Health and Wellbeing

Our shared commitment

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

Holistic approaches to Aboriginal health and wellbeing are critical to improving outcomes. This includes not only considering the physical, mental and social determinants of Aboriginal health, wellbeing and safety, but also the cultural determinants, such as connection to culture and Country. While many Aboriginal Victorians report good health, health inequities remain.

Together, government service providers, Aboriginal organisations 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 overall health outcomes and having a good quality of life is a basic necessity to ensure all Victorian Aboriginal communities can thrive.

Closing the Gap - How Victoria is tracking nationally

Outcome 1: Nationally, Aboriginal and Torres Strait Islander males born in 2020-22 are expected to live to 71.9 years and females to 75.6 years, and non-Indigenous males and females to 80.2 years and 83.4 years respectively. Nationally, based on progress from the baseline, the target shows improvement but is not on track to be met for males or females. Aboriginal and Torres Strait Islander estimates of life expectancy are currently not produced for Victoria due to poor data collection processes and under-reporting of Aboriginal deaths.

Measure 11.1.1 Expectation of life at birth, by sex

Life expectancy estimates are important measures of population health. Aboriginal and Torres Strait Islander life expectancy estimates include deaths from all states and territories. It is not currently possible to construct separate reliable life expectancy estimates for Victoria, South Australia, Tasmania, the Australian Capital Territory. This is due to several factors including the small number of Aboriginal and Torres Strait Islander deaths. There is also an under-reporting of Aboriginal deaths in Victoria due to incomplete or inaccurate Aboriginal identification. The Department of Health is working with the Registry of Births, Deaths and Marriages and the Coroners Court to identify opportunities to improve Aboriginal identification. This will support a joint action plan to ensure the availability of robust Aboriginal life expectancy estimates for Victoria.

Measure 11.1.2 Proportion reporting ‘excellent or very good’ health status, by sex

In 2022, Aboriginal Victorians were less likely to report excellent or very good health than in 2020 and 2019. Age standardised results for self-assessed health status from the Victorian Population Health Survey (VPHS) have declined to 27.6 per cent of respondents, down from 29.7 per cent in 2020 and 32.2 per cent in 2019. Survey results for non-Aboriginal Victorians improved over this period. 43.5 per cent of non-Aboriginal respondents said their health is either excellent or very good. A 2.9 percentage point increase from 2020 and a 1.7 percentage point increase since 2017. Historic results for Aboriginal Victorians for this question have not had a consistent trend. This means that some results may be attributed to variation in response.

Continued effort is required to increase survey response rates and make sure Victorian Aboriginal voices are heard in a culturally appropriate way within health reporting. The 2021 VPHS was not conducted in 2021 due to the COVID-19 pandemic.

Measure 11.1.3 Rate of daily smoking

Smoking is the leading cause of lung cancer and contributes to poor health outcomes. The proportion of daily tobacco smokers increased among Aboriginal Victorians aged 18 and above between 2020 and 2022, from 22 per cent to 24.7 per cent. This was the first and only recorded rise in daily smoking over the six-year period from 2017 to 2022 and may signal a change in the longer-term trend. As asked, the daily smoking question in the Victorian Population Health Survey does not explicitly include the use of e-cigarettes or vapes. As such current data does not include non-tobacco smoking. Continued effort is required to increase survey response rates in the future, to ascertain whether this rise in daily smoking is part of a longer-term trend.

The 2021 VPHS was not conducted in 2021 due to the COVID-19 pandemic.

Measure 11.1.4 Rate of hospitalisations for potentially preventable causes (vaccine preventable, acute, chronic and all)

In 2021-22, the rate of hospitalisations for potentially preventable causes remained steady for Aboriginal Victorians at 55 per 1,000 people. This follows a significant decline in the year earlier. The rate in 2021-22 is much higher Aboriginal people than that for non-Aboriginal Victorians (21.7 per 1,000 people). Aboriginal Victorians are still not receiving fair access to preventative health care. For example, access to vaccinations and acute and chronic illness identification and management.

Chronic illness accounts for more than half of all potentially preventable hospital visits. The rate of potentially preventable hospitalisations for Aboriginal Victorians with chronic illness declined between 2019-20 and 2021-22. From 36.6 to 29.5 hospitalisations per 1,000 people. The rate for non-Aboriginal Victorians is 10.8 hospitalisations per 1,000 people. Earlier support, intervention, and culturally appropriate care for Aboriginal Victorians are key to making a fairer health system.

Measure 11.1.6 Rate of emergency department presentations for alcohol or drug-related harm

In 2022-23 1,796 Aboriginal Victorian presented to emergency departments for alcohol or other drug related harm. This is an increase of 207 people since 2021-22. This is a rate of 26.5 people per 1,000 presenting at emergency departments.

Aboriginal Victorians aged 15-24 emergency department for the same cause reached 30.4per 1,000 presentations in 2022-23. This represents the highest this has been since 2018-19, a year in which included drug and alcohol related self-harm in official statistics. The rate of presentations increased significantly in 2020-21 and has maintained a high rate since.

Non-Aboriginal Victorians presentations to emergency departments has remained significantly low in comparison. The rate for non-Aboriginal Victorians of all ages and aged 15-24 was 3.9 and 7.3 per 1000 presentations respectively in 2022-23. This means that Aboriginal Victorians are 6.8 times more likely to need emergency healthcare from alcohol and other drug related harm for all ages. Aboriginal Victorians aged 15-24 are 4.2 times more likely.

In Victoria, Aboriginal and Torres Strait Islander people experience fatal overdoses at a rate more than three times higher than non-Aboriginal people^[1].

[1] ‘Coroners Aboriginal Engagement Unit and Coroners Prevention Unit (2023). Fatal overdose among Aboriginal and Torres Strait Islander people, Victoria, 2018-2021.’

Measure 11.1.7 Specialist alcohol and other drug treatment services provided to Aboriginal Victorians

In 2021-22 there were 9,902 closed episodes for alcohol and other drug treatment services. This is an increase of 968 since 2020-21. In 2021-22 Aboriginal Victorians were 13.5 times more likely to need alcohol and other drug treatment services than non-Aboriginal Victorians. Ten years ago (2012-13) this was only 8.3 times. A treatment episode is considered closed where any of the following occurs: treatment is completed or has ceased; there has been no contact between the client and treatment provider for 3 months; or there is a change in the main treatment type, principal drug of concern or delivery setting.

Increased alcohol sales during the COVID-19 pandemic may have contributed to an increase in risky drinking. Reducing the harm of alcohol and other drugs requires a greater focus on increasing protective factors and preventative measures. As well as ensuring access to high quality, culturally safe alcohol and other drug treatment services.

Case study: Rough sleeper packs - Ngwala Willumbong

SDRF enabler - Address trauma and support healing

In response to community needs, $50,000 from Better Connected Care was diverted to Ngwala Willumbong to support the mobile sobering up service being delivered as part of public intoxication reforms. The funding was used to provide rough sleeper packs (consisting of a sleeping bag, clothes sources through Aboriginal owned and operated Clothing the Gap, a first aid pack and essential items) for participants of the mobile service, acknowledging the link between homelessness and substance use and creating opportunities for Ngala Willumbong to link individuals with culturally safe services to address the underlying causes of their alcohol consumption. Since commencement of public intoxication reforms on 7 November 2023, Ngwala Willumbong has connected over 777 individuals and provided 1,000 beverages, such as tea or coffee. Expansion of the service will see an additional mobile bus, to be shared between the North West and South East Metro Regions providing place based services.

Goal 12: Aboriginal Victorians access the services they need

Overview

Measures under Goal 12 have improved

In 2023 more Aboriginal people of all ages are attending MBS Aboriginal and Torres Strait Islander specific health checks, participating in breast cancer screenings and are accessing aged care services. In 2023 more Aboriginal people of all ages are attending health checks, participating in breast cancer screenings, and are accessing aged care services. Access to the NDIS is at near parity for Aboriginal and non-Aboriginal participants.

Goal 12 directly aligns with the following Closing the Gap Outcome and Target

The National Agreement does not contain outcomes and targets that align with this VAAF goal. Victoria is pursuing more ambitious and comprehensive goals under the VAAF, which are reported on in this chapter and the Data Dashboard.

Closing the Gap - How Victoria is tracking nationally

Not applicable.

Measure 12.1.1 Proportion who received a health check or assessment by age

In 2022-23 14.1 per cent of Aboriginal Victorians aged 0-14 received a health check or assessment. In the same year 13 per cent of Aboriginal Victorians aged 15 to 54 years received a health check or assessment. This is an increase of 3.3 per cent and 3 per cent, respectively, bringing the rate of health checks for Aboriginal Victorians in these cohorts back in line with pre-pandemic levels.

For the 55+ age bracket, 20.9 per cent received a health check or assessment in 2022-23. This means that more Aboriginal Victorians in this age bracket are accessing health checks than ever before, with at least 1 in 5 Aboriginal Victorians aged 55 and over receiving a health check or assessment in 2022-23.

Number of health checks refers to the number of Aboriginal and Torres Strait Islander people who had an Medicare Benefits Schedule health check that is Aboriginal and Torres Strait Islander-specific^[2].

Measure 12.1.2 Participation rates for breast cancer screening

Since 2012-13 the number of Aboriginal Victorian women participating in breast screenings has risen. In 2021-22, the rate of participation in breast screenings was 23 per cent for Aboriginal women aged 40 and over. In the same year, more than one third of Aboriginal women between the ages of 50 and 74 participated in breast screenings. In comparison, more than half of all women aged 50-74 participated in breast screenings.

Breast cancer remains one of the highest detected cancers, with early detection key to providing adequate treatment and increase survivability. Women aged 40 and over are eligible for free breast screenings with BreastScreen Australia every 2 years. Women aged 50–74 are actively invited to participate in the program.

The Beautiful Shawl Project is a collaborative program between BreastScreen Victoria, VACCHO and ACCOs across the state to reduce barriers to breast screening. It provides customised screening shawls to Aboriginal women that are culturally appropriate, familiar and beautiful to wear during their breast screen. 291 screens were performed for Aboriginal women across Victoria in 2022-23 as part of the Beautiful Shawl Project.

Measure 12.1.4 Number and proportion accessing aged care services

14.1 per cent of Aboriginal Victorians (aged 50+) were accessing aged care services in 2022-23. This represents 1,726 a growth of 510 people since 2021-22. In 2014-15 only 7.2 per cent of Aboriginal Victorians aged 50+ had access to aged care services. In 2022-23 18.4 per cent of non-Aboriginal people aged 65+ have access to aged care services. Culturally safe aged care facilities are an important part of late-stage life care. It is important for Victoria to support Aboriginal community controlled aged care organisations like Aboriginal Community Elder Services (ACES) to provide culturally safe aged care services in Victoria.

The Victorian Government launched Victoria’s first whole-of-government LGBTIQA+ strategy, Pride in our future: Victoria’s LGBTIQA+ strategy 2022–32 in February 2022. Priority area 2 is Equitable, inclusive, and accessible services. Implementation of the strategy is underway. Including action to support Aboriginal and Torres Strait Islander lesbian, gay, bisexual, trans and gender diverse, intersex, queer, sistergirl and brotherboy (LGBTIQ+SB) communities.

Case study: LGBTIQ+ inclusion training

In the 2023-24 State Budget, the Victorian Government announced an investment of $1.85 million for Rainbow Health Australia to deliver inclusion training to service organisations to make sure they are safe for and trusted by LGBTIQA+ communities. The investment is supporting up to 400 organisations to undertake Rainbow Health Australia’s How2 training program, helping them to improve inclusion in their workplaces in sustainable ways. As part of this investment, Rainbow Health Australia has built close relationships with First Nations-led organisations and recruited a First Nations project officer to lead a dedicated self-determination component, supporting ACCOs and other Aboriginal-led organisations to undertake this inclusion work.

Case study: Aboriginal flood relief and recovery

SDRF enabler - Transfer power and resources to communities

DFFH embedded self-determination in the state’s response to the 2022/23 floods. A bilateral relationship was developed with Emergency Recovery Victoria to ensure a coordinated and collaborative response to flood affected Aboriginal communities across Victoria. Three Aboriginal community forums were held, where issues raised were rapidly responded to at a local level and also addressed through state-wide governance and policy frameworks, and strategies. As communities recover, the Aboriginal community forums have ceased to meet and the bilateral relationship between the Aboriginal Self-determination and Outcomes Division and Emergency Recovery Victoria has now concluded.

DFFH also centred Aboriginal community control and self-determination in the way it dispersed funds to aid the flood recovery effort. Regional governance groups and ACCOs decided on the disbursement of $2 million in Aboriginal flood relief and recovery funding allocated to six Aboriginal community-controlled organisations (ACCOs) in flood affected regions of Victoria; Rumbalara Aboriginal Cooperative, Bendigo Aboriginal Cooperative, Mallee District Aboriginal Services, Murray Valley Aboriginal Cooperative, Njernda Aboriginal Corporation and Loddon Mallee Aboriginal Reference Group. The funding will strengthen the health and wellbeing of Aboriginal people through emergency relief and recovery packages and psycho social supports such as cultural connection programs and activities. The funding will also support each ACCO to research the impacts of floods on community and business continuity, and develop strategies to manage future emergencies.

Goal 13: Health and community services are culturally safe and responsive

Overview

Measures under Goal 13 have worsened

Improving cultural safety for Aboriginal and Torres Strait Islander health care users can improve access to appropriate, high quality health care. This means an accessible health system that is free from racism and discrimination, and providing equitable health services that respects the cultural values, strengths and differences of Aboriginal people and their communities.

First Peoples in Victoria are experiencing racism at higher levels in health settings and are leaving/discharging themselves from hospitals at higher rates.

Closing the Gap – Relevant Outcomes and Targets for Goal 13

The National Agreement does not contain outcomes and targets that align with this VAAF goal. Victoria is pursuing more ambitious and comprehensive goals under the VAAF, which are reported on in this chapter and the Data Dashboard.

Closing the Gap - How Victoria is tracking nationally

Not applicable.

13.1 Increase the cultural safety and responsiveness of services

Measure 13.1.1 Proportion reporting experiences of racism in the health system

In 2022, 20.6 per cent of Aboriginal people reported that they experienced racism in health settings within the previous 12 months. Non-Aboriginal people reported 7.6 per cent for the same period. Aboriginal people experience racism in health settings at 2.6 times the rate of non-Aboriginal people. These results are from the 2022 Victorian Population Health Survey. Aboriginal peoples have been experiencing increasing racism in health settings since 2018. 14.3 per cent of Aboriginal respondents reported experiencing racism in health settings in the 2018 VPHS. Racism and culturally inappropriate health care can contribute to reduced access and engagement in services and can lead to poorer health outcomes. Depression and anxiety are strongly associated with experiences of racism for Aboriginal patients. Approximately two-thirds (65.5 per cent) of Aboriginal adults who experienced racism had been diagnosed with depression and/or anxiety.

With reduced access to culturally safe health services that are free from racism, Aboriginal people are less likely to have their health and wellbeing needs met, and therefore more vulnerable to poorer health and wellbeing outcomes. We need to build more accessible and equitable health care system that is more aligned to the needs of First Peoples in Victoria to address increasing health and wellbeing gaps between Aboriginal and non-Aboriginal people in Victoria.

Measure 13.1.3 Hospitalisations where patients left against medical advice/ were discharged at own risk

In 2022-23, 881 Aboriginal Victorians left hospital against medical advice or were discharged at their own risk. This is a 73 person increase compared to 2021-22. The proportion of Aboriginal Victorians that left hospital against medical advice was 12.8 per 1,000 people compared to 2.5 per 1,000 people for non-Aboriginal Victorians in 2022-23. Aboriginal people left hospital against medical advice at 4.9 times the rate of non-Aboriginal people.

Understanding the cause of patients leaving hospital against medical advice is complex. As per Measure 13.1.1, Aboriginal Victorians experience racism in health settings at 2.6 times the rate of non-Aboriginal Victorians. The impact of intergenerational trauma, distrust, and Western modes of care likely also influence experiences in the health care system.

Case study: Human Service and Child Safe standards in both ACCOs and mainstream services

SDRF enabler - Address racism and promote cultural safety

The Human Services Regulator (HSR) is responsible for regulating Aboriginal cultural safety against the Human Service and Child Safe standards in both ACCOs and mainstream services and is particularly conscious of the sensitivity of doing so in ACCOs.

With a view to promoting and ensuring an Aboriginal led culturally safe approach to regulatory oversight:

• The HSR has adopted the approach, when concerns regarding non-compliance are identified within an ACCO, of having an initial meeting with ASDO to seek their input on any issues DFFH need to be aware of in relation to that ACCO and enable ASDO to offer support to the ACCO as relevant
• Ensuring that where issues have been identified the newly established role of HSR Manager, Aboriginal Cultural Safety and Engagement is involved in planning HSRs initial approach to, and first meeting with, the ACCO to promote and ensure a culturally safe approach to the regulatory oversight.

Initial indications are that this approach has resulted in ACCOs being more confident that their cultural needs and rights are being acknowledged and respected with a correlating improvement in engagement between the ACCO and HSR, a more constructive approach to address any areas on non-compliance and improved service outcomes for clients.

Case study: Outcomes-based funding reform

SDRF enabler - Transfer power and resources to communities

The Aboriginal Health and Wellbeing Partnership Agreement and Action Plan 2023-2025, endorsed by Cabinet and the Partnership Forum in May 2023, identified sustainable outcomes-based funding (OBF) as a key priority for the ACCHO sector.

DH committed to transition all ACCOs to self-determined, longer-term outcomes-based funding for all their recurrent health and wellbeing funding. This includes:

• Multi-year funding agreements: In May 2023, DH notified 36 ACCOs of their recurrent core four-year funding, a key milestone and first phase of the transition to Aboriginal-specific funding models.
• Flexibility and self-determined outcomes: From 1 July 2024, ACCOs can use their recurrent funding to self-determine the outcomes they will progress with their local communities, which will align to the five priority domains of the 10-year Aboriginal Health and Wellbeing Partnership Forum Agreement.
• Streamlined outcomes-focused reporting: From 1 July 2024, ACCOs will report their outcomes to DH through annual impact reports and audited financial statements. These community-based impact reports will help DH to monitor state-wide Aboriginal health and wellbeing outcomes while the financial statements will be used to support yearly acquittals to ensure financial accountability.
• Ongoing support: DH will collaborate with VACCHO to support all ACCOs to transition to outcomes-based funding. This includes support to develop innovative funding models geared to the unique operational needs and readiness of ACCOs to transition to outcomes-based funding.

Goal 14: Aboriginal Victorians enjoy social and emotional wellbeing

Overview

Measures under Goal 14 have worsened

Social and emotional wellbeing is a holistic individual and community experience encompassing many factors such as connection to Country, culture, family, and community.

Aboriginal people in Victoria are experiencing increasing levels of psychological distress and are presenting at higher levels of self-harm at emergency departments. People are also accessing clinical mental health services more than ever before.

Goal 14 aligns with the following Closing the Gap Outcome and Target

Outcome 14 Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing

• Target 14 Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.

The VAAF contains measures related to social and emotionally wellbeing but not suicide.

Closing the Gap - How Victoria is tracking nationally

Outcome 14: Current reporting is based on the AIHW National Mortality Database. This only covers jurisdictions which have adequate levels of Indigenous identification in mortality data. Data for those with a usual residence in Victoria, Tasmania and the Australian Capital Territory is excluded as it is considered unsuitable for comparisons of changes over time. Progress in Victoria cannot be assessed.

In 2021, the suicide age-standardised rate for Aboriginal and Torres Strait Islander people was 29.3 per 100,000 people for NSW, QLD, WA, SA and the NT combined. This rate is worse than the baseline year of 2021.

Measure 14.1.1 Proportion reporting ‘high or very high’ levels of psychosocial distress

In 2022 35.0 per cent of Aboriginal people reported high or very high levels of psychological distress. Psychological distress has increased 10 percentage points since 2017. When comparing with the non-Aboriginal population there has been a similar increase in reported high or very high levels of psychological distress. In 2022 Aboriginal Victorians are 1.5 times more likely to report high or very high levels of psychological distress. In 2019 Aboriginal respondents were 2.6 times more likely to report high or very high levels of psychological distress. Experiences of racism, and financial and housing stress can to mental health.

Measure 14.1.2 Rate of self-harm related emergency department presentations (by 15-24 years, and all)

In 2020-21 the rate of self-harm presentations increased to an all-time high of 21.2 presentations per 1,000. This is five times the rate for non-Aboriginal Victorians. 4.2 per 1000 presentations for self-harm. Presentations have increased dramatically since 2008-09. In 2008-09 6.1 Aboriginal people per 1,000 presented to emergency departments for self-harm.

Due to changes in the methodology of identifying self-harm there has been a significant increase in 2018-19 (up by 11.6 per 1000 presentations).

In 2020-21 42.4 15-24-year-old people per 1000 presentations presented for self-harm at emergency departments. In 2019-20 this was 38.7 per 1000 presentations. In 2020-21 15–24-year-old non-Aboriginal people increased but was significantly lower than Aboriginal representations. Presentation by non-Aboriginal people were 13.6 in 2020-21.

Measure 14.1.5 Number of Aboriginal Victorians receiving clinical mental health services

Contacts with community mental health care services increased for both Aboriginal and non-Aboriginal Victorians between 2020-21 and 2021-22. The number of contacts was 1,301 per 1,000 people in 2021-22 for Aboriginal Victorians. It was 285 per 1,000 people in 2021-22 for non-Aboriginal Victorians. This means Aboriginal Victorians accessed community mental health care services at more than 4.5 times the rate of non-Aboriginal Victorians.

Increased contacts with community mental health services does not necessarily represent a decrease in the wellbeing of Aboriginal Victorians. This could also represent greater access to culturally safe services. But it does show there is a growing demand for community mental health services. It will be up to government to support service providers to meet that demand.

Case study: Ngootyoong Mara Cultural Healing Centre

SDRF enabler - Address trauma and support healing

Under the Royal Commission into Victoria's Mental Health System, DH allocated funding to Dhauwurd Wurrung Elderly and Community Health Services (DWECH) for social and emotional wellbeing (SEWB) services, resulting in greater funding for the Ngootyoong Mara Cultural Healing Centre. Funding allowed the centre to be used to its full extent.

This Centre addresses physical repair, psychological well-being, social nurturing, cultural reclamation, and spiritual maintenance. Operating a flexible model, it combines traditional and modern practices to provide a physically, socially, and culturally safe space.

The Centre's success is evident in increased community engagement, with families actively participating and contributing to program planning. This involvement has led to significant personal growth and cultural connection within the Community and the approach has encouraged clients who had not sought help before to engage with the SEWB team, resulting in positive outcomes.

Despite being newly established, the Centre has already seen decreased substance use amongst community members and fewer interventions from external services, showcasing the effectiveness of the support provided by the SEWB team and the impact of the Centre.

The Victorian Government is working with service providers, Aboriginal organisations and communities to ensure that all Aboriginal Victorians have access to high-quality, culturally safe and responsive health and wellbeing services.

The key Aboriginal Governance Forums for realising outcomes in this Domain are the Aboriginal Strategic Governance Forum and the Victorian Aboriginal Health and Wellbeing Partnership Forum.

Disability

Victoria’s response to the Disability Royal Commission

The Disability Royal Commission made a range of recommendations specifically aimed at improving outcomes for First Nations people with disability. On 5 March 2024, Disability Reform Ministers committed that governments would respond to these by mid-2024. The Victorian government is committed to working with people with disability and the sector on its response to the Disability Royal Commission, including with First Nations People.

The Victorian Government’s submission to the Disability Royal Commission emphasised the Government’s commitment to self-determination and its support for Victoria’s treaty and truth-telling process. The proposed reforms and recommendations in the submission were guided by six overarching objectives, one of which was to embed Aboriginal self-determination. Specifically, the submission recommended that:

• All jurisdictions, including the Commonwealth Government, should support the self-determination of Aboriginal people with disability and the role of Aboriginal Community Controlled Organisations in policy, governance and service delivery.
• The NDIS Commission should update the NDIS Practice Standards and Quality Indicators to incorporate a focus on culturally safe service provision to Aboriginal people.

The submission will be made publicly available on the Disability Royal Commission’s website.

Inclusive Victoria: State disability plan 2022-26

Released in March 2022, Inclusive Victoria: State disability plan 2022-26 (Inclusive Victoria) is Victoria’s plan for making our community inclusive and accessible for everyone as required under the Disability Act 2006. The plan is an important way for the Victorian Government to be accountable for making all parts of the community inclusive and accessible for everyone.

The actions in Inclusive Victoria reflect the commitments all Victorian government departments are taking to build a fairer, inclusive community. Inclusive Victoria also sets out how government will do this by committing to six systemic reforms that will support a stronger focus on coordinated approaches to inclusion and accountability, including:

• co-design with people with disability
• Aboriginal self-determination
• intersectional approaches
• accessible communications and universal design
• disability confident and inclusive workforces
• effective data and outcomes reporting.

Building genuine inclusion means changing the way we do things. It means having people with disability at the table when we design policies, programs and services. It means working with Aboriginal people with disability and listening to what works best for them and their communities. Inclusive Victoria includes the following definition of Aboriginal self-determination: “the ability for Aboriginal people to freely determine their political status and pursue their economic, social and cultural development. It also describes self-determination as a right that relates to groups of people, not only individuals.” Inclusive Victoria commits the Victorian Government to:

• Coordinating whole-of-government effort to align disability inclusion reforms with Treaty, the Victorian Government’s commitments under the National Agreement on Closing the Gap, the Victorian Aboriginal affairs framework 2018–2023, the Victorian self-determination reform framework, the Korin Korin Balit Djak systems transformation strategy (the Aboriginal health, wellbeing and safety strategic plan 2017–2027) and the five objectives in Wungurilwil Gapgapduir – Aboriginal children and families agreement.
• Continuing our commitment to work closely and in good faith with Aboriginal stakeholders to ensure Aboriginal people with disability have power, control and decision-making and are able to co-design policies, programs and services that affect them.
• Aboriginal representation on the Victorian Disability Advisory Council and related government working groups, as well as engagement with any self-determined representative body for Traditional Owners and Aboriginal Victorians established through Treaty – this will ensure the voices of Aboriginal people with disability and Aboriginal self-determination principles are central to the government’s disability inclusion reforms.
• Further developing the capacity of the Aboriginal community-controlled sector to deliver disability support services and strengthening the Aboriginal disability workforce.

The Victorian autism plan sits under the state disability plan and takes up its structure and outcomes framework. The plan sets out specific initiatives to deliver long-term improvements to the lives of autistic people.

A key comment under the plan is to deliver additional public autism assessments. Work has been undertaken since 2023 to establish trial delivery of assessments under this commitment through select Aboriginal Community Controlled Organisations.

Public health

The Victorian Aboriginal sexual and reproductive health plan 2022–30 was published in March 2023. Victoria's first Aboriginal sexual and reproductive health plan outlines priority actions to improve the sexual and reproductive health of Aboriginal Victorians using a self-determination approach.

Local Public Health Units (LPHUs) are continuing to provide locally based public health responses in disease prevention, as well as health promotion and protection. LPHUs have engaged and built partnerships with community and local stakeholders such as Aboriginal Controlled Community Organisations (ACCOs) and Victorian Aboriginal Community Controlled Organisation (VACCHO) to implement state-wide programs and to co-design locally based public health initiatives. LPHUs have developed Public Health and Wellbeing Catchment Plans, based on the Victorian Public Health and Wellbeing Plan, identifying health priorities for their catchment.

These catchment plans promote equity, address gender disparities, ensuring that health promoting policies, programs, and services are inclusive and culturally responsive to the diverse needs of their community, including First Nations people. Examples of how LPHUs have applied principles of self-determination in various ways to empower First Nations people to inform these plans include having First Nations organisations represented on established advisory committees, inviting ACCOs to determine their own health needs assessment for their community, providing culturally tailored materials and by partnering with local and statewide aboriginal led organisations.

DH is developing engagement guidelines between the networked public health system (including LPHUs), VACCHO and ACCOs to support culturally safe engagement between stakeholders. DH has facilitated mechanisms to support the partnership between LPHUs, VACCHO and ACCOs including:

• LPHU Aboriginal Health Community of Practice, Aboriginal health focused LPHU Director meetings
• Informal network of LPHU Aboriginal health leads co-facilitated by DH and VACCHO.

DH has committed more than $7.8 million to VACCHO for the development and implementation of the Victorian Aboriginal Cancer Journey Strategy 2023-2028 over the next 5 years. This included $1.05 million for VACCHO to lead the development of the Strategy including commencement of pilot initiatives. The remaining $6.75 million has been allocated to VACCHO for implementation of the Strategy across the ACCOs and the mainstream cancer control sector. This funding also includes $600,000 per annum for VACCHO to implement the Victorian Cancer Screening Framework.

Other key actions:

• Continued partnership between Royal Children’s Hospital and Victorian Aboriginal Health Service (VAHS) has supported the access to self-determined health care for Aboriginal children and families within an ACCO.
• DH will work with VACCHO to identify a new approach to the prevention of diabetes and cardiovascular disease for Aboriginal Victorians.
• Continuation of the Best Practice Aboriginal Forum on Reducing Tobacco and E-Cigarette Related Harms, , where ACCHOs are provided opportunities to report on local initiatives, build capacity and share stories and progress in reducing smoking and vaping.
• Continued implementation of the Tackling Indigenous Smoking Program across Victorian Aboriginal communities up to 30 June 2026.
• VACCHO and VAHs coordinate and support strong and culturally safe smoking cessation initiatives led by local Aboriginal communities, in partnership with Quit Victoria, Koori Maternity Services and Safer Care Victoria.

The Commonwealth Government will be investing $15m towards ensuring that Quitline services are equitable for priority populations across Australia under the National Tobacco Strategy with a focus on First Nations people.

• Working Together For Health (WT4H) takes a place-based approach to improving Aboriginal health and wellbeing in central and northwest Victoria (Loddon Mallee). It is a coordinated approach to delivering culturally safe primary prevention and early detection services within Aboriginal communities, by Aboriginal communities. WTFH aims to prevent ill health before it happens and improve the health of Aboriginal communities across the Loddon and Mallee regions. Priority areas have included: reducing tobacco and e-cigarette related harms; increasing cancer screenings; immunisations; 715 health checks; improving mental health; healthy eating and active living; sexual and reproductive health; and oral health promotion.
• In early 2023, a Drugs and Poisons Regulations amendment approved Aboriginal Health Practitioners (AHPs) to apply fluoride varnish (Schedule poison) to children, to help prevent tooth decay. AHPs with appropriate training will be able to apply fluoride varnish on children aged 3-17 who are clients of an ACCHO in Victoria. DH has subsequently funded a project to train AHPs and support ACCHOs to embed fluoride varnish application in their practice.
• In mid-2023, DH Secretary approval has enabled registered Aboriginal and Torres Strait Islander Health Practitioners, who meet the relevant training requirements, to administer vaccinations in line with the National Immunisation Program. DH has subsequently funded VACCHO’s Registered Training Organisation to train AHPs to administer vaccinations.
• In October 2023, the Surgery Recovery and Reform Program published the ‘Planned Surgery Reform Blueprint’ (the Blueprint). The Blueprint outlines a purposeful and systematic plan to improve access to and experiences of planned surgery and non-surgical pathways in Victoria. Underpinned by 12 months of extensive engagement and research, including with VACCHO and Aboriginal Hospital Liaison Officers (AHLOs), the Blueprint features 10 co-designed reforms that will drive system-wide efficiencies, workforce suitability and positive patient outcomes and experiences.

The State Budget 2023-24 allocated $35.04 million over four years to seven ACCHOs to deliver 100,000 culturally informed, prevention focused episodes of care (which includes additional referrals, care plans and primary care services) by 2027. The funding will alleviate the demand on Victorian hospitals and acute services by redirecting treatment for potentially preventable hospitalisations into holistic, primary culturally safe healthcare settings provided by ACCHOs.

The State Budget 2023-24 allocated $34.04 million for ACCHOs to deliver Strengthening Lifelong Aboriginal Health and Wellbeing (Urgent Care Pathways) from 2023-24 to 2026-27. Urgent Care Pathways will improve the health of Aboriginal Victorians by redirecting treatment for potentially preventable hospitalisations from mainstream hospitals to ACCHOs. Greater access to primary care will enable ACCHOs to better treat chronic health conditions or even identify them early they become problematic for the individual. By shifting demand from acute health services and hospitals to ACCHOs who deliver culturally responsive, prevention-focussed health care, DH and the ACCHOs, are working towards closing the gap in Aboriginal health and wellbeing. It is expected that Urgent Care Pathways will reduce the number of Aboriginal Victorians that present to hospitals for Potentially Preventable conditions by ACCHOs providing primary care early. ACCHOs will deliver approximately 100,000 episodes of care by 2026-27 financial year due to the Urgent Care Pathways initiative.

DH is transitioning to an outcomes-based funding model for the Aboriginal Community Controlled Health Sector. This reform will enable improved access to health and community services for Aboriginal Victorians. The aim is to provide the sector with flexible funding agreements that align to locally determined needs and outcomes, reduce administrative and reporting burden and increase the sustainability of ACCHOs. The first phase was delivered in mid-2023 with ACCHOs shifting to multi-year funding arrangements.

The Victorian government has committed $58 million in 2023 over four years to establish 20 women’s health clinics, with once in Victoria specified for Aboriginal women. The Aboriginal women’s health clinic will be operational in 2025-26 and will be developed in partnership with Community. The election commitment also includes a further $5.1 million over the four years to establish a mobile women’s health clinic to improve access for rural and remote Victorian women.

Cultural safety

Cultural safety in transport services

The Transport and Planning Portfolio Cultural Safety Framework (Framework), and accompanying Action Plan, was completed in late 2023. The purpose of the Framework is to advance the cultural safety of the portfolio and provide an accessible workplace for First Peoples.

The Framework enacts the portfolio’s commitment to promote cultural safety as provided in the Transport Portfolio Aboriginal Self-Determination Plan 2020–2023 and supports the Department of Transport and Planning’s strategic goals of thriving places and connected communities.

The Framework’s vision is for our First Peoples employees and transport users to thrive and feel culturally safe in the environments managed by DTP.

In March 2023, DTP commenced a 12-month pilot program with Girraway Ganyi Consultancy, a culturally appropriate Employee Assistance Program. Girraway Ganyi specifically cater for First Peoples employees, managers of First Peoples and employees working in First Peoples affairs within Government.

Over the pilot period a series of interactive workshops were scheduled aimed to foster deeper understanding of First Peoples cultural practices and promoting a more inclusive and culturally safe workplace.

Workshops were held specifically for First Peoples, Managers of First Peoples and in the period following the result of the Voice Referendum. These workshops were designed to provide practical insights into traditional First Peoples customs, a platform to facilitate dialogue and engage in meaningful discussions about the significance of cultural diversity and the positive impact in fostering an inclusive workplace culture.

Cultural safety in health services

Under the new health-led response to public drunkenness, contracted service providers are required to ensure staff complete cultural safety training within the first three months of employment. This is mandated in the model of care and confirmed in the Service Framework.

All services commissioned for the Public Intoxication response are contracted to comply with the model of care and the service framework per the terms of the agreement.

Cohealth have produced a cultural safety guide, in conjunction with Professor Richard Frankland and Koorreen Enterprises, titled “Yakeen Tharn (Dreaming Path) Working with First Nations People – A Cross-Cultural Safety Guide”.

Data collected as part of the 2023 Victorian Population Health Survey, to be available in 2024, will strengthen understanding of the current health and wellbeing of Aboriginal peoples in Victoria including measures of Community participation and connection to culture.

The VACCHO Culture + Kinship model has been underway with the pilot funded for diabetes and cancer screening areas. The model aims to enable communities to make decisions about their health and wellbeing priorities as well as how they are funded and measured. DH is supporting this in alignment with the move to outcomes-based funding that will go live from 1 July 2024. To date, successful outcomes include the strengthening of prevention hubs and the Culture + Kinship program, which young people and new mothers with their elders through programs such as youth on-country camps, possum cloak skin workshops and shared yarns. Evaluation has shown increased confidence, connection, trust, control and an $8 social return on investment.

VACCHO is implementing expansion of the DH-funded Beautiful Shawl Program to include 5 additional ACCOs and to increase access to culturally safe cervical screening services for Aboriginal and Torres Strait Islander women and people with a cervix through provision of culturally appropriate education and resources. The program has supported hundreds of women to access important health services, with 377 screening performed across 15 sites in 2022-23.

Design guidelines are in development to ensure new health facilities are designed to be culturally safe and inclusive, informed by engagement with local Aboriginal communities. The guidelines will be a technical support aimed at creating environments sensitive to culture and will be applicable to all health facilities.

Mainstream health infrastructure service projects are significantly informed by Aboriginal representation and engagement through Community Consultative Committees (CCC).

Aboriginal health cultural safety capability has been enhanced through LPHU operations, connecting with ACCHOs to embed self-determining approaches that meet the public health needs of Aboriginal communities within their catchment. This is being done through LPHU participation at the Aboriginal Health and Wellbeing Partnership Forum (AHWPF). The LPHU Aboriginal Health Community of Practice has been formed to enable LPHU to share knowledge and support Aboriginal public health programs.

DH has funded VACCHO in collaboration with Dental Health Services Victoria (DHSV) to develop a State-wide oral health Model of Care for Aboriginal Victorians. This project will further strengthen the delivery of public dental services for Aboriginal and Torres Strait Islander people.

DH funds the Koorie Heritage Trust to deliver Building Aboriginal Cultural Competency training to Transition Care Program and aged care assessment staff to support Aboriginal Elders’ access to culturally safe services.

DH continues to work with ACCOs to deliver Home and Community Care Program for Younger People (HACC-PYP) services including the resourcing of four (two EFT) Aboriginal Development Officers to facilitate and strengthen participation of ACCOs in the HACC-PYP program.

Victorian public health services must report on their performance in supporting access to services and improving cultural safety for Aboriginal consumers. As part of the annual Statement of Priorities, a contract between a health service and the Minister for Health, health services make a commitment to monitor access to services and implement improvement strategies.

The Aboriginal Health Improvement Initiative, as part of the broader Health Service Partnership (HSP) program, is supporting 8 Health Services (3 Metropolitan, 5 regional) to actively partner with local ACCHOs to develop projects that address the specific needs of local Aboriginal communities. In 2023, the program focused on strengthening both Aboriginal patient identification and discharge planning with an aim to reduce preventable hospital admissions and emergency department presentations.

Aboriginal Cultural Safety Fixed Grants have been recurrently allocated to public health services since 2019-20. The 38 largest public health services in the state received an annual grant (totaling $32 million in 2023-24) to support improving Aboriginal cultural safety. The participating health services are required to submit an annual plan and a report on achievements.

As part of a long-term health services collaboration project, VACCHO, four major Victorian health services, ACCHOs, and DH are partnering with local Aboriginal communities to improve Aboriginal cultural safety in hospitals. The initial focus is on developing locally specific initiatives in emergency departments and urgent care clinics.

Quit Victoria has trained Aboriginal councillors to provide a culturally safe smoking and vaping cessation service to Aboriginal and Torres Strait Islander people.

Social and emotional wellbeing

The 2021-22 Victorian State Budget committed funding of $87 million over four years and $25.7 million in recurrent funding for ACCHOs to establish and/or expand their Social and Emotional Wellbeing (SEWB) teams and commission services for children and young people.

In February 2023, DH held consultations with 25 ACCHOs across Victoria to commence the co-design process for a funding allocation model and outcomes-based reporting framework for SEWB. DH is now working with ACCHOs to improve the way ACCHOs report on social and emotional wellbeing outcomes that aligns with an outcomes-based funding model.

The 2023-24 State Budget committed an investment of $11.8 million to progress the Royal Commission into Victoria’s Mental Health System (the Royal Commission) vision for an expanded and better skilled and supported mental health and wellbeing workforce. This included expanding the capacity and capability of the Aboriginal Alcohol and Other Drugs (AOD) workforce through an increase in Aboriginal AOD FTE and workforce development.

DH is working with the Balit Durn Durn Centre of Excellence in Social and Emotional Wellbeing (established by VACCHO in 2022) on the development of a new Victorian suicide prevention and response strategy, including an implementation plan and accountability framework.

The Balit Durn Durn Centre is planning, in partnership with DH and VACCHO, for the future establishment of two new Aboriginal Healing Centres. VACCHO are leading the co-design process which includes extensive state-wide community consultation to bring people’s stories to life – and ultimately increase supports to improve the social and emotional wellbeing of Aboriginal children and young people.

The 2022-23 State Budget allocated funding of $3.5 million over two years to support a range of Aboriginal suicide prevention and response initiatives, including:

• In-depth analysis of Aboriginal suicides recorded in the Victorian Suicide Register and a review to improve real-time surveillance and response in partnership with the Coroners Court of Victoria
• 12-month extension of the Yarning Safe N Strong helpline
• funding for an Aboriginal community-led suicide prevention and response codesign process (being led by the Balit Durn Durn Centre)
• establishment of an Aboriginal-led suicide and self-harm prevention panel to advise on targeted efforts for Aboriginal people, as well as areas of most need (being led by the Balit Durn Durn Centre).

Equality

Funding to support LGBTIQA+ Aboriginal and Torres Strait Islander communities

Since 2019-20, the Equality portfolio through DFFH has funded Koorie Pride Victoria over $470,000 for its establishment and growth as a peak body supporting Aboriginal and Torres Strait Islander lesbian, gay, bisexual, trans and gender diverse, intersex, queer, sistergirl and brotherboy (LGBTIQ+SB) communities. Due to disruptions caused by the COVID-19 pandemic, funded activities were delivered from 2022 onwards.

The Equality portfolio’s flagship competitive grants programs, the Pride Events and Festivals Fund and the LGBTIQA+ Organisational Development program, both include assessment measures that prioritise applications that support diverse communities including First Nations and Aboriginal communities. Successful applications through these programs would primarily support Domain 4 of the Victorian Aboriginal Affairs Framework “Health and wellbeing” in Goals 12 and 14, “Aboriginal Victorians access the services they need” and “Aboriginal Victorians enjoy social and emotional wellbeing”.

Key activities undertaken in 2023 with Victorian Government’s investment include:

• Funded VACCHO to deliver a “Strong. Proud. Me” event in April 2023 through the 2022-23 Pride Events and Festivals Fund to highlight the talents of queer Aboriginal and Torres Strait Islander people.

Funded Your Community Health to deliver a Rainbow Mob Day Out event through the 2023-24 Pride Events and Festivals Fund to host a festival event featuring gender diverse First Nations performers and artists. This event is scheduled to be held in July 2024.