Academic journal article Health Sociology Review

Addressing the Gap in Indigenous Health: Government Intervention or Community Governance? A Qualitative Review

Academic journal article Health Sociology Review

Addressing the Gap in Indigenous Health: Government Intervention or Community Governance? A Qualitative Review

Article excerpt

INTRODUCTION

In 2007, the Australian Government Liberal National Coalition implemented the Northern Territory Emergency Response (NTER), the Intervention, to protect Aboriginal children in the Northern Territory (NT) from sexual abuse. The Intervention continues at the time of publication (March 2010) under the National Labor Government. Although a signifi cant departure from past attempts to address Indigenous1 disadvantage, the Intervention has received support from prominent Aboriginal community leaders (Calma 2005; Dodson 2007). Its timing just prior to an election, brought unprecedented visibility to the health and social problems of remote Aboriginal communities that, while judged in some quarters as ideologically driven, is viewed in others as an opportunity for change (Langton 2008). Even though Intervention measures have not found universal favour because of their perceived imposed nature, the radical response to fi ndings of widespread child abuse in Aboriginal communities has triggered agreement on the need for dramatic action. Both Indigenous and non-Indigenous people are motivated to shape it into a more sustainable long-term strategy.

We contribute to this debate by reviewing and assessing literature relating to health service delivery and governance in remote Indigenous communities as it relates to sustaining health gains beyond the immediate Intervention period. We form the view that only with a longer-term and locally-based strategy of building intercultural capabilities between Indigenous and non- Indigenous people to effectively deliver and govern health services in remote environments, can the effort of the Intervention be sustained. We base our view on emerging models of community governance and the opportunities they present to improve health services for remote Indigenous communities. We discuss the potential to tailor systems of governance and service delivery as culturally relevant vehicles for reducing the health status gap in Aboriginal communities.

BACKGROUND

In their report Ampe Akelyernemane Meke Mekarle (Little Children are Sacred), Wild and Anderson cite evidence that 'sexual abuse of Aboriginal children is common, widespread and grossly under reported' (Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse 2007:16). What is striking is the discrepancy between the number of sexual abuse notifi cations made and those investigated and resolved, highlighting the diffi culty of government agencies to protect Indigenous children at risk. Also striking is the extent of the discrepancy between the risks for Indigenous and non- Indigenous children: child abuse and neglect are 4-6 times greater for Indigenous children (Steering Committee for the Review of Government Service Provision 2009) and rising 45% from 2002/2003 to 2006/2007 (Langton 2008), while care and protection are 7 times greater and out of home care 8 times greater for Indigenous children (Australian Government 2008a).

The Intervention

Wild and Anderson urged that 'every reasonable (and perhaps some unreasonable) means should be found to combat sexual abuse' (2007:13). The Australian Government responded by implementing measures to protect Aboriginal children in the NT where it has jurisdictional control. Together, the measures represent a comprehensive amalgam of welfare, employment, law and order, education, family support, child and family health (including child health checks), housing, land and coordination activities (Australian Government 2007). A taskforce implemented the health measures in 73 prescribed communities of 100 or more people (Northern Territory Emergency Response Taskforce 2008) using military and volunteer medical personnel.

The response

The response has been mixed. On the positive side, some see it as an opportunity to restore Indigenous health and help Australian society to come to terms with health disparities (Boffa et al 2007; Glasson 2007), and as a chance to negotiate a more sustainable, culturally relevant strategy with fi nancial commitment (Combined Aboriginal Organisations of the Northern Territory 2007). …

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