work in partnership with Aboriginal and Torres
    Strait Islander peoples and their representatives, particularly when developing
    and implementing a health equality plan; and
    
    
    
  • national effort for health equality to be enhanced and be integral
    to the roll out of the National Health and Hospital Network (NHHN) and future
    reforms.
    
    
    
• Reflecting this, the Prime Minister should continue to report to
  the Parliament and the nation on efforts to ‘close the gap’
  (including in relation to health outcomes) on the opening day or the first
  session of federal Parliament each year.

2. A partnership
between Aboriginal and Torres Strait Islander peoples, their representatives and
Australian governments

• A partnership between Aboriginal and Torres Strait Islander
  peoples, their representatives and Australian governments (partnership) must
  underpin the national effort to achieve health equality.

• The mechanism to achieve a sustainable partnership will be
  through;
  
  
  
  • the thirteen signatories (including the National Congress of
    Australia’s First Peoples) creating a single community partnership
    interface. The signatory bodies pledge to work together and engage with
    Australian governments as equal partners at the national level to progress
    health equality.
    
    
    
  • Australian governments creating a single government partnership
    interface that should include:
    
    
    
    • the Minister for Health and Ageing and the Minister for Indigenous
      Health;
      
      
      
    • the Minister for Indigenous Affairs; and
      
      
      
    • State and Territory Governments.
      
      
      
  • The support of all Opposition parties, minor parties and
    Independents for the partnership arrangements set out in this paper should be
    secured to ensure continuing political support for the achievement of health
    equality until 2030.
    
    
    
    
• The partnership should be formalised through a framework agreement
  that clearly articulates the rules of engagement between all parties,
  based on the United Nations Declaration on the Rights of Indigenous
  Peoples, paying particular attention to:
  
  
  
• The Second Preambular paragraph
  
  Affirming that
  indigenous peoples are equal to all other peoples, while recognizing the right
  of all peoples to be different, to consider themselves different, and to be
  respected as such.
  
  
  
  • Article 3
    
    Indigenous peoples have the right to
    self-determination. By virtue of that right they freely determine their
    political status and freely pursue their economic, social and cultural
    development.
    
    
    
  • Article 18
    
    Indigenous peoples have the right to participate in
    decision-making in matters which would affect their rights, through
    representatives chosen by themselves in accordance with their own procedures, as
    well as to maintain and develop their own indigenous decision-making
    institutions.
    
    
    
  • Article 19
    
    States shall consult and cooperate in good
    faith with the indigenous peoples concerned through their own representative
    institutions in order to obtain their free, prior and informed consent before
    adopting and implementing legislative or administrative measures that may affect
    them.
• Genuine sharing of decision-making power is essential to this
  partnership. This should be reflected in:
  
  
  
  • co-chairing arrangements between Aboriginal and Torres Strait
    Islander peoples and their representatives and Australian governments in all
    partnership fora;
    
    
    
  • the agreement of quorums in partnership fora that ensure an agreed
    minimum level of Aboriginal and Torres Strait Islander representation at times
    of decision-making;
    
    
    
  • acknowledgement of Aboriginal and Torres Strait Islander
    leadership, experience and knowledge at all stages of the national effort to
    achieve health equality, including in relation to the development and
    implementation of a health equality plan; and
    
    
    
  • adequate resource allocations and flexibility in funding
    arrangements to the Aboriginal and Torres Strait Islander partnership
    organisations to enable them to participate effectively in the
    partnership.
• For specific issues within the domains of the peak bodies and
  stakeholders, engagement with those peak bodies and stakeholders would continue
  to occur.
  
  
  
• The National Indigenous Health Equality Council will continue to
  advise the Minister for Indigenous Health and the Minister for Health and
  Ageing.
  
  
  
• State and territory-level Aboriginal and Torres Strait Islander
  health forums would continue as before, with the affiliates of the National
  Aboriginal Community Controlled Health Organisation (NACCHO) who are parties
  connecting to the national level process through NACCHO’s participation in
  the national forum.

3. The development of a health equality
plan

• Several dimensions of health-related planning are needed in a
  national effort to achieve health equality: to address both health inequality
  itself, and its social and cultural determinants. The negative impact of racism,
  intergenerational trauma and disempowerment, in particular, must be addressed.

• A health equality plan development process should be efficient and
  not absorb unnecessary time or resources. The National Aboriginal Health
  Strategy (1989) and the National Strategic Framework for Aboriginal and
  Torres Strait Islander Health (2003 – 2013) provide a starting
  point.

• A health equality plan must be ‘owned’ by both
  Aboriginal and Torres Strait Islander peoples and their representatives and
  Australian governments. This reinforces the need for partnership as the basis
  for developing and implementing a health equality plan.

• Empowerment will be a vital contributor to health equality. Any
  policy or program under a health equality plan should be assessed as to how it
  will increase the ability of Aboriginal and Torres Strait Islander individuals,
  families and communities to take control of their own lives.

• The commitment to achieve Aboriginal and Torres Strait Islander
  health equality within a generation, and the approach to this set out in the
  Close the Gap Statement of Intent, must be embedded in all current and future
  health reform processes.

Content of a health equality plan

• The Close the Gap National Indigenous Health Equality
  Targets, Overcoming Indigenous Disadvantage Framework indicators and
  the Aboriginal and Torres Strait Islander Health Performance Framework provide a starting point for the agreement of the targets and sub-targets. The
  former has been developed by peak bodies and experts in the field of Aboriginal
  and Torres Strait Islander health.

• The plan should:

• invest in and build Aboriginal and Torres Strait Islander
  leadership at all levels of the health system;

• build the capacity and enhance the leadership of the Aboriginal and
  Torres Strait Islander Community Controlled Health Sector;

• address the mental health and social and emotional well-being of
  Aboriginal and Torres Strait Islander peoples, including problematic alcohol and
  drug use;

• address the social and cultural determinants of health;
  and

• ensure data collections and other measures are in place to enable
  the effective monitoring of progress towards health equality, and an evaluation
  of the quality of the plan, over time.

• The Statement of Intent commitments to achieve Aboriginal and
  Torres Strait Islander health equality within a generation must be embedded in
  the NHHN reforms.

• A strong national Aboriginal and Torres Strait Islander leadership
  should oversee those parts of the national effort for health equality that will
  be delivered through the
  NHHN.

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