Overcoming biases to close the gap

‘We nurture our culture for our future, and our culture nurtures us’.
 
That is the theme of this year’s Close the Gap Campaign report. Recognition of Aboriginal and Torres Strait Islander empowerment as vital to wellbeing is at the heart of the report.
 
Released on Close the Gap Day, Thursday 19 March, the report prepared by the Lowitja Institute urges governments to implement 14 recommendations to protect Aboriginal and Torres Strait Islander people and avoid further preventable deaths.
 
‘Our report details some great programs and initiatives designed and led by our communities, but we are achieving these solutions inside a system that is not designed for us. This cannot continue,’ June Oscar and Karl Briscoe, co-chairs of the Close the Gap Campaign, said.
 
The report has welcomed the new shared decision-making agreement reached between the Council of Australian Governments (COAG) and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations.
 
‘Research has shown when Aboriginal and Torres Strait Islander people are involved in decision-making service delivery, we know that we receive better health outcomes,’ Mr Briscoe, who was a speaker at the RACGP Close the Gap event, told newsGP.
 
Launched in 2006, the campaign has seen more than 200,000 people pledge their support for closing the healthcare gap.
 
While it has had a positive impact, there is still a way to go as Aboriginal and Torres Strait Islander people continue to endure higher levels of illness and comorbidity in comparison to non-Indigenous Australians, experiencing three times the rate of preventable admissions to hospital, overcrowded housing and a lack of access to basic health services.
 
To reach the campaign’s goal and ensure that Aboriginal and Torres Strait Islander people have better health outcomes, Mr Briscoe, a Kuku Yalanji man, says adequate and affordable housing is necessary.
 
‘One of the main causes of rheumatic heart disease is overcrowding in housing. So if adequate housing is actually addressed, a lot of these third world diseases that we see in a first world country can be eliminated,’ he said.
 
However, the biggest system reform required to ensure better access to health services, Mr Briscoe said, is ‘the elimination of racism’. He believes a culturally safe environment is vital, and calls on healthcare practitioners to be aware of unconscious bias.
 
‘A lot of the practitioners [need to] self-reflect on their own biases – because we all have biases – and see how they could actually make their practice more culturally safe so our people can access them without being or without feeling discriminated against,’ he said.
 
Thomas Mylne, student leader on the Australian Indigenous Doctors Association (AIDA) Board of Directors, agrees. He said that while there is great momentum around Aboriginal and Torres Strait Islander health, there remains a ‘racist undercurrent within Australian society as a result of colonialism’.
 
To help change these attitudes, the 2020 Close the Gap report takes a strengths-based approach, flipping the dialogue from a deficit model. Mr Mylne, a Gangalu man, believes this is important because it highlights the successes rather than focusing on the problems.  
 
‘Focusing on those deficits becomes quite exhausting because, at the end of the day, things aren’t quick to change; people become disinterested or disengaged and I think that’s a real threat to the ongoing success of programs like Close the Gap,’ he told newsGP.
 
‘We need to look at the fact that it’s not shared problems but shared opportunities for success. Every time we improve something, it’s not that we fixed a problem.
 
‘We are actually succeeding together.’
 
Currently in his fourth year of an intercalated Medicine and Master of Public Health course at the University of Melbourne, Mr Mylne said it is important to be an advocate and encourages others in the field to do so as well.
 
‘Everything someone does to be a better Indigenous [Australian] health practitioner makes them a better practitioner across the board,’ he said.
 
‘Through improving Indigenous health we ultimately improve health for everyone.’
 
Meanwhile, a new national recommendation based on research from the Australian National University (ANU) launched this week could make a big difference in Aboriginal and Torres Strait Islander health outcomes.
 
The consensus statement, published in The Medical Journal of Australia and endorsed by the RACGP, recommends that Aboriginal and Torres Strait Islander people have their heart checked by a GP by the age of 18 at the latest, down from age 35. Young adults with type 2 diabetes and microalbuminuria, kidney disease, and very high blood pressure or high cholesterol will be identified as high-risk of cardiovascular disease (CVD).
 
While the rate of deaths from CVD among Aboriginal and Torres Strait Islander people has seen improvements in the last 20 years, it remains a leading cause of preventable morbidity and mortality. Three out of four Aboriginal and Torres Strait Islander adults under 35 have at least one CVD risk factor.
 
‘Just about every Aboriginal person I know has a family member or a community member who’s died young from a heart attack or stroke. We need to change that,’ ANU lead researcher Dr Jason Agostino said.
 
Associate Professor Peter O’Mara, Chair of RACGP Aboriginal and Torres Strait Islander Health, welcomed the new recommendation as a ‘positive step’ forward in improving early detection and treatment.
 
‘We cannot hope to close the gap without making evidence-based changes,’ he said.
 
‘The RACGP has over 40,000 members, including 10,000 members in … Aboriginal and Torres Strait Islander Health. While many GPs know about early screening, not all do.
 
‘These new recommendations will help spread awareness among GPs, improving access to early screening and quality care.’
 
Mr Briscoe shared the sentiment.
 
‘The earlier that we can look at addressing cardiovascular disease the better it will be for our people into the future,’ he said.
 
Given the increased incidence of pre-existing health conditions among Aboriginal and Torres Strait Islander people, all public events for Close the Gap Day have been cancelled due to the coronavirus pandemic. Supporters have been encouraged to hold online events instead.
 
‘I’d encourage all GPs and practices who aren’t signed up to the Close the Gap Campaign to access ANTaR’s website in order to put their pledge forward to closing the gap.’
 
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