Wednesday, 17 June 2020

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.

The success of the actions has shown the huge potential of this Aboriginal community-controlled health sector. To maintain this effective and efficient response, it is critical that the Government support capacity-building of the ACCHS, with a focus on preventing burnout and empowering local people and organisations.

What is the historic context of disease and infection passed to Indigenous communities? How does this context shape current needs and priorities?

Since colonisation, disease and infection have decimated Indigenous populations in Australia and worldwide. This has been well documented, most recently by the devastating effects of the H1N1 influenza.

The social determinants of health mean that the most vulnerable in society are likely to be hit hardest by the pandemic, and we have seen this in the black and Indigenous American communities. Marginalised peoples who were already suffering from chronic illness, mental ill-health, and poverty prior to the COVID-19 crisis are likely to be further devastated by the economic and mental health crisis that will inevitably characterise the COVID-19 recovery.

The effect of cumulative risk factors needs to be addressed.

For Aboriginal and Torres Strait Islander peoples, cultural determinants of health provide resilience and strength for peoples and communities. The Social and Emotional Wellbeing (SEWB) Framework [PDF, 3.56MB]describes the importance of having a healthy mind and body, and the importance of enhancing wellbeing through connections to family, community, culture, land, and spirituality.

The disruptions to these connections by government policies to contain the virus need to be addressed, and re-establishing and revitalising these connections needs to be a core characteristic of the pandemic health and mental health response to communities. It is critical that both mainstream and community-led services acknowledge the SEWB framework and the significant impacts of historical, social, and cultural determinants of health.

What are some of the lessons learned (or that might be learned) from this crisis in terms of Australia’s relationship with Indigenous people?

The COVID-19 pandemic has highlighted and simultaneously reinforced the gaps in Australia’s social safety net, including racial inequity, social determinants of health, and the longstanding shortfalls in health policy. All these factors that influence the health and mental health outcomes of COVID-19 also affect an individual’s ability to achieve health and wellness.

The need for Australia to recognise Indigenous peoples, to enhance relationships of reconciliation and healing the relationship is essential now. However, we remain the only colonised country without a treaty.

The need to address key human rights issues, including self-determination, tackle social determinants such as housing and ensure that equitable health care is provided are the important lessons learned from the COVID-19 pandemic in Australia.

Professor Jill Milroy is a Palyku woman from the Pilbara region of Western Australia. Jill is Pro Vice Chancellor Indigenous Education at The University of Western Australia and is the Director of UWA’s Poche Centre for Indigenous Health. She has more than 30 years experience in Indigenous higher education developing programs and support services for Indigenous students as well as a range of Indigenous curriculum and research initiatives. Jill has served on a number of national policy advisory bodies and has been a strong advocate within the national higher education arena for the formal recognition and resourcing of Indigenous knowledge systems.  In 2011 she was appointed a Member of the Order of Australia in recognition of her services to Indigenous education.

Kate Derry is a research assistant at the Poche Centre for Indigenous Health at the School of Indigenous Studies in The University of Western Australia. Her research areas include child development, self-psychology, and suicide prevention.

Professor Pat Dudgeon is from the Bardi people of the Kimberly area of Western Australia. She is a psychologist, professor, and Research Fellow at the Poche Centre for Indigenous Health at the School of Indigenous Studies in The University of Western Australia. She is also Director of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention and the National Empowerment Project. Her research areas include social and emotional wellbeing and suicide prevention and she is actively involved with the Aboriginal community and committed to social justice.


UWA Public Policy Institute