Aboriginal people have access to health care that is timely, high quality, effective, culturally safe, considers local context, and is responsive to and commensurate with their needs.
When the NSW health system considers the contexts of family, culture, community and Country, it can be more responsive to the needs of Aboriginal people.
A responsive health system is one that embeds access to holistic, integrated, person- and family-centred healthcare, regardless of location.
Healthcare is holistic when it recognises and supports Aboriginal peoples’ indivisible connections to the mental, physical, cultural, social, environmental and spiritual health of their communities, and the effects of these domains on individual people’s and families’ wellbeing.
The multilateral nature of these connections–to body; mind and emotions; family and kinship; community; culture; Country; and spirit, spirituality and ancestors92 –is a core principle that underpins Aboriginal ways of knowing, being and doing. As the vision of this plan makes clear, it is essential for health systems to integrate Aboriginal knowledges and methodologies if they are to most effectively support Aboriginal peoples’ wellbeing.
Integrated pathways across different levels of health care–primary, secondary and tertiary–combined with effective care coordination represents whole-of-health system care and contributes to a holistic approach.
This is particularly important in supporting people to manage chronic conditions (which may require the involvement of multiple healthcare professionals from a range of disciplines across varying timeframes).
It is also critical in the context of healthcare organisations interfacing with service providers in other (related) sectors, such as social services or family support organisations working to prevent or mitigate issues which can have serious impacts on the management of existing health conditions and co-morbidities.
Delivering healthcare in ways that respond to people’s and families’ unique needs (instead of being driven exclusively by government systems and structures, which do not always align with how people experience healthcare needs in their daily lives) connects to the importance of Aboriginal peoples’ healthcare being person-centred. By empowering people as partners in planning and decision-making about health services, person-centred care directly contributes to changes in service delivery and improved health outcomes. For Aboriginal peoples, the right to self-determined care is a critical element of wellbeing–in and of itself it contributes positively to health literacy and a holistic approach.
The Australian Commission on Safety and Quality in Health Care describes health literacy as “how people understand information about health and health care, and how they apply that information to their lives, use it to make decisions and act on it”93. The health literacy of Aboriginal people and communities is therefore a critical facet of health promotion, prevention and early intervention. Lower health literacy is linked to lower levels of trust in health systems94, lower engagement with health services95, and lower patient involvement in shared decision-making96 for person-centred care.
Health literacy initiatives can strengthen Aboriginal peoples’ confidence in seeking healthcare, advocating for their rights and needs, and making healthcare decisions.
To ensure cultural safety and respect for Aboriginal knowledges, health literacy initiatives need to be inclusive, responsive to communities’ needs, and created in partnership with Aboriginal people and organisations.
Communication strategies developed in partnership with Aboriginal people, which prioritise sharing information in accessible and culturally appropriate ways, will enhance the health literacy of Aboriginal people and communities.
Health literacy initiatives are resourced commensurate with need, reflect priorities that are determined by Aboriginal people and are inclusive in their representation of and reach into priority population groups.
“Lack of health literacy can be a barrier to accessing health services. Health literacy can be lower amongst our mob, and some of us might not know the importance of health messaging or treatments. You won’t be put off receiving ongoing treatment when you understand what the doctor is saying.” Aboriginal NSW Health staff consultation participant
“Lack of health literacy can be a barrier to accessing health services. Health literacy can be lower amongst our mob, and some of us might not know the importance of health messaging or treatments. You won’t be put off receiving ongoing treatment when you understand what the doctor is saying.”
Holistic healthcare requires an integrated, whole-of-system approach by which Aboriginal people can access the full range of wellbeing supports they need, throughout their lifetimes, without the barriers created by organisational or sector silos. This will require comprehensive and collaborative efforts by all NSW health organisations across the cultural and social determinants of health to deliver a system that can be understood and navigated easily by Aboriginal people97.
“There’s all these services that are there, but there’s so many accessibility issues, whether it’s transport, travel, cost, cultural competency–and they’re sort of the barriers that are prohibiting people from even accessing care”. Youth (urban) consultation participant
“There’s all these services that are there, but there’s so many accessibility issues, whether it’s transport, travel, cost, cultural competency–and they’re sort of the barriers that are prohibiting people from even accessing care”.
Effective collaboration and partnership between ACCHOs, NSW Health services and private healthcare providers will be critical to ensuring healthcare is delivered in an integrated fashion that minimises silos and gaps. As noted in Priority reform area 2, ACCHSs are preferred by many Aboriginal people, but are not always easily accessible across NSW. In 2018-19, National Aboriginal and Torres Strait Islander Health Survey results indicated that around two-thirds (67 per cent) of Aboriginal people in NSW attended a mainstream primary healthcare service98, meaning LHDs and SHNs are also primary providers of care for many Aboriginal people. Accordingly, where an ACCHO is not available to an Aboriginal community, it will be important for mainstream primary care providers to build their capacity to deliver culturally safe and responsive care to Aboriginal people, potentially through partnerships with Aboriginal community governance structures and/or peak bodies across NSW.
Aboriginal people experience well-coordinated health care journeys, with smooth transitions within, and continuity of care between primary, secondary and tertiary health journeys.
Person-centred care refers to care that is tailored to a person according to their own needs and priorities. This includes accounting for differing health literacy, language, living/lived experience, cultural background, sexual and gender identification, age, and ability. The development of trust, relationships, and clear and responsive communication is vital for determining person-centred and family-centred care pathways.
“Health navigators are vital to help people navigate through the health system and out into the social care system, whether that’s helping support to get to GP’s, look at peer support workers that work in the mental health space, those with lived experiences, you know. That’s who people can resonate and associate with and they’re on the same level”. Health staff (regional) consultation participant
“Health navigators are vital to help people navigate through the health system and out into the social care system, whether that’s helping support to get to GP’s, look at peer support workers that work in the mental health space, those with lived experiences, you know. That’s who people can resonate and associate with and they’re on the same level”.
Easy access to culturally safe, place-based and person-centred health care for Aboriginal people is standard practice across primary, secondary and tertiary health care settings in NSW.