How the Social Determinants of Indigenous Health became Policy Reality for Australia's National Aboriginal and Torres Strait Islander Health Plan

Abstract

The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.

Social Determinants of Indigenous Health and Indigenous Rights in Policy: A Scoping Review and Analysis of Problem Representation

“…He argued that the structure of these agreements, which tie federal and state governments to each other, has resulted in "solutions" that cannot respond to local problems. Fisher, Battams, McDermott, Baum, and MacDougall (2018) highlighted an exception to this in Australia in the National Aboriginal and Torres Strait Islander Health Plan. In this policy, community control and partnership between Indigenous leaders and the government was seen as a priority, which contrasted Indigenous leaders' assessment of past policy processes (including the National Indigenous Reform Agreement) in which attempts to form partnerships were inadequate.…”

“…In this policy, community control and partnership between Indigenous leaders and the government was seen as a priority, which contrasted Indigenous leaders' assessment of past policy processes (including the National Indigenous Reform Agreement) in which attempts to form partnerships were inadequate. Fisher et al (2018) argued that this leadership and advocacy was cruicial in the successul intergration of social determinants of Indigneous health into national health policy. D. Smith (2007) noted that government has a role in creating broader complex policy processes that are reflected in the unnecessary multiplication of programs and onerous funding processes.…”

“…A specific example of policy that has recognised social determinants of Indigenous health is the Australian National Aboriginal and Torres Strait Islander Health Plan. Fisher et al (2018) described the way that policy actors responded to a window of opportunity to challenge conventional problem definitions and to place social determinants of Indigenous health at the centre of health policy for the first time. Their analysis showed that despite a commitment to partnership and collaboration, this policy was unclear in implementation and was not fully funded.…”

“…D. Smith (2007) argued that successive Australian governments have fundamentally failed to invest in Indigenous self-governance despite cases in which Indigenous communities successfully "establish[ed] good governance" and thereby "secur[ed] important social, cultural and economic outcomes" (p. 9) using a strengths-based approach. The limited implementation and lack of funding for the National Aboriginal and Torres Strait Islander Health Plan, which included culture at the centre of health policy, is further evidence of the lack of action on policy that promotes social determinants of Indigenous health (Fisher et al, 2018). Lavoie and Dwyer (2016) highlighted that, without a treaty with Indigenous Peoples in Australia, self-determination is not a priority for the Australian government and constitutional reform may be required to fully address issues of governance and health equity.…”

“…An example from Klein (2015) suggested that consultation has been "more to convince local people of the merit of preconceived policies and principles than to inform the policies themselves, and allow deliberation and community participation" (p. 7). Fisher et al (2018) also found that, even when policy is driven by consultation and a strength-based approach, action on social determinants of Indigenous health is often left unimplemented or unfunded.…”