Improving health outcomes for First Australians

Bronwyn Clark, Chief Executive Officer

Earlier this year I gave a presentation at the Monash Pharmacy Education Symposium in the wonderful town of Prato in Italy to talk about improving Indigenous health. While I was cognisant of the ancient history that surrounded me there, the history was put into perspective given that of our Indigenous population that dates back 60,000 years.

Aboriginal peoples of Australia are the oldest surviving culture in the world. They had established ways of managing their land and society that were sustainable and ensured good health. Studies also show that there were about 250 Aboriginal language, tribal or nation groups languages in Australia at the time Europeans arrived, and an estimated 750,000-plus Aboriginal people.

By way of background, I’m a ‘Kiwi’ and so my connections with Indigenous culture and health also stem from my New Zealand heritage and experience as a practising pharmacist in New Zealand. In fact, the gaps in health outcomes is not dissimilar in New Zealand with Māori peoples.

Today, I’m in the privileged position of leading the Australian Pharmacy Council which sets the standards for pharmacy training and education and is the independent accreditation authority for pharmacy.

On that basis, I ensure we set our standards according to the International Pharmaceutical Federation (2014) framework of need-based pharmacy education, pictured here.

At APC, this cycle underpins all that we do. Our role is to ensure that the public is protected by safe and accountable pharmacists, but it is more than public safety – more than do no harm.

Our work has to also be socially accountable - that is to do good as well.

This means we need to aware of the needs of our local communities, and that includes all peoples including those who are the first peoples – the Aboriginal and Torres Strait Islander peoples.

Since colonisation, Aboriginal and Torres Strait Islander populations began to dwindle and disturbingly their health declined dramatically.

Since this time, Aboriginal and Torres Strait Islander peoples have experienced significant inequities in health outcomes due to a range of factors, and importantly their inability to access appropriate, culturally safe services.

Currently Aboriginal men live 10.6 years less than other Australians, for women it’s 9.5 years fewer.

More equitable health outcomes may be achieved by a number of strategies, including:

• increasing participation of Indigenous peoples in the workforce
• designing healthcare services by Indigenous peoples for Indigenous peoples
• supporting the current workforce to provide culturally safe health care

As outlined in the Commonwealth Government Aboriginal and Torres Strait Islander Health Curriculum Framework, the concept of cultural safety in health service delivery focuses on the subjective experience of the health service user, whereby they experience an environment that does not challenge, assault or deny their cultural identity.

For building capacity though, Aboriginal and Torres Strait Islander people remain significantly under-represented in the registered health practitioner workforce.

Despite around 3% of the Australian population being indigenous, current data indicates only 0.07% of registered health practitioners identify as ‘Australian-born Indigenous’.

For pharmacists it is even less with just 73 people self-identifying as “Australian-born Indigenous” on the pharmacist register, which is only 0.02% of pharmacists.

These numbers speak volumes.

Therefore, our best strategy is to ensure that all current pharmacy graduates are culturally competent, while we attempt to further build our workforce.

Contrary to opinion, the majority of indigenous peoples live in urban areas.

So our responsibility is that pharmacists, wherever they work, must:

• be aware of the impact of their own culture and cultural values on the delivery of services, historically and at present, and
• have knowledge of, respect for and sensitivity towards the cultural needs of Aboriginal and Torres Strait Islander people

And as the standard-setting and accreditation body, the APC has an important role to play to steer improvements to make a difference. We plan to do this through a six-strand strategy by:

• committing to a Statement of Intent to improve Indigenous health across the National Scheme. (This Statement was signed on 5 July 2018 by all parties developed in close partnership with Aboriginal and Torres Strait Islander organisations and experts)
• collaborating with our accreditation colleagues across the health professions
• researching the current state of play of health profession education re: Indigenous curricula and cultural safety
• setting Standards for education providers and supporting them to achieve them
• training our people in cultural safety and Indigenous history
• leading and educating our profession, through conferences and events

And, all of this will be informed through an Indigenous lens, that is, through our Indigenous-led Expert Advisory Group.

The aim is to:

• achieve increased participation by Aboriginal and Torres Strait Islander people in the registered health workforce
• provide a culturally safe health workforce supported by nationally consistent standards, codes and guidelines across all professions
• achieve greater access for Aboriginal and Torres Strait Islander Peoples to culturally safe services from all health professionals

Further to our work, the APC is well positioned on the Health Professions Accreditation Collaborative Forum of which I am chair of this 15-member group of regulated health professions in Australia, to share in this Indigenous health journey.

The Forum:

• supports the development of cross-profession standards to ensure all graduates are able to deliver culturally safe care;
• supports members to assess programs against standards, and
• undertakes research into the role that accreditation can play in improving Indigenous health outcomes

In this work we have been very much assisted by professions that are further down the track than others. For example, the Australian Medical Council has included standards with an explicit focus on an Aboriginal and Torres Strait Islander health curriculum that includes the study of the histories, cultures and health of Aboriginal and Torres Strait Islander peoples since 2007.

This focus on histories, cultures and the health of Aboriginal and Torres Strait Islander peoples now underpins much of the Forum’s research.

Our research within the HPAC Forum has been focused on two strands:

• to better understand the role that accreditation plays in improving indigenous health outcomes
• producing a culturally safe workforce

One is about identifying the decision-makers within our own organisations and their understanding and identification of Indigenous issues that can facilitate accreditors to make meaningful decisions.

The other is a thematic review of the current education programs in Australia.

In the space of a mere 200+ years, this colonised nation has a lot to answer for when it comes to Aboriginal and Torres Strait Islander health. From this point forward, we must reverse this, and we can and should reverse this in a short timeframe. I fear though, that time is not on our side. Each of us needs to conscientiously advocate and push for better health outcomes for Aboriginal and Torres Strait Islander peoples, and it takes each and every organisation such as the APC, to set the standards and expectations of its members, pharmacists and colleagues to believe in and appreciate what this means to take the action and to make the change.

I’m convinced we can deliver culturally safe care and I’m hopeful we can significantly improve Aboriginal and Torres Strait Islander health outcomes into the future. But I implore pharmacists and our future pharmacists to acknowledge and commit to making this change.

This presentation was given at the Monash Pharmacy Education Symposium, July 2019, Prato, Italy

About us

The Australian Pharmacy Council Ltd (APC) is the independent accreditation authority and standard-setting body for pharmacy education and training. We play a key role in protecting the public safety by ensuring high standards of pharmacy education.

We work within the National Registration and Accreditation Scheme in partnership with the Pharmacy Board of Australia. We also deliver accreditation services to the Pharmacy Council of New Zealand.