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Appendix 5: Position paper on achieving Aboriginal and Torres Strait - Social Justice Report 2011

Social Justice Report 2011

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Appendix 5: Position paper on achieving Aboriginal and Torres Strait
Islander health equality within a generation

Articles 24(2) and 23 of
the United Nations Declaration on the Rights of Indigenous Peoples state:

Indigenous individuals have an equal right to the enjoyment of the highest
attainable standard of physical and mental health. States shall take the
necessary steps with a view to achieving progressively the full realization of
this right.

Indigenous peoples have the right to determine and develop priorities and
strategies for exercising their right to development. In particular, indigenous
peoples have the right to be actively involved in developing and determining
health, housing and other economic and social programmes affecting them and, as
far as possible, to administer such programmes through their own
institutions.

In relation to the achievement of Aboriginal and Torres Strait Islander
health equality within a generation, this position paper is an expression of
these rights by the following national Aboriginal and Torres Strait Islander
health peak bodies and key stakeholders:

  • Aboriginal and Torres Strait Islander Social Justice Commissioner
    of the Australian Human Rights Commission;
  • Australian Indigenous Doctors’ Association;
  • Australian Indigenous Psychologists’ Association;
  • Congress of Aboriginal and Torres Strait Islander Nurses;
  • Indigenous Allied Health Australia Inc.;
  • Indigenous Dentists’ Association of Australia;
  • Lowitja Institute;
  • National Aboriginal and Torres Strait Islander Healing Foundation;
  • National Aboriginal and Torres Strait Islander Health
    Workers’ Association;
  • National Aboriginal Community Controlled Health Organisation;
  • National Congress of Australia’s First Peoples;
  • National Coordinator, Tackling Indigenous Smoking; and
  • National Indigenous Drug and Alcohol
    Committee.

These positions also reflect those agreed by the
following national workshops, hosted by the Close the Gap Campaign for
Indigenous Health Equality and attended by representatives from across the
Aboriginal and Torres Strait Islander health sector and Australian
governments:

  • Close the Gap - National Indigenous Health Equality Summit,
    Canberra, March 2008;
  • Close the Gap - Partnership in Action Workshop, Sydney, November
    2008; and
  • Close the Gap – Making it Happen Workshop, Canberra, June
    2010.

1. Principles to underpin a national effort to achieve
Aboriginal and Torres Strait Islander health equality

  • Achieving Aboriginal and Torres Strait Islander health equality
    within a generation (health equality) is a national priority.
  • The Close the Gap Statement of Intent is a foundational
    document, guiding efforts to meet this aim of health equality for Aboriginal and
    Torres Strait Islander peoples.
  • The Statement of Intent commitments comprise an interdependent and
    coherent framework for achieving health equality and are not to be selectively
    interpreted or implemented. Therefore, the social and cultural determinants of
    Aboriginal and Torres Strait Islander health inequality must be addressed as a
    part of a national effort to achieve health equality, and within a national
    health equality plan.
  • By meeting the commitments in the Statement of Intent, Australian
    governments will:

    • adopt ‘best practice’ policy, targets and guidelines
      for achieving health equality, as supported by research findings and the
      evidence base;

    • adopt the most efficient way of achieving health equality.
      Partnership, in particular, should be considered as an efficiency measure:
      helping to maximise the health outcomes from the resources available;
      and

    • align their efforts with the human rights of Aboriginal and Torres
      Strait Islander peoples, including those set out in the United Nations
      Declaration on the Rights of Indigenous Peoples
      .


  • To drive this national commitment, the Prime Minister should lead
    the effort for achieving health equality through COAG and partnership with
    Aboriginal and Torres Strait Islander peoples through their representative
    organisations. This collective leadership should enable and be accountable for
    achieving the:


    • vital intergovernmental and intersectoral cooperation needed to
      achieve health equality;


    • public sector to work in partnership with Aboriginal and Torres
      Strait Islander peoples and their representatives, particularly when developing
      and implementing a health equality plan; and


    • national effort for health equality to be enhanced and be integral
      to the roll out of the National Health and Hospital Network (NHHN) and future
      reforms.


  • Reflecting this, the Prime Minister should continue to report to
    the Parliament and the nation on efforts to ‘close the gap’
    (including in relation to health outcomes) on the opening day or the first
    session of federal Parliament each year.

2. A partnership
between Aboriginal and Torres Strait Islander peoples, their representatives and
Australian governments

  • A partnership between Aboriginal and Torres Strait Islander
    peoples, their representatives and Australian governments (partnership) must
    underpin the national effort to achieve health equality.

  • The mechanism to achieve a sustainable partnership will be
    through;


    • the thirteen signatories (including the National Congress of
      Australia’s First Peoples) creating a single community partnership
      interface. The signatory bodies pledge to work together and engage with
      Australian governments as equal partners at the national level to progress
      health equality.


    • Australian governments creating a single government partnership
      interface that should include:


      • the Minister for Health and Ageing and the Minister for Indigenous
        Health;


      • the Minister for Indigenous Affairs; and


      • State and Territory Governments.


    • The support of all Opposition parties, minor parties and
      Independents for the partnership arrangements set out in this paper should be
      secured to ensure continuing political support for the achievement of health
      equality until 2030.



  • The partnership should be formalised through a framework agreement
    that clearly articulates the rules of engagement between all parties,
    based on the United Nations Declaration on the Rights of Indigenous
    Peoples
    , paying particular attention to:


  • The Second Preambular paragraph

    Affirming that
    indigenous peoples are equal to all other peoples, while recognizing the right
    of all peoples to be different, to consider themselves different, and to be
    respected as such.


    • Article 3

      Indigenous peoples have the right to
      self-determination. By virtue of that right they freely determine their
      political status and freely pursue their economic, social and cultural
      development.


    • Article 18

      Indigenous peoples have the right to participate in
      decision-making in matters which would affect their rights, through
      representatives chosen by themselves in accordance with their own procedures, as
      well as to maintain and develop their own indigenous decision-making
      institutions.


    • Article 19

      States shall consult and cooperate in good
      faith with the indigenous peoples concerned through their own representative
      institutions in order to obtain their free, prior and informed consent before
      adopting and implementing legislative or administrative measures that may affect
      them.
  • Genuine sharing of decision-making power is essential to this
    partnership. This should be reflected in:


    • co-chairing arrangements between Aboriginal and Torres Strait
      Islander peoples and their representatives and Australian governments in all
      partnership fora;


    • the agreement of quorums in partnership fora that ensure an agreed
      minimum level of Aboriginal and Torres Strait Islander representation at times
      of decision-making;


    • acknowledgement of Aboriginal and Torres Strait Islander
      leadership, experience and knowledge at all stages of the national effort to
      achieve health equality, including in relation to the development and
      implementation of a health equality plan; and


    • adequate resource allocations and flexibility in funding
      arrangements to the Aboriginal and Torres Strait Islander partnership
      organisations to enable them to participate effectively in the
      partnership.
  • For specific issues within the domains of the peak bodies and
    stakeholders, engagement with those peak bodies and stakeholders would continue
    to occur.


  • The National Indigenous Health Equality Council will continue to
    advise the Minister for Indigenous Health and the Minister for Health and
    Ageing.


  • State and territory-level Aboriginal and Torres Strait Islander
    health forums would continue as before, with the affiliates of the National
    Aboriginal Community Controlled Health Organisation (NACCHO) who are parties
    connecting to the national level process through NACCHO’s participation in
    the national forum.

3. The development of a health equality
plan

  • Several dimensions of health-related planning are needed in a
    national effort to achieve health equality: to address both health inequality
    itself, and its social and cultural determinants. The negative impact of racism,
    intergenerational trauma and disempowerment, in particular, must be addressed.

  • A health equality plan development process should be efficient and
    not absorb unnecessary time or resources. The National Aboriginal Health
    Strategy
    (1989) and the National Strategic Framework for Aboriginal and
    Torres Strait Islander Health
    (2003 – 2013) provide a starting
    point.

  • A health equality plan must be ‘owned’ by both
    Aboriginal and Torres Strait Islander peoples and their representatives and
    Australian governments. This reinforces the need for partnership as the basis
    for developing and implementing a health equality plan.

  • Empowerment will be a vital contributor to health equality. Any
    policy or program under a health equality plan should be assessed as to how it
    will increase the ability of Aboriginal and Torres Strait Islander individuals,
    families and communities to take control of their own lives.

  • The commitment to achieve Aboriginal and Torres Strait Islander
    health equality within a generation, and the approach to this set out in the
    Close the Gap Statement of Intent, must be embedded in all current and future
    health reform processes.

Content of a health equality plan

  • The Close the Gap National Indigenous Health Equality
    Targets
    , Overcoming Indigenous Disadvantage Framework indicators and
    the Aboriginal and Torres Strait Islander Health Performance Framework provide a starting point for the agreement of the targets and sub-targets. The
    former has been developed by peak bodies and experts in the field of Aboriginal
    and Torres Strait Islander health.

  • The plan should:

  • invest in and build Aboriginal and Torres Strait Islander
    leadership at all levels of the health system;

  • build the capacity and enhance the leadership of the Aboriginal and
    Torres Strait Islander Community Controlled Health Sector;

  • address the mental health and social and emotional well-being of
    Aboriginal and Torres Strait Islander peoples, including problematic alcohol and
    drug use;

  • address the social and cultural determinants of health;
    and

  • ensure data collections and other measures are in place to enable
    the effective monitoring of progress towards health equality, and an evaluation
    of the quality of the plan, over time.

  • The Statement of Intent commitments to achieve Aboriginal and
    Torres Strait Islander health equality within a generation must be embedded in
    the NHHN reforms.

  • A strong national Aboriginal and Torres Strait Islander leadership
    should oversee those parts of the national effort for health equality that will
    be delivered through the
    NHHN.

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Mr Mick Gooda, Co-chair of the Close the Gap Campaign for
Indigenous Health Equality and Aboriginal and Torres Strait Islander Social
Justice Commissioner
Dr Tom
Calma, Co-chair of the Close the Gap Campaign for Indigenous Health Equality
and

National Coordinator - Tackling Indigenous Smoking


Associate
Professor Peter O’Mara President Australian Indigenous Doctors’
Association


Ms Florence Onus, Chair National Aboriginal and Torres
Strait Islander Healing Foundation


Adjunct
Professor Pat Dudgeon, Chair Australian Indigenous Psychologists’
Association


Mrs
Jennifer Poelina, Chairperson National Aboriginal and Torres Strait Islander
Health Workers’ Association


Dr Sally
Goold OAM, Chair Congress of Aboriginal and Torres Strait Islander Nurses


Mr Justin
Mohamed, Chair National Aboriginal Community Controlled Health
Organisation


Ms
Faye McMillan, President Indigenous Allied Health Australia Inc.


Mr Sam Jeffries and Ms Josephine
Bourne, Co-chairs National Congress of Australia’s First Peoples


Dr Chris
Bourke, President Indigenous Dentists’ Association of Australia


Associate
Professor Edward Wilkes, Chair National Indigenous Drug and Alcohol
Committee


Dr Kerry Arabena, Chief Executive, Lowitja Institute

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