Aboriginal and Torres Strait Islander Wellbeing Report - NSB202

This report delves into the multifaceted aspects of Aboriginal and Torres Strait Islander peoples' wellbeing, examining the crucial role of Aboriginal Community Controlled Health Services (ACCHS) in providing culturally appropriate primary healthcare. It highlights the significance of self-determination in healthcare and the responsibilities of Aboriginal and Torres Strait Islander Health Workers (ATSIHWs) in bridging cultural gaps and promoting holistic wellbeing. The report addresses the challenges faced by both Aboriginal communities and healthcare providers, including barriers to primary care, autonomy issues for general practitioners, and the importance of cultural safety. It emphasizes the need for interdisciplinary teamwork, cultural mentorship, and the application of cultural safety principles to improve healthcare delivery and foster a sense of belonging and empowerment within Aboriginal communities. The report also covers the international context of self-determination and its relevance to Indigenous rights, concluding with the benefits of ACCHS and the importance of community leadership in supporting family and child wellbeing.

Aboriginal and Torres Strait Islander Peoples' Wellbeing
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Introduction
Aboriginal community controlled health service is a suitable cultural outcome in primary
health services started, governed and planned by local Aboriginal communities in Australia
through the Aboriginal board of directors who are elected. ACCHS deals with early intervention
and comprehensive care and prevention to reduce challenges to get health care (Clapham,
Bennett‐Brook & Hunter, 2018). The National umbrella organization representing Aboriginal
Community Controlled Health Organization is involved in the expansion, promotion and
increasing of the provision of culturally appropriate healthcare; addressing the health needs of
Aborigines through research and data analysis; representing and advocating for Aborigines in
health services, programs and research. Benefits in ACCHS include integrated holistic service
deliver (Jackson, 2018).
Definition of ACCHS and Response to Holistic Needs
The ACCHS are autonomous primary health services that are appropriate culturally;
initiated, controlled and planned by local Aboriginal community through Aboriginal board of
directors elected by the people. According to Coombs (2018) ACCHS are practically the
expressions of Aboriginal self-determination in their health and are important in delivery of
services that involves Aboriginal people primary care which is comprehensive. ACCHS responds
to holistic health needs as per Aboriginal and Torres Strait Islander definition of health by
ensuring that incorporation is a must by Aboriginal organizations, initiated by the local
Aboriginal community, based locally, governed by directors of the Aboriginal board and
delivering appropriate health services that are cultural and holistic to the community. The
improvement of Aboriginal health involves working towards the emotional, social, and cultural
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well-being of all individuals as well as improving the physically well-being of the whole
community in which every member has the chance achieve their full potential as human beings.
Approximately 50% of all primary health care is provided by ACCHSs to Aboriginal and
Torres Strait Islander peoples who oversee, run and own health services that are community-
controlled. ACCHS that gives Aboriginal people a say on what their health service is all about is
an example of Aboriginal self‐determination in practice (Mazel, 2016). With the care models
more team-based than general practitioner-focused, it is part of ACCHS leadership that involves
both the community and ACCHS management. Nonetheless, the ACCHS and PCMH models
have so much in common. Care is patient-focused but may encompass the family and may also
have a significant physician inclusion which is combined with the help of health specialists,
mental health community services and professionals especially those delivered at home and is
defined by participation in quality-improvement programs found in clinics. Importantly, with the
increase in government policy and regionalization that involves supporting more models of care
that are community driven. (with the advent of Medicare Locals and Health and Hospital
Networks), community-operated health services are provided with prototypes by the ACCHSs
ACCHSs and GPs
ACCHS doctors work in multidisciplinary teams. Knowledge of both the social and
cultural aspects of the background of a patient is important to patient management which every
Aboriginal health workers’ and registered nurses’ should be having, and they mostly are
independent on their work on aspects that involve planned care. Allowing GPs to work with a
health care team that is primary and truly multidiscipline, ACCHS is supported by health
professionals and specialists who visit occasionally. Time pressures, job demands and perpetual
change are the stressors of mainstream general practice
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Autonomy loss in practice management is a major stress for GPs workers in an
ACCHS. Community-elected boards govern ACCHSs are responsible in making many GPs
decisions in mainstream practices instead of GPs ordinarily making the decisions themselves.
Some board members have been highly trained in the health field while others not as much
which may or may not affect their decisions to be in line with GPs’ perceptions on how
operations on a medical clinic should be carried out. The implementation of change can be
difficult due to lack of autonomy when the ultimate decision for acquisition of equipment,
recruitment, conference attendance, or participation in research and population health programs
lies with the board (Wilson, 2015).
Indigenous Australians low primary care usage influences the Aboriginal and Torres
Strait Islander gap in life expectancy. Many indigenous Australians are regarded as general
practitioners who are private which is their common source of healthcare. A range of barriers
however, results in a generally low access to primary care which results to chronic diseases
having subsequent inadequate prevention and management. (Barrett, Salem, Wilson, O'neill,
Davis & Bagnulo, 2015). Requirement of indigenous primary care involves the development of
the GP with a set of attributes. The needs of local indigenous communities may need the
tampering of clinical autonomy to be responsive.
Role of the Aboriginal and Torres Strait Islander Health Worker (ATSIHW).
Aboriginal and Torres Strait Islander Health Worker role is primary care setting
emphasizes that partnership with health providers who are non-indigenous like general
practitioners and nurses bringing skills with complementary together to increase Aboriginal
people health care and also to reduce communication barriers and culture while delivering such
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health care. Clinical, health promotion, education and leadership are different skills and roles of
aboriginal health workers. The role of Aboriginal health workers has an increased recognition in
providing non-indigenous colleagues with cultural mentorship. (James, Toombs & Brodribb,
2018). The general health workers have duties such as identifying health needs of patients;
advocacy; ensuring the provision of services in a way that maximizes respect of the culture and
acceptability.
Issues nurses need to consider when working with ATSIHW in an interdisciplinary team
are specific factors that influence the working experience of health professional at interface so
that such factors are addressed through health professional training and development. These
factors may include the organization-it can enable or make it difficult for nurses to interact with
patients and health workers; organizational culture- there should be a space for Aboriginal and
non-Aboriginal people to work together ensuring the is an improvement of health care;
organizational support- it is effective for both Aboriginal and non- Aboriginal staff; accessibility
for health service –should be enhanced (Lai, Taylor, Haigh & Thompson, 2018). Applying
primary health care general knowledge, skills and demonstrating the capacity to perform tasks,
using defined techniques and knowledge under supervision are the abilities should be possessed
by a generalist health worker.
Self-determination and it relation to ACCHOs, ATSIHWs and cultural safety.
Self-determination is not only a basic human right that makes all people entitled to a
basic requirement of justice, but also a basic human need that allows people to lay claims as a
fundamental component of their well-being. It can be defined as a capability that can only be
realized in common by members of a distinct political community, working together with shared
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political institutions determining the laws and policies that shapes individual and collective
features. Self-determination replaced assimilation as the approach which is official to Indigenous
affairs when the power in 1972 was taken by Whitlam government (Hocking, 2018). Composed
of Indigenous peoples, an establishment of the Aboriginal and Torres Strait Islander Commission
(ATSIC) was created, with its role was to maximize participation of the Indigenous in the
development and implementation of policies which affected them. By culture, to fundamentally
enhance personal empowerment, safe service delivery should be considered which should result
to the promotion of pathways that are meaningful and effective for Indigenous people with self-
determination. Cultural safety principles that should be involved include aboriginal self-
determination, equity, social and restorative justice, sustainability, negotiated partnership,
transparency, reciprocity, accountability, political bipartisanship and cultural contextually.
(Kendall & Barnett, 2015).
The establishment of ACCHOs plays a crucial role in the improvement of cultural
identity and fostering the Aboriginal communities with a sense of belonging, cultural pride and
ownership. (Brigg, & Curth-Bibb, 2017). The self-determination right is contained in both article
1 of the International Covenant on Civil and Political Rights (ICCPR) and article 1 of the
International Covenant on Economic, Social and Cultural Rights which states that right of self-
determination applies to all people. (Roth, 2018). The virtue of that right gives them the freedom
to pursue their cultural, economic and social development and also determine their own political
status. All people may freely dispose of their natural wealth and resources for their own ends
without responsibility to any obligations that rises out of the international economic co-operation
that is entirely based upon the principle of mutual benefit and international law.
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By own means of subsistence, depriving the people should not be done in any case.
Promotion of the realization of the right to self-determination as part of the States Parties to the
present Covenant is the responsibility of the administration of Non-Self-Governing and Trust
Territories. The respect of that right is expected, in conformity with the provisions of the United
Nations Charter.
Conclusion
Controlled Health Services by Aboriginal Community may result to benefits such as
integrated and holistic service delivery; improved access to flexible and responsive delivery; cost
effective and efficient health care delivery system and even provides a resource for culturally
appropriate research. G.P ensures communication between general practitioner, information
sharing and support is useful especially to people located in rural and remote areas. G.P has a
potential to reduce isolation and also address the general practitioners needs of support hence
improving Aboriginal community interaction controlled sector general practice organizations.
The communities functioning effectively plays a crucial role in supporting the well-being of
families and children that is social and economic. The primary driver of human development in
Aboriginal communities is the good community leadership and governance. The holistic
understanding of well-being and health involves the whole life-course of the whole community.
It includes broad issues like equality, rights and social justice, as well as knowledge of the
traditions, connection, and healing of the country.
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References
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delivering a child safety‐focused home visiting program for Aboriginal families in an
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Jackson, C. (2018). International Experiences of Primary Health Care-linkages and lessons for
Australia.
Coombs, D. (2018). Primary Health Networks’ impact on Aboriginal Community Controlled
Health Services. Australian Journal of Public Administration, 77(S1), S37-S46.
Mazel, O. (2016). Self-determination and the right to health: Australian aboriginal community
controlled health services. Human Rights Law Review, 16(2), 323-355.
Wilson, S. (2015). Primary care review-a brave new world for GPs or little
change?. Medicus, 55(8), 36.
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Barrett, E., Salem, L., Wilson, S., O'neill, C., Davis, K., & Bagnulo, S. (2015). Chronic kidney
disease in an Aboriginal population: A nurse practitioner‐led approach to
management. Australian Journal of Rural Health, 23(6), 318-321.
James, S., Toombs, M., & Brodribb, W. (2018). Barriers and enablers to postpartum
contraception among Aboriginal Australian women: factors influencing contraceptive
decisions. Australian journal of primary health, 24(3), 241-247.
Lai, G., Taylor, E., Haigh, M., & Thompson, S. (2018). Factors affecting the retention of
Indigenous Australians in the health workforce: a systematic review. International
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Hocking, J. (2018). ‘A transforming sentiment in this country’: The Whitlam government and
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Brigg, M., & Curth-Bibb, J. (2017). Profiling an ACCHO model of governance: working for
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In Autonomy and Self-determination. Edward Elgar Publishing.
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