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National Heath Implementation Plan - Donna Ah Chee & Tom Calma
- 1. Revision of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 Donna Ah Chee and Tom Calma Implementation Plan Working Group NACCHO Members’ Conference – 5 November 2019 1
- 2. Developing the new Implementation Plan 2 • The Implementation Plan is now being revised to: • embed the social determinants of health and cultural determinants of health; • ensure alignment with relevant policies and priorities, including the Closing the Gap Refresh; and • simplify the goals and actions. • It is anticipated that the revised Implementation Plan will be released in mid-late 2020, aligning with the Closing the Gap Refresh. • The Implementation Plan is being revised with, not for, Aboriginal and Torres Strait Islander people. This includes reflecting the My Life, My Lead consultations.
- 3. 3 Implementation Plan Working Group • An Implementation Plan Working Group has been established to partner with the Department of Health to develop the Implementation Plan. MEMBER POSITION Ms Donna Murray (Chair) Chief Executive Officer, Indigenous Allied Health Australia Prof Tom Calma AO (Deputy Chair) National Coordinator, Tackling Indigenous Smoking, Department of Health Ms Donna Ah Chee Chief Executive Officer, Central Australian Aboriginal Congress Corporation Ms Dania Ahwang Chief Executive Officer, Wuchopperen Health Service Ltd Dr Chris Bourke Strategic Programs Director, Australian Healthcare and Hospitals Association Ms Tania Brown Deputy Chief Executive Officer, Aboriginal Health and Medical Research Council Dr Sean Taylor Adjunct Senior Research Fellow Australian Institute of Tropical Health & Medicine College of Public Health, Medical and Veterinary Sciences – James Cook University Dr Lucas de Toca Assistant Secretary, Health Plan, Early Years and Engagement Branch, Indigenous Health Division,
- 5. Collaborative, cohesive policy •Co-design approach to ensure that diverse community needs are articulated and applied •Ensure a bottom-up, place-based feedback loop between community and government •Provide best-practice guidance document for government programs, policies •Align with key policies at the national and jurisdictional level, including the 10 Year Preventive Health Strategy, the 10 Year Primary Care Plan, mental health reform initiatives, and many others. 5
- 6. 6
- 7. 7 Governance
- 8. Draft Framework for new Implementation Plan 8
- 9. Draft Vision Aboriginal and Torres Strait Islander peoples enjoy long and healthy lives 9
- 10. Health in the Aboriginal and Torres Strait Islander context • Health and wellbeing are heavily linked with social connectedness and culture. • Stronger connections to culture and Country build self- esteem, resilience and improved outcomes across a range of determinants. • To close the gap, approaches must take a whole-of-life focus. 10
- 11. 11
- 12. What is different about this framework? The life course framework will be underpinned by: • Focus areas that identify where change is needed to support improved health outcomes across each stage of life and throughout the health system • Activities across the focus areas: • Identifying what action is needed across each stage of life • Targeting the social determinants and/or promoting the cultural determinants of health • Contributing to a more effective, culturally safe, and responsive Australian health system that is accountable to Aboriginal and Torres Strait Islander individuals, families and communities 12
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- 17. Workforce • Aboriginal and Torres Strait Islander representation in the health workforce • Culturally safe workforce in Aboriginal and Torres Strait Islander health • Culturally safe and responsive mainstream sector 17
- 18. Healthy Living • Preventative health measures • Early intervention • Enabling healthy choices • A high quality of life • Social and emotional wellbeing, including mental health support and services 18
- 19. Cultural Wellbeing • Support and value Aboriginal and Torres Strait Islander peoples’ language, knowledge and beliefs, kinship, cultural expression and exchange, country and caring for country in the health context • Aboriginal and Torres Strait Islander governance • Nation Building 19
- 20. Aboriginal and Torres Strait Islander Organisations • Support Aboriginal and Torres Strait Islander community controlled health services • Co-design with communities • Aboriginal and Torres Strait Islander-led research and knowledge translation • Communities driving policy change • Aboriginal and Torres Strait Islander-led public health approaches 20
- 21. Strong families and communities • Food security • Healthy built and natural environments • Safe communities • Connection to culture and community • Aboriginal and Torres Strait Islander governance and decision-making • Aboriginal and Torres Strait Islander voices: knowledge and experience at the centre • Data sovereignty 21
- 22. Cross-sector Partnerships • Safe, security housing • Education sector • Justice systems • Employment and job creation • Income support • Disability support • Child protection and family support systems • Infrastructure • Aged care sector • Co-design and shared decision making with communities and Aboriginal and Torres Strait Islander organisations 22
- 23. Next steps • Ongoing, targeted stakeholder engagement on the framework until March 2020 • Continued engagement across government to ensure alignment with relevant policies, particularly the Closing the Gap Refresh • Implementation Plan expected to be finalised in mid-2020. If you have any questions of feedback in relation to the revision of the Implementation Plan please email: health.implementation.plan@health.gov.au 23
Editor's Notes
- The Implementation Plan is being revised to: embed the social determinants of health and cultural determinants of health; ensure alignment with relevant policies and priorities, including the Closing the Gap Refresh; and simplify the goals and actions. Development of the Implementation Plan will be overseen by IPAG. It is anticipated that the revised Implementation Plan will be endorsed in mid-2020.
- An Implementation Plan Working Group has been established to partner with the Department of Health to develop the Implementation Plan. This working group is chaired by Donna Murray and includes representatives from the community controlled sector.
- To ensure future changes are achieved through collaboration, the next Implementation Plan will: Use a co-design approach to ensure that diverse community needs are articulated and applied - this includes incorporating the extensive stakeholder feedback that was received during the My Life My Lead consultations Ensure a bottom-up, place-based feedback loop between community and government The next Implementation Plan will also operate as a best-practice guidance document for government programs, policies and initiatives for Aboriginal and Torres Strait Islander health. The next Implementation Plan will be strongly aligned with other key policies at the national level, ensuring a cohesive approach to Aboriginal and Torres Strait Islander health – including across the mainstream health sector. Key strategies include the 10 Year Preventive Health Strategy, the 10 Year Primary Care Plan, mental health reform initiatives, and many others. For those that are currently under development, the Department of Health will ensure that they are guided by the direction of the revised Implementation Plan with respect to how Aboriginal and Torres Strait Islander peoples and their perspectives are engaged and considered.
- The development of the Implementation Plan is being guided by the direction of the Closing the Gap Refresh, which we are treating as the overarching policy framework. In particular, the Priority Reform Areas that have been developed by the Coalition of Peaks and agreed in principle by governments will be embedded in the Implementation Plan. These include: Develop and strengthen structures to ensure the full involvement of Aboriginal and Torres Strait Islander people in shared decision making at the national, state, local and regional level and embedding their ownership, responsibility and expertise to close the gap; Build the formal Aboriginal and Torres Strait Islander community-controlled service sectors to deliver closing the gap services and programs in agreed priority areas; and Ensure mainstream government agencies and institutions that deliver services and programs to Aboriginal and Torres Strait Islander people undertake systemic and structural transformation to contribute to closing the gap. The governance structure reflects the new way of working, with Government working in partnership with Aboriginal and Torres Strait Islander peoples to co-design the policies that impact our lives. The Implementation Plan is being developed in parallel with the Closing the Gap Refresh, with overlapping membership between the Implementation Plan Advisory Group and the Coalition of Peaks. It is important that these two policies are completely aligned to ensure there is no duplication or inconsistencies.
- This governance structure further demonstrates the new way of working, with Government working in partnership with Aboriginal and Torres Strait Islander peoples to co-design the policies that impact our lives. The governance structure also demonstrates how the Implementation Plan is also being developed in parallel with the Closing the Gap Refresh, with overlapping membership between the Implementation Plan Advisory Group and the Coalition of Peaks. It is important that these two policies are completely aligned to ensure there is no duplication or inconsistencies.
- The next iteration of the Implementation Plan will have a simple, outcome-centric vision: that Aboriginal and Torres Strait peoples enjoy long and healthy lives. The social determinants and cultural determinants of health will be foundational, ensuring that the approach is focussed on promoting enablers of good health and targeting the underlying barriers. The focus areas and activities that underpin the Implementation Plan will be the drivers that work toward achieving this vision, with aim that Aboriginal and Torres Strait Islander peoples have equal opportunity to good health.
- Health is a holistic concept that incorporates the physical, social, emotional and cultural wellbeing of individuals and their communities. Culture is a key enabler of good health - acknowledging that stronger connections to culture and Country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety (Prof. Ngiare Brown cited in The Lowitja Institute – Cultural Determinants Roundtable, 2014). For their to be real and sustained change, health and wellbeing must be self-determined and relative to place-based need. Changing the marginal position in society of Aboriginal and Torres Strait Islanders people will need an approach that takes in the whole of life, starting with women of child bearing age, focussing on the care of infants and young children and proceeding through the life course (Tom Calma, Social Justice Report, 2005). The colonial legacy of systemic abuse and dispossession has lead to complex intergenerational trauma. This means that Aboriginal and Torres Strait Islander peoples do not begin with an equal opportunity to be as healthy as other Australians (Tom Calma, Social Justice Report, 2005).
- This visual represents this framework in a context that is relevant to Aboriginal and Torres Strait Islander peoples, underscoring that culture is at the very centre of our lives and must be considered across all policies and programs. This diagram also represents the impact of health system effectiveness and the social determinants of health on the personal health journey through entire life-course. The Implementation Plan will have an overarching vision that Aboriginal and Torres Strait Islander people enjoy long and healthy lives.
- The focus areas identify what will be centred around culture and ensure that Aboriginal and Torres Strait Islander people are supported by a health system that is effective, culturally safe, and responsive and is accountable to Aboriginal and Torres Strait Islander individuals, families and communities. The activities in the next Implementation Plan will be simplified to adopt an outcomes focus and be relevant to both governments and communities. These activities will address the focus areas across each stage of the life course, with a focus on outcomes rather than outputs. While the focus will be on the Australian health system, this will include the need for cross-sector partnerships to effectively target the social determinants.
- This framework illustrates how the new Implementation Plan will come together as a cohesive policy, incorporating the life course approach that is so integral for the Aboriginal and Torres Strait Islander health context. This framework is a departure from a siloed, segmented approach, demonstrating the interconnectedness of each aspect of the policy. Proposed Focus Areas under the Implementation Plan Framework encompass: Workforce Healthy Living Cultural Wellbeing Aboriginal and Torres Strait Islander Organisations Strong Families and Communities Cross-sector Partnerships
- The social determinants and cultural determinants are foundational and will be reflected across the focus areas, through a life course lens. The activities will not be segmented and will address what is needed across to enable positive health outcomes and experiences across each stage of life.
- Each focus area is interconnected, not only with one another, but with the entire Australian health system. The policy framework also emphasises the that an effective, safe, responsive and accountable whole-of-health system is essential for supporting improved health outcomes across each stage of life. The entire Australian health system has an important role to play across each focus area, and this will be reflected in the new policy moving forward.
- The workforce focus area will centre on what changes are needed across the health workforce to drive equitable access to culturally safe, responsive and high quality health care. This includes supporting the Aboriginal and Torres Strait Islander health workforce, as increasing this representation across the entire Australian health system is critical to improving access to quality health care. This focus area will also encompass greater cultural safety and responsiveness in the workforce across the mainstream sector, which needs to morph if equality of access is to be achieved. It also encompasses ensuring the cultural safety and responsiveness of the health workforce across the community controlled sector. This focus area aligns with the focus of the developing National Aboriginal and Torres Strait Islander Health Workforce Plan, which has a focus on growing the Aboriginal and Torres Strait Islander Health Workforce.
- The healthy living focus area addresses the key measures that are needed to support healthy living. These include: Preventative health measures, such as: immunisation, health checks, screening, dental checks etc. Activities to support early intervention, such as child and family health programs, childhood hearing health activities and mechanisms that enhance youth engagement. Ensuring the appropriate systems, supports and health promotion activities are in place to enable healthy choices. Health literacy will be a fundamental component of this. Supporting a high quality of life: this includes activities aimed a reducing the burden of disease and support access culturally safe specialist services, respite care and disability support. This will align and link with the various activities already underway, including the development of roadmaps for ear health, eye health, rheumatic heart disease and renal disease. Supporting social and emotional wellbeing throughout the life course, including through mental health support and services. This includes Aboriginal and Torres Strait Islander peoples having access to trauma-informed care. This will complement the existing Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Framework and the other action underway to address mental illness and suicide clusters among our people and communities. As across all focus areas, the activities will stretch across the whole life course and through a cultural lens, ensuring the entire Australian health system plays its part in achieving the outcomes.
- This focus area is to ensure that Aboriginal and Torres Strait Islander peoples cultural wellbeing is supported and valued through the implementation of actions that support the cultural determinants of health: Language Knowledge Beliefs Kinship Cultural expression Country and caring for country These cultural determinants have been informed by the Mayi Kuwayu study on Aboriginal and Torres Strait Islander wellbeing and further work by the Lowitja Institute, Australia’s national institute for Aboriginal and Torres Strait Islander health research. The Lowitja work is ongoing and is informing how the cultural determinants will be embedded in this focus area, and across the next Implementation Plan as a whole. This focus area will include applying a cultural lens to health promotion and literacy, health education programs should place Aboriginal concepts, knowledge and beliefs as co-shapers of the communication materials. It also acknowledges the importance of nation building and governance as essential to ensure that cultural wellbeing is widely supported and valued. These are strong enablers and must be embedded if real change is to be achieved.
- The Aboriginal and Torres Strait Islander Organisations focus area emphasises the important role community controlled organisations play in driving culturally responsive solutions. The Aboriginal community controlled health sector is leading the way in the delivery of comprehensive primary health care services for Aboriginal and Torres Strait Islander peoples, and also plays a significant role in employing, training and retaining the Aboriginal and Torres Strait Islander health and medical workforce. Consistent with the agreed the Closing the Gap Reform Priority Areas, we must continue to support this sector to deliver the services aimed at improving outcomes for Aboriginal and Torres Strait Islander peoples. This includes ensuring that governments work with communities to co-design programs, with change being community owned and driven. This also includes the delivering of public health approaches, which must be community led if they are to reach out to and meet the needs of local populations. Aboriginal and Torres Strait Islander researchers are leading the way in quality, ethical research and knowledge translation. This must continue to be supported to build the evidence base on what works.
- For communities and families to be strong, community voices and experiences must be at the centre of knowledge, understanding and decision making. Aboriginal people must be involved in decision making at all levels, and voices must be heard to determine the best way forward. Communities must also have control and ownership over the collection and application of data that concern their Country and their lives. This is a valuable resource that is imperative to communities developing and driving their own solutions based on local need. Aboriginal and Torres Strait Islander peoples involvement in national, regional and local governance mechanisms is essential to ensure that cultural wellbeing is supported and valued, particularly in the local context. This is consistent with the Closing the Gap Priority Reform Area that Aboriginal and Torres Strait Islander peoples be fully involved in shared decision making and embedding our ownership, responsibility and expertise in decisions that affect our lives. Communities must be safe and the environment healthy. This includes addressing the environmental health, with Aboriginal and Torres Strait Islander peoples more likely to experience environmental conditions in our home and surroundings that directly contribute to poor health outcomes. Food security remains a significant issue for communities across the country. With so many of the principal causes of poor health nutrition related, we must ensure the barriers to food security are minimised.
- This focus area is about how to address the OTHER determinants that influence a person’s health. If the underlying causes of poor health are to be effectively targeted, responses need to joined-up and supported by person-centred, wrap-around approaches. This would not be complete without consideration of the interrelated service areas that impact health outcomes. Cross-partnership approaches involves better planning and coordination between governments, communities and service sectors—particularly mainstream services—to meet the needs of the person, and in the context of their family and community, and respond to these unimpeded by organisational and service silos. This approach will enable a person-centred model of care that takes into account the needs of the individual. This includes consideration of how a persons health and wellbeing outcomes are being influenced by a range of factor and what health responses are needed. The rollout of whole-of-government implementation plans as part of the Closing the Gap refresh framework provides an opportunity for aligning priorities across different sectors.
- Ongoing stakeholder engagement at key stakeholder conferences and National Partnership Forums. Continued engagement within government to ensure alignment across relevant policies, particularly the Closing the Gap Refresh. Implementation Plan expected to be finalised in mid-2020. If you have any questions of feedback in relation to the revision of the Implementation Plan please email health.implementation.plan@health.gov.au