Indigenous response to health equity

Social inequality health expert Sir Michael Marmot has seen some of the benefits of ‘Aboriginal health in Aboriginal hands’ during a visit to Central Australia this month.

The Director of the University College London Institute of Health Equity joined members of Flinders University’s Southgate Institute for Health, Society and Equity in Alice Springs for meetings with leaders of the Central Australian Aboriginal Congress.

He also visited a remote community clinic 200km from Alice Springs and gave a lecture at the Centre for Remote Health hosted by Flinders Northern Territory on Friday 4 May. (Watch the ‘Health Equity: Taking Action’ seminar video).

Professor Jonathan Craig, the Vice-President and Executive Dean of the College of Medicine and Public Health, joined Centre for Remote Health director Professor Tim Carey and senior lecturer in Indigenous Health Ms Kathleen Martin at the Alice Springs seminar.

Described as “the founder of social epidemiology,” Professor Sir Michael Marmot has worked extensively with the Southgate Institute since its foundation 10 year ago and expanding his influence in adopting change in healthcare services.

“Why treat people then send them back to the conditions that made them sick?” Professor Marmot says.

“It’s taken a long time for this (the social determinants of health) to take off.

“Consistent, running all the way through what I do, is that fact that inequalities in health are not confined only to poor health for the poor and good health for everybody else.”

However, life expectancy trends of the bottom 30 per cent of the poorest people is declining in one of the richest countries, the USA. And he describes the life expectancy and infant mortality of Australian Indigenous people as “shameful … with a lot to do with socio-economic issues, but not all of it”.

“It has to be, in principal, entirely preventable,” he says.

Professor Marmot is acknowledged as leading a “paradigm shift” in connecting the social and economic opportunities and equality with health outcomes.

Professor Tim Carey and Ms Kath Martin, from the Centre for Remote Health, left, Flinders NT director Professor John Wakerman and Professor Jonathan Craig from the College of Medicine and Public Health, with Professor Sir Michael Marmot, and Professor Fran Baum and senior researcher Dr Toby Freeman from the Southgate Institute (right).

Still chairing the Southgate Institute’s international advisory board, he first worked with Southgate director Flinders Professor Fran Baum on the Commission on Social Determinants of Health, set up by the World Health Organisation in 2005.

The commission’s first report entitled Closing the Gap in a Generation published in 2008 is regularly monitored for improvements.

Key policy objectives of the 2008 report were to:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure healthy standards of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health prevention.

In Australia, where gaps in Indigenous health services are also regularly reviewed, with the Southgate Institute now leading new Australian Government research focusing on how Aboriginal and Torres Strait Islander primary health care services respond to social and economic inequalities caused by ongoing colonisation.

The project, in collaboration with the Central Australian Aboriginal Congress and four other Aboriginal and Torres Strait Islander primary health care services, involves Southgate researchers Professor Baum, Dr Toby Freeman, Dr Tamara Mackean and Associate Professor Anna Ziersch, and fellow researchers from Flinders University (Professor Judith Dwyer), Queensland Health and University of Queensland (Associate Professor Deb Askew), the University of Sydney (Professor Juanita Sherwood), Professor Annette Browne from the University of British Columbia, and Professor Michael Kidd, from the University of Toronto, Canada.

The partners of the $1.45 million National Health and Medical Research Council project will meet in Adelaide in July to expand planning for the five-year project. The Southgate Institute at Flinders University was also awarded another NHMRC grant last year to work with Aboriginal and Torres Strait Islander health workers and liaison officers in quality acute care services.

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