Framework development
The Framework has been developed in close consultation with key stakeholders including the Aboriginal and Torres Strait Islander Health Committee (ATSIHC) and the Māori Health Committee (MHC), RACP Board Directors, senior management, as well as consultations with leading Indigenous health organisations to whom we express our sincere thanks.
The ATSIHC and MHC have broad responsibilities in the RACP in relation to Indigenous health. The Committees will provide the cultural knowledge and leadership required in the ongoing implementation and evaluation of the Framework.
Strategic initiatives in this area are more likely to be successful if based on Indigenous aspirations and priorities, fitting within an Indigenous framework and process, and placed in the context of Indigenous self-determination. Indigenous leadership, agency and decision making is critical from the beginning of the process, and throughout the implementation and evaluation of the Framework. The implementation will follow agreed cultural protocols, drawing on Indigenous strengths and assets, in an empowering process for Indigenous leadership both internal and external to the RACP.
Aboriginal and Torres Strait Islander peoples and Māori have unique and diverse cultures, belief systems and world views. Indigenous knowledges and ways of working, expressed through stories, histories, ceremonies, language, and family and community relationships. These beliefs and practices have informed the development of the Framework and will continue to inform its implementation.
Ways of working, such as the established biennial Hui and other forums, support effective engagement and collaboration with Indigenous health stakeholders including community members, Indigenous partner organisations, RACP leaders, and Aboriginal and Torres Strait Islander and Māori health leaders, to discuss key issues and develop a joint platform for change through the Framework, whilst respecting the needs of each group.
Within the context of the work of the ATSIHC, the MHC, and the Framework, it is also crucial to recognise that, while Australia and Aotearoa/New Zealand have experienced similar impacts of colonisation, the Indigenous peoples of each country have unique political, social, cultural, and historical differences in relation to issues of Indigenous agency and engagement, treaty, diversity, land rights, language, government policies, and historical trauma. The shared legacies of colonisation such as loss of land, culture and identity are perpetuated in contemporary Indigenous societies, and manifest in intergenerational trauma which continues to affect the health and wellbeing of Indigenous peoples. Postcolonial scholars have argued that ‘settler’ countries such as Australia and Aotearoa/New Zealand are either colonial or neo-colonial, rather than postcolonial, and are still subject to ongoing discrimination and dominant systems of power. In this context, Indigenous peoples are not only affected by intergenerational trauma, but are also repeatedly impacted by structures that continue to marginalise their human and legal rights and fail to address the social determinants of health. These factors need to be recognised, respected, and incorporated into the planning and implementation of the Framework’s strategies and in all College work related to Indigenous health.
It needs to be noted that although the Framework relates to Aboriginal and Torres Strait Islander peoples and Māori, the College has Pasifika members and that, as a result, there are three spheres of indigeneity.
To be successful the Framework will require the commitment of all members of the College, through the process of a shared vision and commitment to achieving the strategies contained therein. The College will need to reflect and adopt new ways of working, including new policies and practices, to ensure collaborative and effective outcomes.
A broad range of social determinants influence the physical, emotional, mental and spiritual dimensions of health among Aboriginal and Torres Strait Islander peoples and Maori. These include circumstances and environments as well as structures, systems and institutions that affect the development and maintenance of health. Social determinants of health are categorised as distal (e.g. historic, political, social and economic contexts), intermediate (e.g. community infrastructure, resources, systems and capacities), and proximal (e.g. health behaviours, physical and social environment, poverty).
Determinants in relation to Indigenous peoples also include racism, exclusion, culture, and self-determination and resilience, as contributors to health outcomes in the context of ongoing colonisation. Although there have been some positive, albeit limited, outcomes in relation to Indigenous health, data and qualitative evidence clearly demonstrate that Aboriginal and Torres Strait Islander peoples and Māori continue to experience significant disparity in health outcomes and in equitable access to health services.