Australia Communities and society , Covid-19

Covid-19: Vulnerability of Indigenous Australians not a new phenomenon

Summary

This briefing looks at how Aboriginal community-controlled organisations and governments responded quickly and decisively to protect Aboriginal and Torres Strait Islander communities from COVID-19, and considers immediate and longer-term implications for remote communities.

Briefing in full

In late March and early April, Australia’s National Cabinet rapidly introduced new levels of restrictions on our daily lives in order to bring the COVID-19 pandemic under control. At the time of writing, Australia has ‘bent the curve’ on new infections, and some state governments are relaxing some of the lock-down measures in order to revive their economies.

However, as Dr Bill Fogarty from the ANU states: ‘There is a palpable fear that COVID-19 will devastate Aboriginal populations in remote communities in Northern Australia’. Dr Fogarty maintains that the Aboriginal and Torres Strait Islander population of northern Australia are ‘highly vulnerable as a result of systemic and long-term neglect. Sadly, overcrowding, high rates of chronic disease, comorbidity, poor water security, high rates of unemployment, substance abuse and mental health issues are well established realities of the socioeconomic condition in remote communities.’ (Fogarty, 2020:21).

The threat of infectious diseases to the Aboriginal and Torres Strait Islander peoples of Australia is not a new phenomenon. They have had to contend with infectious diseases introduced from overseas to which they have no immunity ever since the arrival of the first fleet in 1788. Historically, epidemics of various diseases (e.g. smallpox, venereal disease, colds, flu, tuberculosis and measles) have wrought widespread misery and death on many Indigenous peoples across the country. As June Oscar, the Aboriginal and Torres Strait islander Social Justice Commissioner notes, Australia’s inability to close the health gap between Indigenous and non-Indigenous Australians means our Indigenous peoples are more susceptible to the severe impacts from COVID-19. They know from first-hand experience what infectious diseases can do to a community, and do not underestimate the very real threat to the loss of law and custom.

Indigenous communities acted swiftly

Many Aboriginal and Torres Strait Islander community health organisations foresaw the threat posed by coronavirus and acted swiftly.

The Aboriginal Medical Services in the NT and the Kimberley Aboriginal Medical Services have collated several resources on their website with links to external sites – for members, for community, for clinicians and for health professionals and the health workforce relating to COVID-19 – and they are continuing to update the resources as more information becomes available.

Covid-19: Vulnerability of Indigenous Australians not a new phenomenon

Source: Aboriginal Medical Services Alliance Northern Territory, CC BY

The Northern and Central Land Councils provided outstanding leadership and culturally appropriate information in the form of posters and a series of videos in 18 languages. The Northern Territory Government also produced YouTube videos in many different Aboriginal languages.

Travel restrictions to remote communities

By early March 2020 many of the Aboriginal Land Councils across Australia had stopped issuing non-essential permits, and revoked all existing non-essential permits for access to remote communities.

On 19 March 2020, the Combined Aboriginal Organisations of Alice Springs called for a special control area for the Northern Territory so they could apply the same travel restrictions that apply to international visitors domestically, to visitors to the Northern Territory from any Australian jurisdiction in order to control the exponential spread of COVID-19 into Aboriginal communities.

On 24 March, the Mapoon Aboriginal Shire in Queensland implemented its own travel ban before the Australian Government enacted its international travel ban on 25 March. The Council website states that the ban will stay in place until further notice.

By early April, the Queensland, Western Australian, South Australian and Northern Territory Governments had imposed strict travel restrictions on movement into and out of remote Aboriginal communities.

The travel restrictions are a ‘double-edged sword’ in some respects. They were introduced to prevent the spread of the virus into remote communities, but at the same time they have become a restriction on people’s movements for essential services and cultural obligations. Various Land Councils in the Northern Territory (NT) are now calling for some of the travel restrictions to be eased, provided that NT border restrictions remain in place.

National Management Plan for Indigenous Australians

In early March 2020, the Australian Government convened the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 to develop and deliver a National Management Plan to protect vulnerable communities. The taskforce is co-chaired by the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Department of Health, and includes leaders from NACCHO and their affiliates, Aboriginal Health Services, state and territory public health representatives, the Australian Indigenous Doctors Association and the National Indigenous Australian’s Agency (NIAA), as well as Public Health Medical Officers (PHMOs) and communicable disease experts.

In late March, the taskforce released a National Management Plan for Aboriginal and Torres Strait Islander Populations which adopts COVID-19 responses already underway elsewhere in Australia, but with specific operational guidance tailored for Aboriginal and Torres Strait Islander communities. The National Management Plan includes four phases:

  • Phase 1 – Preparedness: engaging with stakeholders to ensure culturally safe and consistent advice for Aboriginal and Torres Strait Islander peoples by developing the guiding principles, context, key issues and targeted action for planning, response and management for COVID–19.
  • Phase 2 – Suspected or initial cases: Building on the preparedness phase, the taskforce has developed advice on a range of actions to prevent sustained community transmission.
  • Phase 3 – Outbreak situations: Delivering an effective response to outbreaks in communities will require an increased response, including the potential deployment of mobile respiratory clinics.
  • Phase 4 – Stand-down and evaluation: When the threat of COVID-19 has reduced and risk to communities is lowered, the Australian Government will support communities in their recovery. Lessons learned from this pandemic will be incorporated into future National Pandemic Planning.

The National Management Plan was endorsed by the Australian Health Protection Principal Committee (AHPPC) on 27 March and came into effect on 31 March 2020.

The National Management Plan operates on four principles:

  1. Shared decision making between Government and Aboriginal and Torres Strait Islander people.
  2. Aboriginal and Torres Strait Islander community-controlled sectors are supported and resourced to deliver culturally appropriate services and programs.
  3. Cultural safety across whole-of-population systems and equity constitute the underlying determinant of health care delivery during this pandemic.
  4. Data and evidence-based responses on the best possible information and data inclusive of Aboriginal and Torres Strait Islander knowledges.

Long term effects

The reality is that Indigenous Australians are (and will continue to be) affected by COVID-19 in ways that differ from those effects presenting on other Australians, principally because they are already inflicted with deep-seated health, social and economic inequities when compared to the broader Australian demographic.

The Centre for Aboriginal Economic Policy Research (CAEPR) at the Australian National University has released a Topical Issue paper, comprising nine short papers by experienced researchers that identify a range of public policy issues arising from the COVID-19 crisis, and that have a particular bearing on the Aboriginal and Torres Strait Islander peoples of Australia. The contributors focus on employment impacts, social security reforms, Indigenous governance, violence against women, the Indigenous health workforce, school closures, energy security in remote communities, and a proposal for an Indigenous reconstruction agency. The various authors draw the following conclusions:

  • Despite being at the frontline of job losses, retrenched Indigenous workers will struggle to re-enter the workforce once the crisis is over and will likely be the last to return to employment during the economic recovery phase (Dr Yonatan Dinku).
  • Concerning income, Indigenous Australia has already experienced a sharp budgetary contraction since 2014-15, with remote and very remote areas being particularly hard hit. In the longer term there is a need for an income safety net for those unable to find secure employment, one that does not relegate social security recipients into deep structural poverty (Dr Francis Markham).
  • The current crisis shows in stark terms that Indigenous peoples are able to act swiftly, effectively and appropriately to such a crisis, despite the fact that the same Indigenous organisations have borne the brunt of repeated funding cuts by recent governments, and have been subjected to a rollercoaster of short-termism in government policymaking and program implementation (Dr Diane Smith).
  • Although all women are at greater risk of experiencing violence in times of crisis, Indigenous women in remote communities are at especial risk. Two levels of response are required to acknowledge and alleviate heightened danger at this time: support for consciousness-raising at a community level, and safety planning at an individual level (Chay Brown).
  • Indigenous health staff play an instrumental role in delivering better health outcomes for Indigenous patients. Factors crucial to responding adequately include developing respectful partnerships, providing culturally safe forms of care and culturally relevant information at the local level, all of which are unique to the capacity of the Aboriginal and Torres Strait Islander health workforce (Dr Julie Lahn).
  • School closures in Indigenous communities are particularly problematic as they leave students at a loose end in communities already dealing with a raft of social issues. Many children in communities are cared for by Elders who are the most vulnerable to COVID-19, and social practices mean children have far greater autonomy in their day-to-day lives than in other parts of the country. Many children and families also depend upon school nutrition programs just to meet basic food needs (Dr Bill Fogarty).
  • In many communities, structural factors (such as inadequate and poor-quality housing, fixed high energy use appliances, overcrowded and under-serviced households, and high levels of residential mobility) will present immediate challenges to residents, communities, service providers and policy makers over the coming months. The current crisis provides an opportunity to think deeply about the need for resilient and well-resourced remote communities supported by robust, reliable, affordable and culturally appropriate essential services and housing (Brad Riley).
  • Given the certain and significant but presently unquantifiable social, economic, health and cultural costs of the crisis, the Australian Government should initiate action immediately to begin the process of addressing the primary needs of Indigenous peoples and communities, particularly where mainstream services and programs are not able to meet their needs. Recovery should focus on strengthening the social determinants of health and building economic resilience – policy issues on which governments and policymakers have failed to deliver for First Nations citizens over the past four decades (Michael Dillon).

Federalisms shortcomings

As Tony Dreise, the Director of CAEPR concludes, the collection of papers is ‘more than just the sum of its parts’ and they ‘confirm that the stakes for First Nations people could not be higher’ (Dreise 2020:1) as the pandemic ‘risks exacerbating deep-seated health, social and economic inequalities between First Nations people and other Australians.’ While the Aboriginal and Torres Strait Islander community health sector was able to move quickly, the pandemic has also revealed the shortcomings of Australia’s federalism and the nation-to-nation governance gap between Indigenous peoples and Australian governments that is difficult to ignore (Dreise 2020:1).

Dreise also maintains that the disruption caused by the pandemic crisis opens up new opportunities for public policy change, a time for ‘informed policy bravery’ to ‘create new foundations for a better future’ as ‘old articles of faith’ have had to be ‘quickly discarded’ (Dreise 2020:1).

Roadmap to Recovery for Indigenous Australians

In April the Group of Eight (Go8) universities convened a group of over a hundred of the country’s leading experts across a cross section of disciplines to chart a Roadmap to Recovery. The Roadmap was not commissioned by Government, but devised instead by leading Australian researchers based on the latest evidence available in less than three weeks.

The chapter dealing with Indigenous Australians includes four recommendations:

  • The right to self-determination to keep Indigenous communities safe, recognition of cultural practices and the need for efficient pandemic responses must be respected, along with the continued financial and logistical support of Indigenous COVID-19 planning force and taskforces in all jurisdictions for the remainder of the pandemic.
  • An immediate supply of alternative housing to alleviate the pressure on over-crowded households, and to enable effective disease suppression. In the medium term, an urgent supply of permanent housing infrastructure and sustainable supply of utilities is required to ensure that future outbreaks are containable.
  • The existing Aboriginal and Torres Strait Islander Health Advisory Group should be maintained until Australia has fully recovered from COVID-19. Particular effort will be required to ensure adequate monitoring of COVID-19 cases: timely, accurate and accessible information must be communicated regularly to the Indigenous public. Indigenous-led research based on scholarly and culturally ethical practices into the effects of COVID-19 on community social and emotional wellbeing and mental health to evaluate how Aboriginal and Torres Strait Islander peoples have fared through COVID-19 will provide important learnings for future pandemics and crises.
  • A review of the Aboriginal and Torres Strait Islander health workforce to ascertain how best to increase and retain Aboriginal health practitioners, how to scale up Aboriginal public health and infectious disease expertise, and the need for surge workforces should outbreaks occur in communities.

It will be interesting to see how governments at all levels respond to these recommendations.

Comment

Swift action by many Aboriginal community-controlled organisations and governments has ensured that many remote Aboriginal communities have been able to avoid the initial impact of the virus. The quick mobilisation of thousands of Aboriginal people back to their communities and homelands out of harm’s way has been hailed by June Oscar, the Aboriginal and Torres Strait Islander Social Justice Commissioner, as a ‘huge peacetime effort’. As June Oscar also notes, the irony of returning to Country is not lost on the Aboriginal people. For the past two decades the prevailing policy position was to under invest in homelands and remote communities in the belief that Aboriginal people would be better off living in urban areas. The return to remote communities has highlighted the massive level of systematic underinvestment in critical infrastructure in the Indigenous way of life.

As the rest of Australia starts to lift some of the restrictions to revive the national economy, caution will need to be exercised in lifting travel restrictions into and out of remote Aboriginal and Torres Strait Islander communities, as the risks of COVID-19 are far from over. Despite this, there are some important lessons we can learn from ongoing efforts to curb the contagion –  especially what ultimate success ought to look like. Most importantly, trusted community leadership and culturally-appropriate messaging are essential, as well as swift government support at all levels, federal state/territory and local.

While this briefing has focussed on remote communities, we should not forget that all Aboriginal and Torres Strait Islander peoples are at greater risk, including those that live in our major urban centres.

For more information on this briefing contact LGiU Australia by emailing mzierke@sgsep.com.au