For decades, it has been common public knowledge that the health of Aboriginal and Torres Strait Islander peoples is significantly worse than that of the country as a whole. This has generated public sympathy, but has all too often been accompanied by the assumption that nothing really can be done about it because 'nothing ever changes’ in Aboriginal health.
This assumption has been powerful and surprisingly resilient, even in the face of significant changes in the health of Aboriginal and Torres Strait Islander communities. It has exerted a subtle but constant pressure on public policy, such that governments and policy makers have needed to be able to justify the continued (or increased) funding of health services for Indigenous communities.
However, the recent Parliamentary Apology to Australia’s Indigenous peoples marks a change in public attitude and an opportunity to break free of scepticism about the possibilities of genuine improvements in Aboriginal health.
Of course, for many years the research community and the Aboriginal and Torres Strait Islander health service sector (amongst others) have argued that the better provision of primary health care will lead to, and is already leading to, improvements in the health status of Australia’s Indigenous people. From the 1980s onwards, this view has generally formed the basis for Aboriginal and Torres Strait Islander health policy, with Aboriginal community controlled primary health care services at centre stage (especially following the 1989 National Aboriginal Health Strategy) and State and Territory governments committing to improving their own primary health care strategies for Aboriginal and Torres Strait Islander people.
Nevertheless, high-level evidence for primary health care improving the health of the Aboriginal and Torres Strait Islander population within Australia has remained sparse.1
A significant attempt to review and summarise the evidence was the study commissioned by the Commonwealth Health Department in 2001. Better Health Care2 found that the international evidence confirmed the effectiveness of primary health care in improving the health status of Indigenous peoples, and that comprehensive primary health care can improve the health of Australia’s Indigenous population, provided that it is well planned, locally coordinated, supported by a competent workforce, and able to engage the local community in action for health. Significantly, it concluded that
… there is a need to continue to … gather evidence on effective approaches, in order to build on the foundations already established.3
Six years on, a dozen years since the transfer of Aboriginal primary health care funding responsibility to the Commonwealth Health Department, and in the light of revived optimism about positive change in Indigenous Affairs in Australia, this Review attempts to revisit the international and local evidence that primary health care can deliver results for Indigenous peoples.4
1 We note here while the that the delivery of ‘better health outcomes’ has been the focus of Aboriginal primary health care policy (and is the reason behind this report), primary health care itself has a value beyond its contribution to health gain. This is its role in the alleviation of suffering and its ability to assist people to live productive and able lives – whether or not this is measurable in terms of the usual outcomes. This principle is, it seems, broadly supported for mainstream health services, where access to a doctor (for example) is seen to be a good in itself, and where the provision of such services is not seen as conditional on demonstrating their effectiveness in terms of outcomes.
2 Commonwealth of Australia (2001). Better Health Care: Studies in the successful delivery of primary health care services for Aboriginal and Torres Strait Islander Australians. Canberra.
3 Ibid. p 15
4 Within the time frame specified for the preparation of this report (three months) it is, of course, not possible to reproduce a study of the length and depth of Better Health Care.