1. Strategies and Approaches in Aboriginal Health Dr Ross Bailie Associate Professor in Public Health Dr Ross Bailie Associate Professor in Public Health Flinders NT Clinical School Flinders NT Clinical School Menzies School of Health Research Menzies School of Health Research Ph 08-89228835 or 08-89228196 Fax 08-89275187 email: ross.bailie@menzies.edu.au

2. I believe that all those employed in the medical professions must undertake the difficult task of recognising, in all its implications, that, by definition, health work is political work. If the health professions ignore the shocking state of Indigenous health in this country then they exacerbate the problems of history. On the other hand, if they take the initiative to act, to advocate and to work for significant change, they assist in the crucial work of reconciliation between black and white Australians. This stance inevitably requires a commitment to radically reformist positions about health. Lowitja O’Donoghue 1999 I believe that all those employed in the medical professions must undertake the difficult task of recognising, in all its implications, that, by definition, health work is political work. If the health professions ignore the shocking state of Indigenous health in this country then they exacerbate the problems of history. On the other hand, if they take the initiative to act, to advocate and to work for significant change, they assist in the crucial work of reconciliation between black and white Australians. This stance inevitably requires a commitment to radically reformist positions about health. Lowitja O’Donoghue 1999

3. Learning Objectives

4. Performance Objectives

5. Sources of information and Acknowledgements Australian Indigenous Health Infonet web siteAustralian Indigenous Health Infonet web site National Aboriginal and Torres Strait Islander Health StrategyNational Aboriginal and Torres Strait Islander Health Strategy Australian Indigenous Health Infonet web siteAustralian Indigenous Health Infonet web site National Aboriginal and Torres Strait Islander Health StrategyNational Aboriginal and Torres Strait Islander Health Strategy

6. Background Lack of progress Shifting responsibility Competing interests Assimilation Funding pressure Poor coordination Lack of progress Shifting responsibility Competing interests Assimilation Funding pressure Poor coordination

7. Background (continued) Control Treaties Control Treaties

8. The National Aboriginal Health Strategy

9. National Aboriginal Health Strategy (continued) Social and Physical environment Self-determination Health hardware Major identified problems Social and Physical environment Self-determination Health hardware Major identified problems

10. National Aboriginal Health Strategy (continued) Failure of implementation Office of Aboriginal and Torres Strait Islander Health (OATSIH) Failure of implementation Office of Aboriginal and Torres Strait Islander Health (OATSIH)

11. Five key strategies Infrastructure Self-determination Access to community controlled services Adequate resourcing Skilled workforce Infrastructure Self-determination Access to community controlled services Adequate resourcing Skilled workforce

12. Infrastructure Housing Water Sewage Roads Communication Educational facilities Health facilities Housing Water Sewage Roads Communication Educational facilities Health facilities

13. Infrastructure (continued) Intersectoral responsibilty Infrastructure standards Intersectoral responsibilty Infrastructure standards

14. Self-determination Community control

15. Access to community controlled health services AMS’s Patchy access Comprehensive services Poor coordination with the mainstream AMS’s Patchy access Comprehensive services Poor coordination with the mainstream

16. Adequate resourcing Resourcing levels are inadequate Urban/rural/remote disparity Resourcing levels are inadequate Urban/rural/remote disparity

17. Skilled workforce Education strategy AHWs Health professionals Education strategy AHWs Health professionals

18. New Solutions?

19. Framework Agreements Governments, ATSIC, NACCHO National Council of Aboriginal and Torres Strait Islander Health Governments, ATSIC, NACCHO National Council of Aboriginal and Torres Strait Islander Health

20. Coordinated Care Trials Community control Cashing out of MBS and PBS Coordination of care Community control Cashing out of MBS and PBS Coordination of care

21. Priority specific health issues Chronic disease Communicable disease Social and emotional wellbeing Chronic disease Communicable disease Social and emotional wellbeing

22. Comprehensive Primary Health Care Healthy public policy Prevention and health promotion Better management Healthy public policy Prevention and health promotion Better management

23. Conclusion Poor record Fundamental strategies Recent initiatives Reconciliation Underlying determinants Poor record Fundamental strategies Recent initiatives Reconciliation Underlying determinants

24. References Anderson I. The National Aboriginal Health Strategy. In Health Policy in Australia. Editor Gardner H. Oxford University Press 1997. Guthridge S, Cairnduff S, Gollow P, Pearce M, Kennedy K. Structure, Function and Health: a review of the health impact of infrastructure change in remote Aboriginal communities in the Top End. Territory Health Services 1999. Kunitz SJ. Disease and social diversity: the European impact on the health of non- Europeans. New York: Oxford University Press, 1994 Anderson I. The National Aboriginal Health Strategy. In Health Policy in Australia. Editor Gardner H. Oxford University Press 1997. Guthridge S, Cairnduff S, Gollow P, Pearce M, Kennedy K. Structure, Function and Health: a review of the health impact of infrastructure change in remote Aboriginal communities in the Top End. Territory Health Services 1999. Kunitz SJ. Disease and social diversity: the European impact on the health of non- Europeans. New York: Oxford University Press, 1994