be best addressed if health systems and providers simply focus on ‘the gap’. This ignores the many factors that underpin the burden of poor Aboriginal health. These factors include the burden and the nature and scope of dispossession, the contamination of cultures and government sanctioned attempts of genocide, entrenched poverty, racism and the ongoing denial of the fundamental and unique rights and freedoms of Aboriginal peoples in Australia. Clearly the current strategy is not working, suggesting that a new policy approach should be adopted. Such an approach should be designed to develop effective and empowering negotiated partnerships with Aboriginal people, particularly at the local community level. Incorporated into any new policy approach should be targets for truth telling and social and restorative justice. Increasingly research is telling us something that Aboriginal peoples have always known: it is only when Aboriginal people are in control of their own lives do we witness a real shift in the socio-political circumstances, including health, that defines the life journey of most Aboriginal people. Currently in Australia there are three sites where research is being conducted that is exploring what a new model of community governance might look like. These communities are the Gunditjmara people in Victoria, the Ngarrindjeri nation in South Australia and groups and individuals from the Wiradjuri nation in NSW. The Australian research is based on the Harvard Project wherein researchers work in partnership with First Nation communities in the USA to explore new models of Indigenous governance and economic development. The research from that project tells us that: Sovereignty matters When Aboriginal nations make their own decisions about what development approaches to take, they consistently out-perform external decision makers on matters as diverse as governmental form, natural resource management, economic development, health care, and social
service provision. Institutions matter - For development to take hold, capable institutions of governance must back the assertions of sovereignty. Nations do this as they adopt stable decision-making rules, establish fair and independent mechanisms for dispute resolution, and separate politics from dayto-day business and program management. Culture matters Successful economies stand on the shoulders of legitimate, culturally grounded institutions of self-government. Indigenous societies are diverse; each nation must equip itself with a governing structure, economic system, policies, and procedures that fit its own contemporary culture. Leadership matters - Nation building requires leaders who introduce new knowledge and experiences, challenge assumptions, and propose change. Such leaders, whether elected, community, or spiritual, convince people that things can be different and inspire them to take action. The research emanating from the Harvard Project indicates that there is an obvious and urgent need to shift paradigms if real and sustainable traction and meaningful outcomes are to be achieved in Aboriginal health, poor education experiences and learning outcomes, disproportionate incarceration rates, poverty and spiritual fatigue. If long overdue and sustainable change is to occur it will require the design and adoption of a new model of engagement,
one that empowers local communities so that Aboriginal people are in greater control of their lives and how best to address their needs and aspirations. Health systems in NSW, and equivalent bodies in other health jurisdictions, must work with local Aboriginal communities to negotiate an Aboriginal Health and Wellness Accord, which is underpinned by a set of clearly defined and community endorsed principles and strategies that are designed to, implement, monitor and continuously evaluate progress against agreed local Aboriginal health and other social justice targets. There is no ‘one size fits all’ solution to address the long-denied rights and freedoms of Aboriginal people, including health inequality and the right to live free of poverty, racism and discrimination, and with dignity. Even in the face of brutal indifference and pathological racism, not to mention the intransigence that defines the political and societal treatment of our uniqueness as the First Australians, Aboriginal people have survived. Change and transformation in the health status of Aboriginal people requires a shift in policy and programming and in the hearts of power. A shift that creates empowering involvement of Aboriginal peoples through negotiated partnerships between health and other service providers and members of Aboriginal communities.
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