Academic journal article Australian Aboriginal Studies

Australian Federalism and Aboriginal Health

Academic journal article Australian Aboriginal Studies

Australian Federalism and Aboriginal Health

Article excerpt

Abstract: In this paper we explore the changing relationship between Aboriginal peoples and the Australian state within the context of Australian federalism. Our particular focus is on the relationship between the institutional organisation of Australian health systems and the equitable provision of health services to Aboriginal Australians. We examine the historical development of this relationship over three key periods. The period from Australian federation in 1901 to the 1967 referendum resulted in the deletion of race clauses from the Australian constitution. The Commonwealth's racialised constitutional and legislative framework created a structural basis for racial rationing. Incrementally, from 1967 to 1995, the Commonwealth developed a national Aboriginal health program but without a corresponding development of institutional links with national health financing and policy structures. Since 1995 there has been some success in the development of intergovernmental agreements in Aboriginal health (the Framework Agreements for Aboriginal and Torres Strait Islander Health) and a National Strategic Framework for Aboriginal and Torres Strait Islander Health which is linked to the Aboriginal and Torres Strait Islander health performance measurement framework. We argue that these developments provide a platform for the equitable provision of health services to Aboriginal Australians and we identify some of the key barriers to the realisation of this.

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It is a reasonable premise for health policy that access to health care services should be proportionate to health need. For Aboriginal Australians, (1) health care access is shaped by various factors, including the values, preferences and experiences of those using Aboriginal health services. There are local service factors such as location of services, their cost, and responses of health staff to clients, that is, their capacity or willingness to engage with Aboriginal cultures, languages and prior health experiences. There are institutional factors, including financing, administration and organisation of service delivery. Here we focus on the relationship between the institutional organisation of the Australian health system and the equitable provision of health services based on need.

In Australia, responsibility for financing, administration and delivery of health services is shared between different levels of government, and between the government and private sector. The main role of the Commonwealth government in health is that of financier, while state and territory jurisdictions are responsible for the administration of health programs, regulatory activities and the delivery of health services. There are significant exceptions to this. The Commonwealth administers an aged care program and an Aboriginal primary health care program, providing funding for approximately 140 Aboriginal community-controlled health services across the country (AGDHA & NACCHO 2006). These institutional arrangements evolved over the history of federation, and the Commonwealth-dominant position in financing health care did not become established until the 1970s (Butler 1991). It is estimated that government provided 92.7% of funding for Aboriginal health care expenditure in 2001-02 (AIHW 2005:5). In order to examine critically the link between allocation of health resources and delivery of needs-based services, we need to investigate the role of institutional structures associated with health federalism.

Australia has been characterised as a settler-colonial state in which the relation between the state and Indigenous peoples is based on dispossession of Indigenous peoples from their natural and cultural resources, and management of colonised peoples through settler administrative systems that articulate Indigenous peoples with the institutional structures of the settler-colonial state. This system of management has created a differentiated citizenship for the Indigenous 'Other', protecting the settler citizenry from the ongoing historical claims of Indigenous peoples, while acting to protect Indigenous peoples from the excesses of colonialism (Morris-Suzuki 1994). …

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