Policy

pattern

Health, housing and disability

There's a lot of evidence that self-determination delivers results for Aboriginal people; that it is actually the best way to improve outcomes for Aboriginal people.

- Darren Smith, CEO Aboriginal Housing Victoria

 

The health of Aboriginal Victorians is improving across a broad range of infant and child development indicators. However, improvements in Aboriginal health have not been demonstrated elsewhere. Statistics show that disparities in health, housing and disability endure, indicating a re-focusing of efforts is required to close the gap.

In partnership with the Aboriginal community, Victoria is working towards positive health outcomes for Aboriginal Victorians through the 10-year Aboriginal health, wellbeing and safety strategic plan, Korin Korin Balit-Djak (‘growing very strong’), released in October 2017.

Korin Korin Balit-Djak is informed by an extensive consultation process with Aboriginal communities across Victoria and a strong evidence base. The plan contains a clear commitment to support Aboriginal self-determination to improve health, wellbeing and safety for all Aboriginal Victorians, and to provide culturally safe and responsive health and human services.

Headline Indicator 8. Improve the health status of Aboriginal Victorians

Target: Close the gap in the proportion of Aboriginal and non-Aboriginal Victorians that report their health status as ‘excellent’ or ‘very good’ by 2031.

The proportion of Aboriginal Victorians who rated their health as ‘excellent’ or ‘very good’ is declining. In 2007­­–08, about half of all Victorian Aboriginal adults reported excellent or very good health, compared to 40.2% in 2014­–15.

Overall, fewer Victorians rated their health as ‘excellent’ or ‘very good’ in 2014­–15 compared to 2007–­08; however, the percentage point decline was larger for Aboriginal Victorians. In 2007–­08, about half of all Aboriginal Victorians reported ‘excellent’ or ‘very good’ health (47%) compared to 40.2%, in 2014­­­­­–15; a decline of ~7 percentage points in self-rated health status and a widening of the gap of ~4 percentage points between Aboriginal Victorians and the general population.

Target: Close the gap between Aboriginal and non-Aboriginal adults reporting ‘high’ or ‘very high’ levels of psychological distress by 2031.

Aboriginal Victorians experience psychological distress at twice the rate of non-Aboriginal Victorians.

High or very high levels of psychological distress are a significant risk factor for depression and anxiety. Aboriginal Victorians experience psychological distress at twice the rate of the general Victorian population. Psychological distress puts individuals at greater risk of chronic disease, as well as self-harm and suicide.

Psychological distress reported as 'high' or 'very high'

Balit Marrup: the Aboriginal Social and Emotional Wellbeing Framework (SEWB) is one of the top three priorities in Victoria's 10-year mental health plan. It recognises the fundamental role of culture, community and spirituality in Aboriginal wellbeing and has been developed in partnership with Aboriginal organisations, Elders, leaders and communities to support Victorian Aboriginal communities in the areas of promotion, prevention, recovery and healing from trauma and mental illness.

 

Other measure: The rate of self-harm among Aboriginal people.

In 2015–16, Aboriginal Victorians presented with self-harm related injuries at more than 4 times the rate of non-Aboriginal Victorians.

Emergency presentations for self-harm have fluctuated since 2007–08 from around 4 per 1,000, to as high as 6 per 1,000 in 2014–15. In 2015–16, 5.3 per 1,000 Aboriginal Victorians presented to emergency departments with self-harm related injuries; almost four times the rate of non-Aboriginal Victorians.

Self-harm related emergency department presentations; rate per 1,000

#HerTribe, a 16-week community-designed empowerment program for Aboriginal women, was developed by the Victorian Aboriginal Health Service (VAHS) and the University of Melbourne. The program demonstrated positive outcomes including reduced psychological distress, increased resilience, stronger personal connections, and increased cardiovascular fitness. #HisTribe, a modified version for Aboriginal men, will be developed and piloted.

The Jekkora Spear Group, developed and delivered by Njernda Aboriginal Corporation, is a response to a growing rate of suicide in the Echuca Aboriginal community. The program trains community members to identify and support people at risk of suicide. Independent evaluation described the program as a ‘unique and promising suicide prevention model’.

 

Target: Reduce the proportion of Aboriginal adults who are current smokers to 21% by 2023.

Rates of smoking have declined slightly but remain very high at just under 3 times the rate of the general population.

In 2014–15, almost 40% of Aboriginal Victorians smoked. While this represents a decline in rates of smoking (down from 48% in 2007–08), rates of smoking are still very high at just under 3 times the rate of the general population. Data from VAHS shows Aboriginal men aged 35–44 represent the highest prevalence group of smokers, at 71%.

Smoking rates for Aboriginal people aged 15 years and older

Tackling Tobacco, delivered by VAHS, is aimed at cutting the rates of smoking in the Aboriginal community. The program runs health promotion and smoking cessation education initiatives and supports referrals to Aboriginal Quitline counsellors.

 

Other measure: The rate of harmful alcohol consumption among Aboriginal Victorians.

Aboriginal Victorians presented at emergency departments for alcohol-related causes at more than three and a half times the rate of non-Aboriginal Victorians.

Alcohol abuse is associated with health conditions like liver disease, diabetes, cardiovascular disease and some cancers. It is also related to a higher incidence of accidents and injury, as well as a significant factor in mental and substance use disorders and injury.

In 2015–16, Aboriginal Victorians presented at emergency departments for alcohol-related causes at more than 3.5 times the rate of non-Aboriginal Victorians. While the rate of alcohol-related injuries varies from year to year, fluctuations may indicate a downward trend in the rate of presentations in recent years.

Alcohol-related emergency department presentations; rate per 1,000

Other measure: The proportion of Aboriginal adults who are obese.

A slightly higher proportion of Aboriginal Victorians are obese. Rates of obesity are increasing across Victoria.

After smoking, being overweight or obese is the most significant health factor contributing to the gap in life expectancy of Aboriginal people. While the increasing rate of obesity and being overweight is an issue impacting the health of all Victorians (66% of all Victorians and 64% of Aboriginal Victorians are either overweight or obese), a slightly higher proportion of Aboriginal Victorians are obese (34% versus 26%).

The Nutrition team at the Victorian Aboriginal Community Controlled Health Organisation Incorporated leads strategic programs and campaigns to encourage a healthy eating culture in health services, children's settings, workplaces and events across Aboriginal Victorian communities. The team provides accredited nutrition training, support and mentorship opportunities to Aboriginal health workers, Aboriginal children’s services staff and population health recruits located in Aboriginal Controlled Community Health Organisations, local councils and other settings. In 2016, the team also collaborated with Diabetes Australia to implement The Road to Good Health, the Aboriginal component to Diabetes Australia’s Life! Program. These initiatives, along with others such as the Aboriginal Rethink Sugary Drinks advertisement, Sports Drinks are Gammin! social media campaign, the Caring for The Community with a 5 star BBQ, and Yarning About Breastfeeding, have significantly increased the capacity of the Aboriginal workforce and mainstream health organisations to address Aboriginal nutrition and health.

 

Other measure: The proportion of Aboriginal people with a disability receiving disability services.

In 2015–16, Aboriginal Victorians represented almost 2% of Victorians receiving disability services.

The number and proportion of Aboriginal people receiving disability services in Victoria declined between 2007–08 and 2011–12 to just under 2% in 2015–16.

Absolutely everyone: state disability plan 2017-2020, includes a commitment to Aboriginal self-determination and the importance of ensuring that Aboriginal people have access to robust, culturally safe disability services and supports through both the mainstream disability sector and Aboriginal organisations.

Balit Narrum is an Aboriginal disability network that supports Aboriginal family and individual needs within the disability service system including helping clients navigate the National Disability Insurance Scheme. Balit Narrum also offers Yarning Circles, which provide an opportunity for community members to learn more about what a disability is, what services are available and to better understand community needs.

 

Other measure: The proportion of Aboriginal Victorians who are homeless.

Now, having a home, I have started to work toward and repair the disconnection my mental illness caused with my children.

- Wadamba Wilam client

The housing needs of Aboriginal people aren't just about providing a safety net for the Aboriginal community. It should be a part of how the Aboriginal community can actually move forward and improve their circumstances.

- Darren Smith, CEO Aboriginal Housing Victoria

Victoria has one of the highest proportions (37%) of Aboriginal people who have experienced homelessness. During 2015–16, almost 9% of all clients accessing specialist homelessness services in Victoria were Aboriginal.

In Victoria, it is estimated that between 11,000 and 16,000 Aboriginal people reside in social housing at any one time, equating to around 20% of the Victorian Aboriginal population. For many vulnerable Aboriginal households, access to affordable, secure social housing is often the first step to improved life experience, rather than simply a solution to their housing crisis. Without culturally appropriate coordinated housing and support services, these households struggle to maintain their tenancies and are at serious risk of further episodes of housing insecurity and homelessness.

 

Ownership of the social housing properties … has been a long-held aspiration of AHV. In fact, the original community members and Elders who formed the Aboriginal Housing Board of Victoria (the forerunner to AHV) in 1981 strongly advocated for greater self-determination and the restoration of dignity and respect for Aboriginal people in the delivery of housing services. Several decades on, these aspirations have been realised.

- Aboriginal Housing Victoria

It wasn't very secure, you didn't know when you had to move out. So we were, you know, kind of on edge all the time there. … But then when this place came up it was like a sigh of relief. We're happy here.

- Aboriginal Housing Victoria tenant

The 2016 decision to transfer housing assets to Aboriginal Housing Victoria (AHV), valued at almost $500 million, represents one of the most significant acts of self-determination in Victoria’s history. Aboriginal-owned and controlled housing are key examples of community-led and community-controlled responses.

In all, over 1,440 properties formerly managed by AHV on behalf of the Director of Housing will be transferred to AHV. The transfer of title to AHV is the largest to any single housing agency in Victorian history and makes AHV the largest Aboriginal community housing owner in Australia.

The move is part of a larger remit to ensure homes are owned and managed by an Aboriginal organisation for the benefit of Aboriginal people, in turn enabling AHV to grow its social housing stock and provide even more affordable homes and related services. The first transfer of 511 public housing properties was delivered in 2016. Tranche 2, delivered on 1 July 2017, saw the transfer of 470 properties, and Tranche 3, the final transfer of more than 460 properties, is scheduled for delivery in 2018–19.

 

Policy directions

There has been limited progress in improving and addressing the health, wellbeing and safety outcomes of Aboriginal Victorians. Continuing to approach Aboriginal health, wellbeing and safety in this way maintains a system that is not responsive to the needs and aspirations of Aboriginal communities.

For Aboriginal Victorians and Aboriginal people across Australia, the social determinants of health inequality have their genesis in colonisation, which continues to impact Aboriginal people today. In addition, structural inequalities in income, employment and housing continue to impact the health and wellbeing of Aboriginal Victorians. What is not measured is the impact and importance of culture as a determinant of Aboriginal health. The importance of connection to culture demonstrates the need for Aboriginal community-led responses to support the health and wellbeing of Aboriginal Victorians.

Korin Korin Balit-Djak provides an overarching framework for action to improve the health, wellbeing and safety of Aboriginal Victorians now and over the next 10 years. It sets out the Victorian Government’s vision and direction for ensuring positive outcomes for Aboriginal Victorians.

Korin Korin Balit-Djak embraces a cultural determinants approach to Aboriginal health, wellbeing and safety, which aligns with the Aboriginal community’s holistic understanding of health. It has been developed alongside 2 other key initiatives to support the improved health, wellbeing and safety of Aboriginal Victorians: Balit Murrup: the Aboriginal social and emotional wellbeing framework; and the Aboriginal governance and accountability framework.