How the Social Determinants of Indigenous Health became Policy Reality for Australia's National Aboriginal and Torres Strait Islander Health Plan

AbstractThe paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.

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Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia

BMC Public Health ◽

10.1186/s12889-020-09943-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

O. Pearson ◽

◽

K. Schwartzkopff ◽

A. Dawson ◽

C. Hagger ◽

...

Keyword(s):

Health Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Torres Strait Islander ◽

Determinants Of Health ◽

Annual Reports ◽

Aboriginal Community ◽

Primary Health ◽

The Social ◽

Torres Strait

Abstract Background Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. Methods The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. Conclusions This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

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Aboriginal Community Controlled Health Organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia.

10.21203/rs.3.rs-25090/v2 ◽

2020 ◽

Author(s):

Odette Pearson ◽

Kate Schwartzkopff ◽

Anna Dawson ◽

Christina Hagger ◽

Agape Karagi ◽

...

Keyword(s):

Health Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Torres Strait Islander ◽

Determinants Of Health ◽

Annual Reports ◽

Aboriginal Community ◽

Primary Health ◽

The Social ◽

Torres Strait

Abstract Background: Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. Methods: The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed . A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results: Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. Conclusions: This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

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The Centre of Clinical Research Excellence in Aboriginal and Torres Strait Islander Health: An Operational Rationale and Some Reflections on Progress so far

Australian Journal of Primary Health ◽

10.1071/py06028 ◽

2006 ◽

Vol 12 (2) ◽

pp. 97 ◽

Cited By ~ 2

Author(s):

Glenn Giles ◽

Merridy Malin ◽

Peter Harvey

Keyword(s):

Health Services ◽

Clinical Research ◽

Indigenous People ◽

Torres Strait Islander ◽

Aboriginal People ◽

Aboriginal Health ◽

Health Council ◽

Torres Strait ◽

Research Excellence ◽

Torres Strait Islander Health

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

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Ngaa-bi-nya Aboriginal and Torres Strait Islander program evaluation framework

Evaluation Journal of Australasia ◽

10.1177/1035719x18760141 ◽

2018 ◽

Vol 18 (1) ◽

pp. 6-20 ◽

Cited By ~ 7

Author(s):

Megan Williams

Keyword(s):

Torres Strait Islander ◽

Success Factors ◽

Aboriginal Health ◽

Well Being ◽

Evaluation Framework ◽

Social Programs ◽

Cultural Leadership ◽

Social And Emotional ◽

Torres Strait ◽

Torres Strait Islander Health

The Ngaa-bi-nya framework presented here is a practical guide for the evaluation of Aboriginal and Torres Strait Islander health and social programs. It has a range of prompts to stimulate thinking about critical success factors in programs relevant to Aboriginal and Torres Strait Islander people’s lives. Ngaa-bi-nya was designed from an Aboriginal practitioner-scholar standpoint and was informed by the holistic concept of Aboriginal health, case studies with Aboriginal-led social and emotional well-being programs, human rights instruments, and the work of Stufflebeam. Aboriginal and Torres Strait Islander health and social programs have been described as suffering from a lack of evaluation. Ngaa-bi-nya is one of the few tools developed specifically to reflect Aboriginal and Torres Strait Islander peoples’ contexts. It prompts the user to take into account the historical, policy, and social landscape of Aboriginal and Torres Strait Islander people’s lives, existing and emerging cultural leadership, and informal caregiving that supports programs. Ngaa-bi-nya’s prompts across four domains—landscape factors, resources, ways of working, and learnings—provide a structure through which to generate insights necessary for the future development of culturally relevant, effective, translatable, and sustainable programs required for Australia’s growing and diverse Aboriginal and Torres Strait Islander populations.

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Aboriginal Community Controlled Health Organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia.

10.21203/rs.3.rs-25090/v1 ◽

2020 ◽

Author(s):

Odette Pearson ◽

Kate Schwartzkopff ◽

Anna Dawson ◽

Christina Hagger ◽

Agape Karagi ◽

...

Keyword(s):

Health Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Torres Strait Islander ◽

Determinants Of Health ◽

Annual Reports ◽

Aboriginal Community ◽

Primary Health ◽

The Social ◽

Torres Strait

Abstract Background Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented.Methods The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings.Results Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes.Conclusions This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

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The social determinants and starting and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers

Australian and New Zealand Journal of Public Health ◽

10.1111/1753-6405.12626 ◽

2017 ◽

Vol 41 (3) ◽

pp. 230-236 ◽

Cited By ~ 6

Author(s):

David P. Thomas ◽

Kathryn S. Panaretto ◽

Maureen Davey ◽

Viki Briggs ◽

Ron Borland

Keyword(s):

Social Determinants ◽

Torres Strait Islander ◽

National Sample ◽

The Social ◽

Quit Attempts ◽

Torres Strait

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Aboriginal Community Controlled Health Organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia.

10.21203/rs.3.rs-25090/v3 ◽

2020 ◽

Author(s):

Odette Pearson ◽

Kate Schwartzkopff ◽

Anna Dawson ◽

Christina Hagger ◽

Agape Karagi ◽

...

Keyword(s):

Health Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Torres Strait Islander ◽

Determinants Of Health ◽

Annual Reports ◽

Aboriginal Community ◽

Primary Health ◽

The Social ◽

Torres Strait

Abstract Background: Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented.Methods: The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results: Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes.Conclusions: This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

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'I'm not sure it paints an honest picture of where my health's at' – identifying community health and research priorities based on health assessments within an Aboriginal and Torres Strait Islander community: a qualitative study

Australian Journal of Primary Health ◽

10.1071/py16131 ◽

2017 ◽

Vol 23 (6) ◽

pp. 549 ◽

Cited By ~ 8

Author(s):

Geoffrey K. Spurling ◽

Chelsea J. Bond ◽

Philip J. Schluter ◽

Corey I. Kirk ◽

Deborah A. Askew

Keyword(s):

Torres Strait Islander ◽

Indigenous Health ◽

Health Assessment ◽

Health Priorities ◽

Assessment Data ◽

Structured Interviews ◽

Key Informants ◽

Health Assessments ◽

Torres Strait ◽

Torres Strait Islander Health

Aboriginal and Torres Strait Islander health assessments are conducted annually in Australian primary care to detect risk factors, chronic diseases and implement preventive health measures. At the Inala Indigenous Health Service, health assessment data have also been used for research purposes. This research has been investigator-driven, which risks misinterpreting or ignoring community priorities compared with community-led research. The objective of this research was to learn about the Aboriginal and Torres Strait Islander community’s health priorities that could be translated into research themes, and investigate these using health assessment data. A thematic analysis of data was conducted from 21 semi-structured interviews with purposively selected key informants from an urban Aboriginal and Torres Strait Islander community. Key informants articulated an authoritative understanding of how interrelated, inter-generational, social, cultural and environmental determinants operated in a ‘cycle’ to influence the community’s health. Key informant views supported the inclusion of these determinants in health assessments, reinforced the importance of comprehensive primary healthcare and strengthened referral pathways to community resources. Some key informants were ambivalent about Aboriginal and Torres Strait Islander health assessments because of their biomedical emphasis. This research also revealed limitations of health assessment-based research and the biomedical emphasis of the health system more broadly.

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Using participatory action research to prevent suicide in Aboriginal and Torres Strait Islander communities

Australian Journal of Primary Health ◽

10.1071/py14043 ◽

2014 ◽

Vol 20 (4) ◽

pp. 345 ◽

Cited By ~ 12

Author(s):

Adele Cox ◽

Pat Dudgeon ◽

Christopher Holland ◽

Kerrie Kelly ◽

Clair Scrine ◽

...

Keyword(s):

Psychological Distress ◽

Protective Factors ◽

Participatory Action Research ◽

Social Determinants ◽

Torres Strait Islander ◽

Well Being ◽

Participatory Action ◽

Social And Emotional ◽

The Social ◽

Torres Strait

The National Empowerment Project is an innovative Aboriginal-led community empowerment project that has worked with eight Aboriginal and Torres Strait Islander communities across Australia over the period 2012–13. The aim of the Project was to develop, deliver and evaluate a program to: (1) promote positive social and emotional well-being to increase resilience and reduce the high reported rates of psychological distress and suicide among Aboriginal and Torres Strait Islander people; and (2) empower communities to take action to address the social determinants that contribute to psychological distress, suicide and self-harm. Using a participatory action research approach, the communities were supported to identify the risk factors challenging individuals, families and communities, as well as strategies to strengthen protective factors against these challenges. Data gathered during Stage 1 were used to develop a 12-month program to promote social and emotional well-being and build resilience within each community. A common framework, based on the social and emotional well-being concept, was used to support each community to target community-identified protective factors and strategies to strengthen individual, family and community social and emotional well-being. Strengthening the role of culture is critical to this approach and marks an important difference between Aboriginal and Torres Strait Islander and non-Indigenous mental health promotion and prevention activities, including suicide prevention. It has significant implications for policy makers and service providers and is showing positive impact through the translation of research into practice, for example through the development of a locally run empowerment program that aims to address the social determinants of health and their ongoing negative impact on individuals, families and communities. It also provides a framework in which to develop and strengthen culture, connectedness and foster self-determination, through better-informed policy based on community-level holistic responses and solutions as opposed to an exclusive focus on single-issue deficit approaches.

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