Health and wellbeing

Our shared commitment:

Self-determining, healthy and safe Aboriginal people and communities.

Enjoying good health and wellbeing is fundamental. While many Aboriginal Victorians report good health, there remain areas for improvement. Together, government, service providers and communities must take significant steps to ensure that all Aboriginal Victorians have access to high-quality, culturally-safe and responsive health care services.

Improving health outcomes and having a good quality of life will ensure all Victorian Aboriginal communities can thrive.

Goal 11: Aboriginal Victorians enjoy health and longevity

11.1 Improve Aboriginal health status, quality of life and life expectancy

Measures:

• 11.1.1 Life expectancy at birth, by sex
• 11.1.2 Proportion reporting ‘excellent or very good’ health status, by sex*
• 11.1.3 Rate of daily smoking, by sex*
• 11.1.4 Rate of hospitalisations for potentially preventable causes (vaccine preventable, acute, chronic and all)

Life expectancy is not the only way to measure health and wellbeing, but it is an important indicator of overall health and access to health services.

Life expectancy at birth was on average 77.9 years for Aboriginal women and 74.4 years for Aboriginal men who were born between 2011 and 2015. While there have been some fluctuations in life expectancy rates over time, it has generally been improving. Life expectancy at birth in 2011-15 is on average 2 years higher for Aboriginal women and men compared to estimates in 2006-10 and 2001-05 respectively. Despite gains, the latest estimate of the life expectancy gap (2011-15) between Aboriginal and non-Aboriginal Victorians remains approximately 7 years.

In 2014-15, 36.9 per cent of Aboriginal Victorians rated their own health as ‘excellent’ or ‘very good’, which is slightly down from 2004-05 (39.7 per cent). There also remains a significant disparity when compared to the reported health status of non-Aboriginal Victorians.

Providing culturally-safe and responsive health and wellbeing services is essential to ensuring Aboriginal Victorians feel empowered and comfortable to access preferred services.

Smoking is the leading cause of preventable death in Australia. While the proportion of Aboriginal Victorians who smoke daily is still high (39.8 per cent in 2014-15), there has been a longterm downward trend in daily smoking (down from 47.0 per cent in 2004-05). The declining prevalence of smoking among young people is an encouraging signal that trends are set to decline further. According to the 2017 Aboriginal and Torres Strait Islander Health Performance Framework, in 2014-15, 56.1 per cent of Aboriginal young people aged 15 to 24 in Australia had never smoked; up from 44.3 per cent in 2002.

Increasing access to primary health care is essential for supporting equitable health outcomes. Getting the right primary health care at the right time can prevent hospitalisations later on.

In the last 10 years, the rate for all categories of potentially preventable hospitalisations has increased for Aboriginal Victorians. Most notably the hospitalisation rate for chronic conditions has increased by almost 85 per cent.

Hospitalisation for a potentially preventable cause includes:

• Vaccines that could have prevented hospitalisation (like measles)
• Acute conditions (like an ear infection)
• Chronic conditions (like complications from diabetes)

For Aboriginal Victorians, barriers to accessing health services and preventative care can include the high cost of care, availability, insurance coverage and a lack of culturally-responsive care.

Achieving equitable health outcomes means having timely access to affordable health and culturally-safe services. Addressing barriers to accessing services and increasing accessibility to a range of culturally-appropriate services are essential to improved health outcomes for Aboriginal Victorians.

Prevention and Early Intervention Coordination across Aboriginal Community Controlled Health Organisations (ACCHOs)

The Victorian Government is supporting reform within the Aboriginal health sector to better coordinate early intervention and prevention services with Aboriginal Victorians. Working hand in hand with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), the Victorian Government has provided funding over 3 years to support the roll out of Prevention and Early Intervention Coordinator (PEIC) roles in ACCHOs.

PEICs are working with ACCHOs and their staff to enhance their capability to undertake and record Aboriginal specific health checks with client referrals to culturally-appropriate pathways for prevention programs and healthcare. These health checks act as an initial screening that provide pathways into evidence-based, culturally-safe prevention programs.

As part of this initiative, VACCHO is also developing a dedicated data dashboard enabling each organisation to monitor the number of Aboriginal Health Assessments to capture and extract data around smoking rates, cancer screening participation, sexual health checks and other prevention areas. The ACCHOs are the custodians of this data and it informs their responses to a range of prevention priorities. Access to data is at the discretion of the organisations involved in its capture.

^{*Gender disaggregation not available at time of reporting.}

Aboriginal Life!

The Aboriginal Life! Program is helping to prevent type 2 diabetes and cardiovascular disease by providing specialised culturally responsive services to Aboriginal Victorians. Funded by the Victorian Government and coordinated by Diabetes Victoria, the Aboriginal Life! Program is a culturally-appropriate lifestyle modification program that aims to reduce the incidence of type 2 diabetes and cardiovascular disease in Aboriginal Victorians.

Government is also working with VACCHO to identify a new approach to diabetes and cardiovascular prevention for Aboriginal Victorians, with the recommendation for a new community-led, strength-based model anticipated in 2020.

Measures:

• 11.1.6 Rate of emergency department presentations for alcohol or drug-related harm
• 11.1.7 Specialist alcohol and other drug treatment services provided to Aboriginal Victorians

Between 2008-09 and 2017-18, the rate of emergency department presentation for alcohol or drug-related harm increased for Aboriginal Victorians from 20.4 to 29.3 per 1,000 persons.

In 2017-18 the rate for Aboriginal Victorians was approximately 5 times the rate of non-Aboriginal Victorians.

The rate of emergency department presentations for alcohol or drug-related harm for young Aboriginal people also increased from 19.9 to 35.8 per 1,000 persons. However, as an individual may present to an emergency department multiple times for the same reason in a 12-month period, it is not possible to attribute the number of presentations to the number of Victorians who attended emergency departments with this data.

While it is possible that this increase reflects a better recording of Aboriginal status in hospital records, it also highlights the need for increased community-based drug and alcohol support services.

The data does show an increase in service provision of specialist alcohol and other drug treatment for Aboriginal Victorians. Between 2008-09 and 2016-17, the number of clients completing treatment per 1,000 persons increased from 64.7 to 89.0 per 1,000 persons.

Measuring access to specialist alcohol and other drug treatment services is an important indicator of access to support that may help prevent more serious or acute mental health issues.

Goal 12: Aboriginal Victorians access the services they need

12.1 Improve access to health and community services for all Aboriginal Victorians

Measures:

• 11.1.5 Incidence of selected cancers
• 12.1.1 Proportion who received a health check or assessment, by age
• 12.1.2 Participation rates for cancer screening
• 12.1.5 Number and proportion of people aged 55 years or over who had an annual health assessment

Between 2007-08 and 2017-18, the proportion of Aboriginal Victorians who received a health check or assessment increased for all age groups. Health checks can help a person understand their health needs and identify potential risk factors and care options.

The largest increase in participation at an annual health check was for those aged 55 and above (which increased from 7.5% in 2007-08 to 25.7 per cent in 2017-18).

Over the last 10 years, the proportion of Aboriginal Victorians aged 0-14 who had a health check increased from 1.5% to 16.9%.

Measuring annual health checks is an important indicator of access to preventative health care. For Aboriginal Victorians, this increase highlights widespread improvements that may support further improvements in health outcomes over time.

Increases in health checks for Aboriginal Victorians reflects the work of ACCHOs who continue to provide culturally-safe and appropriate health services to community.

Cancer does not discriminate against race, gender, social position or wealth. While broadly in Australia there has been a reduction in cancer mortality, this success is not shared by Aboriginal people. We must continue to ensure that cancer prevention, detection and management services are available, accessible and appropriate for Aboriginal Victorians.

Between 2012 and 2016, there were 942 cancer diagnoses for Aboriginal Victorians (an average of 188 diagnoses per year).

In the 5-year period 2012-16 inclusive, the incidence rate of cancer in Aboriginal Victorians was 57.7 and 49.9 per 10,000 for men and women, respectively, which is considerably higher than the incidence rate of cancer in non-Aboriginal men and women (34.7 and 28.6 per 10,000 respectively).

Compared to non-Aboriginal Victorians, the incidence rate of certain cancers were higher for Aboriginal Victorians:

• Lung cancer (2.7 times higher for men and 4.4 times higher for women)
• Liver cancer (3.2 times higher for men and 3.3 times higher for women)
• Head and neck cancer (1.7 times higher for men and 2.1 times higher for women)
• Cervical cancer (2.7 times higher for women)

For Aboriginal and non-Aboriginal Victorians, 4 cancer types were most common between 2012-16: lung, breast, bowel and prostate cancers.

Under exposure to screening and delayed detection is a significant driver of the survival gap between Aboriginal and non-Aboriginal Victorians in cancer treatment. Participation in cancer screening is vital for ensuring earlier detection and improved health outcomes.

Between 2010-11 and 2015-16, the proportion of Victorian Aboriginal women aged 50-69 participating in the BreastScreen Australia breast cancer screening program increased from 25.2% to 36.8%. Over the same period of time, the proportion of Victorian non-Aboriginal women remained relatively the same at 55.1% and 54.5%, respectively.

A range of other cancer screening programs exist (such as cervical, bowel and prostate screening), however available data was not of sufficient quality to report by Aboriginal status in Victoria.

The Aboriginal Women’s Breast Screening Shawl pilot project

The pilot is a strength-based and Aboriginal community-led initiative that responds to challenges in providing a culturally-safe service to Aboriginal women. With support from DHHS and Deakin University, VACCHO and the Victorian Aboriginal Health Service (VAHS) led the project in partnership with BreastScreen Victoria.

The project aims to improve Aboriginal women’s experience with breast screening. Key objectives included designing a shawl featuring local Aboriginal artwork, supporting Aboriginal women to screen together as a group and increasing the cultural competence of BreastScreen Victoria staff. The project has been successful in improving Aboriginal Women’s experience during a breast screen, and will be replicated by ACCOs across the state in 2019-20.

Improving Cancer Outcomes for Aboriginal Communities

The Improving Cancer Outcomes for Aboriginal Communities Working Group is a coalition of experts, bringing together diverse knowledge and perspectives. Established in partnership with VACCHO, the Working Group aims to drive action to reduce the incidence, mortality and morbidity associated with cancer that is disproportionately experienced by Aboriginal people in Victoria.

The Working Group has commissioned the Menzies School of Health Research to conduct a desktop review on the knowledge and evidence for priority issues in the cancer care system.

Measures:

• 12.1.3 Proportion and number accessing disability services and the National Disability Insurance Scheme
• 12.1.4 Number and proportion accessing aged care services
• 14.1.4 Proportion of Aboriginal Victorians with a disability who have strong social support networks

Aboriginal Victorians with a disability often face additional barriers to achieving health and wellbeing. The successful transition to the National Disability Insurance Scheme (NDIS) must be informed by and responsive to the needs of Aboriginal Victorians.

It is difficult to know how many Aboriginal Victorians require disability support services, due to limited data which accurately reflects the prevalence and spectrum of disability amongst Aboriginal peoples. According to the 2016 ABS Census, 3,897 Aboriginal people in Victoria ‘require assistance with core activities’.

At June 2019, the NDIS identified 3,403 Aboriginal Victorians as potential candidates for NDIS support. Of these, 45.5% (1,550 clients) had been assessed and successfully transitioned to an NDIS plan, representing 2.4% of Victorian NDIS participants with a plan. While the NDIS continues to roll-out, users of disability services continue receiving support under the National Disability Agreement.

Currently, there is no publicly available data to ascertain the proportion of Aboriginal Victorians with a disability who have strong social support networks. However, we anticipate that this will be included in next year’s Report.

The NDIS is driving significant change to interactions and relationships between disability services and clients. These changes add to the uncertainty and complexity of an already challenging service system for many Aboriginal people with a disability.

Ensuring disability services are accessible, responsive and safe for Aboriginal people with a disability and their families is integral to ensuring a high quality of life for Aboriginal Victorians with a disability.

Supporting Aboriginal Elders and older people to access health and community services promotes greater independence, cultural and social inclusion and quality of life.

The proportion of Aboriginal Victorians aged 50 and above accessing aged care services⁵ has increased between 2007-08 and 2017-18 from 4.5% to 7.6%.

Over the same period, the proportion of non-Aboriginal Victorians aged 65 and above accessing aged care services has remained relatively stable at 6.7% and 6.6%, respectively.

In addition to the mainstream aged care programs reported in Victoria, there were 124 placements under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program in 2017-18, which provides culturally-appropriate care for Aboriginal Victorians in locations close to their communities.

Maintaining health and wellbeing as people get older is important and can dramatically impact on a person’s ability to remain independent and to experience a full life.

^{5. Aged care services are provided to assessed Aboriginal Victorians aged 50 years and older, and provided to assessed non-Aboriginal Victorians aged 65 years and older.}

Descriptive Measures:

• 12.1.6 Services implement strategies, partnerships and campaigns, and offer care and support that is inclusive and addresses the needs of Aboriginal people who are LGBTI

Indigenous cultures worldwide have always had sex, sexuality and gender (SSG) diverse peoples living within their communities. Aboriginal and Torres Strait Islander SSG diverse peoples have a unique set of strengths and needs.

The Victorian Aboriginal community has a proud history of supporting Aboriginal SSG peoples with the first ever known Aboriginal out and proud network, OutBlack established in the early 1990s, providing safe spaces and community events for Victorian Aboriginal SSG people.

In 2018 around 60 participants attended Nanyubak Yapaneyeputj: Dreaming together retreat on Yorta Yorta Country in Shepparton to celebrate diversity and talk about what it means to be both Aboriginal and LGBTI.

The program included cultural activities, self-care, workshops, wellness and pampering sessions.

The objectives of the retreat were to:

• Strengthen resilience, engagement and inclusion for Aboriginal LGBTI community members
• Promote Aboriginal LGBTI networks
• Promote a sense of pride in being both Aboriginal and LGBTI

Participants identified a number of priorities for Aboriginal LGBTI health, wellbeing and safety into the future.

Designing for Diversity

The Victorian Government is committed to ensuring that service delivery is inclusive and affirming for all Victorians.

Designing for Diversity has been developed by DHHS as a framework for embedding responsiveness and inclusive practice for LGBTI communities, Aboriginal people, people from culturally and linguistically diverse and faith communities, refugees and asylum seekers, people with a disability, and people of all genders.

This framework is underpinned by the recognition that a person’s needs require an understanding of a broad range of personal and social characteristics, including religion, ethnicity, gender, sex, sexual orientation, age, culture, language and communication requirements or disability. It also involves acknowledging contextual differences such as socio-economic status, geographic location and visa status.

The initiative is an important strategy in fulfilling the Victorian Government’s commitment to person centred services and care, supporting local solutions and advancing quality, safety and innovation in health and human services.

Goal 13. Health and community services are culturally-safe and responsive

13.1 Increase the cultural safety and responsiveness of services

Measures:

• 13.1.1 Proportion reporting experiences of racism in the health system
• 13.1.2 Proportion reporting positive client experience of GP services
• 13.1.3 Hospitalisations where patients left against medical advice/were discharged at own risk
• 13.1.4 Number and proportion of Aboriginal people employed in the health or social services sector

The most recently available data from a 2010-11 study of 755 Aboriginal Victorians aged 18 and above found that almost 3 in 10 Aboriginal adults had experienced racism in health settings within the previous 12 months.

Culturally-safe and culturally-responsive health services are vital to ensure Aboriginal Victorians are getting the health care that they need - whether that be from an Aboriginal organisation or a mainstream service. One way of supporting a culturally-safe health service is for government to support a skilled Aboriginal workforce.

ACCHOs play an important role in service provision as they provide culturally-safe and appropriate services which has been shown to be an important factor for Aboriginal people when choosing to access and use services.

The number of Aboriginal Victorians employed in the health and social services sector has increased substantially, almost doubling between 2006 and 2016.

In 2016, 2,213 Aboriginal Victorians were employed in the sector. This represents 0.6% of all Victorians employed in the sector. Achieving population parity (0.8%) would require an additional 738 Aboriginal Victorians employed in the health or social services sector.

Leaving a hospital against medical advice provides indirect evidence of the extent to which health services are responsive to Aboriginal patient needs.

Discharge against medical advice may result in poorer health outcomes and increase the risk of hospital readmission.

In 2017-18, Aboriginal Victorians were discharged from hospitals against medical advice at a rate of 13 per 1,000 people, which is over 5 times the rate of non-Aboriginal Victorians. This demonstrates the importance of culturally-responsive care in Victoria’s health system.

Further work is required to better understand Aboriginal client experiences of racism across the health service system at different stages and in different parts of the system and how this impacts outcomes.

Feedback on patient experiences of health care services are important for shaping health services and policy.

The most recently available data for Victoria is drawn from the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey in which the majority of Aboriginal Victorians reported positive experiences with their GPs, including feeling heard and respected.

These factors enable Aboriginal Victorians to be active participants and give informed consent regarding their healthcare, and are likely to contribute to an increased feeling of cultural safety and improved health outcomes.

The Aboriginal and Torres Strait Islander Cultural Safety Framework

The Aboriginal and Torres Strait Islander Cultural Safety Framework reflects the government’s commitment to ensuring services for Aboriginal Victorians are free from racism and discrimination. It has been designed to create environments where Aboriginal service users and staff feel safe and there is no challenge to their identity.

The framework, launched in June 2019, was developed in partnership with Aboriginal communities and organisations and Aboriginal staff from the Department of Health and Human Services.

Goal 14: Aboriginal Victorians enjoy social and emotional wellbeing

14.1 Improve Aboriginal mental health and social and emotional wellbeing

Measures:

• 14.1.1 Proportion reporting ‘high or very high’ levels of psychological and psychosocial distress
• 14.1.2 Rate of self-harm related emergency department presentations (by 15-24 years old, and all)
• 14.1.3 Proportion reporting strong social networks they can draw on in times of crisis
• 14.1.5 Number of Aboriginal Victorians receiving clinical mental health services

Mental illness accounts for one of the largest and fastest growing categories of disease in Victoria. Mental ill-health can have devastating effects on individuals, families and communities, with 1 in every 2 people experiencing a mental illness in their lifetime.

In 2014-15, 35.8% of Aboriginal Victorians aged 15 and above reported ‘high’ or ‘very high’ levels of psychological distress, an increase of 4.3 percentage points since 2011-13.

At the same time, there has been a worrying increase in the rate of self-harm related presentations to emergency departments for Aboriginal people.

Aboriginal Victorians presented at hospital emergency departments for self-harm at 4.7 times the rate of non-Aboriginal Victorians and rates are increasing, particularly among young people.

Many Aboriginal Victorians have strong social support they can draw on in times of crisis, with over 90% reporting they were able to get help from someone outside their household if they needed it. Strong social support and connections with family and friends are important to maintaining mental health.

However, sometimes clinical support is needed. In 2016-17, Aboriginal Victorians accessed mental health care services at approximately 3.7 times the rate of non-Aboriginal patients.

This highlights the importance of providing appropriate services to support improved mental health indicators under an Aboriginal-led understanding of social, cultural and emotional wellbeing.

The impact of the Aboriginal Liaison Officer in the Coroner’s Court

Disproportionate rates of Aboriginal suicide are widely known and documented, including that the suicide rate for Aboriginal people is double the national average. However, to date, Victorian data has been unreliable.

In response, the recently created Aboriginal Liaison Officer role in Victoria’s Coroner’s Court system is leading reforms to achieve accurate Aboriginal suicide data. This is possible through better identification of Aboriginality status and providing culturally-sensitive support to Aboriginal families who have experienced the tragic loss of a family member.

VACCHO will be collaborating with the Coroner’s Court to meet the pressing need for data and evidence as a first step to take action to reduce the high number of suicide deaths in Aboriginal communities across Victoria.

Improving Mental Health Outcomes for Aboriginal Victorians

Four mental health projects are delivering integrated, culturally-safe mental health services for Aboriginal Victorians across 3 focus areas: adult mental health, child protection and corrections. Delivered by an Aboriginal Community Controlled Organisation in partnership with a local public health service, the 4 projects include:

• Ballarat and District Aboriginal Co-operative (BADAC), in partnership with Ballarat Health, is supporting parents who have mental illness with children in, or at risk of entering, the child protection system.
• Mallee District Aboriginal Service (MDAS), in partnership with Mildura Base Hospital and Mallee Family Care, is supporting clients in the justice system.
• Wathaurong Aboriginal Co-operative (Wathaurong), in partnership with Barwon Health, is supporting Aboriginal adults with moderate to severe mental illness who are experiencing social disadvantage.
• Victorian Aboriginal Health Service (VAHS), in partnership with St Vincent Health, Austin Health, and Northern Area Mental Health Service, is supporting Aboriginal adults with moderate to severe mental illness.

To improve access to culturally-responsive services, the Victorian Government allocated $20.2 million in 2016/17 over 3 years for 4 consortia demonstration projects to test new service models for Aboriginal Victorians with moderate to severe mental illness, trauma and other complex health needs. All 4 project sites are reporting positive client outcomes due to strengthened partnership between services, improved coordination of care and a steady increase in client referrals into the service.

Action the Victorian Government is taking

The Victorian Government, in partnership with Aboriginal communities, community organisations and mainstream service providers, is driving action to improve the health and safety of Aboriginal Victorians through Korin Korin Balit-Djak: Aboriginal health, wellbeing and safety strategic plan 2017-2027.

The strategic plan adopts an approach based on cultural and social determinants of health and is guided by the principle of self-determination.

Under the plan, government and partners are progressing several actions to empower communities to deliver culturally-safe health services that meet the needs of Aboriginal Victorians. Significantly, the Victorian Government is transitioning most Aboriginal specific funding from the Department of Health and Human Services (DHHS) to Aboriginal organisations, and supporting these organisations with funding for corporate infrastructure improvements.

Korin Korin Balit-Djak also focuses on improving Aboriginal Victorians’ health and longevity, including through:

• the Optimal Cancer Care Pathway for Aboriginal and Torres Strait Islander People and cultural competency training in cancer services
• funding for disability advocacy initiatives being delivered in partnership between disability advocacy organisations and ACCOs
• initiatives to improve nutrition including the ‘Aboriginal Rethink Sugary Drinks’ campaign and accredited training in early years nutrition for Aboriginal health workers increasing sport and recreation opportunities for Aboriginal children and young people in out-of-home care, including Aboriginal sporting carnivals
• 34 additional alcohol and other drugs workers

Other actions include the Cultural Safety Framework to create culturally-safe environments across the mainstream health sector and the Aboriginal Health and Human Services Workforce Strategic Action Plan to support and increase the Aboriginal health workforce.

The Victorian Government acknowledges that the best health and wellbeing outcomes are achieved when Aboriginal communities lead the development, delivery and evaluation of the policies and services that affect them. DHHS is embedding Aboriginal leadership and decision making at all levels, to strengthen accountability and transparency to Aboriginal communities, and capture the diversity of Aboriginal voices.

Improving the social and emotional wellbeing of Aboriginal Victorians is a key commitment of the Victorian Government, being driven by Balit Murrup: Aboriginal social and emotional wellbeing framework 2017-2027. The framework provides a self-determination and culturally based approach to improving mental health outcomes for Aboriginal Victorians, aligning with a holistic and interconnected Aboriginal view of health which embraces social, emotional, physical, cultural and spiritual dimensions of wellbeing. Current action underway includes:

• funding Aboriginal clinical and therapeutic mental health positions in 10 ACCOs
• supporting 10 Aboriginal mental health trainee positions
• funding for 4 mental health demonstration projects between an ACCO and a local public health service to deliver integrated, culturally-safe mental health and wellbeing services

The Royal Commission into Victoria’s Mental Health System currently underway will provide recommendations about other action government can take to realise the shared vision of self-determining, healthy and safe Aboriginal people and communities.