Our Choices Our Voices - Australian Human Rights Commission

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Our Choices Our Voices - Australian Human Rights Commission
Our Choices
Our Voices
A report prepared by the Lowitja Institute for the Close the Gap Steering Committee | March 2019

                                                                                          OUR VOICES, OUR CHOICES.   |   i
Our Choices Our Voices - Australian Human Rights Commission
This report is a collaborative
effort of the Close the Gap
Campaign Steering Committee.
Funding for the report was provided             Foreword...............................................................................................1
by Oxfam Australia.

Authors: The Lowitja Institute                  Introduction...........................................................................................2
Consulting team: Mary Guthrie,
Tahlia Eastman, Leila Smith, Romlie
Mokak                                           PRIORITY THEME 1
Editors: Mary Guthrie,
                                                Targeted, Needs-based Primary Health Care                                                                       6
Tahlia Eastman, Romlie Mokak                         Birthing on Country Project ...................................................................................7
Cristina Lochert, Fiona Walls
                                                     Institute for Urban Indigenous Health – Inner City Referral Service......................9
Design and Layout: Hyve Design
                                                     Family Wellbeing Empowerment Program for Young Aboriginal Men.................11
Printing: Indigi-Print

Published by: The Close the Gap
                                                PRIORITY THEME 2
Campaign Steering Committee
                                                Responsive Health Care System                                                                               13
@ Close the Gap Campaign
Steering Committee for                               Northern Territory Aboriginal Health Academy Project........................................14
Indigenous Health Equality, 2019
                                                     Health System Reform – Winnunga Prison Health Service.................................16
This work is licensed under the                      Anaemia Prevention Program, Katherine East, Northern Territory......................18
Creative Commons Attribution
– NonCommercial – ShareAlike                         IndigiLez Leadership and Support Group............................................................20
2.5 Australia License. To view a
copy of this license, visit: http://
                                                PRIORITY THEME 3
by-nc-sa/2.5/au or send a letter to             Good Housing for Good Health
Creative Commons, 171 Second
                                                     Yawuru Home Ownership Program......................................................................24
Street, Suite 300, San Francisco,
California, 94105, USA.                              Torres Strait Island Regional Council....................................................................26
Copies of this report and more                       Mununjali Housing and Development Company Ltd...........................................27
information are available to
download at: www.humanrights.
gov.au/social_justice/health/                   Endnotes.............................................................................................28
index.html and www.antar.org.au/
close-gap                                       Acronyms and Abbreviations..............................................................32
Cover Photo: Smoking Ceremony,
Welcoming Waminda Goodjaga’s
on Yuin Country. L–R; Gemmah
Floyd, Elizabeth Luland, Patricia
De Vries and their babies. Photo
by Jerusha Sutton Photography;
courtesy Waminda South Coast
Women’s Health and Welfare
Aboriginal Corporation.

                                                 Aboriginal and Torres Strait Islander people should be aware that this document may
                                                 contain images or names of people who have since passed away.
ii      |                 OUR VOICES, OUR CHOICES.
Our Choices Our Voices - Australian Human Rights Commission
It is of great concern to us, the Close the Gap
Campaign—as indeed it should be to the Australian
nation—that the target to close the gap in life
expectancy between Aboriginal and Torres Strait
Islander people and non-Indigenous people by 2031 is,
in 2019, widening rather than closing.1 In his Closing
the Gap Report 2019 to Parliament, the Prime Minister
acknowledged that this target is not on track.2

In the past, we have provided a ‘Shadow Report’ including a ten-year review
published in 2018. The review assessed the most significant national effort to
date to improve Aboriginal and Torres Strait Islander health—the 2008 Council
of Australian Governments’ (COAG) Closing the Gap Strategy—with its target
to achieve life expectancy equality by 2030.3

In 2019, the Campaign is taking a different approach to its report. After
identifying what we believe are urgent priority themes for addressing the
health gap, this year we are highlighting stories that illustrate success from
Aboriginal and Torres Strait Islander perspectives. The report addresses the
following three priority themes:

•   Targeted, needs-based primary health care

•   Responsive health care system

•   Good housing for good health.

The stories profiled in this report demonstrate that when Aboriginal and Torres              Ms June Oscar AO
Strait Islander people are involved in the design of the services they need, we              Aboriginal and
are far more likely to achieve success. These stories illustrate that ‘our choice            Torres Strait Islander
and our voice’ are vital if we are to make gains and start to close the gap.                 Social Justice Commissioner
The Campaign welcomes the announcement in December 20184 that
                                                                                             Mr Rod Little
governments will work in true partnership with Aboriginal and Torres Strait
Islander peoples, and their appropriate organisations and representatives.
                                                                                             National Congress of
This is a critical time for the government to work hand-in-hand with us on
                                                                                             Australia’s First Peoples
solutions, to ensure we turn this gap around and do not allow it to widen any
                                                                                             Co-chairs - Close the Gap
Finally, as Co-Chairs, we sincerely thank the almost fifty Close the Gap                     Campaign
Campaign members for their contribution to this work. We could not do
what we do without the enduring support and commitment to better health
outcomes from our membership.

                                                                                 OUR VOICES, OUR CHOICES.                |   1
Our Choices Our Voices - Australian Human Rights Commission
                              To address the widening life expectancy gap between
                              Aboriginal and Torres Strait Islander people and non-
                              Indigenous Australians, we have identified three priority
                              areas that must be addressed. We have illustrated
                              what success looks like in these areas, from varying
                              Aboriginal and Torres Strait Islander perspectives, via
                              stories that highlight Aboriginal and Torres Strait Islander
                              voices and leadership.

                              The three areas of focus for this                The overriding principle throughout
                              year’s report are:                               the stories is that the success
                                                                               of these initiatives is based on
                              •     Targeted, needs-based                      community governance and
                                    primary health care                        leadership, which is imperative
                              •     Responsive health care system              to the success and longevity of
                                                                               the programs. The stories also
                              •     Good housing for good health.              highlight the importance of cultural

                                  FIGURE 1:
                                  Gap between Indigenous and non-Indigenous life expectancy5

                                     Gap between indigenous                      Gap between indigenous
                                     and non-indigenous Males                   and non-indigenous Females

                                              10.2                    2001-2005                 9.6

                                              10.2                    2006-2010                  10

                                             10.8                                              10.6

Our Choices Our Voices - Australian Human Rights Commission
determinants of health such as          health and wellbeing. Overcrowded
strength, resilience, identity and      and unhealthy housing is a major
importantly—self-determination.         factor in the spread of diseases
                                        and a strong contributing factor to
Aboriginal Community Controlled         poor health, especially in young
Organisations (ACCOs) are an            children. Again, as recommended in
essential success component of the      our ten-year review, the Campaign
provision of holistic, affordable and   sees it as vitally important to have
appropriate primary health care for     a national, overarching health
Aboriginal and Torres Strait Islander   infrastructure and housing plan to
people. ACCOs have a proven track       address this need.
record in delivering effective and
cost-efficient primary health care.     The Campaign welcomed the 2018
We, the Campaign, continue to           Council of Australian Governments
urge investment in targeted, needs-     (COAG) decision to establish formal
based comprehensive primary             partnership arrangements between
health care. This is essential in       COAG and Aboriginal and Torres
addressing the unacceptable health      Strait Islander peoples through
disparities between Aboriginal and      their peak bodies on Closing the
Torres Strait Islander and non-         Gap.6 We support the work of the
Indigenous Australians. We strongly     Aboriginal and Torres Strait Islander
support increased investment in         peak bodies in their negotiations
ACCOs to increase the quality and       with governments on the details
accessibility of culturally sensitive   of the partnership. This will be an
and appropriate health care where it    historic agreement and, if we get it
is needed most.                         right, Aboriginal and Torres Strait
                                        Islander people will have shared
We call for governments to commit       decision-making in the design,
to an Australian health care system     implementation, monitoring and
that is responsive to the needs of      review of Closing the Gap policies
Aboriginal and Torres Strait Islander   and programs for the first time.
peoples. This means building a
robust, equitable and transparent       The establishment of a Joint COAG
health care system where                and Aboriginal Torres Strait Islander
institutional racism is acknowledged    Council on Closing the Gap7 has
and addressed; where cultural           the potential to be a significant
safety training is recognised           milestone in the relationship
and valued as an important step         between governments and
in closing the gap; and where           Aboriginal and Torres Strait Islander
Aboriginal and Torres Strait Islander   peoples and is a much-needed step
people are integrated in to health      to make the necessary gains to
professions across workforce.           close the gap.

Health and housing are inextricably     There are many Aboriginal and
linked. It has long been understood     Torres Strait Islander individuals
that housing is a significant           and organisations whose everyday
determinant of Aboriginal and           work is improving health outcomes.
Torres Strait Islander peoples’

                                                                            OUR VOICES, OUR CHOICES.   |   3
Our Choices Our Voices - Australian Human Rights Commission
We urge governments to take             peoples and communities, including
                              advantage of this important             our young people.
                              source of leadership, expertise,
                                                                      Importantly, the stories also reflect
                              guidance and networks, and to
                                                                      the principles of the United Nations
                              recognise how these valuable
                                                                      Declaration on the Rights of
                              qualities contribute towards the
                                                                      Indigenous Peoples. They affirm the
                              success of programs included in
                                                                      unique contribution that Aboriginal
                              this report and beyond.
                                                                      and Torres Strait Islander peoples
                              This report draws on Aboriginal         make to the diversity and richness
                              and Torres Strait Islander-designed     of civilisations and cultures and
                              and led initiatives. The stories        promote cultural diversity and
                              demonstrate enormous diversity in       understanding.
                              the way Aboriginal and Torres Strait
                                                                      The Campaign’s work is grounded
                              Islander peoples are making things
                                                                      in a human rights approach to
                              work in our communities, tailored
                                                                      health. We are committed to
                              for local aspirations and goals.
                                                                      harmonious relations—based on
                              It is important to note that what
                                                                      partnership, engagement and
                              works well in one community may
                                                                      cooperation—between states and
                              not replicate in other communities.
                                                                      Indigenous peoples, as well as
                              However, the principle of self-
                                                                      mechanisms to support this at
                              determination must apply, and
                                                                      national and international levels.
                              acknowledge that Aboriginal and
                              Torres Strait Islander peoples          Working in genuine partnership
                              know what works for our own             means that governments and
                              lives, families and communities.        agencies must understand that
                              Success in this context means that      Aboriginal and Torres Strait
                              Aboriginal and Torres Strait Islander   Islander peoples have a deep
                              peoples have created, designed and      and long-standing appreciation
                              implemented our own solutions, in       of the issues and the solutions
                              our voice and choices.                  related to our health and wellbeing.
                                                                      Governments have been attempting
                              The stories featured in this report
                                                                      to resolve these issues, broadly,
                              were obtained through a referral and
                                                                      for decades, and more specifically
                              a highly engaged interview process;
                                                                      through the 2008 Closing the Gap
                              they highlight programs at various
                                                                      targets. Aboriginal and Torres
                              stages of implementation.
                                                                      Strait Islander people witness the
                              Throughout the interviews, we           constant turnover in governments
                              heard repeatedly that insecure          and agency arrangements, and the
                              and insufficient funding is a           consequent changes in policy and
                              significant limitation to longer-term   program approaches – not always
                              success. This confirms what the         for the better. Funding cuts and
                              Campaign has always identified:         freezes have a debilitating effect on
                              that funding limitations, especially    effective delivery of programs and
                              where funds are not directed to         services.
                              services delivered and designed by
                                                                      It is critically important that
                              Aboriginal and Torres Strait Islander
                                                                      governments commit to this matter
                              people, compromise the health,
                                                                      beyond rhetoric. This can be
                              wellbeing, and the lives of our

achieved through closer alignment       supporting Aboriginal and Torres
between words and actions.              Strait Islander led initiatives and a
Aboriginal and Torres Strait Islander   commitment to working in genuine
people can lead this process, with      partnership, governments can
genuine support from governments.       address this critical health policy
                                        challenge for a population of 3
The Campaign remains committed          per cent of Australia’s citizens. We
to addressing health outcomes for       believe it is a matter of significant
Aboriginal and Torres Strait Islander   urgency for the Australian nation.
people. We are optimistic that, by

             The position and the work of the
         Close the Gap Campaign is underpinned
                by the following principles:

    The Campaign is underpinned by a human rights approach

    The Campaign believes that self-determination is a defining
    factor in improving health outcomes, and that this should be
    reflected in all efforts to close the gap

    The Campaign reaffirms the recommendations of the 2018
    Close the Gap Ten-Year Review to reset the future approach
    to the Federal Government’s Closing the Gap strategy.

    The Campaign fully supports The Uluru Statement from
    the Heart (Uluru Statement), which resulted from wide and
    meaningful dialogues across Aboriginal and Torres Strait
    Islander communities in Australia

    The Campaign is committed to empowering Aboriginal
    and Torres Strait Islander voices, including calling for
    an Indigenous representative voice to Parliament as
    recommended in the Uluru Statement

                                                                                OUR VOICES, OUR CHOICES.   |   5

                              Targeted, Needs-based
                              Primary Health Care
                              Aboriginal and Torres Strait Islander people have
                              a right to access the health care we need, in the
                              location we choose.

                              Yet, the life expectancy gap is widening, not closing8 and health
                              and wellbeing statistics are alarming. For example, the data
                              pointing to suicide rates,9 a burden of disease at 2.3 times that
                              of the non-Indigenous population,10 and chronic disease such as
                              diabetes,11 continue to be of serious concern to the Campaign.

                              We stand by the recommendations made in the ten-year review
                              and we remain committed to working with all governments to
                              achieve health equity for Aboriginal and Torres Strait Islander

                              Aboriginal community controlled organisations are an essential
                              component of the provision of holistic, affordable and
                              appropriate primary health care to Aboriginal and Torres Strait
                              Islander peoples.

                              ACCOs provide holistic and comprehensive services, both
                              designed and led — by the community — for the community.
                              Services and programs include treatment and management,
                              prevention and health promotion, as well as addressing the
                              social and cultural determinants of health.

                              The stories that follow are representative of and designed
                              for local need. They are not always transferrable between
                              communities; however, some elements could be applied across
                              the country, and internationally. For example, the Institute for
                              Urban Indigenous Health (IUIH) Inner City Referral Service could
                              be seen as a potential model for cities and towns, adapted as
                              needed for individual settings.

                              Throughout this report, each story shares a common strength in
                              leadership, initiation and design by Aboriginal and Torres Strait
                              Islander peoples and incorporate our voices and choices. The
                              programs reflect the diversity of ACCOs measures of success
                              and echo the need for community control, with each story
                              highlighting how these measures have influenced the success of
                              their respective programs.


Birthing on Country Project
The Birthing on Country              While there is a long history of
                                     Aboriginal and Torres Strait Islander
                                                                                             A metaphor
Project provides Aboriginal          led birthing programs, the Birthing                     for the best
and Torres Strait Islander           on Country Project is currently
women access to culturally           piloting two programs in Australia:                     start in life.
and clinically safe, inclusive       •   South East Queensland in                            Birthing on Country
                                         collaboration with Indigenous                       Workshop Report 201212
care that incorporates                   Urban Health Institute and
cultural birthing traditions             Aboriginal and Torres Strait
within mainstream                        Islander Community Health
                                         Services Brisbane, and
maternity services.13
                                     •   Nowra, New South Wales,
It was established by the Congress       alongside Waminda South Coast
of Aboriginal and Torres Strait          Women’s Health and Welfare
Islander Nurses and Midwives             Aboriginal Corporation.
                                                                                            PHOTO: Smoking Ceremony; Welcoming
(CATSINaM), the Australian College                                                        Waminda Goodjaga’s on Yuin Country Mum
                                     The Birthing on Country Project
for Midwives (ACM), and members                                                            and Bub; Elizabeth Luland & Nat McLeod;
                                     develops the Aboriginal and                             photo by Jerusha Sutton Photography;
of the University of Sydney and
                                     Torres Strait Islander workforce by                   courtesy Waminda South Coast Women’s
University of Queensland.                                                                  Health and Welfare Aboriginal Corporation

                                                                             OUR VOICES, OUR CHOICES.                    |       7

offering a culturally safe workplace                   pregnancy. She also said that                 treated like a woman expecting
with opportunities for growth.14                       having her second child using the             a baby, and not a person with an
Aboriginal and Torres Strait Islander                  program was much easier, feeling              illness’.
Health Workers in support roles                        confident knowing she had full
have options to upskill at the first                   support from the Aboriginal and               A common thread shared by
Aboriginal and Torres Strait Islander                  Torres Strait Islander midwives               participants was that the success
Birthing Centre in Nowra — set to                      and health workers: ‘The Birthing             of the birthing programs was due
commence construction in 2020.                         Program is built on a background of           to the leadership and ongoing
                                                       understanding – the Aboriginal and            development by Aboriginal and
‘I’m aware of Aboriginal and Torres                    Torres Strait Islander midwives and           Torres Strait Islander people.
Strait Islander health workers who                     health workers understood my family           Program stakeholders felt that one of
have enrolled in a Bachelor of                         background and became my friends              the main barriers of non-Indigenous
Midwifery since there is a guarantee                   during the process.’                          led birthing programs was that they
that identified roles for Aboriginal                                                                 operate out of a mainstream hospital
and Torres Strait Islander people will                 Accessible birthing programs                  or health service, making the
be available with the new Birthing                     increases the likelihood of                   process less culturally safe.
Centre opening in Nowra’ said                          Aboriginal and Torres Strait
Cherisse Buzzacott, an Aboriginal                      Islander women who were once                  The opening of the Nowra
midwife working with the ACM.                          cautious, didn’t feel comfortable,            Aboriginal Birthing Centre is set to
Cherisse also commented that                           or refused to present at                      be ground-breaking. It will create
working for communities that are                       mainstream services, to now                   opportunities for Aboriginal and
driven and passionate fires her up.                    access complete care and feel                 Torres Strait Islander mothers to
‘It has been fulfilling to see how the                 culturally safe knowing that this             experience holistic care outside
program has progressed in the past                     program nurtures individual needs             mainstream services; it will expand
12 months, with the community in                       from the beginning of pregnancy               the Aboriginal and Torres Strait
Nowra independently coming up                          to the end.                                   Islander workforce; and will utilise
with ideas to ensure the program                                                                     the skills and leadership found in
launches successfully.’                                Hayley Longbottom used the Mums               Aboriginal community controlled
                                                       and Bubs Birthing Program run by              health services. The experience and
Karina Hogan, who participated                         Waminda and told us how ‘knowing              hopes of participants and workers,
in the Birthing in Our Community                       that when I was to become a mum               voiced by Karina, is that the Birthing
Program in Queensland, said that                       again, my experiences from my                 on Country project ‘is the bridge to
the program made her feel prepared                     previous children was going to be             giving babies the best start in life’.
about what to expect for her first                     different. I was comfortable, I was

                  FIGURE 2:
                  Maternal and infant health outcomes of women in a Birthing on Country Program compared to Aboriginal and Torres
                  Strait Islander women nationally, ANC = antenatal care, graph taken from Birthing on Country case study.15

                        100                                                                    Aboriginal and Torres Strait
                        90                                                                     Islander women nationally 2013
                                                                                                Birthing on Country women 2013


                                 ANC in        5+ ANC Visits      Casarean         Low birth         Preterm          Neonatal
                              1st Trimester     (babies

Institute for Urban
Indigenous Health
– Inner City Referral Service
The Institute for Urban                  empathy. He said he ‘loves being

Indigenous Health’s (IUIH)
                                         able to work with mob who may                       It works
                                                                                             because its
                                         require extra support initially but
Inner City Referral Service              who grow to be able to advocate for
(ICRS) is an outreach                    themselves and seek appropriate
                                         supports and services as need
                                                                                             run for Mob
service that supports                    arises. Seeing someone who has                      by Mob.
Aboriginal and Torres Strait             never had a place of their own obtain
                                         and maintain their own housing and                  Randall Frazer, Team Leader
Islander people who have                 linking someone who hasn’t received
alcohol, tobacco and other               any support for their health issues
drug and/or mental health                with the appropriate continuing care
                                         is very rewarding’.
and/or chronic health
                                         As with many Aboriginal and
issues, living within a five-
                                         Torres Strait Islander services, lack
kilometre radius of the                  of secure funding is a barrier to
Brisbane GPO.                            sustainable service delivery. With
                                         extra funds and certainty of funding,
The program utilises a number            ICRS could more effectively meet
of approaches – intensive case           community needs. Other barriers to
management, assertive outreach           greater success include the inability
                                         to provide brokerage and co-                FIGURE 3:
and strengths-based, community                                                       Homelessness, Queensland, 2016 Census16
and family focused practice. Randall     ordination with other agencies and
Frazer, a Bidjara man, Team Leader       services, and a coherent strategy of
with the ICRS, said that ‘we have        service provision across all levels.          Homelessness Queensland
a network of twenty Aboriginal           These would assist to address
community-controlled clinics and         the needs of the community more
other services that we can link mob      consistently.
into through our system of care          Randall noted that ICRS is often
which opens the door to medical,         the only service to break through
allied health, dental and other health   to people who do not or cannot
services. We can also link our mob       access other services. ICRS have
to broader social services supports,     successfully housed Elders back on
including housing’.                      their own country at times of terminal
Resilience and dedication to working     illness, supported young women to
with Aboriginal and Torres Strait        access domestic violence services
Islander communities are strong          and obtain their own housing in a
                                                                                           Aboriginal and/or
themes of the ICRS. Randall believes     safe environment, and linked people
                                                                                           Torres Strait Islander people
that the program works because           experiencing severe mental illness to
of the respect, compassion and           appropriate specialised care.                     Non-Indigenous people

                                                                             OUR VOICES, OUR CHOICES.                |         9

“Tony” (not his real name) is a                                consumption. ICRS also provides               Aboriginal and Torres Strait Islander
33-year-old Aboriginal man who was                             guidance with paying rent and bills,          people in Queensland comprise 4.9
removed from his single mother’s                               and with the support of ICRS, he              per cent of population, and 21 per
care and had suffered physical                                 has had not returned to prison. He            cent of the total homeless population
and emotional abuse at the hands                               successfully maintains a tenancy,             in Queensland.17 Nationally,
of carers. As a teenager he was                                he regularly accesses physical                Aboriginal and Torres Strait Islander
sent to an institution where he was                            and mental health services and is             people made up 20 per cent
sexually and physically abused. He                             connected back into the Brisbane              of the total national population
spent his entire adult life either in                          Aboriginal community.                         experiencing homelessness.18
prison or homeless in the inner-city
area. He didn’t have the necessary                             Randall said that
skills or ability to self-regulate his                         ‘we respect the human rights and
emotions and was at risk of being                              the self-determination of our Mob
excluded from the support agency                               and value their autonomy to make
that referred him to ICRS at the start                         their own decisions and live the lives
of the year.                                                   they want to live. We intentionally
With the support of the ICRS, “Tony”                           challenge structures, systems
achieved his first tenancy. He now                             and organisations by encouraging
attends weekly sessions at his                                 compassion, empathy and
local Aboriginal Health Service to                             respect for our Mob and the
manage with physical conditions                                ways they should be supported
and past traumas. ICRS also referred                           by these structures, systems and
him to outpatient counselling for                              organisations; and by supporting
his substance use issues at a                                  our Mob on their pathways to
major hospital, and to positive                                transforming their lives – whether
social inclusion activities such as                            that be from the street or park to
a Men’s Group that have resulted                               places where they feel strong, safe
in a significant reduction in alcohol                          and empowered to live their lives.’

                         FIGURE 4:
                         Aboriginal and Torres Strait Islander homelessness, National19

                         120.0                                                            Aboriginal and/or          Non-Indigenous
                                                                                          Torres Strait Islander
       Rate per 10,000






                                         NSW           VIC          QLD          SA        WA           NT         ACT   AUSTRALIA

10     |                                 OUR VOICES, OUR CHOICES.

Family Wellbeing
Empowerment Program for
Young Aboriginal Men
Central Coast Primary                   Funded by the Primary Health

Care in New South Wales
                                        Network (PHN), the FWB program                       Without the
                                                                                             program, male
                                        is an avenue of support for young
has been facilitating a                 men in the area who may not have
Family Wellbeing Program                expressed their vulnerability to
                                        a doctor, an Aboriginal Medical
                                                                                             youth on the
(FWB) as an Aboriginal                  Service, or a counsellor. It is                      Central Coast
and Youth Social and
                                                                                             would fall apart.
                                        beneficial that the people running
                                        the program understand the different
Emotional Wellbeing                     situations young men present, and
                                                                                             Anthony Freeman – Program
project since 2012.20                   the vulnerable and occasionally
                                        reluctant nature in which some
The FWB program was originally          young men may attend the program.
developed in 1993 by the Aboriginal
                                        Nigel expressed how he genuinely
Employment Development Branch
                                        relates to the young men – he shares
of the South Australian Department
                                        his personal experiences with them
of Education, Training and
                                        and says, ‘I’m vulnerable, and the
Employment. Over the last 21 years,
                                        same as they are, I share my full story
the FWB program has continued and
                                        from the highs to the lows – they
spread with little formal support and
                                        don’t teach that in schools’.
is now nationally active across most
states and territories, along with      Some of the topics discussed in the
some international uptake.21            program are around trauma-informed
                                        practice and psychological tools,
Aboriginal Family Wellbeing
                                        and aside from the experience Nigel
Coordinator Nigel Millgate has
                                        brings to the program, there are
been running the program since its
                                        Elders and community members to
inception. He has seen more than
                                        call for support, offering knowledge
200 Aboriginal young men aged
                                        and guidance for the young men.
between 13 and 18 participate
across eighteen programs. ‘I love       One of the program’s first
this project, I’ve watered it and       participants, Anthony Freeman,
nurtured it from the beginning’         shared his story about the impact
Nigel remarked as he explained          the program has had on his life.
the empowerment, teachings and          Anthony said he was ‘sceptical
development that weave through the      about the program initially, that going
program, and how these learnings        somewhere to talk about feelings
support young men who have often        wasn’t really for him.’ After only a
experienced ‘a lack of positive male    short time under the mentorship
role models in their lives’.            of Nigel and others, Anthony was

                                                                             OUR VOICES, OUR CHOICES.             |    11

                                           so deeply engaged in the program           parents and kids who might not
                                           that he didn’t want to leave, and he       have the capacity or means to get
                                           hasn’t. Seven years later, Anthony         to the program any other way. This
                                           remains a mentor for the program.          has helped with participation and
                                           ‘As a 25-year-old man talking to a
                                           14-year-old knowing he’ll understand       It is evident that people working
                                           the emotional power and understand         and participating in the program are
                                           that different ages don’t matter, this     passionate about nurturing young
                                           will always be the first and last step –   men in the community by providing
                                           it’s our foundation’ said Anthony.         ongoing support and encouraging
                                                                                      them to become emotionally
                                           ‘It is fundamental that the                intelligent and proud young men.
                                           program is community driven                As one of the first participants,
                                           and supported’ said Nigel. He              Anthony advocates for the program
                                           believes community engagement              wholeheartedly saying — ‘this is
                                           with the program is imperative to          where I learned how to express my
                                           the program’s success, though              emotions, now let’s show the boys
                                           expresses deep concern around the          what we can do’.
                                           way in which uncertain government
                                           funding affects the program’s long
                                           and short-term security. Highly
                                           skilled staff members have ceased
                                           working for the program due to
                                           insecure funding.

                                           Another challenge for the program
                                           initially was transport, though the
                                           FWB program has since coordinated
                                           buses to relieve pressure from

12   |               OUR VOICES, OUR CHOICES.

Responsive Health
Care System
Australia has a fundamental responsibility to its
First Peoples to structure and resource its health
care system to be culturally safe, well-trained and
responsive to the needs of Aboriginal and Torres Strait
Islander peoples. As a wealthy nation,22 Australia has
no defence for not delivering on this fundamental right.

To deliver, Australia needs to grow the Aboriginal and Torres Strait
Islander health workforce, equip the broader health workforce with
the right training to deliver culturally safe health care, and invest in the
greater development of ACCOs satellite and outreach services.

Institutional racism in hospitals and health services continues to be
a crucial barrier to effective health service provision. Comprehensive
health workforce development and training strategies such as cultural
safety training are essential as is the growth of an Aboriginal and Torres
Strait Islander health care workforce.23

The Campaign welcomes Australia’s Health Ministers’ 2018
commitment to the development of an Aboriginal and Torres Strait
Islander-led, National Aboriginal and Torres Strait Islander Health and
Medical Workforce Plan.24

The National Aboriginal and Torres Strait Islander Health Plan (2013–
2023)25 and its Implementation Plan26 were developed to improve
the Australian health care system through meaningful engagement
with Aboriginal and Torres Strait Islander people and organisations.
However, the Campaign reiterates Recommendation 5 of our ten-year
review – that the Government renew its commitment to both Plans
and undertake a comprehensive costing of the Implementation Plan to
ensure it is properly resourced.

The Health Care and Social Assistance sector — covering areas such
as health services, aged and child care — was the largest employing
industry of Aboriginal and Torres Strait Islander peoples in the 2006, 2011
and 2016 censuses.27 This sector is also projected to remain the area of
greatest employment growth for the next five years, with the Government
estimating over 250,000 additional jobs.28 This offers an important
opportunity to support the Aboriginal and Torres Strait Islander workforce
across a range of sectors to help close the gap in health outcomes.

                                                                               OUR VOICES, OUR CHOICES.   |   13

                                               Northern Territory Aboriginal
                                               Health Academy Project

       It offers                               Indigenous Allied Health                and increase high school retention to
                                                                                       Year 12.
                                               Australia (IAHA), working in
       more than                                                                       Rikki Fisher has been involved
                                               partnership with Aboriginal
       the standard                            Medical Services Alliance
                                                                                       with the Academy since its
                                                                                       commencement and thinks that it has
       pathway into                            Northern Territory                      been successful ‘due to the people

       allied health.
                                                                                       involved, the support the program
                                               (AMSANT), has developed                 has been getting from families and
       Rikki Fisher, IAHA Director
                                               an innovative project to                the community and people seeing
       and Academy mentor                      increase the number of                  the value and believing in what the
                                                                                       program is about’.
                                               young Aboriginal and
                                                                                       ‘I think it’s been a really
                                               Torres Strait Islander
                                                                                       well-designed process, with
                                               people completing Year                  commitment from families and
                                               12 and entering the health              communities.’ Rikki said, ‘but it
                                                                                       also needs funding commitment that
                                               workforce.                              aligns with the values and integrity of
                                                                                       the program. We wouldn’t want it to
                                               The Northern Territory Aboriginal       be vulnerable to a lack of support or
                                               Health Academy project (the             governments funding cycles.’
                                               Academy) was designed over four
                                               years with Northern Territory (NT)      Students are supported to achieve
                                               students, families, community and       a Certificate II in Health Support
                                               key stakeholders.                       Services and a Certificate III in
                                                                                       Allied Health Assistant qualifications
                                               The Academy is taking a new             while working in a School Based
                                               approach to education and training.     Traineeship or a VET in schools’
                                               This is a community-led learning        pathway with a local employer.
                                               model focused on re-shaping             They attend one day a week for
                                               and re-designing the way training       theory and one day with their
                                               is delivered to Aboriginal and          employer on placement. Employers
                                               Torres Strait Islander high school      are encouraged to participate from
                                               students. The Academy model             diverse organisations including
                                               centres on ensuring that training       the public, NGO and community-
                                               and education is delivered in a way     controlled sectors in primary
                                               that embeds culture, while having       healthcare, rehabilitation and therapy,
                                               a holistic approach to health with      disability, aged care, wellbeing
                                               Aboriginal and Torres Strait Islander   services and oral health. Providing
                                               health and wellbeing at its centre.     a broader experience for students,
FIGURE 5:                                      It works collaboratively across         across sectors is important to ensure
Students in the Academy designed their
own logo, representing their different         health disciplines and organisational   that future workforce needs are met,
cultures and identities as well as the         structures such as health, education,   particularly where specific needs are
collective group.
                                               training and employment to improve      identified, such as disability services.

14    |                  OUR VOICES, OUR CHOICES.

Twenty-five Aboriginal students from       IAHA and AMSANT support                      learning, the way in which they learn,
five Darwin high schools enrolled in       the Academy through leading,                 and the environment in which they
the first intake, with the first cohort    facilitating, coordinating and               feel both safe and included. The
due to complete their Certificate III in   collaborating with students and              Academy is located on the Charles
Allied Health Assistance in December       stakeholders; developing new ways            Darwin University campus where
2019.                                      of delivering mainstream courses to          students engage in a tertiary setting,
                                           our young people, focused on their           gaining confidence and feeling
IAHA and AMSANT are driving                aspirations, goals and needs, as well        comfortable in attaining further
the project with IAHA and other            as employment opportunities in their         educational goals.
partner organisation and their             region.
members actively participating as                                                       The Northern Territory Aboriginal
role models, guest speakers and            The model assists in assessing               Health Academy model could
mentors. These Aboriginal and/or           and demonstrating the success                potentially transfer to other
Torres Strait Islander members are         of education and training                    communities where the community,
health professionals and support           outcomes where social, cultural              families and young people identify
workers who volunteer their time           and environmental determinants               that it would meet their needs. This
to share their experiences, skills         are addressed with wraparound                model provides opportunities for
and knowledge with students                supports. Also, by embedding                 Aboriginal and Torres Strait Islander
through practical and interactive          culturally safe and responsive               high school students to consider,
activities that promote the diverse        practices brought together                   explore and pursue a career in
opportunities within the health            and led by local students,                   health. The delivery and coordination
workforce. Cultural mentors are            families, community and partner              of the Academy model can be
actively engaged with the students,        organisations. The Academy                   contextualised to communities’
attending and hosting classes,             promotes educational achievement             aspirations through working in
functions and presentations on             and leadership with students                 partnership with key Aboriginal and
building cultural capabilities.            actively setting the direction for their     Torres Strait Islander stakeholders.

       0.4 per cent of the allied health professionals                                         Progress is on track
      registered under the National Registration and                                             to halve the gap
     Accreditation Scheme (NRAS) in 2017 identified as                                        in Year 12 attainment
            Aboriginal and Torres Strait Islander.                                                   by 2020.

    Data limitations mean it is not currently possible to obtain a                           While this is only a target to
    precise count of the total allied health workforce in Australia, or                      halve the gap, it is progress
    a profile of the Aboriginal and Torres Strait Islander allied health                     nonetheless, which present
    workforce – registered and self-regulated – in Australia, or a                           potential to attract students
    profile of the Aboriginal and Torres Strait Islander allied health                       into the Aboriginal and Torres
    workforce. Nonetheless, it is clear from available data that allied                      Strait Islander health and
    health continues to have among the lowest representation of                              medical workforce. There is a
    Indigenous professionals. Allied health professionals are also                           significant take up of a health
    among the least well distributed health professions, meaning                             degree by Aboriginal and
    people health professions with the largest gap between Indigenous                        Torres Strait Islander people
    and non-Indigenous professionals.29                                                      studying at university.30

                                                                                  OUR VOICES, OUR CHOICES.              |      15

                                             Health System
                                             Reform – Winnunga
                                             Prison Health Service

        Institutional                        Winnunga Nimmityjah                         Ms Julie Tongs has been the CEO
                                                                                         at Winnunga for the past 21 years.
                                             Aboriginal Health and
        racism can be                                                                    She said that ‘while Canberra is
                                             Community Services                          considered to be a wealthy city,
        an everyday                          (Winnunga) provides a                       behind the affluence there are people

        issue for many
                                                                                         who struggle with poverty; who
                                             range of medical and                        don’t have stable housing, perhaps
        Aboriginal and                       social health services in                   don’t even have mobile phones, and
                                                                                         can find themselves in a destructive
                                             the Canberra region and
        Torres Strait                                                                    cycle.’
                                             has provided outreach
        Islander people.                     corrections health services
                                                                                         Winnunga provides Aboriginal and
                                                                                         Torres Strait Islander support staff,
        Julie Tongs,                         to surrounding districts in                 as well as support around child
        CEO, Winnunga Nimmityjah                                                         protection issues. Winnunga staff
        Aboriginal Health and                Goulburn and Cooma for
                                                                                         provide court attendance support
        Community Services                   many years.                                 for detainees, via a hotline from
                                                                                         AMC to Winnunga. This means that
                                             When the Alexander Maconochie               detainees can have a free phone call
                                             Centre (AMC) prison and remand              to access staff at Winnunga and feel
                                             centre was established in Canberra          safer and better supported to have
                                             ACT in 2008, it was a natural               access to families (who often are
                                             transition for Winnunga to provide          also clients of Winnunga).
                                             services to Aboriginal and Torres
                                             Strait Islander detainees, though           After the death of an Aboriginal man
                                             services were never enough to               in custody in 2015, a formal inquiry
                                             meet needs. As of June 2017, the            found that the broader treatment
                                             incarceration rate for Aboriginal           of the detainee was deficient,
                                             and Torres Strait Islander people           marred by a series of failings
                                             accounted for 27.6 per cent of the          involving corrections, police, and
                                             total prison population.31                  health authorities. Winnunga has

                     NATIONALLY                                                    ACT

            27.6%   As of June 2017, nationally,                        22.4%     In June 2017, in the ACT, Aboriginal
                    Aboriginal and Torres Strait Islander                         and Torres Strait Islander people
                    people accounted for 27.6 per cent                            accounted for 22.4 per cent of the
                    of the total prison population.34                             total prisoner population. 35

     The proportion of Aboriginal and Torres Strait Islander prisoners in the ACT, over the ten-year period
             2008-2018, has more than doubled 10.1 per cent to 22.4 per cent as of June 2017.36

16      |              OUR VOICES, OUR CHOICES.

been advocating for better prison          counselling; there will continue to           health services, including mental
health services for a very long time,      be Aboriginal support staff in there,         health and drug and alcohol
particularly following the death of        and they will know when people are            services, but that detainees have
this man. That inquiry found there         going to court and be in court with           access to a multi-disciplinary
was a need to reform the relationship      them… Doctors are now available               social health team.
between justice and health teams           as needed, and the program will be
operating at the jail and introduce        supported by four nurses including            Winnunga is hopeful that this service
the Winnunga Prison Health                 mental health, who can commence               will support the AMC to be a human
Service.32                                 their day at 6.30am, to be available          rights compliant detention centre.
                                           for detainees going to court.’                That comliance will go some way to
In 2018, the ACT Government                                                              helping detainees overcome a cycle
announced a 24/7 holistic model of         A flexible arrangement has been               of illness and hence be rehabilitated
care would be led by Winnunga for          made with a local pharmacy which              rather than come out of prison worse
all detainees in AMC.33                    can deliver to the AMC. As the                than when they entered.
                                           Winnunga model roles out detainees
Julie explained: ‘this model will mean     will also have access to a dentist,
that Winnunga will have an ongoing         audiologist and optometrist. This
presence at the AMC. Aboriginal            social health, wrap-around service
and Torres Strait Islander staff will be   approach means not only that
there as support staff. There will be a    detainees have better access to
psychologist to provide one-on-one

                                                                                                                   PHOTO: Mural outside
                                                                                                                   Winnunga Nimmityjah
                                                                                                                   Aboriginal Health and
                                                                                                                   Community Services,
                                                                                                              Canberra. Reproduced with
                                                                                                              permission from Winnunga.

                                                                                   OUR VOICES, OUR CHOICES.                     |     17

                                           Anaemia Prevention
                                           Program, Katherine East,
                                           Northern Territory

      Kids are much                        Anaemia is a critical public            significant significantly higher than in
                                                                                   Community A.
                                           health issue in Australia
      more active and                                                              The Anaemia Prevention Program
                                           for Aboriginal and Torres
      show interest                        Strait Islander people. It is
                                                                                   implemented in Community A is the
                                                                                   only anaemia prevention program
      in learning and                      a complex, multifaceted                 in the NT. While it did not prevent

      doing work.
                                                                                   anaemia in all participant children
                                           condition and one of the                (as there are other causes of
      Katrina Mitchell,
                                           most serious global public              anaemia, such as infection),
                                           health problems.37                      anaemia was less prevalent and
      Aboriginal Health
                                                                                   started later in children on the
                                                                                   prevention program, than those
                                           Worldwide, pregnant women
                                                                                   who were not.
                                           and children have the highest
                                           anaemia rates and are the major         Research has found that a
                                           groups targeted for screening and       prevention program needs to be
                                           intervention programs.                  started early in life, before the age
                                                                                   of three months, with education
                                           An Anaemia Prevention Program has
                                                                                   and an iron dose that is provided
                                           been running in three communities
                                                                                   consistently by a dedicated
                                           serviced by Sunrise Health in East
                                                                                   Aboriginal Health Practitioner
                                           Katherine region in the Northern
                                                                                   with intimate knowledge of the
                                           Territory (NT). An evaluation of this
                                                                                   community and the local social
                                           program was conducted by the
                                                                                   determinant issues that hinder
                                           Menzies School of Health Research
                                                                                   parents and primary health care
                                           in 2016, supported by the Lowitja
                                                                                   services from providing the care
                                                                                   required to prevent an anaemic
                                           Research for this program found         episode.
                                           that there were marked differences
                                                                                   An integral component of the
                                           in the delivery of health services
                                                                                   success of the Prevention
                                           between Community A (~350
                                                                                   Program has been the
                                           people), B (~1000 people) and C
                                                                                   engagement of an Aboriginal
                                           (~300 people). Community B and
                                                                                   Health Practitioner, Ms Katrina
                                           C did not have a dedicated person
                                                                                   Mitchell, practicing at Sunrise
                                           responsible for anaemia and thus
                                                                                   Health Service. Katrina is a local
                                           opportunistically screen and treat
                                                                                   young mother and has close
                                           children attending the primary
                                                                                   connections with other mothers
                                           health care service in accordance
                                                                                   within the community She knows
                                           with the CARPA manual.39 Anaemia
                                                                                   what’s happening with families in
                                           rates in Community B and C were
                                                                                   the community, and as a local can

18   |               OUR VOICES, OUR CHOICES.

explain the program, and encourage     outcome in the health service and
mothers to attend the clinic.          the whole wellbeing for all the kids
                                       in the community.’
Katrina says: ‘As an Aboriginal
health practitioner my first job was   Ms Raelene Brunette, an
monitoring for the yearly full child   Aboriginal researcher working
health check, immunisation and the     on the evaluation said: ‘One of
anaemia iron program for the under     the key findings in the program
5 kids. I get lots of good positive    being successful was due to the
feedback from the child health         commitment from the Community
coordinator, teachers and mum’s,       Health Centre local staff whom
aunts and other extended family        held strong connections within
members.’                              the community and who were well
                                       respected by their people. Health
‘Because of the program, the           and education go hand-in-hand, you
coordinator and teachers notice        cannot have one without the other
a big difference in the kids who       in order to create change. This is
had low haemoglobin counts. All        very much so with Aboriginal Health
the kids are much more active and      Practitioners who have a challenging
show interest in learning and doing    and rewarding job at the frontline of
work. As a young Aboriginal person     primary health care.
working and delivering the Anaemia
Program, sometimes it’s difficult      We cannot achieve success in
and frustrating but also its good      improving good health outcomes for
being patient and supportive. I am     our people without Aboriginal Health
committed to achieving a positive      practitioner’s involvement”.

                                                           PHOTO: Ms Katrina Mitchell,
                                                           Aboriginal Health Practitioner,
                                                           Sunrise Health, Anaemia
                                                           Prevention Program

                                                                                  OUR VOICES, OUR CHOICES.             |    19

                                                         IndigiLez Leadership
                                                         and Support Group

           As Indigenous                                 IndigiLez Leadership                                       aiming to create a culturally safe,
                                                                                                                    healing space for Aboriginal and
                                                         and Support Group
           lesbians we                                                                                              Torres Strait Islander women
                                                         was founded in 2008 by                                     to discuss identity, gender and
           are a minority                                Rebecca Johnson and                                        sexuality, safely among peers.40

           within a                                      Tanya Quakawoot. Both                                      Rebecca has worked at local, state

           minority within
                                                                                                                    and national levels to advocate
                                                         founders volunteer their                                   for Aboriginal and Torres Strait
                                                         time and funds to offer
           a minority,                                                                                              Islander LGBTIQ women, including
                                                                                                                    through Tekwabi Giz — a national
                                                         support for Aboriginal
           we’re black,                                  and Torres Strait Islander
                                                                                                                    collaboration of Aboriginal and
                                                                                                                    Torres Strait Islander representatives
           we’re women                                   lesbian, gay, bisexual,                                    from across each state and territory

           and we identify                               transgender, intersex and                                  around Australia.41

           as lesbian or                                 queer (LGBTIQ) women                                       ‘It’s important to provide a space
                                                                                                                    for women to develop pride
                                                         where possible.
           being same                                                                                               as Aboriginal and Torres Strait
                                                                                                                    Islander women as well as a deadly
           sex attracted                                 As part of the work with IndigiLez,                        and proud LGBTIQ+ women’,
                                                         the group has held a series of
           women.                                        Rainbow Dreaming Retreats at
                                                                                                                    Rebecca explained. She feels this
                                                                                                                    is fundamental because ‘building
                                                         Nungeena Aboriginal Women’s                                self-esteem provides opportunities
           Rebecca Johnson,
                                                         Corporation in Queensland, each                            for women to feel empowered and
           Co-Founder of IndigiLez

                                                                               es Strait Islander
                                                                        d Torr                         LG
                                                                   l an                                     BT
                                                                ina          rigina  l and T orres St
                                                            ir g        f Abo                        rait         el
                                                           o         n o                                  Isl
                                                          b         o  i           r Aborigina fo
                                                                                                             an  l and
                                                                     at                  ety                                          de

                                                                                      saf                              Tor


                                                                                   al                                     res
                                                                               ltu                                            Isl





                                                                              u               nd T
                                                                                                  orres Strait Islan

                                                                                          al a                      de



                                                                                               igi                    ro

                                                                                             or                         gr


                                                                                           Ab                             am

NOTE: The rainbow represents




what is needed: there are





minimal to no facts about




Aboriginal and Torres Strait


Islander LGBTIQ people.

  Recommendations to enhance the health and wellbeing of Aboriginal and Torres Strait Islander LGBTI people

20        |                      OUR VOICES, OUR CHOICES.

educated in areas of sexual health,
general health, and social and
emotional wellbeing’ which may
otherwise not be addressed if the
space is unsafe.

High on the list of priorities for
IndigiLez is to find resources to fund
research that investigates holistic
concepts of social and emotional
wellbeing (SEWB) and cultural
safety for Aboriginal and Torres
Strait LBGTIQ women. Rebecca
and the team want to know what
the most appropriate and effective
ways are, to create a safe care
pathway for Aboriginal and Torres
Strait Islander LGBTIQ mob. These
questions inform a larger discussion
around co design of frameworks and
strategies for Aboriginal and Torres
Strait Islander LGBTIQ people being
seen by mainstream health services,
Aboriginal Medical Services (AMSs),
                                         PHOTO: L–R: Belinda Ott, Taz
and Primary Health Networks
                                         Clay & Chantel Keegan

 ‘Would a mainstream health
service or AMS understand the
use of a binder by a person who          of Aboriginal and Torres Strait
is transitioning?’ Rebecca asks,         Islander LGBTIQ women and
among a range of other questions         communities. Success so far has
and concerns about understanding         been demonstrated by witnessing
the particular health and SEWB           women expressing pride in their
needs, and visibility of Aboriginal      sexuality, gender, cultural identity
and Torres Strait Islander LGBTIQ        and overall sense of feeling valued.
people. IndigiLez would like to          IndigiLez co-designs programs with
see questions like this reflected        Aboriginal and Torres Strait Islander
in reports that directly impact          LGBTIQ women, which means
the community. Simply including          that ‘mob saw themselves in the
Aboriginal and Torres Strait Islander    programs, recognising that when
LGBTIQ people in health strategies       we work together that it increases
is ‘not good enough’ said Rebecca,       social inclusion and service access,’
who wants to see Aboriginal and          Rebecca said. According to her,
Torres Strait Islander LGBTIQ women      mobilising all that IndigiLez aims
included in governmental targets and     to achieve is about recognising
not seen as a sub-category in the        the importance of ongoing
overall strategies.                      funding in this space, investing in
                                         research and listening to what the
Ultimately, IndigiLez will continue      LGBTIQ+ community needs are, by
to focus on strategies that aim to       acknowledging that ‘being part of
optimise the health and wellbeing        the conversation is the prevention’.

                                                                                OUR VOICES, OUR CHOICES.             |    21

                               Good Housing
                               for Good Health
                               As a campaign, we have long recognised housing
                               as a determinant of health,42 and we call on all
                               governments to invest in housing to ensure that
                               Aboriginal and Torres Strait Islander people have
                               the best chance of healthy and safe lives.

                               The linkage between affordable and appropriate housing and
                               health outcomes must be recognised in the Closing the Gap
                               Refresh strategy. It is clear that we will never achieve good
                               health outcomes while people live in poor quality, overcrowded
                               housing which can have profoundly adverse impacts on
                               Aboriginal and Torres Strait Islander health outcomes.43

                               We note COAG’s commitment in December 2018 to secure
                               appropriate, affordable housing as a pathway to better lives, and
                               the housing draft target under the Government Refresh process.
                               While this is a commendable goal, the Campaign reiterates
                               Recommendation 6 of our ten-year review44 for an overarching
                               health infrastructure and housing plan be developed, costed and
                               implemented as a matter of urgency.

                               The approach could be in the form of a ‘good housing for
                               good health’ strategy to improve home health and safety for
                               Aboriginal and Torres Strait Islander people, including the
                               ‘Housing for Health’ program45 to eliminate third world diseases.

                               Again, we welcome COAG’s commitment to work in true
                               partnership with Aboriginal and Torres Strait Islander peoples.

                               We are committed to working with Commonwealth and state
                               and territory governments to ensure that remote, regional and
                               urban housing supply is responsive towards improving the
                               health of Aboriginal and Torres Strait Islander peoples.

                               The housing stories reflect the strength in community led and
                               community-controlled programs, and while there is nuance
                               in how this is presented, each program is equally committed
                               towards Aboriginal and Torres Strait Islander people driving the
                               process forward, using our own voice and choices. Living on


Country was seen to be an important aspect for people we spoke to
about housing, while for some people, being close to family was the
most important even if that meant living off Country. Most importantly,
all Australians should have the protections that good housing offers for
good health.

              In the 2016 Census, 20 per cent
     of the homelessness population in Australia were
       Aboriginal and Torres Strait Islander people.46

        Across all States and Territories, Aboriginal
        and Torres Strait Islander households were
      between 1.7 and 2.4 times more likely than other
          households to live in rented dwellings.47

      In the 2016 Census, almost one fifth of persons
        living in Aboriginal and Torres Strait Islander
      households (18 per cent) lived in dwellings that
         required one or more additional bedrooms.
       Overcrowding was worse in non-urban areas
   (28 per cent) than in urban areas with (16 per cent).48

                                                                       OUR VOICES, OUR CHOICES.             |    23

                                             Yawuru Home
                                             Ownership Program

      Home                                   There is a large disparity in            program is consistent with this
                                                                                      objective and supports Yawuru
                                             home ownership between
      is home.                                                                        individuals to be empowered home
                                             Aboriginal and Torres                    owners.
      Naomi Appleby,
                                             Strait Islander people                   The YHOP program is a first for
      home owner
                                             and the non-Indigenous                   Australia. It allows Yawuru first
                                                                                      home owners to enter the housing
                                             population.49 The Yawuru                 market, in a partnership with NBY,
                                             Home Ownership Program                   by purchasing housing and land
                                             was established in 2015                  packages in a Yawuru-developed
                                                                                      housing area. In order to meet
                                             to address this issue for                Keystart’s minimum standard
                                             Yawuru people in Broome.                 criteria, NBY can retain up to 50 per
                                                                                      cent equity in the house and land
                                             Nyamba Buru Yawuru Ltd (NBY) is          package.
                                             a not for profit company owned by
                                                                                      Naomi Appleby is a home owner
                                             the Yawuru Native Title Owners in
                                                                                      under the YHOP program. Yawuru
                                             the Broome region. NBY partnered
                                                                                      made 50 per cent of the funds
                                             with the Kimberley Development
                                                                                      available, and Naomi repays the
                                             Commission and State Government
                                                                                      shared mortgage with Yawuru. Now
                                             mortgage lender Keystart to develop
                                                                                      three years into the arrangement,
                                             the Yawuru Home Ownership Project
                                                                                      she plans to, eventually, own her
                                             (YHOP). YHOP made eight new
                                                                                      home outright. Naomi believes
                                             homes available to local Yawuru
                                                                                      the program provides a very
                                             families through a shared-equity
                                                                                      affordable option for home
                                             purchase arrangement.
                                                                                      ownership and excellent options
                                             Following the recognition of Yawuru      for anyone seeking a home –
                                             Native Title and the establishment       single parents, young families,
                                             of the Yawuru Native Title Holders       and older people.
                                             Aboriginal Corporation (PBC) in
                                                                                      For some people, YHOP has meant
                                             2008, the Yawuru community
                                                                                      achieving accessible housing
                                             highlighted housing as a key priority.
                                                                                      finance, when previous attempts
                                             To deliver on this area of concern,
                                                                                      have failed. The program offers
                                             NBY has a number of programs to
                                                                                      financial counselling for the home
                                             assist Yawuru people to improve
                                                                                      owners so they can become good
                                             their quality of life through improved
                                                                                      money managers and learn about
                                             housing conditions. The YHOP

24   |                 OUR VOICES, OUR CHOICES.
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