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COVID-19: Indigenous perspectives
Impacts of historical, social and cultural determinants of health
Jill Milroy, Kate Derry & Pat Dudgeon
Jill, Kate and Pat explore how the particular exposure of Indigenous communities to COVID-19 has highlighted existing inequities and human rights issues, especially in relation to health care and housing, and what the government should learn from this crisis.
What are the distinct vulnerabilities and challenges that the Indigenous community faces in the pandemic?
The COVID-19 pandemic has shone a light on the many inequities between different groups of people. Across the world, Indigenous peoples have been disproportionately affected by the pandemic. This inequity has brought renewed attention to the social determinants of health and the need to address key human rights issues, such as access to housing and health care.
In 2009, the United Nations noted [PDF, 2.8MB] that the health and socioeconomic disparity between Indigenous and non-Indigenous peoples is particularly pronounced in Australia. Aboriginal and Torres Strait Islander peoples have significantly higher rates of psychological distress and chronic health problems and face significant barriers to accessing health care services.
This health gap is the result of long-term systemic neglect of the historical and social determinants of health, and during a pandemic this gap translates to increased risk that exposure to the virus is more likely to result in hospitalisation and fatality.
Social determinants of health, such as employment, education, health care and housing, have contributed to how marginalised people have coped during the pandemic.
One of the biggest health challenges for Aboriginal and Torres Strait Islander peoples during the COVID-19 pandemic has been overcrowding and lack of housing. In the crisis phase of COVID-19 it was critical for families to self-isolate and physically distance themselves from others. This was simply not possible in many circumstances.
The lack of adequate housing directly impacts the ability of local health services to control the spread of the virus and further exacerbates a complex set of social issues, including child and family social and emotional wellbeing and safety, as well as over-policing violations of isolation policies.
The critical housing shortages in Aboriginal communities have been well documented for many years. Australia has been incredibly fortunate to keep the virus out of these communities but it is imperative that the housing issue is addressed before the next wave or pandemic.
How has government accommodated for those vulnerabilities and challenges in its policies and containment measures? What has been missed?
Aboriginal and Torres Strait Islander peoples were sent back to their communities, which had both benefits and challenges. Facilitating connection to family, community, culture and land enhances social and emotional wellbeing and resilience, but without adequate housing and a local health workforce or culturally competent telehealth workforce it may have also increased risk.
The lockdown was also in the public’s best interests but the disruption to Sorry Business and cultural practices is likely to have had unintended adverse consequences.
These cultural complexities are why it is essential that the Federal Government honours the commitment to equal partnership and shared decision-making that was made in this year’s Close the Gap report. A cultural governance framework must accompany any legislation that may impact Aboriginal and Torres Strait Islander peoples to ensure the positive impacts are optimised and potential adverse impacts are mitigated.
What can we learn from Indigenous communities in how they have responded to the crisis?
The main lesson is that self-determination works. Self-determination is the key evidence-based policy structure to improve outcomes for Indigenous peoples. The key takeaway from COVID-19 has been the importance and impact of self-determination in promoting the health and wellbeing of Aboriginal and Torres Strait Islander peoples in contemporary Australia.
Aboriginal and Torres Strait Islander communities have been kept safe through the COVID-19 health response, due to the leadership, innovation, cooperation, and management of the Aboriginal community-controlled health sector (ACCHS).
The State and Territory peak organisations and member services across the nation participated in a national COVID-19 Advisory Group and responded early in the pandemic to mitigate risk and protect communities. This was achieved by acting independently, without waiting for directive from the Government, uniting diverse sectors (health, education, land councils, and government agencies) and developing effective, culturally appropriate communication and health care strategies.
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