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Govt co-design ‘not an equal partnership’: Aboriginal health CEO

Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,” Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne.

A particularly vivid example of this is engagement on the establishment of family violence hubs around the state. Gallagher, who is on the family violence industry taskforce, said she was handed a draft plan already outlining the main priorities on Monday, and asked to provide a written response by Wednesday. “A report the size of a PhD,” she added.

“So when they say ‘we want to co-design with you guys’, always ask them what their version of co-designing is,” she told the audience. “Without systematic change in mainstream attitudes and practices, and incorporation of Aboriginal peoples in all stages of policy design, health policies will remain unproductive.”

While Gallagher says she understands the challenges of trying to co-design with a community, government needed to make a more concerted effort to do it properly.

“It doesn’t give us due respect of being part of the beginning right through to the evaluation.”

Culture is strength

Aboriginal culture is often seen in the wider Australian population as a barrier to health, implying that assimilation is the only way forward, Gallagher said.

She rejects this idea. “Cultural differences need to be celebrated and preserved. They are a source of strength and resilience for our peoples, which offer protective factors against traumatic life events.”

Cultural safety and trust can have a big impact on engagement with institutions. She points to the fact that around the country, Aboriginal people are discharged against medical advice or at their own risk at eight times the rate of the rest of the population. This has obvious flow on effects for overall wellbeing.

“When we have a culturally safe place for patients and our people, we improve access to services and improve health for individuals, therefore health for families, therefore health for communities.”

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Creating that environment should not only be up to Aboriginal employees or a good CEO, but come out of an organisation’s systems. This means more than just creating a few identified positions — it’s everyone’s responsibility.

Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being. While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.

“Possessing a strong sense of cultural identity is also vital for one’s self-esteem. A positive cultural connection not only contributes to better mental health and physical health, but may lessen the consequences of social prejudice against Aboriginal peoples.”

Yet despite plenty of experience to show the importance of culture as a source of resilience, it “remains largely unexplored” as a public health resource, she says.

Funding models that don’t fit

Governments ignoring the role of culture creates other problems, Gallagher explains.

The Commonwealth made a capital investment a few years ago to create a childcare centre and kindergarten in Melbourne’s northern suburbs called Bubup Wilam. Recurrent funding was only given for two years, with the idea that it would become self-sustaining by the end of that short period.

“Bubup Wilam grew and evolved and it’s a beautiful childcare centre and kindergarten for Aboriginal children, where they can learn and express aboriginal culture but also have access to what every other kid has access to.

Despite the success, it’s “struggling to continue that at the moment” and is trying to raise funds in the community, she says, “because it doesn’t just provide a kindergarten like for a mainstream nuclear family.”

“Because a lot of the kids and families that access Bubup Wilam are families that live well under the poverty line, a lot of them are touched by the child protection system. What Bubup Wilam tries to do is work with the children, but also work with the families — the mum or the dad or the caregiver — and that takes a lot of resources.

“So our model there does not fit within the mainstream model of how they fund a nuclear, non-Aboriginal childcare centre. … So that’s an example of how the differences and different needs and funding formulas don’t fit what we need to achieve.”

This comes back to the co-design problem: governments aren’t paying enough attention to what the community says, and end up designing the system to fit what they think the community needs, which is different to what it really needs.

“It’s about involving us from the word go,” says Gallagher.

“What Fitzroy might need is different to what Fitzroy Crossing might need.”

Author Bio

David Donaldson

David Donaldson is a journalist at The Mandarin based in Melbourne.