Beyond the rhetoric: how can non-government organisations contribute to reducing health disparities for Aboriginal and Torres Strait Islander people?

Abstract

The prevailing disparities in Aboriginal health in Australia are a sobering reminder of failed health reforms, compounded by inadequate attention to the social determinants shaping health and well-being. Discourse around health reform often focuses on the role of government, health professionals and health institutions. However, not-for-profit health organisations are also playing an increasing role in health policy, research and program delivery across the prevention to treatment spectrum. This paper describes the journey of the National Heart Foundation of Australia in West Australia (Heart Foundation WA hereafter) with Aboriginal employees and the Aboriginal community in taking a more proactive role in reducing Aboriginal health disparities, focusing in particular on lessons learnt that are applicable to other non-government organisations. Although the Heart Foundation WA has employed and worked with Aboriginal people and has long identified the Aboriginal community as a priority population, recent years have seen greater embedding of this within its organisational culture, governance, policies and programs. In turn, this has shaped the organisation's response to external health reforms and issues. Responses have included the development of an action plan to eliminate disparities of cardiovascular care in the hospital system, and collaboration and engagement with health professional groups involved in delivery of care to Aboriginal people. Examples of governance measures are also described in this paper. Although strategies and the lessons learnt have been in the context of cardiovascular health disparities, they are applicable to other organisations across the health sector. Moreover, the most powerful lesson learnt is universal in its relevance; individual programs, policies and reforms are more likely to succeed when they are underpinned by whole of organisation ownership and internalisation of the need to redress disparities in health.

‘Believe in me and I will believe in myself’, a rural Australian health service learns how to mangan dunguludja ngatan (build strong employment) for Aboriginal and Torres Strait Islander people: a qualitative study

“…In addition, it engenders self-pride in the Aboriginal employee and a belief that the organisation trusts and understands them ‘…believe in me and I will believe in myself’. The Heart Foundation in Western Australia (WA) found that both trust and flexibility are essential ingredients in supporting the personal development of an Aboriginal employee in a mainstream workplace [39].…”

“…Aboriginal health workers employed in a mainstream health service experience little separation from their community and their workplace duty to continuously advocate and create cultural safety, ultimately increasing the risk of emotional exhaustion and burnout [41, 42]. Culturally strong and flexible workplaces enable early identification of burnout and the need for additional unexpected support such as time off for ‘sorry business’ [39, 41, 42]. In Australia, compassionate leave entitles any full- or part-time employee to 2 days paid leave [43].…”

“…Mainstream employment was reported as being isolating when only few Aboriginal people are employed, indicating that an informal Aboriginal Staff Network would bridge that gap by ensuring interaction. Wood et al [39] agreed that although most employees require nurturing and support to improve performance, the need is magnified among Aboriginal employees, particularly those working in mainstream organisations. Both Karreeta Yirramboi and the national strategic framework for developing the Aboriginal health workforce indicate that mentoring support and Aboriginal networks are important for retaining Aboriginal employees by facilitating career progression and knowledge development [8, 33].…”

Making progress: the role of cancer councils in Australia in indigenous cancer control

“…This takes time [18]. Overall, there is an increased consciousness within Cancer Councils of the need for specific strategies to address the disparity seen in Indigenous cancer outcomes, although the strategic [comprehensive] approach recently described by the Heart Foundation in WA is not evident [24]. Wood and colleagues described the recognition by the National Heart Foundation at a whole-of-organizational level of the need to embrace cultural security – through proactive appointment of Indigenous people, appointment of Aboriginal people to Boards, senior committees and working groups; establishment of a dedicated Indigenous health program and team; and integration of Indigenous health across the whole organisation.…”

Editorial Issue 4 2011: Rethinking health inequities at a time of reform: a lost opportunity?

“…Wood et al (2011) provide the only paper in this edition focussed on Aboriginal communities. They describe the process of organisational change in a non-government organisation (NGO) as it embeds a focus on Aboriginal health within its work.…”