Statement to the Senate Select Committee on Health (2015)

15 April 2015  
The Lowitja Institute Statement to the Senate Select Committee on Health

I wish to acknowledge the traditional people of the land that we are meeting on today – the Ngungawal and the Ngambri peoples.

The Lowitja Institute is the national institute for Aboriginal and Torres Strait Islander health research. It is an Aboriginal and Torres Strait Islander organisation, named in honour of its Patron, Dr Lowitja O’Donoghue AC CBE DSG. The Institute was established in 2010, emerging from a 14-year history of Cooperative Research Centres.

The Lowitja Institute works with communities, researchers and policy makers to facilitate research. The voice of Aboriginal and Torres Strait Islander people informs all of our activities, whether we’re conducting community-based research or setting strategic direction. This puts Aboriginal and Torres Strait Islander peoples’ knowledge and cultural understanding at the heart of the research process. Our approach ensures that we are more likely to have effective and relevant research outcomes.

The Prime Minister, in delivering his 2015 Closing the Gap report – described progress as “profoundly disappointing”. The target of closing the gap in life expectancy within a generation has made limited progress only, and is not on track. This, together with the findings of the AIHW’s Burden of Disease Study for Aboriginal and Torres Strait Islander People (released this week) is very concerning for the Lowitja Institute. I draw the Committee’s attention to a quote in that report – that there were around 2,950 deaths of Indigenous Australians in 2010, resulting in almost 100,000 years of life lost to premature mortality.

In our submission to the Committee, we outline overarching principles that Aboriginal and Torres Strait Islander people have identified over many years. These principles are worth reiterating. They include the Aboriginal definition of health; the importance of Aboriginal and Torres Strait Islander leadership; the role of human rights; understanding what genuine partnership and engagement is; the importance of building an Aboriginal and Torres Strait Islander workforce; the role of culture in health; locally tailored and targeted solutions, and the wisdom of strengths-based values over the ‘deficit model’.

The Lowitja Institute strongly supports the National Aboriginal and Torres Strait Islander Health Plan 2013–2023. The Health Plan expresses a vision of a health system that is free of racism and inequality, and importantly, it also places culture and wellbeing as central to the health of Aboriginal and Torres Strait Islander people. The Plan, which was developed in close partnership with the National Health Leadership Forum (of which the Lowitja Institute is a member), was developed and endorsed by the previous government. An effective Implementation Plan will be essential to honour the vision of the Health Plan and we recognise the commitment by the current government to this.

The Lowitja Institute recently launched – in this place – Recognise Health, an initiative that promotes understanding of the important link between health and wellbeing and constitutional recognition of Aboriginal and Torres Strait Islander people. The initiative, led by the Lowitja Institute, has brought together a coalition of, to date, over 125 non-government organisations across the Australian health system. The initiative supports the importance of identity, pride, history and belonging to this land – factors which contribute to social and emotional wellbeing, which we know is important for overall health. The Institute is working closely with Recognise, the people’s movement to recognise Aboriginal and Torres Strait Islander peoples in the Australian Constitution.

It is important also, that our political leaders (and health policymakers) understand that for Aboriginal and Torres Strait Islander people, land, culture, community and identity and therefore health – are intrinsically linked. We recently highlighted this point in a statement responding to the movement to close Western Australian communities, and remove Aboriginal and Torres Strait Islander people from their land. We also welcome the call in the Health Plan for a culturally respectful and non-discriminatory health system. The Lowitja Institute-funded research demonstrates that racism is bad for our health and wellbeing. The study found that racism was prevalent in the lives of those Aboriginal Victorians surveyed (755 Aboriginal Victorians, aged 18 years and older, living in four municipalities – two rural, two metropolitan) and that racism is more likely to lead to higher levels of psychological distress and mental health problems. The work reminds us that racism does exist, and is experienced by many Aboriginal and Torres Strait Islander people in their everyday lives. It identifies the need for increased support and educational efforts and the development of strategies to promote respect and social cohesion within communities as strategies for change.

The Lowitja Institute is committed to a program of research about social determinants of health, however, it also believes there is work to be done to understand more about the cultural determinants of health – to understand how things like culture, language, attachment to land, identity – impact on people’s wellbeing, and hence overall health. The Lowitja Institute strongly endorses the centrality of culture, identified in the Health Plan.

We support a Health in All Policies approach to Aboriginal and Torres Strait Islander policy broadly. Good health is central to positive outcomes in terms of education and employment. Health in all Policies approach acknowledges that health is not merely the product of health care activities, but is influenced by a wide range of social, economic, political, cultural and environmental determinants of health, and require joined-up policy and government responses. Equally, we also believe it is important to ensure that the Aboriginal and Torres Strait Islander health impacts are considered in all policies, from design through to implementation. This would reflect Close the Gap as a national priority. Further work is required to ascertain the best mechanisms and processes to achieve the goal of Aboriginal and Torres Strait Islander Health Impact Assessments.

It is important that health policy development is informed by rigorous evidence. The strength of the research undertaken by the Lowitja Institute is that it is informed by researchers, policymakers and most importantly, Aboriginal and Torres Strait Islander people. Translation of research into policy, programs and better practice is our focus.

As the National Institute for Aboriginal and Torres Strait Islander Research, the integrity of our research is also vitally important. We believe that there is no point in doing research in Aboriginal and Torres Strait Islander health, unless it involves Aboriginal and Torres Strait Islander people at every step along the way, and that as the beneficiaries of research, that we are active in the research process. This is the underlying philosophy that has driven the Lowitja Institute and our predecessor organisations from our commencement in 1997. We recently awarded our inaugural ethics award – entitled Tarrn Doon Nonin (the Woiwurrung language term for ‘trust’).

We believe it is important for health policymakers to understand the role of Aboriginal and Torres Strait Islander health organisations in developing health policy. Aboriginal and Torres Strait Islander health organisations, leaders must be engaged in genuine partnership at the negotiating table, if we are to Close the Gap in health and other outcomes.

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