Indigenous Allied Health Australia (IAHA) Submission to Aboriginal and Torres Strait Islander Health Plan

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1 Indigenous Allied Health Australia (IAHA) Submission to Aboriginal and Torres Strait Islander Health Plan Thank you for the opportunity to contribute to the development of the Aboriginal and Torres Strait Islander Health Plan. IAHA looks with hope that the new Health Plan will help guide governments in policy making and program design for improving the health and social determinants of health of Aboriginal and Torres Strait Islander peoples. As outlined in the Close the Gap Statement of Intent, the health plan needs to be a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities in health services, in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non- Indigenous Australians by We are aware of the many and complex issues impacting on the health and wellbeing of Aboriginal and Torres Strait Islander people. This submission is intended to be solution focussed and places particular emphasis on the Aboriginal and Torres Strait Islander context of allied health as determined by the Indigenous Allied Health Australia Board and membership. Summary of IAHA Recommendations IAHA asserts that the Health Plan must 1. Embrace the holistic Aboriginal and Torres Strait Islander view of health, taking into consideration social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their Community; 2. Acknowledge and support the essential role that allied health professionals play in the delivery of holistic comprehensive healthcare to Aboriginal and Torres Strait Islander people; 3. Ensure that health services are available, affordable, acceptable and appropriate in order for Aboriginal and Torres Strait Islander people to equitably access allied health services; 4. Ensure that investment in developing and supporting the Aboriginal and Torres Strait Islander allied health workforce is commensurate with its collective size and on par with investment in recruitment and retention of Aboriginal and Torres Strait Islander people into careers in Medicine and Nursing; 5. Transparently outline how national coordination of government initiatives that impact on Aboriginal and Torres Strait Islander health, including social determinants, will be achieved; 6. Advocate for long term funding to enhance longevity of programs and initiatives that can create generational change and allow sustainable workforce planning; 7. Consider the establishment of a national independent Aboriginal and Torres Strait Islander Health Authority to monitor national programs to decrease duplication and increase efficiencies;

2 8. Allow for locally driven and flexible implementation of policy and initiatives; 9. Enhance leadership capacity within the Aboriginal and Torres Strait Islander health workforce 10. Articulate strategies that create cultures of genuine engagement with Aboriginal and Torres Strait Islander people and organisations; 11. Articulate strategies to eliminate all forms of racism within the health system; 12. Embed Human Rights standards and approach; 13. Articulate strategies, including the funding of targeted research, to establish current and future Aboriginal and Torres Strait Islander health profession workforce requirements 14. Articulate evidence based strategies aimed at recruitment, retention, education and support of Aboriginal and Torres Strait Islander health students and professionals, including allied health; 15. Implement a national Aboriginal and Torres Strait Islander curriculum into all levels of education, including primary, secondary and post-secondary education in order to facilitate consistent understanding of the historical and political context that has contributed to Aboriginal and Torres Strait Islander social disadvantage and poor health outcomes; 16. Articulate the development and implementation of a national cultural respect framework for all health practitioners, led by the National Health Leadership Forum (NHLF); 17. Review incentive structures that drive health service delivery (such as Medicare), to ensure that interdisciplinary collaboration is a financially viable option in the care of Aboriginal and Torres Strait Islander people. Background Indigenous Allied Health Australia Inc. (IAHA) is the national peak organisation representing Aboriginal and Torres Strait Islander allied health professionals and students. IAHA was established in 2009, from a network of committed allied health professionals. IAHA currently has 441 members, including full and associate members. Allied health refers to a variety of non-medical, non-nursing, non-aboriginal and Torres Strait Islander health worker/practitioner healthcare professions that provide a range of critical health care functions that contribute to a person s physical, sensory, psychological, cognitive, social, emotional and cultural wellbeing. All Aboriginal and Torres Strait Islander allied health professionals who have graduated from an allied health course with a recognised qualification and Aboriginal and Torres Strait Islander students who are enrolled in an allied health course are eligible for Full Membership of IAHA. IAHA welcomes non-indigenous allied health professionals, all allied health assistants and Aboriginal and Torres Strait Islander people studying or working in other health related fields as Associate Members. IAHA Vision For Indigenous Australians to have access to professionally and culturally competent allied health services delivered by Indigenous allied health professionals who are recognised and acknowledged as an essential part of a holistic approach to Indigenous Health. Page 2

3 IAHA Purpose To advance the health status of Indigenous Australians through IAHA s contribution to the national health agenda, facilitation of improved education opportunities for and representation of Indigenous allied health professionals. Understanding Allied Health within an Aboriginal and Torres Strait Islander context The wide-ranging and significant disciplines representing allied health constitute a large and rapidly growing healthcare workforce in Australia. In a political environment driven by healthcare reform, allied health professionals will need to call on their full scope of practice as part of a comprehensive health care team, particularly within the context of Aboriginal and Torres Strait Islander health. There is often a strong alliance between allied health professionals, involving an interdisciplinary relationship in provision of care to their clients and the communities they serve, an inter-professional alliance. They can be regarded as critical partners, or allies, to the more commonly identified doctors, nurses and Aboriginal and/or Torres Strait Islander Health Workers/Practitioners in a health care team. Allied health professionals are also allies with Aboriginal and Torres Strait Islander peoples and communities to whom they provide health care. In Australia, there is no clear and consistent agreement on what comprises the allied health workforce1. There is also a wide array of different interpretations of the occupations that comprise the allied health workforce by various government authorities and departments, health service providers, health funds and tertiary institutions. The very broad definition of allied health and the frequent changes in health care technology and professional standards make it virtually impossible to come up with an all-inclusive list of every allied health discipline practicing in Australia at any one point in time. Aboriginal and Torres Strait Islander Health IAHA endorses the definition that Aboriginal and Torres Strait Islander health means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their Community. It is a whole-of-life view and includes the cyclical concept of life-death-life. Health care services should strive to achieve the state where every individual is able to achieve their full potential as a human being and thus bring about the total well-being of their community. 2 1 Australian Health Workforce Advisory Committee (2004), The Australian Allied Health Workforce An Overview of Workforce Planning Issues, AHWAC Report , Sydney. 2 National Aboriginal Health Strategy, 1989 Page 3

4 Recommendation 1 Embrace the holistic Aboriginal and Torres Strait Islander view of health, taking into consideration social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their Community Allied Health IAHA defines allied health as a collective term used to refer to a variety of healthcare disciplines that contribute to a person s physical, sensory, psychological, cognitive, social, emotional and cultural wellbeing, excluding medicine, nursing and Aboriginal and Torres Strait Islander health worker/practitioner roles. Allied health functions include but are not limited to, services related to the identification, evaluation, management and prevention of disease and disorders; dietary and nutritional services; and rehabilitation services. Allied health course IAHA defines an allied health course as field of study or branch of knowledge that is taught and researched at a tertiary level that equips a person with the skills and knowledge to work in allied health. Allied health professional An allied health professional is considered by IAHA to be a health professional who; 1. Has graduated from a tertiary qualification at Bachelor Degree (AQF Level 7) or higher in an allied health course; and 2. Has attained the necessary knowledge, attributes, attitudes and skills required to be an autonomous practitioner and practices in an evidence based paradigm using a recognised body of skills and knowledge to contribute to the physical, sensory, psychological, cognitive, social, emotional and cultural wellbeing of people so that each individual is able to achieve their full potential as a human being; and 3. Does not practise as a medical practitioner, nurse or Aboriginal and Torres Strait Islander Health Worker/Practitioner. Indigenous allied health professional An Indigenous allied health professional is considered by IAHA to be an allied health professional as defined above, who is an Aboriginal and/or Torres Strait Islander person. Indigenous Allied Health A collective term referring to the delivery of culturally and professionally competent healthcare to Aboriginal and Torres Strait Islander people and communities, by tertiary qualified health professionals other than a doctor, nurse or Aboriginal and Torres Strait Islander Health Worker/Practitioner, often within an interdisciplinary healthcare team. This healthcare may be delivered by Indigenous and/or non-indigenous health professionals and is characterised by a holistic and comprehensive approach, taking in to consideration the Aboriginal and Torres Strait Islander person s physical, sensory, psychological, cognitive, social, emotional and cultural wellbeing. Page 4

5 The Importance of Allied Health It is well documented 3 that Aboriginal and Torres Strait Islander people continue to suffer a greater burden of ill health than the rest of the population. Overall, Aboriginal and Torres Strait Islander people experience lower levels of access to health services than the general population, are more likely than non-indigenous people to experience disability and reduced quality of life due to ill health, to be hospitalised for most diseases and conditions and to die at younger ages than other Australians. Aboriginal and Torres Strait Islander people also suffer a higher burden of emotional distress and mental illness than that experienced by the wider community. The impact of these statistics on the health and wellbeing of Aboriginal and Torres Strait Islander individuals and communities demands a coordinated interdisciplinary approach in order to improve health outcomes. Allied health professionals are an essential element in a responsive and equitable health system that is able to accommodate the widely varying needs of Aboriginal and Torres Strait Islander people, many with chronic and complex conditions. Allied health professionals work in widely diverse settings, including but not limited to clinics, hospitals, rehabilitation centres, laboratories, schools, long-term care facilities, Aboriginal Medical/Health Services, community health centres, and home healthcare agencies. The increase in number of people living with complex and chronic conditions across both Aboriginal and Torres Strait Islander populations and the wider community, has resulted in a greater need for a diverse range of health professionals working within primary and preventative health care settings. The majority of allied health professionals are private practitioners and the shift from acute to chronic models of care means that a much greater level of cooperation and collaboration between the acute, subacute and primary healthcare settings will be required in order to improve Aboriginal and Torres Strait Islander health outcomes. Allied health professionals will play an indispensable role in development of collaborative models of care that will benefit Aboriginal and Torres Strait Islander people. A significant challenge for health care reform is to find cost-effective ways to ensure the efficient delivery of quality health care to larger, culturally and geographically diverse patient populations. Interprofessional service delivery will be vital to address rising costs and improving Australian health outcomes. Allied health professionals are an integral part of an interprofessional approach to costeffective and high-quality health care delivery 4. Interdisciplinary care occurs when allied health professionals, Aboriginal and Torres Strait Islander Health Worker/Practitioners, nurses and medical practitioners come together in dynamic collaborative teams to address complex healthcare needs. 3 AIHW Indigenous Observatory Accessed August Thomas, S, McLean, L, Debnam, A (2012) The Role of Allied Health in Health Care Reform NCMJ vol. 72, no. 5. Page 5

6 IAHA asserts that it will be the crucial role played by allied health professionals that will determine the future of the Australian health system and thus positively impact on the health and wellbeing of Aboriginal and Torres Strait Islander people. Recommendation 2 Acknowledge and support the essential role that allied health professionals play in the delivery of holistic comprehensive healthcare to Aboriginal and Torres Strait Islander people Access to Allied Health Services The health system could work better for Aboriginal and Torres Strait Islander people by ensuring that Aboriginal and Torres Strait Islander people have the access they need to high quality allied health services. Access is more than just physical or geographical access 5, also including cultural, economic and social dimensions which all impact on whether Aboriginal peoples and Torres Strait Islanders can use allied health services. Allied health services must be available. Health service availability often depends on the geographic location of the allied health professional or service, a barrier to access particularly for Aboriginal peoples and Torres Strait Islanders living in rural, remote and very remote areas. There is a maldistribution of the allied health workforce and many areas of rural and remote Australia find it difficult to attract allied health professionals. However even in urban areas where allied health services are more geographically available and allied health workforce numbers are higher, Aboriginal and Torres Strait Islander people can find that allied health services are not available when needed, or waiting times are long. Allied health services must be acceptable to Aboriginal and Torres Strait Islander people. The acceptability of allied health services to Aboriginal and Torres Strait Islander people is related to the notion of cultural safety. Aboriginal and Torres Strait Islander people need to know that they will receive allied health care from a culturally competent workforce. The availability of Aboriginal and Torres Strait Islander staff is another important factor in whether or not Aboriginal and Torres Strait Islander people are able to effectively access health services 6. Allied health services must be appropriate to meet the complex health needs of Aboriginal and Torres Strait Islander people. Allied health services must consider the Aboriginal and Torres Strait Islander holistic view of health and use an interdisciplinary approach to deliver comprehensive care that addresses the whole of the person. Many clients rely on referral to allied health services by their local GP. Clear referral pathways and strong Interprofessional relationships are required to ensure Aboriginal and Torres Strait islander people are referred and can access allied health services appropriately AMA Indigenous Health Report Card - "Best Practice in Primary Health Care for Aboriginal Peoples and Torres Strait Islanders" Accessed August Ivers, R, Palmer, A, Jan, S & Mooney, G 1997, Issues Relating to Access to Health Services by Aboriginal and Torres Strait Islander People, Discussion paper 1/97, Department of Public Health and Community Medicine, University of Sydney. Page 6

7 Allied health services must be affordable. The majority of allied health professionals are private practitioners and current Medicare rebates and other funding sources for allied health service delivery are inadequate and often fail to reimburse for reports, consultation with other service providers and coordinated care for clients with more complex needs. The gap payment that is required to meet the cost of high quality allied health service provision can often be a barrier in access for Aboriginal and Torres Strait Islander people. Recommendation 3 Ensure that health services are available, affordable, acceptable and appropriate in order for Aboriginal and Torres Strait Islander people to equitably access allied health services Equitable Investment for Equitable Workforce Distribution Significant investment has been made into developing the Aboriginal and Torres Strait Islander Medical Practitioner and Nursing workforces over the years which is important in order to improve Aboriginal and Torres Strait Islander health outcomes. However support for the recruitment and retention of Aboriginal and Torres Strait Islander people into allied health careers has not been as targeted. This may be due to the fact that there are so many allied health professions that collectively comprise the allied health workforce. The wide-ranging disciplines representing allied health constitute a large and rapidly growing healthcare workforce in Australia. Allied health professionals comprise approximately 20% of the current Australian health workforce (in excess of 116,000 practitioners), with only nursing at 35% having a greater professional representation. As one of the largest and most effective professional health workforce cohorts, allied health professionals are well placed to ensure Aboriginal and Torres Strait Islander people receive treatment in the most appropriate place, avoid unnecessary hospitalisations and stay well for longer. There are numerous scholarships and initiatives available aimed at encouraging Aboriginal and Torres Strait Islander people to embark on careers in health. However, due to the higher profiles of Medicine and Nursing as potential career options, allied health participation in these schemes are relatively low. IAHA advocates that Aboriginal and Torres Strait Islander people think outside the square, to consider the many and varied careers in allied health. For this to occur, targeted and sustainable funding for allied health specific scholarships, student support and mentoring is required in order to recruit and retain Aboriginal and Torres Strait Islander people into allied health careers. Better promotion of existing support mechanisms is also required. IAHA advocates that increasing the number of Aboriginal and Torres Strait Islander people working in allied health careers will have a beneficial effect on the wider health workforce and ultimately, Aboriginal and Torres Strait Islander health outcomes. Page 7

8 Recommendation 4 Ensure investment in developing and supporting the Aboriginal and Torres Strait Islander allied health workforce is commensurate with its collective size and on par with investment in recruitment and retention of Aboriginal and Torres Strait Islander people into careers in Medicine and Nursing. Funding and Monitoring of Health Plan Significant investment has been made in improving Aboriginal and Torres Strait islander health outcomes through the COAG Closing the Gap initiative. The funding for this initiative is provided by both commonwealth and state/territory governments, across numerous departments and sectors involved in addressing the multilayered impact of social determinants upon the health and wellbeing of Aboriginal and Torres Strait islander peoples, including education, employment, income, housing, environment, social, family and community connectedness. However inter-sectoral and inter-departmental collaboration can be complex and challenging. A lack of central coordination and monitoring of the various programs and initiatives being funded has the potential to be problematic and cause confusion and duplication. IAHA asserts that national monitoring and coordination is essential, and lines of responsibility and accountability must be understood by all stakeholders. Recommendation 5 Transparently outline how national coordination of government initiatives that impact on Aboriginal and Torres Strait Islander health, including social determinants, will be achieved Historically, Aboriginal and Torres Strait Islander organisations are funded on a year by year basis. Such short term funding can negatively impact on service delivery and workforce planning. Longer term funding, with clear deliverables and evaluation guidelines may ensure that service delivery and workforce planning can occur in a more sustainable manner. Improving Aboriginal and Torres Strait Islander health outcomes is a long term goal and requires an approach that embeds longer term funding commitments beyond the life of any particular government or political party. One cannot expect to facilitate generational change in the health and wellbeing of Aboriginal and Torres Strait Islander people without a sound and sustainable financial foundation underpinning service delivery and community development. Recommendation 6 Advocate long term funding to enhance longevity of programs and initiatives that can create generational change and allow sustainable workforce planning IAHA asserts that funding must be used more effectively for equitable Aboriginal and Torres Strait Islander health outcomes to be achieved. This may be achieved through monitoring Page 8

9 and comprehensive evaluation by an external, objective Aboriginal and Torres Strait Islander led body. A monitoring body could be independent and authoritative; driving cooperation, accountability and transparency between all levels of government to assist in the implementation of the Health Plan and the delivery of effective health services. An independent national monitoring body could provide transparent oversight of the implementation of the Health Plan, and all expenditure on Aboriginal and Torres Strait Islander health. Recommendation 7 Consider the establishment of a national independent Aboriginal and Torres Strait Islander Health Authority to monitor national programs to decrease duplication and increase efficiencies It is essential that processes and policies are implemented in ways that suit the needs of local Aboriginal and Torres Strait Islander people and organisations. How implementation occurs is just as important as what and why when considering policy development and implementation. Implementation must be flexible and adaptive and take a community development approach rather than just a service delivery approach. Aboriginal and Torres Strait Islander peoples have a right to be actively involved in the developing and determining of health programmes that affect them 7. Recommendation 8 Allow for locally driven and flexible implementation of policy and initiatives Aboriginal and Torres Strait Islander Leadership and Engagement IAHA provides national leadership around Aboriginal and Torres Strait Islander allied health and workforce issues. It is one of a number of key organisations, led by Aboriginal and Torres Strait Islander people, which must continue to be actively involved in policy and initiatives that may result from the development of the Health Plan. It is encouraging to note that the government has worked in partnership with the National Health Leadership Forum (NHLF), the national representative body for Aboriginal and Torres Strait Islander peak bodies whose core business is the health of Aboriginal and Torres Strait Islander peoples, in the development of the Health Plan to date. This partnership demonstrates recognition by government of the leadership and expertise of NHLF members. However it is imperative that the Health Plan and its subsequent implementation continues to build upon key leadership capacity in Aboriginal and Torres Strait Islander organisations and fosters environments that facilitate and support authentic engagement with Aboriginal and Torres Strait Islander peoples. 7 Article 23 of the United Nations Declaration on the Rights of Indigenous Peoples Page 9

10 Recommendation 9 Enhance leadership capacity within the Aboriginal and Torres Strait Islander health workforce IAHA, through its participation in the government s Stakeholder Advisory Group (SAG) is a key partner in the development of the Health Plan. The SAG brings together government and organisations with expertise in Aboriginal and Torres Strait Islander health, the health sector and social determinants of health. The establishment of the SAG is a demonstration of the government s commitment to working collaboratively with Aboriginal and Torres Strait Islander peoples in the development of this plan. The extensive nationwide consultation forums have provided an opportunity to engage Aboriginal and Torres Strait Islander peoples and give them the opportunity to provide input on the development of the plan. The process by which the government has undertaken the development of the Health Plan so far is a positive sign of the government s commitment to working in partnership with Aboriginal and Torres Strait Islander peoples and organisations. However, if we are to truly make a difference in the health and wellbeing of Aboriginal and Torres Strait Islander peoples then collaborative and inclusive engagement at all levels must continue to be the cornerstone of the development and implementation of the Health Plan. Recommendation 10 Articulate strategies that create cultures of genuine engagement with Aboriginal and Torres Strait Islander people and organisations Racism in Health IAHA stands against all forms of racism and racial discrimination. Aboriginal and Torres Strait Islander health professionals often play an integral role in addressing racism and improving health outcomes for Aboriginal and Torres Strait Islander people. However the responsibility for eliminating racism from our healthcare system does not just rest with individuals; strong commitment from and collaboration between individuals, organisations and communities is required. Health is a fundamental human right and every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity 8. Racism and subsequent racial discrimination can impede the achievement of this right for Aboriginal and Torres Strait Islander people, who deserve culturally safe health service delivery. Racism takes many forms. In general, it is a belief that a particular race or ethnicity is inferior or superior to others. Racial discrimination involves any act where a person is treated unfairly or vilified because of their race, colour, descent, national or ethnic origin 9. 8 Article 12 of the International Covenant on Economic, Social and Cultural Rights. Accessed at (viewed 10 August 2012). 9 Australian Human Rights Commission (AHRC), National Anti-Racism Partnership and Strategy Discussion Paper, March Accessed at (viewed 9 August 2012). Page 10

11 Institutionalised racism 10 is evident when racist beliefs or values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups. Lateral violence, or intra-racial conflict 11, is another form of racism that is perpetrated by Aboriginal and Torres Strait Islander community members on each other and can have a devastating impact on the health and wellbeing of Aboriginal and Torres Strait Islander people. The physiological and psychological effects of racism in health care on Aboriginal and Torres Strait Islander people are considerable and enduring 12 but they are amenable to remedial action. Such actions, however, must be multi-tiered and multidimensional and must relate directly to both individual responsibilities and to organisational accountabilities in the healthcare setting. Wide disparities in the mortality and morbidity rates between Indigenous and non- Indigenous Australians persist in spite of successive government policies aimed at reducing such inequities. In large part, these inequities are the result of overt and covert discriminatory structures, words and/or actions that may be unrecognised by the agent or agency using them. These structures, words and actions are also a predictable consequence of institutional cultures that reflect the social and political values of the privileged groups that often dominate health service delivery and design 13. It is essential that the harmful effects of racism on Aboriginal and Torres Strait Islander people are recognized and acknowledged by all organisations and individuals providing services in the healthcare system. Allied health professionals are well-placed, due to the large number of professions represented and the wide range of settings in which they interact with Aboriginal and Torres Strait Islander people 14, to play a role in the elimination of racism in healthcare settings. Indigenous allied health professionals in particular can take a lead role addressing systemic racism and ensuring that culturally secure policies, procedures and practices are adopted and adhered to in organisations within which they work. However in order for this to occur, there will need to be a concerted effort to ensure equitable distribution of opportunities, benefits and resources for Aboriginal and Torres Strait Islander staff and clients, through reform of conditions, practices, policies and procedures in all healthcare organisations and institutions, including governmental departments 15. There also needs to be a strong and enduring collaborative effort to increase the number of Aboriginal and Torres Strait Islander people employed in these agencies and institutions, 10 Henry, B. Houston, S. and Mooney, G Institutional racism in Australian Healthcare: a plea for decency. Medical Journal of Australia, Vol 180, May Australian Human Rights Commission - Social Justice Report 2011, Chapter 2, accessed at viewed August Williams, D., Mohammed, S Discrimination and racial disparities in health. Journal of Behavioural Medicine. 32(1): Larson, A., Coffin, J., Gilles, M., Howard, P It s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian and New Zealand Journal of Public Health. Vol 34 S Armstrong, K and Kendall, E Translating knowledge into practice and policy: the role of knowledge networks in primary health care. Health Information Management Journal, Vol 39 2: Paradies, Y., Cunningham, J Experiences of racism among urban Indigenous Australians: findings from the DRUID study. Ethnic and Racial Studies. 32(3): Page 11

12 with appropriate recognition of their professional and cultural knowledge, skills, experience and/or qualifications. Accountability is critical when monitoring the impact of interventions against racism. Organisations, institutions and government departments should be held accountable for their long-term effectiveness in increasing access to quality services by Aboriginal and Torres Strait Islander people. Delivery of culturally secure healthcare and contributions to attainment of better health outcomes for Aboriginal and Torres Strait Islander people 16 must also be assessed. It is imperative that Aboriginal and Torres Strait Islander people are engaged in the development and implementation of policies, programs and initiatives aimed at Aboriginal and Torres Strait Islander people. Significant collaboration and partnerships between policymakers, mainstream inter-disciplinary health services, education bodies, academics and Aboriginal and Torres Strait Islander stakeholders are required in order to recognise, address and ultimately eliminate all forms of institutional and interpersonal racism within their respective organisations and staff. IAHA asserts that it will only be through working together that the necessary trust between mainstream organisations and institutions and Aboriginal and Torres Strait Islander people can be established that will lead to an equitable and respectful health system where the dignity of all human beings is celebrated and defended. Recommendation 11 Articulate strategies to eliminate all forms of racism within the health system. Human Rights Approach On 18 June 2012, the National Health Leadership Forum (NHLF) within which IAHA plays an active role, endorsed a Position paper: The right to health. IAHA recommends that human rights standards be embedded within the National Aboriginal and Torres Strait Islander Health Plan. This includes the development of strategies, outcomes and targets that take a human rights based approach, namely; non-discrimination, progressive realisation, the content of the right to health, and participation in decision-making as discussed within the Position Paper. In 2008, the government formally endorsed the United Nations Declaration on the Rights of Indigenous Peoples and the Health Plan must articulate the necessary steps with a view to achieving progressively the full realisation of these rights for Aboriginal and Torres Strait Islander people. Consistent with the endorsed Declaration, all Aboriginal and Torres Strait Islander people have an equal right to 1. the enjoyment of the highest attainable standard of physical and mental health. 2. determine and develop priorities and strategies for exercising their right to development; and 16 Jorgensen, M (ed) Rebuilding Native Nations: Strategies for Governance and Development. University of Arizona Press, Tucson. Page 12

13 3. be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions. It is imperative that Aboriginal and Torres Strait Islander peoples are given every opportunity to realise these human rights through the implementation of the Health Plan. Recommendation 12 Embed Human Rights standards and approach Build the Aboriginal and Torres Strait Islander Allied Health Workforce IAHA is funded to support and build the Aboriginal and Torres Strait Islander allied health professional workforce. It is imperative that the Health Plan articulates the important role that peak bodies such as IAHA play in the recruitment and retention of Aboriginal and Torres Strait Islander people into the health workforce. Further investment is required in order to attract and retain Aboriginal and Torres Strait Islander people into the health workforce, at all levels and in all professions. However in order to grow the Aboriginal and Torres Strait Islander health workforce, better data collection and research into the implications of this data is required particularly in relation to allied health professions. Health Workforce Australia has begun this process, with the development of the Health Workforce 2025 report which provides medium to longterm national workforce planning projections for doctors, nurses and midwives. It is essential that the data around Aboriginal and Torres Strait Islander workforce participation is strengthened and that the report is expanded to include allied health professions. IAHA also supports the funding of further research around the skill mix, health professions and service delivery models required to best meet the healthcare needs of Aboriginal and Torres Strait Islander people. Recommendation 13 Articulate strategies, including the funding of targeted research, to establish current and future Aboriginal and Torres Strait Islander health profession workforce requirements to meet Aboriginal and Torres Strait Islander healthcare needs A flexible education pipeline and increased linkages/partnerships between the VET sector and Tertiary sector must be developed in order to create authentic career pathways into allied health for Aboriginal and Torres Strait Islander people. There needs to be financial incentives to ensure that partnerships are developed which will meet the education needs of Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander people of all ages must be exposed to and encouraged to explore careers in health. Not only do we need to attract more Aboriginal and Torres Strait Islander people into tertiary health courses, but we need to retain them through appropriate support measures. Page 13

14 Lifelong education opportunities for Aboriginal and Torres Strait Islander health professionals must be available, including higher education and professional development opportunities. In order for this to occur, communities and workplaces must be supported to facilitate ongoing learning opportunities for Aboriginal and Torres Strait Islander people working in health, at all levels. Previous work gives guidance around what may work to increase numbers of Aboriginal and Torres Strait Islander people working in health. It is worth revisiting the 2008 National Aboriginal and Torres Strait Islander Health Council s A blueprint for action Pathways into the health workforce for Aboriginal and Torres Strait Islander people 17. This document outlined clear ways forward to increase Aboriginal and Torres Strait Islander participation in the health workforce. It is timely to evaluate progress against these recommendations prior to completing the Health Plan. It is also essential that the government reviews and implements the recommendations found within the Review of Higher Education Access and Outcomes for Aboriginal and Torres Strait Islander People Final Report, July This review outlines the enablers and barriers to improving recruitment and retention of Aboriginal and Torres Strait Islander people into University studies and provides recommendations on the way forward. In line with our core business, IAHA seeks further investigation into what constitutes best practice in the delivery of allied health professional education to Aboriginal and Torres Strait Islander people. We know that flexible delivery and community driven innovation, particularly in remote communities, is essential. In order to increase the number of Aboriginal and Torres Strait Islander people choosing to be an allied health professional it will be essential to research, develop, resource and implement new models of allied health education delivery and support. This may include block release study options and require intersectoral partnerships between education providers. Recommendation 14 Articulate and resource evidence based strategies aimed at recruitment, retention, education and support of Aboriginal and Torres Strait Islander health students and professionals, including allied health Mainstream health professionals working with Aboriginal and Torres Strait Islander peoples IAHA asserts that a culturally competent/respectful health workforce is imperative in order to ensure Aboriginal and Torres Strait Islander people receive the culturally safe healthcare required to improve health outcomes. We have strongly advocated for the development and implementation of a framework similar to the existing CDAMS Indigenous Health Curriculum Framework within allied health courses tion/finalreport/iherfinalreport.pdf Page 14

15 The medical profession s CDAMS framework was endorsed by all the Deans of Medicine and has been included in the Australian Medical Council s accreditation guidelines for basic medical education since 2006; requiring all medical schools to include core Indigenous Health content in their medical curricula. IAHA has long argued for the development of a culturally inclusive, interdisciplinary Aboriginal and Torres Strait Islander Health Curriculum Framework to be integrated into tertiary entry level health profession training since our inception in Health Workforce Australia (HWA) is now funding its development. The framework that will be developed must be funded for implementation and embedded within health profession course accreditation. IAHA believes education providers need to be held accountable for the cultural competence of its health graduates. It is anticipated that health outcomes for Aboriginal and Torres Strait Islander people will be improved by healthcare delivered by health professionals who are better prepared to work with Aboriginal and Torres Strait Islander people. All health profession graduates need to be both clinically and culturally competent to affect positive Aboriginal and Torres Strait Islander health outcomes. The implementation of the framework will facilitate a high standard of knowledge and competency within health profession graduates and set the benchmark for teaching the importance of Aboriginal and Torres Strait Islander health within all tertiary health profession courses. Recommendation 15 Implement a national Aboriginal and Torres Strait Islander curriculum into all levels of education, including primary, secondary and post-secondary education in order to facilitate consistent understanding of the historical and political context that has contributed to Aboriginal and Torres Strait Islander social disadvantage and poor health outcomes. In addition to ensuring health professionals have access to consistent, high quality Aboriginal and Torres Strait Islander curricula, mechanisms for accountability must also be established. An international precedent for this is New Zealand s Health Practitioners Competence Assurance Act which sets out the functions of registration authorities, including an obligation to set standards of cultural competence. Whilst Australia may not yet be at the stage yet to legislate cultural compliance, inroads can be made by Aboriginal and Torres Strait Islander-led implementation of a national cultural respect framework. Recommendation 16 Articulate the development and implementation of a national cultural respect framework for all health practitioners, led by the National Health Leadership Forum (NHLF) Page 15

16 Holistic Interdisciplinary Approach IAHA asserts that interdisciplinary collaboration, including allied health professionals as essential team members, will dramatically improve the integration, coordination and delivery of comprehensive health care for Aboriginal and Torres Strait Islander people. However current funding mechanisms such as Medicare, aim to incentivise the delivery of multidisciplinary care through a variety of assessment, care-planning and allied health Medicare item numbers, and even then remuneration does not adequately cover the cost of allied health professional involvement. Therefore it is important to explore and understand the difference between Multidisciplinary and Interdisciplinary approaches to healthcare, particularly in the context of working with Aboriginal and Torres Strait Islander people. Multidisciplinary team approaches use the skills and experience of individuals from different disciplines, with each discipline approaching the patient from their own perspective. Most often, this approach involves separate individual consultations. Multidisciplinary teams may meet regularly in the absence of the patient, to case conference findings and discuss future directions for the patient s care. Multidisciplinary teams do provide more knowledge and experience than disciplines operating in isolation, however professional silos and boundaries are maintained 19. Interdisciplinary team approaches integrate separate discipline approaches into a single consultation. That is, the history taking, assessment, diagnosis, intervention and short- and long-term management goals are conducted collaboratively by the team, together with the Aboriginal and Torres Strait Islander person, at the one time. The patient is intimately involved in any discussions regarding their condition or prognosis and the plans about their care. A common understanding and holistic view of all aspects of the patient s care ensues, with the patient empowered to form part of the decision- making process, including the setting of long and short-term goals. Individuals from different disciplines, as well as the patient themself, are encouraged to question each other and explore alternate avenues, stepping out of discipline silos to work toward the best outcome for the patient 20. Both health professionals and Aboriginal and Torres Strait Islander people can benefit from the sharing of knowledge, skills and understandings that are the hallmarks of a holistic interdisciplinary approach to healthcare delivery. However the integration and coordination of comprehensive health care for Aboriginal and Torres Strait Islander people will only be improved when incentives adequately match service delivery and workforce needs. Workforce planning and models of service delivery are driven by financial incentives such as Medicare and program specific funding. Top down approaches to changes in models of service delivery will not work unless the service is appropriately incentivised to make those 19 Rebecca L Jessup, Interdisciplinary versus multidisciplinary care teams: do we understand the difference? Australian Health Review August 2007 Vol 31 No 3 20 ibid Page 16

17 changes. Revised incentives may achieve better integration, coordination and interdisciplinary collaboration to improve Aboriginal and Torres Strait Islander health outcomes. Recommendation 17 Review and revise incentive structures that drive health service delivery (such as Medicare), to ensure that interdisciplinary collaboration is a financially viable option in the care of Aboriginal and Torres Strait Islander people. Conclusion IAHA has provided a number of recommendations that will assist the government to develop a Health Plan that will have a positive impact on the health and wellbeing of Aboriginal and Torres Strait Islander peoples. IAHA will continue to support and advocate on behalf of its membership, contributing to allied and wider health policy development, workforce engagement and support, within the context of improving the health and wellbeing outcomes of Aboriginal and Torres Strait Islander peoples. In the spirit of true partnership and collaboration, IAHA welcomes the opportunity to continue to work with government, Aboriginal and Torres Strait Islander organisations and communities in order to ensure the Health Plan is relevant, evidence-based and able to be implemented. Page 17

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