Priority 1: Contribute to addressing Indigenous health equity differences
The health and wellbeing of Aboriginal and Torres Strait Islanders and Māori has been adversely affected by ongoing colonisation through structural oppression, racism, disruption to cultural practices, family structures, traditional lifestyles, and historical trauma. Loss of agency, identity and powerlessness, and the impact of the social determinants of health, has contributed to compromised physical, social, mental and spiritual health for Indigenous peoples. Although some positive gains have been made in recent years, it is unacceptable that the current average life expectancy gap for Aboriginal and Torres Strait Islander peoples is 10 years, and 7 years for Māori.
It has been demonstrated that health strategies that involve Indigenous peoples in leadership, decision-making, and management roles, are most likely to result in improved outcomes, due to Indigenous empowerment and control. There is a growing body of evidence that indicates a strengths-based, human rights approach, focussing on resilience, Indigenous culture and positive identity, rather than problems and deficits, will lead to measures being more effective according to Indigenous priorities and definitions of success. ‘Bottom-up’ rather than ‘top-down’ approaches, in which Indigenous culture is a key theme from the outset, and which incorporate holistic world views on health and well-being, have been shown to gain more Indigenous community support and lead to better outcomes.
Features of policies and programs that deliver on community priorities and health improvements, include Indigenous governance and staff, long-term sustainable funding and support, flexibility, and program development which is based on Indigenous capacity, strengths and cultural considerations.
Benefits of such programs not only include improved physical health, but also increased social, emotional, and
spiritual health. The recognition of protective factors in program design and implementation, such as family, resilience, culture and community, leads to increased self-esteem, empowerment, cultural identity, and agency and control, for Indigenous peoples. This focus recognises the important role that healthy communities play in providing a healthy and safe childhood which in turn mediates whole of life health gains from reduced childhood mortality through to reduced health morbidities and increased life expectancy.
Health professionals play a vital role in working with Indigenous communities, particularly in programs which are Indigenous-led, and where Indigenous world views and ways of working are respected. Practitioners who listen, learn, reflect on their own values and assumptions, and address power differentials, are well placed to make a positive contribution to Indigenous health. There is evidence that suggests that those who possess clinical competence, and who engage in culturally safe practices, and develop relationships based on trust, are most effective in making a long-term difference to Indigenous health.
The RACP currently undertakes a range of initiatives designed to address Indigenous health equity differences. The College is aiming to expand its efforts through this Strategic Framework. Policy and advocacy, cultural competence training, curriculum development and training, will be strengthened through internal collaboration and by working in partnership with local, state and national Indigenous leaders and organisations. Organisations such as Te Ora, AIDA, and NACCHO and
its approximately 150-member organisations, have considerable expertise in Indigenous health. They have Indigenous governance, leadership, cultural knowledges,extensive networks, and work at grass-roots community levels. As strong advocacy, policy and community engagement bodies, it is critical that the RACP partner with these organisations, and form collaborative relationships with key Indigenous leaders to better inform and deliver on the RACP’s work.