After more than 10 years of working as an Indigenous doctor, I have seen too many examples of what happens when services and programs are rolled out without the input of those they are meant to serve. It’s how we’ve ended up with a health system that so often fails to meet the needs of Indigenous people, especially when they’re sick.
It’s part of the reason why, as you can read in the latest issue of The Medical Journal of Australia, that “survival of Indigenous patients following a diagnosis of lung cancer is worse than for other Australians because of treatment differences”.
When services are not designed with the needs of Indigenous people in mind, they are less likely to be effective in engaging with them, and in making a real difference to their lives. Health services need to consider issues such as geography and transport; cultural brokerage; and the Indigenous health workforce in the development and implementation (including evaluation) of health care programs.
Of course, this is not only true in health but for all services, whether education, housing, or transport, for example.
It seems such an obvious point to make but the recent history of the NT intervention shows that meaningful community consultation is too easily forgotten by our society’s powerbrokers, and needs to be continually re-stated.
It’s particularly worth re-stating now, at a time when the Australian Government has pledged $40 billion to an infrastructure fund, including $10 billion to be spent on health and hospitals.
I was filled with mixed emotions when I heard this Budget announcement. Hope that it might lead to the much-needed investment in improving the services to Indigenous Australians across the health care spectrum, whether they live in cities or the bush.
But I was also filled with concern that, if history is any guide, there is a real potential that this billion-dollar investment may be wasted if Indigenous people are not consulted right from the outset about how it can best be used to improve our lives.
Meaningful consultation with Indigenous people is not about being politically correct. It is, among other things, about ensuring that Australia’s investment in the future is well spent and delivers some much-needed improvements in both the availability and quality of services available to Indigenous people.
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This is particularly important in health where there are many powerful interests. It is very easy for the voices of Indigenous people to be drowned out, and all Governments will have to make determined and deliberate efforts to ensure this does not happen.
Equally, it will be important for the Indigenous health leadership (AIDA, the National Aboriginal Community Controlled Organisation and the Council of Aboriginal and Torres Strait Islander Nurses) to provide guidance and useful advice to Governments, agencies and communities when it is needed.
Opportunities like this don’t come along very often. Let’s not blow it.