Shared decision-making crucial to improving outcomes for Aboriginal and Torres Strait Islander people, Productivity Commission finds

By Shannon Jenkins

Thursday December 3, 2020

Indigenous business woman
(Image: Getty)

A new report from the Productivity Commission has highlighted the need for a ‘bottom-up’ approach to Aboriginal and Torres Strait Islander involvement in decision-making and policy design in order to improve life outcomes for their communities.

At more than 4000 pages long, the paper is the most comprehensive report on the wellbeing of Aboriginal and Torres Strait Islander people produced in Australia, according to the PC.

“With the National Agreement on Closing the Gap in place, the report can assist those in policy and program design and delivery and should be compulsory reading for anyone interested in the wellbeing of Aboriginal and Torres Strait Islander people,” it said on Thursday.

There have been mixed outcomes for Aboriginal and Torres Strait Islander people in the four years since the last PC report was released, with some improvements in early child development, economic participation, health, and education.

For example, mortality rates for children improved between 1998 and 2018, particularly for 0<1 year olds, whose mortality rates more than halved from 13 to 5 deaths per 1000 live births.

In education, the proportion of 20–24 year olds completing year 12 or above has increased, while the proportion of 20–64 year olds with or working towards post-school qualifications has almost doubled from 2002 to 2018-19.

But outcomes in several areas have not improved for Aboriginal and Torres Strait Islander people.

The rate of deaths from suicide and self-harm increased by 40% over the decade to 2018, and the proportion of adults reporting high levels of psychological distress increased from 27% in 2004-05 to 31% in 2018-19.

The adult imprisonment rate increased by a massive 72% between 2000 and 2019. While the youth detention rate has decreased, it is still 22 times the rate for non-Indigenous youth.

Meanwhile, rates of children in out-of-home care have almost tripled in the past 15 years, to 60 per 1000 children in 2018-19.

These outcomes must be understood in context in order for change to occur, according to PC chair Michael Brennan.

“Poorer outcomes are not due to people being Aboriginal or Torres Strait Islander, but can be attributed to the additional personal challenges and structural barriers faced by many Aboriginal and Torres Strait Islander people,” he said.

It must also be understood that policies and programs that appear neutral on the surface may actually operate in an uneven or unfair manner that is detrimental to Aboriginal and Torres Strait Islander people.

“Removing these structural barriers is critical if the wellbeing of Aboriginal and Torres Strait Islander people is to improve,” Brennan added.


Read more: Productivity Commission puts Aboriginal and Torres Strait Islander people at the centre of policy evaluation with new strategy


Commissioner Romlie Mokak noted shared decision-making is a common element in approaches that seem to be successful in improving outcomes.

“Aboriginal and Torres Strait Islander people’s participation in decisions on policy, program and service design and delivery is important to drive real change on the ground,” he said.

For this reason, the case studies detailed in the PC report focus on governance, and specifically identify arrangements that support shared decision-making between Aboriginal and Torres Strait Islander people and Australian governments in areas that affect Aboriginal and Torres Strait Islander people and contribute to their overall wellbeing.

The paper noted that Aboriginal and Torres Strait Islander community involvement in a ‘bottom-up’ rather than ‘top-down’ approach can help close the gap in life outcomes between Aboriginal and Torres Strait Islander people and non-Indigenous people.

It found governance arrangements where Aboriginal and Torres Strait Islander people make decisions alongside Australian governments include structures, rules and laws that:

  • Provide Aboriginal and Torres Strait Islander people with decision-making authority, and ensure a deliberative and negotiated process, not just information giving or consultation,
  • Promote Aboriginal and Torres Strait Islander cultural frameworks, processes, context and time frames; with government as facilitators, enablers, or partners,
  • Recognise power inequalities, and share power, through mechanisms that are transparent — for example, contracts or agreements, and agreed conflict resolution processes,
  • Ensure Aboriginal and Torres Strait Islander people can choose their representatives, and these representatives have the resources and support (including information) that they need to negotiate on an equal footing,
  • Define desired outcomes, the steps to achieving them and the roles and responsibilities of participants, along with their mutual accountabilities.

Read more: Governments must improve engagements with Aboriginal and Torres Strait Islander people to ensure they are comprehensive and transparent, report finds


Aside from shared decision-making, other common characteristics of approaches which appear to be successful in improving outcomes include addressing racism and discrimination in the Australian community through structural changes and education, and addressing laws, policies, and practices that operate to the detriment of Aboriginal and Torres Strait Islander people.

Ongoing government investment, collaboration and coordination, and ensuring access to effective culturally safe services at the right time and suited to the local context were also identified as characteristics of successful approaches.

The report was produced in consultation with all Australian governments, the Coalition of Aboriginal and Torres Strait Islander Peak Organisations, and other Aboriginal and Torres Strait Islander people and organisations.

 

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