Aboriginal community health’s success with Covid-19
As early as January, the Apunipima Cape York Health Council, which delivers primary health to 11 Cape York communities, began assembling the weaponry to safeguard their people against an as yet undeclared pandemic.
“At first it looked like a severe flu,” the council’s Dr Mark Wenitong told The Saturday Paper. “And then when the epidemiology started coming out of China on the amount of deaths, and particularly the risk factors – age and chronic disease – that’s when we started worrying. And by the time Australia got its first case, we had started doing public health messages. We just needed to react quickly … honestly, it took two weeks for public health to catch up.”
Part of the reason was that Aboriginal communities had more experience than others in dealing with the threat of viruses – from the H1N1 swine flu pandemic in 2009, during which Aboriginal people made up 11 per cent of cases in Australia, to the threat of Zika in the tropical north.
So, this year, across the country, Aboriginal community-controlled health services sprang into action, swapping public messaging and material, and working together to inform their own mob in a time when confusion was spreading nearly as fast as the virus.
The Northern Land Council (NLC) translated messages into 18 different languages for the Top End and posted them as videos across social media. Apunipima received advice from as far away as Canada, with First Nations contacts sending templates of their communities’ pandemic plans.
The threat grew, and with it, debates about toilet paper deserts and rugby league games. Communities, meanwhile, quietly began closing borders: first the Anangu Pitjantjatjara Yankunytjatjara Lands in remote South Australia, and then in Cape York and parts of Western Australia. Many of them did so without any word from the government. They said no to outsiders, exercising sovereignty that had never been ceded. The NLC suspended all existing non-essential permits to Aboriginal lands.
But later, at the end of March, when the federal government announced travel restrictions to remote communities under the Biosecurity Act, the crucial roles of Aboriginal health services, land councils, experts and communities themselves were largely lost in the coverage.
“I can almost assure you that, at least for remote, there was no one waiting to be saved,” Wenitong says. “This was the most proactive response I had seen from our mob.” Mayors and communities in his own region, he said, had “utilised the public health evidence base better than any level of government in Australia”.
Professor James Ward, a leading Indigenous public health expert based at the University of Queensland’s Poche Centre for Indigenous Health, says the Aboriginal community-controlled health sector had been “incredible”.
In early February, he was among those to call for a national Aboriginal advisory taskforce to respond to Covid-19. “This was too much for one person; we needed a national advisory group,” he told The Saturday Paper.
By the first week of March, the taskforce – comprising the National Aboriginal Community Controlled Health Organisation (NACCHO), public health clinicians and Aboriginal health services, among others – had begun advocating, meeting at least twice a week.
“It’s been quite different to a lot of other approaches,” Ward says, “because in Aboriginal health it’s been a very united voice.
“I feel like it’s really been self-determination in practice. People knew the risks. They decided what they had to do. And they did it.”
There is a common narrative about Indigenous health, based on dysfunction and vulnerability, in which Aboriginal people themselves are blamed through the mantra of individual choices. There is little room to focus on strength and agency when you are simply a “problem” to be solved, a “gap” to be filled.
The Aboriginal health sector’s response to Covid-19 has flipped that on its head.
“There are fundamental flaws with public health within this country. Let’s not kid ourselves that we are all on an even playing field,” Indigenous epidemiologist Dr Lisa Whop told The Saturday Paper. “But Australia never owns its failures. If you think of the increased risks we face from Covid-19, it is never about the fundamental failure of government to address the issues that put us at an increased risk – such as overcrowding and poor housing.
“How do you socially distance in an overcrowded house?”
If Covid-19 were to get into communities, there would be limited chances for Aboriginal people to self-isolate within their own homes or practise the hygiene expected in order to slow a virus outbreak.
Public housing is also often poorly designed for Aboriginal cultural contexts and not properly maintained by authorities. A 2016 survey by researchers at the University of Sydney found that the majority of remote houses surveyed did not have working showers or appropriate kitchen areas, or were electrically unsafe.
But even in the face of government neglect and poor Indigenous policy, the Aboriginal community-controlled health sector has known the solutions – largely because these are their own communities, their own people.
“It is up to the labour of black people to protect mob every day – pandemic or not,” Whop says. “The fact of the pandemic is not only about having to ensure the right services, the right PPE [personal protective equipment], the right testing – we also have to be able to address those complicated factors around housing, sanitation and the higher and more complex comorbidity profiles for much younger mob.”
“The reason the community-controlled health sector is doing so well in responding to Covid-19 is because we know our patients and we know our community,” says Angela Young, general manager of the Queensland Aboriginal and Islander Health Council (QAIHC), the peak body for 28 community-controlled health services in the state.
“Our members are aware of the social determinants of health impacting on our families. They know the living situations of their patients – who lives in an overcrowded home, who has caring responsibilities, who might be at risk of family violence.”
But while QAIHC’s member services have been quickly responding to the needs of their communities in relation to Covid-19, they have not been funded to do so. While the federal government has allocated $15 million to Aboriginal community-controlled health organisations for Covid-19 responses, the funding is stretched thin. Young says organisations in Queensland are already eating into their budgets.
“This is an incredibly under-resourced sector,” she says. “We know that by increasing community support during this time, the majority of our member services have consumed a good portion of revenue they have generated over the past few years.”
It’s a situation that frustrates NACCHO’s chief executive, Pat Turner, who says the critical importance of the Aboriginal community-controlled health sector has only been highlighted by the Covid-19 crisis.
Despite a funding injection of $90 million into the sector by the Morrison government late last year – reallocated from other areas of the black health budget – the sector remains chronically underfunded.
“We’ve been right out there for months,” Turner told The Saturday Paper. “Better prepared than the state health systems. And we’ve done it on the smell of an oily rag.”
Aboriginal community-controlled healthcare is about looking at the person “as a whole, not as body parts”, she says, but is not funded on a needs-based model.
“We have had constant lobbying for needs-based funding,” Turner says. “Constant leadership to get the government to understand how underfunded we are. If you’ve got a population with two to three times the burden of disease, then we should be funded two to three times more for the work we do.”
For now, despite the strength of the black community response, the threat is still ever-present. Restrictions remain in place in remote communities, and there are emerging concerns about food security, particularly in remote Northern Territory, with reports of families taking backroads to regional centres to get supplies.
Communities across the nation have developed their own local action plans to prepare for a potential outbreak but the complicated problem of fly-in, fly-out health workers and the 14-day quarantine period remains.
Health organisations are still waiting on vital PPE, while world-first rapid testing machines – some of which are already in communities to test for sexually transmitted infections – are being equipped with cartridges to test and provide results for Covid-19 within an hour.
For Pat Turner, the idea of lifting the restrictions in the cities still poses a severe threat to Aboriginal communities: “They can’t expect to lift restrictions in the cities and then allow people to come back into the country without measures to prevent it from spreading to [Aboriginal] communities.”
For the Aboriginal community-controlled health sector, the continuing threat is a matter of protecting not only community but also sovereignty – the right for Aboriginal people to have a say about their own lives and Country.
“Last week the prime minister was using the term ‘sovereignty’ and ‘protecting sovereignty’,” Whop says. “And I thought, ‘Someone needs to remind him – sovereignty was never ceded in this country.’ We’ve been fighting infectious diseases since the first ships arrived. If anyone is going to know how to care for our mob during a pandemic response, it’s going to be us. That’s our lives on the daily.”
This article was first published in the print edition of The Saturday Paper on Apr 25, 2020 as "Community quest".
A free press is one you pay for. In the short term, the economic fallout from coronavirus has taken about a third of our revenue. We will survive this crisis, but we need the support of readers. Now is the time to subscribe.