Project Plan

Close the Gap of Health Inequality between Aboriginal and Torres Strait Islander People and Non-Indigenous People in Australia

Introduction
Project plans suggested in this paper aims to create a positive change in health inequality experienced by Aboriginal and Torres Strait Islander people in Australia. This particular topic was chosen due to its significance to Indigenous people, affecting their lives both in short-term and long-term. Also, this topic holds urgency in reconciling because the fact Indigenous people are not having access to an equal opportunity to be healthy is against their human rights (Calma 2008, p.21).

As an example of those inequalities, there was approximately 17 years difference in life expectancy between Indigenous people and non-Indigenous people during 1996 to 2001 (ABS 2005). Some other health inequalities faced by Indigenous people will be quoted later in this report to elaborate this issue’s seriousness and its pressing need for a change.

In order to achieve the aim for the project plans, collective action and community education are used in order to engage with the community members and systems that are relevant to this particular issue. An collective action is focused through the project plans due to the belief that this issue can be only solved through the team work of Indigenous people, non-Indigenous people who believe in equality and voice their stances, and governments who are dedicated to make change through legislations to close the gap (Calma 2008, p.30). Therefore, the target populations for the projects involve all the people in Australia.

Also, Community Education approach is another focus of the projects as community empowerment occurs when members of a community become active learners through a development of a critical understanding of their world, and take actions to transform their community to better meet their fundamental human needs (Healy 2006, p. 262). This approach’s belief on empowerment and transformation is well illustrated by the ancient saying, ‘Give a man a fish and he eats for a day, teach a man to fish and he eats for a life time (Healy 2006, p. 259).

Two pieces of plans are proposed to be used collaboratively in order to maximise the effectiveness of my projects. Moreover, a balanced application of banking and co-learning education styles are used to raise the awareness of the issue in the community as well as in the relevant systems, and also to empower people to take action for a change.

As the first plan, the author will be exploring and taking every opportunity to hold/attend events where she presents this particular issue, and encourages people to take collective actions through signing petitions, and deepening the understanding of the issue. At the same time, the author will be encouraging community members to hold their own events within their networking spaces to promote this collective action.
As the second plan, sustainable community project is to be created by Indigenous community members in Inala, and funded through government as a part of National Strategic Framework for Aboriginal and Torres Strait Islander Health. The author is to intervene with community members to come up with the plan, and help to write a funding submission.

By using those two plans collaboratively, the author aims to work on the issue both on the national level as well as on the local level, in order to respond to the urgent need for a change. Also, applying plans on the different levels enables the author to measure its effectiveness through various sectors of a society.
Background History

As one of developed countries, Australia holds a shameful fact that Aboriginal and Torres Strait Islander people are still experiencing the level of education, unemployment, health, and housing conditions that are equivalent to those of impoverished countries (Australian Government Department of Age and Housing/AGDAH 2007, p. 6). The main reason for this ill-health of Indigenous population is originated in a long history of dispossession, racism and discrimination through the colonization over past two centuries (Mitchell 2007. P. 41).

For example, majority of Indigenous people (75 per cent for male, and 65 per cent for female) die before they reach the age of 65 years. This is disturbing knowing only 26 per cent of males and 16 per cent of females who are non-Indigenous die before the age of 65 years (Calma 2008, p.21). Moreover, this difference in life expectancy means that the age specific death rates for Indigenous people are twice as high compared to those of non-Indigenous people.

Furthermore, in terms of self assessed health status, Indigenous people feel their health as poor twice as likely as non-Indigenous people (ABS 2008).

The relevancy of this statistic to the proposed projects is that the reasons for death are mainly related with health issues. Those chronic diseases include; renal failure, cardio-vascular diseases, type-2 diabetes, heart failure, rheumatic fever and rheumatic heart disease, and coronary/ischaemic heart disease (Ride & Thomson 2010, p.8). Noting many of those chronic diseases are uncommon cause of death for non-Indigenous population, and that they are preventable clearly shows the need for urgent and effective health interventions.

The concept of ‘close the gap’ of such health inequalities mentioned above, originated in New Zealand during 1990, targeting Maori and Pacific Islander people’s health (Altoman et al 2009, p.226). On the other hand, during in the late 1980s, Bob Hawke Labor Government attempted to close the inequalities between Indigenous and non-Indigenous people in Australia by 2000 through policies such as ‘Aboriginal Employment Development Policy’. While Bob Hawke called this movement, ‘statistical equality’, John Howard aimed to close the gap by calling his approach as ‘practical reconciliation’ through its focus on ‘normalisation’ (Altoman et al 2009, p.226).

As another significant historical background regarding to this issue, on 13 February 2008, current Prime Minister, Kevin Rudd made the national apology to the Stolen Generations, and as a part of this ceremony, he signed ‘a declaration of intent to eliminate the life expectancy gap in Indigenous and other child mortality rates within a generation’ (Altoman et al 2009, p.227).

This historical apology triggered Australia to focus not only on the life expectancy difference but also on the social determinants that are affecting Indigenous people’s health to be disadvantaged in Australian society (Altoman et al 2009, p.227).

Analysis
As it is obvious from the background history illustrated above, Australian governments have been working on closing the gap of health inequality between Indigenous and non-Indigenous people.
Especially since the election of the Rudd Government in November 2007, there has been a steadily progress through the increased awareness and the commitments from governments and the public (Altoman et al 2009, p.225).

For example, as a progress of governments, they now have a general joint commitment to deliver services to Indigenous people with the purpose of addressing their social disadvantage, including health inequality (Calma 2008, p.25).

Moreover, as an inter level of governments’ commitment, National Strategic Framework for Aboriginal and Torres Strait Islander Health was created with its purpose of providing ‘comprehensive’ primary health care, and recognising various health issues that are affecting Indigenous people in Australia (Calma 2008, p.25).

Regarding to this point, one of the proposed project aims to secure its funding through Department of Health and Ageing as a part of this National Strategic Framework for Aboriginal and Torres Strait Islander Health Australian Government Implementation Plan 2007 – 2013 (reference).

However, there are still some issues with the current approaches of Australian governments that are hindering the acceleration in closing the gap.

First and foremost, there is no clearly specified timeframes for achieving target goals. Moreover, there is no set mechanism to evaluate the process of and progress in closing the gap (Calma 2008, p.26). These factors lead to the minimal accountability of the governments to work on the promised commitments.

Considering other comparative countries such as NZ and Canada, have succeeded in closing the gap in a lot shorter timeframe with greater progress, there is no reason why Australia cannot do the same.

Also, because people’s health outcome is greatly influenced by how they have been brought up during their childhood, it will take over several generations to make any dramatical change without a policy that targets several levels of generations (Altoman et al 2009, p.225).

Furthermore, when coming up with a practical community project plan to make a positive change in people’s heath, it is helpful to consider some of the contributing factors for chronic diseases experienced by many Indigenous people.

According to Ride & Thomson (2010, p. 9), factors such as psycho-social factors, behavioral and biomedical risk factors, poor nutrition, overweight and obesity, physical inactivity, and risky alcohol consumption.

Moreover, it is important to be aware of the relationship between poverty and poor health (Marmot and Wilkinson 1999). As briefly mentioned in the Introduction part of this report, Indigenous people are socioeconomically disadvantaged in all major indicators (Calma 2008, p.22).

Therefore, it is crucial to have holistic approach where recognition of community members’ ‘whole-of-life context’ is aimed when creating a change (Healy 2006, p. 262). In a practice sense, there needs to be a higher health infrastructure to promote higher health status (Calma 2008, p.23).

In a system sense, the project needs to aim to influence government to produce a comprehensive action plan with specified target goals with a timeframe which will increase the accountability of the governments.
These are the reasons for proposing two project plans in order to respond to the urgency of needed changes to happen.

Proposed Projects

Based on the historical background and analysis, two projects are recommended to use collaboratively to effectively respond to the urgent need for change in Indigenous health inequality.
Project 1: Holding and participating in various events during my placement to educate community members and to ask for collective actions.

This project aims:
- To raise awareness about Indigenous Health inequality,
- To broaden community members’ knowledge of Indigenous Health through community education,
- To promote a sense of unity through community concern, action, and support (mass mobilisation), and
- To empower community members through the realisation of their power to change using collective action as a tool.

One of the main reasons for choosing this style of community project is the author’s current student placement at Oxfam where Indigenous health issues are focused. The author had an opportunity to learn about this particular issue deeply through the placement, and as a part of national campaign, she has been involved in the promotion process of the annual national event, called National Close the Gap Day, on 25th March 2010.

Also, due to her role at Oxfam, the author has access to resources to hold an event, as well as chances to networking with other stake holders to work collaboratively to promote the issue through attending various events happening in Brisbane.

Project activities include:
- Promoting the National Close the Gap Day event to key stake holders (e.g. schools, unions, MPs, and radio stations).
- Conduct 30 seconds radio media release with Triple J. Send e-mails to other radio stations in Qld as well as other States suggesting them to broadcast as well.
- Attend various relevant events (e.g. forums, QUT and UQ orientation weeks, ANTAR GM, UNIFEM Breakfast, and Green Earth Festival) to promote National Close the Gap Day event.
- Approach café that is located on the ground floor of Oxfam building, asking them if the event can be held on the day.
- Approach Lecturers and fellow students at University to see if they are interested in participating event on the day.
- Liaise with Oxfam UQ in order to hold an event at visible spot at the University on the day.
- Create a process of feedback with the advice from the National Office of Oxfam.
- (After the event day) Keep promoting about the issue and the possible collective actions people can take through the placement by attending to various events and as guest speakers.

This project has both elements of top-down and bottom-up approach. It is top-down in a way the resource together with some suggested ideas to hold an event is provided through an organisation called Oxfam. Also, this project holds an element of banking education as the event organizer normally has a limited time to share the knowledge about the issue to the audience.
However, it is also bottom-up approach in a way that whether to hold an event is totally up to the community members will. Moreover, the level of engagement for collective action depends on each participant’s choice.

Some of the ways community members can take as a collective action;
- Signing petition
- Signing Organisational Pledge
- Sending an Action Letter to Prime Minister
- Wearing campaign wristbands and tattoos and,
- Conducting a media release.

Suggesting ways of how people can contribute to make a change through various tools mentioned above will not only transfer the ownership of problem from ‘private’ to ‘public’, it will also to make some goals achievable when it is impossible or hard to do so through individual effort (Steinbeck 1939, p. 152). This concept is elaborated in several proverbs such as ‘A single stick is easy to break, a bundle much more difficult’.

Possible Risks and strategies for safeguarding them:
- Since the community members’ primary purpose for gathering is not my event, I need to make sure that the event is promoted in advance to attract the participation.
- In order to measure the level of engagement and its outcome, comprehensive feed-back process is needed to be created.

Project 2: Approaching Indigenous community members in Inala with community project aiming at improving their health.

This project aims to to encourage community members to become co-learners in a community education setting with the focus on improving their health in a sustainable way. On top of its focus on community education, this project is a collective action in a way people who share same goal (i.e. improved health) will gather and have dialogue in order to create a higher health infrastructure that is sustainable, beneficial, and community specific.

In other words, it is hoped that this project with its aim in creating a higher health infrastructure will be a way of building assets for Inala community (Green & Haines 2002, p.34).
The reason for choosing this particular suburb is due to its high density of Indigenous people, and also extra barriers they face to be healthy due to its low socioeconomic demography (ABS 2007). Also, the author has been working closely with some community members in this particular suburb through volunteer work, therefore has some pre-existing knowledge of some community members as well as the existing resources of the community.

Project activities include;
- Weekly (every Saturdays) bus tours to Rocklea Market.
- Followed by interactive cooking classes at Inala Community Centre where healthy, inexpensive, and easy meals will be demonstrated and shared. Participants are encouraged to share their healthy recipes at any time of these classes.
- A guest speaker will be invited each week to discuss about healthy life style after the cooking program.

Some of the suggested guest speakers include: local GP, fitness instructor, Indigenous health worker, and participating community members who would like to share their health tips.
The author and community members will work collaboratively to secure the funding for this project through funding submission to government as a part of National Strategic Framework for Aboriginal and Torres Strait Islander Health.

This project also involves both top-down and bottom-up approaches. It is top-down in a way, the author, as a community development worker approaches with an idea to Indigenous community members in Inala. Having a perspective in securing fund for this community project through funding submission is also top-down approach as it focuses on external resource instead of the community’s existing resources.
On the other hand, this project is also bottom-up as community members will intervene in making the program to be most beneficial, sustainable and Inala community specific. Moreover, if the project succeeds, it can be shared with other communities as a guide, and has a potential to be shared nationally.
Possible Risks and strategies for safeguarding them:

There is a possibility that some of the Indigenous community members in Inala had negative experiences with community project or a social worker in the past. This might lead them to be reluctant or even avoidant in trying new project.

In order to safeguard this risk, the author needs to make sure that she knows the cultural protocols, interest in the topic, and respect to the existing knowledge of the community members (Nguyen &Gardiner 2008, p.1020).

As an example strategy to respect their cultural protocols, the author will set the space at the Inala community centre in a way which encourages people relax by letting them sit in a circle of no more than 15 people when having dialogue with each other and with a guest speaker.

Although one of the main aims of the project is to empower the community, the word ‘empowerment’ might mean different in one culture from another depending on their contexts. In order to avoid the risk of forcing the author’s interpretation of ‘empowerment’, she needs to have an open-minded and welcome the ‘dialogical co-invention and interpretation of meaning’ with community members of Inala (Burkett 2001, p.9). One of the practical strategies to be open-minded is through holding the author’s practitioner analysis back or ‘on hold’ in order to encourage community members to lead their way (Westoby & Dowling 2009, p.75).

Some community members might feel they can not engage in the project as they have small children. In order to make the project as inclusive as possible, a children’s service officer will be hired on every Saturday when the fresh market is on, and since there will be no school, children are encouraged to come along with participants. I chose an officer over an assistant worker as I need her to instruct volunteers.
By welcoming children to come along with their parents, this project also hopes that exposing them to see healthier food, rather than fast food advertisement on TV will have positive influence on their food choices.

Conclusion
Through this report, the urgent needs for change in health inequalities experienced by Indigenous people in Australia were stressed. The history of several political leaders tried and committed to make progress with the issues were illustrated leading to the discussion of issues with current Governments’ approach in ‘Close the Gap’.

Lack of time frame, target goals, and bench marks were pointed out as some of the issues.
On top of these political issues, socio determents affecting Indigenous people’s health quality were discussed leading to main purpose of this project plan.

Based on the history and the analysis, the author emphasised the need of creating project plans that are holistic, sustainable, community specific, and aims to influence the government to produce comprehensive action plans with specific goals with timeframe.

This led to the two proposed plans, namely, ‘Engaging and promoting the concept of Close the Gap’, and ‘Creating community project to improve health of Indigenous people in Inala community’.
Both plans focus community members to engage in collective action and co-learning process to make a positive change in a society they live in.

Use of both project plans collaboratively is strongly recommended in order to maximise the effectiveness in Close the Gap in one generation time frame.





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