Health is a state of physical, social and emotional well being which assists a person to lead a socially productive and personally satisfying life. A Primary Health Care (PHC) service is most effective where it is well integrated with other social, educational, employment/economic systems and services. Aboriginal Community Controlled Health Services (ACCHSs) are Aboriginal owned and Aboriginal managed organisations. The Health Committees are Aboriginal and make the key policy, resource allocation and staff appointment decisions. The Chief Executive Officers and Clinic Managers are mostly Aboriginal and they ensure that staff are accountable and that services are developed and delivered in the way that Aboriginal people determine. Where specialist programs are developed, Aborigines take key leadership and mentoring roles, advising and supporting program staff.
In keeping with the philosophy of self-determination, Aboriginal communities operate 28 ACCHSs across Victoria. They range from large multi-functional services employing several medical practitioners and providing a wide range of services, to small services without medical practitioners, which rely on Aboriginal health workers and/or nurses to provide the bulk of primary care services, often with a preventive, health education focus. The services form a network, but each is autonomous and independent both of one another and of government. The integrated PHC model adopted by ACCHS is in keeping with the philosophy of Aboriginal community control and the holistic view of health that this entails.
Social determinants are the conditions in which people live and work. They are the "causes behind the causes" of ill health. They include poverty, social exclusion, inappropriate housing, shortcomings in safeguarding early childhood development, employment conditions, and lack of quality health improvement systems. Social determinants are intrinsically linked to inequities in health. They help to explain why poor and marginalised people get sick and die sooner than people in better social positions. They are a significant reason behind the world's vast difference in average life expectancy. Social determinants also account for the majority of health inequities within countries. In Australia, babies born to indigenous mothers are more than twice as likely to die in the perinatal period. The latest data shows a 20 year gap in life expectancy between Aboriginal people and non Aboriginal people in Australia.
The health of the Aboriginal population is well below the average for all Australians. Aboriginal people have a much shorter life expectancy than the average and suffer from more chronic illness. A series of Royal Commissions and official studies conclude that the deplorable state of Aboriginal health is a result of both long-standing and contemporary cultural dislocation, deprivation and social disadvantage. The decline continues and health and community service systems have failed to respond adequately and appropriately.
"It is not merely a matter of the provision of doctors, hospitals, medicines. Health to Aboriginal peoples is a matter of determining all aspects of their life including control over their physical environment, of dignity, of community self-esteem, and of justice."
National Aboriginal Health Strategy Working Party, 1989
To visit the Australian Institute of Health Welfare website click here.
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