Page created by Pamela Warner
A report prepared by the Lowitja Institute for the Close the Gap Steering Committee | March 2020

                                                                   We nurture our culture for our future, and our culture nurtures us.   |   i
This report is a collaborative effort of the Close
the Gap Campaign Steering Committee.

Authors: The Lowitja Institute                       Foreword...............................................................................................2
Writing and editing team: Janine Mohamed,            Executive Summary..............................................................................4
Leonie Wililamson, Phoebe Dent, Josh Power,
Amy Coopes, Marie Macinerney                         Recommendations................................................................................6
Design and Layout: Hyve Design                       SECTION 1
Printing: IndigiPrint
                                                     Introduction and Overview                                                                                                8
Published by: The Close the Gap Campaign
                                                          Why a theme of culture?.......................................................................................10
Steering Committee
                                                          Why now?.............................................................................................................12
@ Close the Gap Campaign Steering
                                                          What are cultural determinants?..........................................................................13
Committee for Indigenous Health Equality,
                                                          Domains featured in this report............................................................................15

This work is licensed under the Creative             SECTION 2
Commons Attribution – NonCommercial                  Self-determination and Leadership                                                                                    16
– ShareAlike 2.5 Australia License. To
                                                          Coalition of Peaks – Collective action towards self-determination.....................18
view a copy of this license, visit: http://
creativecommons.org/licenses/ by-nc-                      Law Yarn – Wuchopperen Health Service............................................................20
sa/2.5/au or send a letter to Creative                    Mäwaya Health Justice Program – NAAJA and Miwatj.......................................22
Commons, 171 Second Street, Suite 300, San
Francisco,California, 94105, USA.                    SECTION 3
Copies of this report and more information are       Indigenous Beliefs and Knowledge                                                                                     24
available t download at: www.humanrights.gov.             Lowitja Institute: Growing the Aboriginal and
au/social_justice/health/ index.html and www.             Torres Strait Islander Health Research Workforce...............................................25
antar.org.au/ close-ga                                    Mayi Kuwayu – Understanding the Cultural Determinants of Health..................26
Cover Artwork: Tracks on the Sand, Brendan
                                                     SECTION 4
Ball, Wudjal Wudjal. The painting tells the story
of Brendan’s journey to eventually becoming          Cultural Expression and Continuity
an Elder for Disability Business, and shows               NuunaRon – Identity and Belonging Through Cultural Connection.....................31
that not everyone leaves foot prints in their
                                                          Creating a Culturally Safe Health System to Facilitate Cultural
journey, some people leave tracks from their
                                                          Expression and Wellbeing....................................................................................34
wheelchair. It talks about where he lives now,
and how he spends time with community
                                                     SECTION 5
and Elders, listening and learning about our
people and how to stay strong. Eventually he
                                                     Connection to Country                                                                                                36
will travel back to the Country of his ancestors          Strong Women on Country and Working for our Country....................................37                                                          Aboriginal and Torres Strait
to learn more and share knowledge about                                                                                                                                                                      Islander people should be
disability in our culture and how we stay            Conclusion..........................................................................................42                                                  aware that this document
                                                                                                                                                                                                             may contain images or
strong, eventually with him taking his place
as an Elder and supporting and guiding other         Acronyms and Abbreviations..............................................................43                                                              names of people who have
                                                                                                                                                                                                             passed away.
people with disability as they make their own
tracks in the sand.
                                                     Close the Gap Campaign Steering Committee Members.................47

                                                                                                                                               We nurture our culture for our future, and our culture nurtures us.                 |        1
Ganinyi ngarri ingga
manjawurrmagi ngindaji
thangani. Thangani
                                                                           The failure over the past 12 years to                              own lives -- ‘nothing about us, without us’ -- should not
gurrijbarra nganggawarra                                                                                                                      be underestimated. In this report, we again demonstrate
                                                                           close the gaps in Aboriginal and Torres                            that, through evidence and case studies with a focus on the
buga yani u, yulngarrawu.                                                  Strait Islander health inequality, and                             cultural determinants of our health and wellbeing.
Binarri yawurrmagi                                                         other measures of social and economic                              Our culture comes from our lore, a very deep and sacred
biyirranggu thangani,                                                      disadvantage, cannot be justified by more                          place. The cultural determinants of our health provide many
                                                                                                                                              of the remedies for Aboriginal and Torres Strait Islander
                                                                           rhetoric or data in another report. Over
Thirrili ngarri warawirragi,                                                                                                                  health equity and these determinants should be respected,
                                                                           the years we have seen so many of these                            understood and embraced by all. This report shows us what
Thirrili ngarri wilawirragi,                                               gaps and measures ignored, overlooked                              can be achieved by Aboriginal and Torres Strait Islander
                                                                                                                                              people through leadership and self-determination, owning
Ganbawirragi ngindaji                                                      and disregarded. Aboriginal and Torres                             our knowledge, continuing our cultures and maintaining
thangani, Yarrangi dinyjili.                                               Strait Islander peoples are not deficits                           connections to Country and kin.

Ngindaji thangani jurali nhi,                                              or statistics. These just hide the truth of                        After ongoing failures, the forthcoming Closing the Gap
                                                                           our lived realities. For us, the harrowing                         refresh must be backed by real action. Every year since
Winyiwunggurragi yarrangi                                                                                                                     2010, our reports have called for significant investment,
                                                                           failure to close the gap is felt through                           not the funding cuts we have suffered. Further investment
nhingi thangani.                                                           sorry business, the countless funerals of                          must be directed towards our capability, our strength, our
                                                                           family and friends, the hospital visits and                        resilience, our cultures. Failure means more preventable
Our ancestors that came                                                                                                                       deaths from diseases that are rare in the developed world,
                                                                           the coronial inquiries that we continue to                         more shamefully high suicide rates driven by poverty
before, created this                                                       painfully endure.                                                  unheard of in comparable countries. It means more deaths
                                                                                                                                              in custody.
knowledge. Our voices                                                      So many of our losses were and are preventable – that is the
                                                                                                                                              Now more than ever is the time to listen to Aboriginal and
carry this knowledge to                                                    failure and pain we carry. Had governments had the grace
                                                                                                                                              Torres Strait Islander ways of knowing, doing and being.
                                                                           to genuinely listen to our voices, to the truth, to solutions
                                                                                                                                              As our Countries burned during the 2019-20 summer,
give to our children to carry                                              and calls to action, perhaps this, the 11th Close the Gap
                                                                                                                                              more than a billion animals perished and sacred sites were
                                                                           Campaign Report, would not be needed.
forever. They must learn                                                                                                                      destroyed. Never before has such devastating impact of the
                                                                           A sensible way of doing business is long overdue as, apart         neglect of Country been witnessed by all Australians. Going
their knowledge so they                                                    from small gains (2 out of 7 targets on track), the attempts       forward we must heed the wisdom of Aboriginal and Torres
                                                                           to close the gaps in Aboriginal and Torres Strait Islander life    Strait Islander peoples. Our knowledge and cultures must                                 Ms June Oscar AO
can stand and speak with                                                                                                                      be viewed as integral to improving not only the health and
                                                                           expectancy, health and education have failed. However, with                                                                                                 Aboriginal and
strength. So they can follow                                               a ten-year national shared decision-making agreement now           wellbeing of our people but of our nation. No Australian can                             Torres Strait Islander
                                                                           signed between the Council of Australian Governments and           afford further repetition of the mistakes of the past.                                   Social Justice Commissioner
and know this wisdom. This                                                 the Coalition of Aboriginal and Torres Strait Islander Peak
                                                                                                                                              Finally, as Co-Chairs, we would like to thank the wider
                                                                           Organisations, we are entering a new era.                                                                                                                   Mr Karl Briscoe
is our umbilical chord to life.                                                                                                               Australian public and the 52 Close the Gap Campaign
                                                                                                                                                                                                                                       CEO National Aboriginal and
                                                                           Our Campaign’s first ‘shadow’ report in 2010 asked for a seat      members for their contribution to this work and for their
This knowledge is from long                                                at this table. The benefits that come from our playing a driving   ongoing support and commitment to better health outcomes
                                                                                                                                                                                                                                       Torres Strait Islander Health
                                                                                                                                                                                                                                       Workers Association
ago, listen to our voices.                                                 role and having legitimate decision-making power over our          for Aboriginal and Torres Strait Islander peoples.

                                                                                                                                                                                                                                       Co-Chairs - Close the Gap

2   |           We nurture our culture for our future, and our culture nurtures us.                                                                                                                     We nurture our culture for our future, and our culture nurtures us.   |   3
Executive Summary
                                     With this report — We nurture our culture for our future,                            health system and externally         As with the 2019 Close the Gap
                                                                                                                          continues to contribute to this      Report, we have relied on the
                                     and our culture nurtures us — we have sought to reflect                              trauma. Measures to promote          narratives of Aboriginal and Torres
                                     the reciprocal and cyclical relationship between culture                             cultural expression as a health      Strait Islander people to provide
                                                                                                                          protective factor and ensure         a strengths-based analysis of
                                     and wellbeing, whereby nurturing culture keeps us, and
                                                                                                                          the cultural safety of the health    Aboriginal and Torres Strait
                                     our future generations, healthy and strong.                                          system are two elements that         Islander health and wellbeing.
                                                                                                                          can be progressed under this         This is in recognition of the hard
                                                                                                                          domain.                              work, resilience and aspirations of
                                     Over the last twelve years,                  communities through culturally                                               Australia’s First Peoples to keep
                                     successive governments have                  centred processes of decision       •   Connection to Country                their families, communities and
                                     failed to deliver the reforms                making and delivers solutions           Aboriginal and Torres                Country strong.
                                     needed to close the gap on health            that respond to local context.          Strait Islander society is
                                     outcomes for Aboriginal and Torres                                                   interconnected with land, sea        However, a strengths-based
                                     Strait Islander people.                  •   Indigenous beliefs and                  and Country. Identity, cultural      approach does not overlook the
                                                                                  knowledge                               practices, social systems,           relationship of power and inequality
                                     At the heart of this report is the           Aboriginal and Torres Strait            traditions and concepts of           on health outcomes and the
                                     recognition of Aboriginal and Torres         Islander people hold complex            spirituality are all drawn from,     responsibility of governments in
                                     Strait Islander empowerment as               and important knowledge                 and depend upon, connection          leading systems reform. The work
                                     vital to wellbeing. The featured             systems. Embedding                      to Country. Aboriginal and           of communities must be matched
                                     case studies have been selected              Aboriginal and Torres Strait            Torres Strait Islander people        by governments through shared
                                     to highlight Aboriginal and Torres           Islander holistic definitions           are uniquely affected by             decision-making, equitable (and
                                     Strait Islander-driven approaches            of health and wellbeing in              accelerating climate change and      sustained) funding and a cohesive
                                     to health policy and program                 the way we deliver health               it is with increasing urgency that   policy approach.
                                     reform across four domains of the            services is critical to improving       we must consider connection to
                                     cultural determinants:                       outcomes. Recognising the               Country in health and wellbeing
                                                                                  expertise of Aboriginal and             policy.
                                     •     Self-determination and                 Torres Strait Islander people
                                           leadership involve practices           and communities in health           These domains have been selected
                                           and processes that incorporate         research, policy and program        because of pragmatic limitations,
                                           not only self-governance and           development is key.                 not as a reflection of importance
                                           shared decision-making, but                                                or priority against the remaining
                                           also rights to express and         •   Cultural expression and             cultural domains of language, and
                                           pass on culture, language, and         continuity are great sources        family, kinship and community.
                                           relationships with Country.            of strength and resilience
                                           Aboriginal and Torres Strait           for Aboriginal and Torres           The interconnected relationship
                                           Islander Community Controlled          Strait Islander people. The         of the different domains means
                                           Health Organisations and               trauma of cultural disruption       that they can never truly operate
                                           the Coalition of Peaks are             and suppression has had a           in isolation and we hope that
                                           examples of self-determination         profound effect on Aboriginal       evidence of the importance of the
                                           and leadership in action. Self-        and Torres Strait Islander          remaining domains is also relayed
                                           determination and leadership in        people’s health and wellbeing.      in this report.
                                           health and wellbeing empowers          Ongoing racism within the

4   |   We nurture our culture for our future, and our culture nurtures us.                                                                                                   We nurture our culture for our future, and our culture nurtures us.   |   5
                                                                                                                                                    Aboriginal and Torres Strait Islander people know the                11. Pursue truth telling as relevant to health system
                                                                                                                                                    solutions to the issues affecting their lives and they                   reform and as an important vehicle for resetting
     For millennia, Aboriginal and Torres                                                                                                           must be in the driver’s seat of health reforms and                       the relationship with Aboriginal and Torres Strait
     Strait Islander peoples have kept their                                                                                                        service delivery for their people. More must be done                     Islander people.
     cultures strong to nurture their health                                                                                                        to link Aboriginal and Torres Strait Islander ways of
                                                                                                                                                                                                                         12. Create a culturally safe Australian health care
                                                                                                                                                    knowing, doing and being with health and wellbeing
     and wellbeing.                                                                                                                                                                                                          system that is responsive to the needs of Aboriginal
                                                                                                                                                    policies and programs, including to:
                                                                                                                                                                                                                             and Torres Strait Islander peoples. This means
     To set us on the path for systems reform                                                                                                       6.   Put Aboriginal and Torres Strait Islander people                    building a robust, equitable and transparent
                                                                                                                                                                                                                             health care system where: institutional racism is
     that supports the cultural determinants                                                                                                             in charge of their own data (and decisions) by
                                                                                                                                                                                                                             acknowledged, measured and addressed; cultural
                                                                                                                                                         recognising and upholding the principles of
     of health that have been outlined and                                                                                                               Indigenous Data Sovereignty.                                        safety training is undertaken regularly and valued as
     showcased in this Report, we affirm the                                                                                                                                                                                 an important step in closing the gap; and Aboriginal
                                                                                                                                                    7.   Invest in Aboriginal and Torres Strait Islander led                 and Torres Strait Islander people are integral and
     following messages and calls to action:                                                                                                             health and wellbeing research, including knowledge                  valued members of the health workforce.
                                                                                                                                                         translation and research impact.

                                                                                                                                                    8.   Recognise and restore Indigenous wellbeing                      Connection to Country is intertwined with Aboriginal
                                                                                                                                                         methods and practices, including healing,                       and Torres Strait Islander health and wellbeing and
                                                                                                                                                         plant-based medicines and ceremony, through                     is a cultural determinant of health. While at the
When Aboriginal and Torres Strait Islander people                                              Community Controlled Health Organisations as a            development of social enterprise. These should                  frontlines of climate change, Aboriginal and Torres
are in control of the decisions that affect their lives,                                       fundamental component of the Australian health            be utilised within healthcare service settings                  Strait Islander peoples also hold unique knowledge
they have better health and wellbeing. We call on                                              system.                                                   and provided appropriate intellectual property                  and practices relevant to addressing the climate
governments and policy makers to adopt the changes                                                                                                       protections.                                                    crisis. These solutions stand to benefit both the
needed to support Aboriginal and Torres Strait                                            3.   Embed the social and cultural determinants of
                                                                                                                                                                                                                         environment and the health of all Australians. We call
Islander self-determination and leadership. They                                               health and wellbeing in the systems undertaking      9.   Support and build the Aboriginal and Torres Strait
                                                                                                                                                                                                                         on governments to:
include to:                                                                                    reform. This must include investment in First             Islander health workforce, including Aboriginal
                                                                                               Nations’ (re)building and development to support          and Torres Strait Islander Health Workers and
                                                                                                                                                                                                                         13. Grow and secure the Indigenous rangers and
1.   Take swift and comprehensive action to support the                                        shared aspirations and collective decision making.        community researchers as important cultural
                                                                                                                                                                                                                             Indigenous Protected Areas programs in line
     calls by Aboriginal and Torres Strait Islander people                                                                                               brokers.
                                                                                          4.   Work together and partner to effect change and                                                                                with calls made by the Country Needs People
     for a Voice to Parliament. As has been so eloquently                                                                                                                                                                    Campaign, including committing to a 10-year
                                                                                               ensure the cultural determinants of health are
     stated in the Uluru Statement from the Heart:                                                                                                                                                                           funding horizon and supporting a long term
                                                                                               embedded across health, and Indigenous affairs       Culture is a protective factor for health and wellbeing,
                                                                                               more broadly. While we are starting to see the       and cultural expression is healing and has health                        target of 5,000 jobs in Indigenous land and sea
     “We seek constitutional reforms that will empower
                                                                                               results from partnerships across sectors, and with   benefits. We must nurture culture to facilitate its                      management across Australia.
     our people and to take a rightful place in our own
     country. When we have power over our destiny our                                          governments, more needs to be done to ensure that    expression and continuity for future generations and                 14. Act to repair, restore and protect Country from
     children will flourish. They will walk in two worlds                                      this work is fully funded and implemented.           ensure that this expression is valued and respected                      future harm. This includes local, national and
     and their culture will be a gift to their country.”                                                                                            by all Australians. This will need governments and                       international cooperation. While Indigenous caring
                                                                                          5.   Develop mutually agreed principles and parameters
                                                                                                                                                    health systems to:                                                       for Country practices are important, they must be
     This call must be heard.                                                                  of partnerships and co-design processes, to
                                                                                               ensure the legitimacy and sustainability of joint                                                                             coupled with government actions and regulations.
                                                                                                                                                    10. Invest in long term Aboriginal and Torres Strait
2.   Support the Coalition of Peaks Priority Reform                                            decision-making arrangements. This must include                                                                               We all must take responsibility for looking after
                                                                                                                                                        Islander designed and led place-based initiatives
     areas for the next Closing the Gap agreement,                                             measures to assess the strength and effectiveness                                                                             Country.
                                                                                                                                                        that use cultural expression to enhance health and
     including investing in community control. This must                                       of partnerships on a regular basis.
     be reflected by upholding the role of Aboriginal

6      |                We nurture our culture for our future, and our culture nurtures us.                                                                                                                    We nurture our culture for our future, and our culture nurtures us.   |   7
SECTION 1   INTRODUCTION AND OVERVIEW                                                                                                                                                                                                               INTRODUCTION AND OVERVIEW      SECTION 1

                                                       and Overview                                                                                the Gap targets, including to close       The 2020 report shows a life
                                                                                                                                                   the life expectancy gap within a          expectancy gap of 8.6 years for
                                                                                                                                                   generation.2                              males and 7.8 years for females
                                                       In 2005, the then Aboriginal and Torres Strait Islander                                                                               remains (Figure 1).4 The Indigenous
                                                                                                                                                   The COAG agreement recognised
                                                       Social Justice Commissioner Tom Calma called for                                            that overcoming Indigenous
                                                                                                                                                                                             burden of disease rate continues
                                                                                                                                                                                             to be 2.3 times higher than for
                                                       Australian governments to commit to achieving equality                                      disadvantage would require a long-        non-Indigenous Australians, with
                                                                                                                                                   term, generational commitment with
                                                       for Aboriginal and Torres Strait Islander people in health                                                                            mental and substance use disorder
                                                                                                                                                   major effort to be directed across        (19%), injuries (including suicide)
                                                       and life expectancy within 25 years. The Close the Gap                                      a range of strategic platforms or         (15%), cardiovascular diseases
                                                       Campaign for Indigenous Health Equality (Close the                                          ‘Building Blocks’ including early         (12%), cancer (9%) and respiratory
                                                                                                                                                   childhood, schooling, health,
                                                       Gap Campaign) was first convened by Commissioner                                            economic participation, healthy
                                                                                                                                                                                             diseases (8%) the leading causes
                                                                                                                                                                                             of total disease burden.5 It is clear a
                                                       Calma in 2006 and the first National Close the Gap Day                                      homes, safe communities, and              reset in our approach is needed.
                                                       was held in 2007. At the heart of the Campaign was the                                      governance and leadership.

                                                       rights-based approach outlined in the 2005 Report.1                                         After an ongoing series of changes
                                                                                                                                                   and the introduction of a seventh
                                                                                                                                                   Closing the Gap target by Australian
                                                       Driven by these calls a Close the                    and life expectancy. Later that        governments, in 2018 the Close the
                                                       Gap Statement of Intent was signed                   same year the Council of Australian    Gap Campaign delivered a ten-year
                                                       in 2008, as a compact between                        Governments (COAG), representing       review that found:
                                                                                                                                                                                                              When I think about
                                                       governments of Australia and                         all tiers of governments, also                                                                    the injustices experienced
                                                       the Aboriginal and Torres Strait                     agreed to focus on addressing          •   Governments had failed to
                                                       Islander peoples, to work together                   Indigenous disadvantage through            coherently implement the Closing              by Aboriginal and Torres Strait
                                                       to achieve equality in health status                 a commitment to meet six Closing           the Gap Strategy, including failure
                                                                                                                                                       to appropriately fund policy
                                                                                                                                                                                                     Islander peoples, I sometimes feel
                                                                                                                                                       commitments and undertake the                 overwhelmed. A widening gap in life
                                                                                                                                                       required systemic reform.
                                                          FIGURE 1:                                                                                                                                  expectancy, soaring rates of incarceration,
                                                          Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017 (extract)
                                                                                                                                                   •   Governments had effectively
                                                                                                                                                       abandoned the Closing the Gap
                                                                                                                                                                                                     our children taken away from their families
                                                                                                                                                       Strategy after five years.                    at 10 times the rate of non-Indigenous
                                                                 80                                                                                The review warned that, without a                 children, our women dying at epidemic
                                                                 70                                                                                reset, the targets would continue to
                                                                                                                                                                                                     levels from domestic and family violence.
                                                                                                                                                   measure nothing “but the collective
                                                                                                                                                                                                     Where do we even start?

                                                                                                                                                   failure of Australian governments to
                                                                                                                                                   work together and stay the course”.3
                                                                 40                                                                                                                                  June Oscar AO
                                                                 30                                                                                Consistent with this prediction,                  Aboriginal and Torres Strait Islander
                                                                 20                                                                                the 2020 Prime Minister’s Closing                 Social Justice Commissioner6
                                                                 10                                                                                the Gap Report found that only
             Source: Australian Bureau of
                                                                                                                                                   two of the seven targets are on
             Statistics 2018, Life tables for
             Aboriginal and Torres Strait
                                                                                                                                                   track. Despite 12 years of action
             Islander Australians, 2015–
                                                                                                Males                         Females              little progress has been made. The
             2017, Cat. no. 3302.0.55.003,                                                                                                         whole-of-government Closing the
             ABS: Canberra. Cited in
                                                                                                                                                   Gap policy agenda has fallen well
             Closing the Gap 2020                                                           Indigenous          Non-Indigenous
                                                                                                                                                   short of the mark.

8    |                    We nurture our culture for our future, and our culture nurtures us.                                                                                                                We nurture our culture for our future, and our culture nurtures us.     |     9
SECTION 1   INTRODUCTION AND OVERVIEW                                                                                                                                                                                           INTRODUCTION AND OVERVIEW      SECTION 1

                                                  Why a theme of culture?
                                                  Aboriginal and Torres                    the emphasis on the social and
                                                                                           cultural determinants of health
                                                  Strait Islander people hold                                                        National Aboriginal                      United Nations Declaration
                                                                                           within the National Aboriginal and
                                                                                                                                     Health Strategy 1989                     on the Rights of Indigenous
                                                  a culturally centred view                Torres Strait Islander Health Plan
                                                                                           2013–2023 (NATSIHP) and the               – Definition of health                   Peoples 2006– Article 24
                                                  of health and wellbeing.
                                                                                           United Nations Declaration of the
                                                  This is anchored in ways                 Rights of Indigenous Peoples.             ‘Aboriginal health’ means not            1. Indigenous peoples have the right to their
                                                  of knowing and being                     This view of health and wellbeing         just the physical well-being                traditional medicines and to maintain their health
                                                                                           was again reflected back by the           of an individual but refers                 practices, including the conservation of their
                                                  that have existed and                    community in the My Life, My Lead         to the social, emotional and                vital medicinal plants, animals and minerals.
                                                  continued for tens of                    national consultations conducted
                                                                                                                                     cultural well-being of the                  Indigenous individuals also have the right to
                                                  thousands of years, shared               by the Australian Government
                                                                                                                                     whole Community in which                    access, without any discrimination, to all social
                                                                                           where the submissions and
                                                  through complex kinship                  consultations emphasised the
                                                                                                                                     each individual is able to                  and health services.
                                                                                                                                     achieve their full potential
                                                  systems and passed down                  centrality of culture and recognised                                               2. Indigenous individuals have an equal right to the
                                                                                           that strong connections to culture        as a human being, thereby
                                                  through systems of law,                                                            bringing about the total well-
                                                                                                                                                                                 enjoyment of the highest attainable standard
                                                                                           and family were vital for good
                                                                                                                                                                                 of physical and mental health. States shall take
                                                  ceremony and song.                       health and wellbeing.7 Yet repeated       being of their Community.
                                                                                                                                                                                 the necessary steps with a view to achieving
                                                                                           governments have failed to                It is a whole of life view and
                                                  Contemporarily this has been
                                                                                                                                                                                 progressively the full realization of this right.
                                                                                           address the structural and systemic       includes the cyclical concept
                                                  expressed by Aboriginal and              discrimination that inhibits our          of life-death-life.
                                                  Torres Strait Islander people in         cultures, and to undertake the
                                                  policy documents such as the             reforms needed to truly embrace a
                                                  1989 National Aboriginal Health          culturally centred approach.
                                                  Strategy’s definition of health,
                                                                                           The 1970s have been described as       cultural burning, revival of Birthing   foundation for good health and
                                                                                           marking the beginning of a ‘cultural   on Country practices, and the           wellbeing?
                                                                                           renaissance’8 of Aboriginal and        rebuilding of languages through
                                                                                           Torres Strait Islander people. As      initiatives such as the Ngunnawal       This Report aims to address this
                                                                                           oppressive laws of assimilation        language revival project being          question and to illustrate the
                                                                                           and segregation lifted, Indigenous     led by the Australian Institute of      pathway forward through case
                                                                                           writers, artists, musicians and        Aboriginal and Torres Strait Islander   studies that speak to four domains
                                                                                           philosophers emerged.                  Studies (AIATSIS) and the Living        of the cultural determinants of
                                                                                                                                  First Language Program through          health:
                                                                                           In 2020 this resurgence of cultural    the Australian Literacy & Numeracy
                                                                                           knowledge and practices continues                                              •   Self-determination and leadership
                                                                                                                                  Foundation (ALNF).
                                                                                           to gain momentum.                                                              •   Indigenous beliefs and
                                                                                                                                  Across the country Aboriginal and           knowledge
                                                                                           Practices that have been hidden,       Torres Strait Islander communities
                                                                                           or laid dormant, under colonial        are leading the way, shaping a          •   Cultural expression and
                                                                                           practices of assimilation are being    vision of health and wellbeing              continuity
                                                                                           revived by Aboriginal and Torres       built upon a foundation of culture.
                                                                                           Strait Islander peoples who are                                                •   Connection to Country.
                                                                                                                                  The challenge for health systems
                                                                                           working to restore the wellbeing       committed to achieving positive         It is hoped that by showcasing these
                                                                                           of their communities and future        change is: how to shift institutions    examples we can help articulate
                                                                                           generations. Examples include the      and thinking beyond embedded            Indigenous-led opportunities for
                                                                                           Firesticks Alliance, an Indigenous     medical models of health towards        broader systems reform.
                                                                                           led network to re-invigorate           a model that puts culture as the

10   |               We nurture our culture for our future, and our culture nurtures us.                                                                                                 We nurture our culture for our future, and our culture nurtures us.     |    11
SECTION 1     INTRODUCTION AND OVERVIEW                                                                                                                                                                                             INTRODUCTION AND OVERVIEW      SECTION 1

                                                     Why now?                                 Aboriginal and Torres Strait Islander
                                                                                              communities and organisations           What are cultural                                     Cultural Determinants originate from
                                                                                                                                                                                            and promote a strength based
                                                     In the 12 years since the                have pushed back on this deficit
                                                                                              discourse and called for system         determinants?                                  perspective, acknowledging that stronger
                                                     Close the Gap Statement                  reforms that support Indigenous
                                                     of Intent was first                      ways of knowing, being and              In the mid-2000s the WHO                       connections to culture and country build
                                                     developed, the debate
                                                                                              doing in health policies, programs      Commission on Social                           stronger individual and collective identities,
                                                                                              and services—approaches that
                                                                                                                                      Determinants of Health
                                                     on health equality versus                centralise self-determination and                                                      a sense of self-esteem, resilience, and
                                                     health equity has grown.                 respect their voices and choices.       helped promote broad
                                                                                                                                                                                     improved outcomes across the other
                                                                                                                                      health policy understanding
                                                     This has included critiques of the
                                                                                              The challenge of interpreting culture
                                                                                              within a framework that can be          of the social and economic
                                                                                                                                                                                     determinants of health, including education,
                                                     Closing the Gap strategy’s target-       broadly applied to health policy and
                                                                                                                                      factors leading to health                      economic stability and community safety.
                                                     driven emphasis on statistical           programs, and to be measured,
                                                     deficit (or disadvantage) rather         has tested health researchers           inequality.                                    Professor Ngiare Brown12
                                                     than a culturally centred analysis       and policy makers over the last
                                                     of health and wellbeing.9 Part           decade. However, we are beginning       While this work played an important
                                                     of what has driven this deficit          to see new ways of knowing              role in understanding poor health
                                                     discourse has been the reliance of       and doing emerge to promote             outcomes in communities such as
                                                     governments on what can easily           a broader understanding of the          First Nations, it was recognised that
                                                     be tracked within the parameters                                                                                         Professor Ngiare Brown offered                            Aboriginal and Torres Strait Islander
                                                                                              cultural strengths and resilience of    the role of culture as a determinant
                                                     of existing government knowledge                                                                                         a strong understanding of the                             standards and within a cultural
                                                                                              Aboriginal and Torres Strait Islander   of health remained largely
                                                     and statistical resource—rather than                                                                                     cultural determinants of health in                        context.
                                                                                              peoples.                                unexplored.13
                                                     an understanding of the inherent                                                                                         her definition (above). However,
                                                                                                                                                                              for some time there was still a                           Perhaps the most notable step, so
                                                     elements of wellbeing as identified                                              For Aboriginal and Torres Strait
                                                                                                                                                                              struggle to articulate how the                            far, in developing contemporary
                                                     by Aboriginal and Torres Strait                                                  Islander people, the concept of
                                                                                                                                                                              critical elements of culture could be                     research on the role of Aboriginal
                                                     Islander people.                                                                 health has always been understood
                                                                                                                                                                              observed, understood and utilised                         and Torres Strait Islander culture
                                                                                                                                      to be holistic and to encompass
                                                                                                                                                                              to drive improvements in individual                       and wellbeing was the launch of
                                                                                                                                      mental, physical, cultural,
                                                                                                                                                                              and community wellbeing.16                                the Mayi Kuwayu National Study of
                                                                                                                                      environmental and spiritual health.14
                                                                                                                                                                                                                                        Aboriginal and Torres Strait Islander
                                                                                                                                      In 2011, in a collaborative process     In 2014, the Lowitja Institute,                           Wellbeing in 2014. As part of its
     Social Determinants of Health                                                                                                    with the Australian Government,         Australia’s national institute for                        groundbreaking work (featured as
                                                                                                                                      Aboriginal and Torres Strait Islander   Aboriginal and Torres Strait Islander                     a case study in Section 3 of this
                                                                                                                                      people ensured that the NATSIHP         health research, held a roundtable                        Report), it has identified six main
     The World Health Organization (WHO) defines the Social Determinants of Health as the conditions in which
                                                                                                                                      2013–2023 placed culture at the         to discuss the need to promote                            domains to describe culture specific
     people are born, grow, work, live, and age. These circumstances are shaped by the distribution of money,
                                                                                                                                      centre of health and wellbeing and      a greater understanding and                               to Aboriginal and Torres Strait
     power and resources at global, national and local levels. The social determinants of health are mostly
                                                                                                                                      spoke to the social determinants        appreciation of the relationship                          Islander peoples in Australia (see
     responsible for health inequities — the unfair and avoidable differences in health status seen within and                                                                between Aboriginal and Torres Strait                      Table 1):20
                                                                                                                                      of health. So too does the National
     between countries.10 Examples of areas where cross-sectoral policy action to address the health determinants                     Strategic Framework for Aboriginal      Islander culture and health to policy
     can be focused include housing, energy, environment, education, transport and social protection.                                 and Torres Strait Islander Peoples’     makers, and to provide evidence to
                                                                                                                                      Mental Health and Social and            support that need, particularly in the
     It has been estimated that up to a third (34%) of the gap between Aboriginal and Torres Strait Islander and
                                                                                                                                      Emotional Wellbeing 2017–2023,          Australian context.
     other Australians’ health outcomes can be explained by social determinants of health, such as education,
                                                                                                                                      which notes that communities
     employment, housing and income, which all exert a powerful effect on the health and wellbeing of all                             can be “sources of support and
                                                                                                                                                                              Organisations such as the
     peoples.11                                                                                                                                                               Australian Indigenous Psychologists
                                                                                                                                      resilience that promote social
                                                                                                                                                                              Association (AIPA),17 Australian
                                                                                                                                      and emotional wellbeing when
     More recently the WHO has framed a Health in all Policies approach, that focuses on policy coherence of                                                                  Indigenous Doctors’ Association
                                                                                                                                      community organisation and
     health across all sectors of government and is an important component of progressing the United Nation’s                                                                 (AIDA)18 and Yawuru19 have also
                                                                                                                                      functioning is culturally informed
     Sustainable Development Goals.                                                                                                                                           contributed to this work by offering
                                                                                                                                      and provides for cultural practice
                                                                                                                                                                              frameworks that define wellbeing by
                                                                                                                                      and transmission”.15

12      |               We nurture our culture for our future, and our culture nurtures us.                                                                                                  We nurture our culture for our future, and our culture nurtures us.     |    13
SECTION 1     INTRODUCTION AND OVERVIEW                                                                                                                                                                                                                                                                              INTRODUCTION AND OVERVIEW                                                                                                SECTION 1

Domains and sub domains for describing culture specific to                                                                                                        Domains featured in this report
Aboriginal and Torres Strait Islander peoples in Australia as
identified in the Mayi Kuwayu literature review                                                                                                                   The domains identified in the Mayi                                                                           •     Self-determination and leadership
                                                                                                                                                                                                                                                                               •     Indigenous beliefs and knowledge
                                                              The six domains are:                                                                                Kuwayu study have been used to inform
                                                                                                                                                                                                                                                                               •     Cultural expression and continuity
                                                                                                                                                                  and frame the cultural determinants of
                                                                                                                                                                                                                                                                               •     Connection to Country.
              Connection to Country                                                                   Family, kinship and community                               health discussed in this Report, which is
                                                                                                                                                                                                                                                                               This is not a position on priority or order, rather a
                         SUB-DOMAINS                                                                                     SUB-DOMAINS                              ordered under four of these domains:                                                                         pragmatic limitation to the amount of material considered.

                     spiritual connection                                                                             family and kinship
                 health and traditional foods                                                                              community
                       living on Country                                                               “A child is a gift to the family—that is to the entire
                  land rights and autonomy                                                              kinship network: he or she is the living evidence
                                                                                                                                                                                                                                                                n individual but refers to t
                                                                                                            that the culture is alive and surviving.” 21
                      caring for Country                                                                                                                                                                                                            e ing of a                               he s
                                                                                                                                                                                                                                                ellb                   nal Aboriginal H          ocia
                                                                                                                                                                                                                                           l w                e. (Natio                               l, e
                                                                                                                                                                                                                                        ca               h-lif                          ea lth            mo
 “Our country is like our garden – we need to look after it. There
                                                                                                                                                                                                                                    h             -d eat                                       Stra          tio
  are trees, birds, waterways, fish, mammals and reptiles, and                                                                                                                                                                    p           life                                                 teg          na
                                                                                                                                                                                                                                e         o f                                                           y 1         la
  they are all important. We keep country healthy and country                                                                                                                                                             s t th cept                                                                      98
                                                                                                                                                                                                                                                                                                             9         nd
                                                                                                                                                                                                                        ju        on                                                                           d e        cu
                        keeps us healthy.”                                                                                                                                                                            t                                                                                           f         l
                                                                                                                                                                                                                                                          al determinants
                                                                                                                                                                                                                     o                                                                                             in
                                                                                                                                                                                                                              a                                                                                      it
                                                                                                                                                                                                                           lic                                                                                         io

                                                                                                                                                                                                                      ec n
            Dhimurru Senior Ranger Fiona Yupunu Marika

                                                                                                                                                                                                                                                      So tion and youth • employ








                                                                                                                                                                                                                                                              s and services • l



                                                                                                                                                                                                                                                            em                   w a and

                                                                                                                                                                                                                                                   •       t                    a
     Indigenous beliefs and knowledge                                                              Cultural expression and continuity                                                                                                            t       ys


                                                                                                                                                                                                                                                                                                                                                                     of t
                                                                                                                                                                                                                                               en nt s                              nd

                                                                                                                                                                                                                                                                                        ju n

                                                                                                                                                                                                       it Is
                                                                                                                                                                                                                                              m      e

                                                                                                                                                                                                                                                   m                                      s


                                                                                                                                                                                                                                              go op
                         SUB-DOMAINS                                                                                     SUB-DOMAINS

                                                                                                                                                                                                                                                                                                         co • a

                                                                                                                                                                                                                                                                        ily, kinship



                                                                                                                                                                                                                                     on w dev

                                                                                                                                                                                                                                                                                                             e • ohol,
                                                                                                                                                                                                                                                                        c                 Ind

                                                                                                                                                                                                                                                                                                                                                                               le Co
                                                                                                                                                                                            fe vie

                spiritual and religious beliefs                                                                              identity                                                                                                                                                    an i

                                                                                                                                                                         Aboriginal and To


                                                                                                                                                                                                                                                             nt n

                                                                                                                                                                                                                                                                                          ge know

                                                                                                                                                                                                                                                      to C ectio
                                                                                                                                                                         It is a whole-of-li

                    traditional knowledge                                                                              cultural practices

                                                                                                                                                                                                                                                                                            no ledge


                                                                                                                                                                                                                                                                                                                        • hous
                                                                                                                                                                                                                          • early chil
                      traditional healing                                                                                art and music

                                                                                                                                                                                                                          • interacti

                                                                                                                                                                                                                                                                                                                          tobacco and ot

                                                                                                                                                                                                                                                                                                                                                                                            in which each i
           knowledge transmission and continuity

                                                                                                    “Having your own voice is very powerful and healing…

                                                                                                                                                                                                                                                                                                                              ing• env
                                                                                                         [M]usic was great therapy for me – it still is.

                                                                                                                                                                                                                                                  deter ader
                                                                                                                                                                                                                                                   and l
       “Culture is central to identity since it “defines who

                                                                                                                                                                                                                                                                                       d res ral
                                                                                                           It gave me a way to express myself…”

                                                                                                                                                                                                                                                     Se nati

                                                                                                                                                                                                                                                                                        co sio
       we are, how we think, how we communicate, what

                                                                                                                                                                                                                                                                                        xp ultu
                                                                                                                                                                                                                                                       mi sh

                                                                                                                    Archie Roach AM endnote23


             we value and what is important to us.”



                                                                                                                                                                                                                                                            ip n

                                                                                                                                                                                                                                                                    Ind                      e



                          Steve Larkins22

                                                                                                                                                                                                                                                                     langu e

                                                                                                                                                                                                                                                                                                                                              dru d in



                                                                                                                                                                                                                                                                                                                                                                                                                   l is
                                                                                                                                                                                                                                                                                                                                                    ep a
               Indigenous language                                                                  Self-determination and leadership


                                                                                                                                                                                                                                                               st enc

                                                                                                                                                                                                                                                                   ctu y • po

                         SUB-DOMAINS                                                                                     SUB-DOMAINS

                                                                                                                                                                                                                                                                             verty              ty
                                                                                                                                                                                                                                                                      re           • food securi


               impacts of language on health                                                                             cultural safety





                    language revitalisation                                                                  self-determination and wellbeing                                                                                                                                            Co                                ul
                                                                                                                                                                                                                                                                                      ir                                     lp
                                                                                                                                                                                                                                                                                    he                                         ote
      Aboriginal and Torres Strait Islander language                                                                       leadership.
                                                                                                                                                                                                                                                                                   t                                              nti
                                                                                                                                                                                                                                                                                of                                                   al a
                        education                                                                                                                                                                                      ah                                                lbei                                                            s
                                                                                                   “We need to own our own risk and that any dramatic shift                                                              um                                           wel
                                                                                                                                                                                                                           an b                                  otal
   “The research shows that knowledge of language helps                                          and change in our circumstances for the better of our children                                                                eing,
                                                                                                                                                                                                                                     thereby bringing about the t
  Aboriginal and Torres Strait Islander people strengthen their                                     and families can only come from our own determination,
    cultural identity, integral to health and wellbeing and by                                    our discipline, commitment and leadership, at an individual
  extension, the health and wellbeing of society as a whole.”                                         and collective level, in driving the change required.”
                    Craig Ritchie, CEO AIATSIS24                                                               Peter Yu, CEO Nyamba Buru Yawuru25

14     |                   We nurture our culture for our future, and our culture nurtures us.                                                                                                                                                                          We nurture our culture for our future, and our culture nurtures us.                                                                                                     |    15

                                                                                                          This can occur through many              Today ACCHOs continue to be at                            Despite the innovation and resilience
                                                                                                          forms, including the operation of        the forefront of ensuring needs-                          evident within their history, ACCHOs
                                                                                                          Aboriginal and Torres Strait Islander    based service delivery reform.                            and other community controlled

                                      and Leadership
                                                                                                          community controlled organisations,      The implementation of Health                              sectors have long struggled to
                                                                                                          Indigenous governance practices,         Justice Partnerships (see Box                             make ends meet under inequitable
                                                                                                          informal community driven reforms        Health Justice Partnerships) within                       and burdensome funding
                                                                                                          to services and systems, and             community controlled settings to                          frameworks and processes.31 The
                                                                                                          through partnerships.                    address the complex intersection                          significance of community control
                                                                                                                                                   between health and legal needs is                         to self-determination, and of self-
                                                                                                          Formal partnerships, which ensure        another example of Aboriginal and                         determination to wellbeing, is in
                                      The right to self-determination is one of the                       the full involvement of Aboriginal       Torres Strait Islander community                          stark contrast with the funding
                                      central principles enshrined by the United                          and Torres Strait Islander people        driven solutions.                                         arrangements, or lack of funding,
                                                                                                          in shared decision-making, are
                                      Nations Declaration on the Rights of Indigenous                                                                                                                        that so often leaves community
                                                                                                          needed at national, state, local         These community driven responses                          organisations and Indigenous
                                      Peoples, acknowledging the right to self-govern,                    and regional levels. To effectively      raise important questions for policy                      leadership vulnerable to changes in
                                      participate in decisions and exercise control.                      embed the expertise, ownership           makers about what resources are                           government.
                                                                                                          and responsibility of Aboriginal         needed for communities to build
                                      Freedom to exercise one’s own values and                            and Torres Strait Islander people,       the governance structures for                             The Close the Gap Campaign
                                      beliefs, or culture, is also a critical element.26                  partnerships require clear               participation in high-level decision                      continues to call for an equitable
                                                                                                          arrangements which say who               making, and how local needs can                           funding framework to not only
                                      ‘Sustainable development’ is a term that has been coined to         is making decisions, how those           shape higher-level system reforms.                        sustain, but expand the work of
                                      frame an understanding of self-determination as a “process          decisions will be made and what                                                                    community controlled organisations.
                                      premised on the notion that evolving indigenous livelihoods,        those decisions will be about.
                                      food security, community governance, relationships to               The Partnership Agreement on
                                      homelands and the natural world, and ceremonial life can            Closing the Gap, agreed in March
                                      be practiced today locally and regionally, thus enabling            2019 and signed by the Australian

                                                                                                                                                      ACCHOs – A history
                                      the transmission of these traditions and practices to future        Government, all State and Territory
                                      generations”.27                                                     governments and the Australian

                                      Effectively implementing the cultural determinants of health
                                                                                                          Local Government Association, has           of self-determination
                                      requires the leadership and self-determination of Aboriginal and
                                                                                                          set a benchmark for partnerships
                                                                                                          with Aboriginal and Torres Strait           and nation rebuilding
                                      Torres Strait Islander peoples. It requires a process whereby       Islander people. It sets out how            “The first Aboriginal community controlled health service was
                                      community define their shared aspirations and lead the design       governments and Aboriginal and              established by the local Aboriginal community in Redfern in July 1971
                                      and delivery of policies and programs accordingly.                  Torres Strait Islander peak bodies          to address the blatant discrimination experienced in mainstream
                                                                                                          will work together to agree a new           services, the ill health and premature deaths of Aboriginal people,
                                      As drawn out in work by Dudgeon et. al. on Indigenous               national agreement on Closing the           and the need for culturally appropriate and accessible health
                                      governance for suicide prevention:                                  Gap, including any new Closing the          services.” Aboriginal Health & Medical Research Council of NSW
                                                                                                          Gap targets and implementation
                                      “When communities are in control of process, better outcomes                                                    Since that first service in Redfern, Aboriginal Community Controlled
                                                                                                          and monitoring arrangements.                Health Organisations (ACCHOs) have pioneered needs-based primary
                                      could be expected. And not only because tailored and culturally
                                                                                                                                                      health care and social justice driven services across Australia. Today
                                      adapted mainstream interventions ‘owned’ (by) a community are       For Aboriginal and Torres Strait
                                                                                                                                                      they form a network of over 141 organisations nationwide.
                                      likely to be significantly more impactful. But more importantly     Islander people control over health
                                      … broader design processes under Indigenous governance will         and wellbeing has always been               From local community driven organisations, they have created an
                                      identify and address other deeper, structural problems that could   significant.29 It is a matter that has      infrastructure of regional, state and national bodies to ensure more
                                                                                                          united communities and driven               effective knowledge creation and translation, program management
                                      also be contributing to suicide, or could protect against it.”28
                                                                                                          the establishment of community              and political advocacy. Importantly, ACCHOs have provided centres for
                                                                                                          governed services and advocacy              Nation rebuilding where Aboriginal and Torres Strait Islander people
                                                                                                          bodies over many years (see Box             across urban, regional and remote communities have been able to
                                                                                                          ACCHOs).                                    come together and form governance structures to enact shared
                                                                                                                                                      decision making and deliver outcomes for their communities. 30

16   |   We
             VOICES,our OUR
                                for our future, and our culture nurtures us.                                                                                      We nurture our culture for our future, and our culture nurtures us.     |    17
SECTION 2   SELF-DETERMINATION AND LEADERSHIP                                                                                                                                                                                         SELF-DETERMINATION AND LEADERSHIP          SECTION 2

Coalition of Peaks – Collective Action
Towards Self-determination
The Coalition of Peaks is a                         “The truth is that the existing          and Torres Strait Islander people
                                                    Closing the Gap framework                and governments. It is also an
representative body made                            was doomed to fail when it was           acknowledgement that Aboriginal
up of almost 50 Aboriginal                          designed without the input of            and Torres Strait Islander people
                                                    Aboriginal and Torres Strait Islander    have been silenced on policies
and Torres Strait Islander
                                                    people,” Pat Turner said, on behalf      and approaches to close the gap
community controlled                                of the Coalition of Peaks when the       in the past and that outcomes for
organisations. It is working                        2020 Closing the Gap report was          Aboriginal and Torres Strait Islander
                                                    released by the Prime Minster.           people are not going to change
with governments to                                 “We know what will work best for         without their genuine involvement in
finalise a new national                             our communities and the Prime            policies and programs.
agreement on Closing the                            Minister even acknowledges in this
                                                    (latest) report that our voice was       This historic partnership has the
Gap. This is the first time                         the missing ingredient from original     potential to transform how Closing
                                                                                             the Gap policy and programs are         PHOTO: Joint Council on Closing the Gap meeting 23 August 2019, Adelaide, South Australia. L–R: Gavin Jennings, David O’Loughlin, John Paterson, Rachel
that Aboriginal and Torres                          framework.”                                                                            Stephen-Smith, Ben Wyatt, Jamie Lowe, Vicki O’Donnell, Stephen Wade, Trevor Pearce, Cindy Berwick, Don Harwin, Muriel Bamblett, Pat Turner, Ken
                                                                                             designed and delivered.
Strait Islander people,                             The Partnership Agreement,
                                                                                                                                                                                                          Wyatt, Natalie Lewis, Selena Uibo, David Warrener, Katrina Fanning, Cheryl Axleby

                                                                                             Knowing that it is vital that other
through their peak body                             formally agreed by COAG and the
                                                                                             Aboriginal and Torres Strait Islander
                                                    Coalition of Peaks in 2019, sets out
representatives, will share                         how they will work together over the     organisations and communities
formal decision making                              next ten years on Closing the Gap.       have their say on the next phase
                                                                                             of Closing the Gap, the Coalition       The Coalition of Peaks have                             controlled services sector to                             The Coalition of Peaks is are
with governments on                                 It sets a new benchmark for              of Peaks has led a series of            proposed three Priority Reforms to                      deliver Closing the Gap services                          now working hard with Australian
policies that affect us.                            partnerships between Aboriginal          engagements across Australia, in        change the way governments work                         and programs in agreed priority                           governments to ensure the
                                                                                             order to hear what changes are          with Aboriginal and Torres Strait                       areas.                                                    outcomes of the engagements
                                                                                             needed to improve the lives of          Islander people and accelerate                                                                                    are reflected in the new National
                                                                                             Aboriginal and Torres Strait Islander   progress on closing the gap. They                   •   Priority Reform 3: Ensuring                               Agreement on Closing the Gap,
               The Coalition of Peaks is a case                                              people.                                 are:                                                    all mainstream government                                 which is expected to be finalised in
                                                                                                                                                                                             agencies and institutions
               study in self-determination. We                                               Among many contributions was            •   Priority Reform 1: Developing                       undertake systemic and

       have exercised political agency by leading                                            this from a community member in             and strengthening structures                        structural transformation to                              Pat recognises that the priority
                                                                                             Broome: “Rather than ‘closing the           to ensure the full involvement                      contribute to Closing the Gap.                            reforms are not new, they are “what
       the way, challenging the possibilities and                                            gap’, governments should ‘open the          of Aboriginal and Torres Strait                                                                               Aboriginal and Torres Strait Islander
                                                                                                                                                                                         The Coalition of Peaks reported
       creating a future of shared decision-                                                 gate’ to Aboriginal and Torres Strait       Islander peoples in shared
                                                                                                                                                                                         overwhelming support for the
                                                                                                                                                                                                                                                       peoples have been saying for a long
                                                                                             Islander people making decisions            decision making at the national,                                                                              time is needed to close the gap
       making with governments on policies and                                               that affect their lives.”                   state and local or regional level               Priority Reforms during the                                   and we now have a formal structure
                                                                                                                                                                                         engagements. One theme that
       programs that impact on our people and                                                Reflecting on the success of these
                                                                                                                                         and embedding their ownership,
                                                                                                                                         responsibility and expertise to                 regularly emerged was that shared
                                                                                                                                                                                                                                                       in place to put those solutions to
       our communities.                                                                      engagements, Pat Turner notes               close the gap.                                  decision-making depends on all
                                                                                             “the conversation is different when                                                         parties having access to the same
       Pat Turner, Lead Convener of the Coalition of Peaks, and CEO of                       Aboriginal and Torres Strait Islander   •   Priority Reform 2: Building the                 information. That is leading to the
       the National Aboriginal Community Controlled Health Organisation                      organisations lead the conversation         formal Aboriginal and Torres                    development of local data projects
       (NACCHO)                                                                              with our people. It leads to better         Strait Islander community                       as a fourth Priority Reform.

18    |                We nurture our culture for our future, and our culture nurtures us.                                                                                                                  We nurture our culture for our future, and our culture nurtures us.     |    19
SECTION 2        SELF-DETERMINATION AND LEADERSHIP                                                                                                                                                                            SELF-DETERMINATION AND LEADERSHIP          SECTION 2

Law Yarn – Wuchopperen Health Service
                                                                                                                                              For Donnella, it was one of many       It documented health and wellbeing                        health, measuring impact in a range
                                                                                                                                              examples she has seen in her work      impacts that have been profound                           of areas, from “being heard and
                                                                                                                                              at Wuchopperen of where justice        for individuals and the community:                        validated in a culturally capable
Nearly two years ago, a group of Elders in northern                                                   They weren’t sure how to get justice    and health intersect.                  less exposure to family violence,                         way” to “addressing racism and
                                                                                                      when they already had so many                                                  reduced anxiety, improved                                 personal and structural social
Queensland were struggling with the process of                                                        reasons to distrust government.         Others, she said, can be in the        connection to health services,                            exclusion”. It concludes:
reclaiming wages that had been stolen for decades by                                                                                          stress of having to go to court,       improved financial resilience,
                                                                                                      Doctors at the Aboriginal               eyesight issues that limit capacity    increased capacity to exercise                            “This particular (Health Justice
the Queensland Government.                                                                            community controlled Wuchopperen        to respond to letters of demand,                                                                 Partnership) is much more than
                                                                                                                                                                                     rights, prevention of homelessness
                                                                                                      Health Service, which works on          sickness that means someone            and support for victims of crime and                      just about ‘delivering legal advice
                                                                                                      the traditional lands of the Gimuy-     cannot work and therefore cannot       historic injustice.                                       in a different space’. It reinforces
                                                                                                      walubarra yidi, Yirrganydji and         pay a fine. It can be that people do                                                             community control and self-
                   Wuchopperen Health Service                                                         Yidinji peoples in and around           not know their rights when they live   The evaluation looks particularly                         determination, and also strengthens
                   represents a home for my mob. I knew                                               Cairns, saw that this worry was         with poor plumbing, in overcrowded     at the cultural determinants of                           culture.”
                                                                                                      affecting the Elders’ health.           housing, or with other tenancy
          that, if we were able to put lawyers in that                                                                                        issues that can affect health and
                                                                                                      They referred the Elders to their
          space, that was going to shift the narrative in                                             onsite lawyer Donnella Mills, from

          a way that my people could access health and                                                the community legal service Law         Donnella also describes another
                                                                                                      Right. Donnella is a Torres Strait      case where she acted for a
          justice, in the one place, through community,                                               Islander woman who is now also          young pregnant woman who was
          through culture, through those systems that                                                 chair of NACCHO.                        experiencing family violence and

          are able to make us feel strong.                                                            “All this historic distrust of
                                                                                                                                              likely would have lost custody of        Health Justice Partnerships
                                                                                                                                              her baby because of a range of
                                                                                                      government had come into play in        structural issues affecting her.         The impact of intersecting health and legal needs on Aboriginal
          Donnella Mills                                                                              a really strong way,” she says of the                                            and Torres Strait Islander people has been well documented within
                                                                                                      Stolen Wages case. “It was causing      However, the health centre worked        inquiries and reports such as the Royal Commission into Black
                                                                                                      high blood pressure and anxiety for     with Donnella to keep the woman          Deaths in Custody and Ampe Akelyernemane Meke Mekarle: ‘Little
                                                                                                      the Elders because they didn’t know     and her newborn safe and together.       Children are Sacred’: Report of the Northern Territory Board of
                                                                                                      how to navigate all the different                                                Inquiry into the Protection of Aboriginal Children from Sexual Abuse.
                                                                                                      systems that were involved.”            Donnella says this is a powerful
                                                                                                                                              example of the way that the health       However, the continual growth in rates of Indigenous incarceration,
                                                                                                      But having a legal centre that is       justice partnership is delivering        deaths in custody and child removal indicate a failure to enact the
                                                                                                                                                                                       type of systems reforms needed.
                                                                                                      embedded at Wuchopperen through         prevention and early intervention
                                                                                                      a Health Justice Partnership with       in culturally safe ways, stopping        Health Justice Partnerships place lawyers in health and wellbeing
                                                                                                      Law Right has opened a new              unmet civil and family issues from       services to work collaboratively with health care professionals.
                                                                                                      pathway to justice.                     escalating into over-representation      They recognise the complexity of health and wellbeing, and that
                                                                                                                                              of Aboriginal and Torres Strait          unaddressed legal needs (such as housing advocacy, unpaid fines
                                                                                                      “We did week after week of ‘pop up’     Islander children in out of home         and family violence) can have a health harming impact.
                                                                                                      clinics, we would bring busloads of     care and prisons “bulging with our
                                                                                                      old people to the clinic, we would                                               Health Justice Partnerships are built around a social determinant
                                                                                                                                              men and women”.                          approach to health and wellbeing. Embedding these services within
                                                                                                      help them with the paperwork and
                                                                                                                                                                                       the Aboriginal and Torres Strait Islander community controlled sector
                                                                                                      give them legal advice,” Donnella       A formal evaluation of the
                                                                                                                                                                                       extends this rights based approach for Aboriginal and Torres Strait
                                                                                                      says.                                   Wuchopperen Health Justice
                                                                                                                                                                                       Islander people and communities by coupling them with culturally
                                                                                                                                              Partnership found that every client
                                                                                                      As well as returning stolen                                                      safe care.
                                                                                                                                              experienced better health and
                                                                                                      wages to around 100 clients, the        wellbeing as a result of their legal     Health Justice Australia, the national centre of excellence in health
                                                                                                      Elders gained “a sense of being         needs being met, and that 86 per         justice partnerships, has recorded 17 health justice services
                                                                                                      empowered and of finally being          cent of those clients would not have     located in Aboriginal and Torres Strait Islander support settings,
                                                                                                      heard about these historical            accessed legal support if it had not     including 15 partnered with Aboriginal Community Controlled Health
                                                                                                      injustices.”                            been based at Wuchopperen.               Organisations.32

PHOTO: Donella Mills (Project Lawyer, LawRight), Gail Sevallos (Wuchopperen Health Service)

20       |                      We nurture our culture for our future, and our culture nurtures us.                                                                                                 We nurture our culture for our future, and our culture nurtures us.     |    21
SECTION 2    SELF-DETERMINATION AND LEADERSHIP                                                                                                                                                                                        SELF-DETERMINATION AND LEADERSHIP                   SECTION 2

                                                      Mäwaya Health Justice Program –
                                                                                                                                                 answer to wellbeing in Aboriginal         These are the sorts of issues that
                                                                                                                                                 communities across Australia.             NAAJA and Miwatj staff now work on

                                                      NAAJA and Miwatj                                                                           “Most of our mob go to Aboriginal
                                                                                                                                                                                           jointly, with health workers learning
                                                                                                                                                                                           skills to untangle legal issues, to ask
                                                                                                                                                 medical services on a regular basis,      clients “how’s it all going with your
                                                                                                                                                 it’s a safe place, a trusted place,       housing?” or ‘”anything of concern                                    Child removal
                                                      Locating lawyers within                  It is the first collaboration of its kind         people know each other,” says             for your kids?”, and to then refer
                                                                                               between Aboriginal community
                                                      health services in remote                                                                  Priscilla, who is an Eastern Arrernte     them for quick legal support, whether                         In 2018, Aboriginal and
                                                                                               controlled legal and health services              woman from Central Australia.             for housing, discrimination, health or                        Torres Strait Islander
                                                      East Arnhem Land                         in Australia.
                                                                                                                                                                                           child protection issues.                                      children were 10.2 times
                                                                                                                                                 “This is the next big thing, it’s
                                                      communities is promising                 Previously, lawyers from NAAJA                                                                                                                            more likely to be living in
                                                                                                                                                 changing how an Aboriginal Medical        What makes the NAAJA/Miwatj
                                                      to be a ‘game-changer’ for               set up their legal support for East               Service and an Aboriginal Legal                                                                         out-of-home care than
                                                                                                                                                                                           collaboration even better is the
                                                      Yolngu people stopping
                                                                                               Arnhem Land communities in front                  Service work,” she says.                                                                                non-Indigenous children.
                                                                                               of the Yirrkala art centre or in the                                                        cultural strength the two community
                                                                                                                                                                                                                                                         Aboriginal and Torres Strait Islander
                                                      many legal issues from                   Nhulunbuy town square. But after                  As with the program at Wuchopperen,       controlled services bring to the                              children represent 37.3 per cent of the total
                                                                                               they moved into a health service,                 the collaboration is important            program.                                                      out-of-home care population, including
                                                      escalating into criminal                                                                                                                                                                           foster care, but only 5.5 per cent of the
                                                                                               their ability to engage with clients              because it stops many legal issues        The intent is to build the collaboration                      total population of Australian children.
                                                      and health issues.                       and with members of the community                 from escalating into criminal and         from a pilot program to a Health                              Without urgent action, the number of
                                                                                               who had previously not accessed                   health issues.                            Justice Partnership. A funding                                Aboriginal and Torres Strait Islander
                                                      The arrangement has come about           legal services was transformed.                                                                                                                           children in out-of-home care is projected
                                                                                                                                                 “The biggest issue for our mob is that    proposal and evaluation of the                                to double within the next 10 years.
                                                      through a pilot Health Justice
                                                                                               NAAJA CEO Priscilla Atkins says that              they don’t realise they can treat their   pilot is currently with the Australian
                                                      program, called Mäwaya, between                                                                                                                                                                    Nationally, Aboriginal and Torres Strait
                                                                                               having lawyers working regularly as               legal problems early, or don’t identify   Government for consideration.                                 Islander children are 2.6 times more likely
                                                      the Darwin-based North Australian
                                                                                                                                                                                                                                                         to be developmentally delayed at the age
                                                      Aboriginal Justice Agency (NAAJA)        ‘visiting specialists’ in a health service        that something is a legal problem that    Priscilla says the dynamics are                               of five33
                                                      and the Miwatj Health Aboriginal         that is embedded in the community                 can be easily addressed,” Priscilla       very different when Aboriginal
                                                      Corporation.                             and in community ways is a huge                   says.                                     organisations governed by Aboriginal
                                                                                                                                                 “Yolngu people have also been             people with Aboriginal staff are
                                                                                                                                                 caught up in unfair practices,            working together.
                                                                                                                                                 for example, where people from            “We routinely use interpreters,
     Having a Health
                                                                                                                                                 remote communities have been sold         all staff—Indigenous and non-                                          Incarceration
                                                                                                                                                 expensive, inappropriate mobile           Indigenous—have to have cultural
     Justice program                                                                                                                             phone plans that they did not             training, we take direction from our                          Aboriginal and Torres Strait
                                                                                                                                                 understand and could not afford—                                                                        Islander people represent
     means it is health                                                                                                                          causing huge debts and anxieties.”
                                                                                                                                                                                           Aboriginal board and management,
                                                                                                                                                                                           and it’s our Aboriginal board and                             28 per cent of the total adult
     working hand in                                                                                           PHOTO: NAAJA and Miwatj staff
                                                                                                                                                 Children have been taken into care        members who ensure we are                                     prison population34 despite
                                                                                                                delivering co-located services
     hand with justice.                                                                                      under the Mäwaya Health Justice     because of ‘failure to thrive’ when a     following cultural protocols in                               making up 2% of the total
                                                                                                               Program at Gunyangara Clinic,     child actually has a medical issue that   community and working respectfully                            Australian adult population35
     The impact on                                                                                                           East Arhem Land
                                                                                                                                                 was not identified by child protection    with the Elders in the community,”
                                                                                                                                                                                                                                                         Aboriginal and Torres Strait Islander
                                                                                                                                                                                           she says.
     health issues is huge                                                                                          L–R: Michaela Vaughan,
                                                                                                                  Gayili Marika, Jordina Rust,
                                                                                                                                                 workers because they did not use an                                                                     young people are 17 times more likely to
                                                                                                                                                                                                                                                         be under youth justice supervision than
                                                                                                                                                 interpreter when talking with people
     if we’re addressing                                                                                                       Vernon Patullo                                                                                                            non-Indigenous young people.36
                                                                                                                                                 for whom English is a third or fourth
                                                                                                                                                                                                                                                         Aboriginal and Torres Strait Islander
     legal issues at an                                                                                                                          language.                                                                                               women represent 34 per cent of the prison
                                                                                                                                                                                                                                                         population37 and more than 80 per cent of
     early stage.                                                                                                                                  Mäwaya was a name given to this project by Miwatj’s Raypirri Rom
                                                                                                                                                                                                                                                         Aboriginal women in prison are mothers38
                                                                                                                                                                                                                                                         Research on the health and wellbeing
                                                                                                                                                   (Social and Emotional Wellbeing) workers who are all Yolngu people.
     Priscilla Atkins,                                                                                                                                                                                                                                   of Aboriginal mothers in prison has
                                                                                                                                                   It is common when translating Yolngu Matha into English for words to                                  found that intergenerational trauma and
                                                                                                                                                   have multiple meanings. Mäwaya is a term that can apply to thoughts of                                the forced removal of their children by
                                                                                                                                                   respect, money, family, housing, health, harmony and peace. The term                                  government services were the most
                                                                                                                                                                                                                                                         significant factors affecting the health and
                                                                                                                                                   reminds Yolngu of their roots, where they come from and who they are.                                 wellbeing of Aboriginal women in prison.39

22    |                  We nurture our culture for our future, and our culture nurtures us.                                                                                                               We nurture our culture for our future, and our culture nurtures us.                |     23
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