By Jane Garcia

You not only have to know the past to understand the present, but you should recognise its effect and potential when dealing with Aboriginal health, according to a Curtin University of Technology expert.

“If I get hit by a truck tomorrow, there is virtually nothing that the emergency department of Royal Darwin Hospital needs to do to take into account my culture to do their job,” says Shane Houston, assistant secretary of the Office of Aboriginal Health in the Northern Territory.

“They get in there and they do what they have to do to keep me alive. But if I’m a woman going in to have a baby or if I’m an old person going in for palliative care or respite care, there are some fairly significant cultural issues that need to be addressed. We need to build them into the logic tree of treatment and service provision so we don’t rely on people’s attitudes but we skill people to behave in the right manner.”

Dr Houston has been involved in Aboriginal affairs for more than 30 years and recently was appointed Adjunct Professor in Health Sciences at the Curtin University of Technology.

In 2004 his doctoral thesis attracted attention for proposing a radical rethinking of Aboriginal health policy. He said current and future Aboriginal health policy should acknowledge the major influence the past has on the current experiences of Aboriginal people, including the importance of being able to live the Aboriginal way and recognising that they exist as a collective whole.

“In Aboriginal communities not only have I got my own personal life experiences to help guide me but in many respects I’ve taken on the life experiences of my Aboriginal family in my community and in my extended Aboriginal family,” Dr Houston says.

“My approach to certain services and facilities offered by government is an aggregate of the experiences of Aboriginal people, sometimes over generations.

“A good example of that is a lot of Aboriginal people think hospitals are the place you go to die. Aboriginal people are very suspicious of welfare because of over the generations they took our kids.

“We have had these experiences passed down to us … and to simply ignore them is folly. We’re dealing with human beings and we have to find a way of taking these things into account when we design and develop services, strategy and policy.”

His thesis provided an applied policy example of how acknowledging the past could be built into a formula for allocating health care resources across Aboriginal communities.

“I asked, ‘what would resource allocation look like if it took into account all of the things that Aboriginal people valued?’ and I constructed a formula that did that,” Dr Houston says.

“It also took into account the reality in Aboriginal communities around the functioning of Aboriginal communities and families and said if you have a community that is struggling it is harder to achieve objectives there than it is in communities that are doing better.

“What has been interesting is it not only has helped form the basis of the work that we are doing here in the territory but we’ve been working with the South African National Government on how they might reorganise resource allocation based on the approach I’ve outlined.”

Call to action
Dr Houston acknowledges that there have been some significant gains in the approach to Aboriginal health in his lifetime. There have been improvements in life expectancy of Aboriginal people, and improvements in birth rates and infant mortality rates as a result of efforts to promote equity and make sure Aboriginal people get their fair share of resources, he says.

But there are still areas Dr Houston suggests need improvement, including new delivery models to facilitate access to critical services in remote areas and how to combine Aboriginal people’s values and priorities into how health services are structured.

Aboriginal people comprise about three per cent of the Australian population, but in the Northern Territory they comprise 30 per cent of the population and are the majority of business for the Department of Health, he says.

“We form the majority of the service population of services offered by this department… so the challenges that we’ve got is how do we explicitly talk about Aboriginal issues in systems that are really structured and geared not to do so,” Dr Houston says.

“I don’t think we should be ashamed to be talking about explicitly Aboriginal people or Aboriginal communities and how we make sure our decisions take into account their needs in an equitable manner.”

“We’ve got to deal with the structural barriers that exist in the health system and in the systems of government. We’ve got to think more carefully about why culture is important to service delivery.

“Culture and your views and your values shape your attitude towards what is health and what is not health, when you decide to seek health care, your attitude towards the care you’ve been provided and towards compliance with the instructions you’ve been given. It’s fundamentally important but we don’t take culture into account enough.”

He says cultural awareness programs have been run across Australia for years but statistics suggest Aboriginal people continue to be dissatisfied with the way in which systems approach our culture. Dr Houston says the time has come for a new approach addressing how to build culture into the knowledge tree of service provision.

“When I get asked as an Aboriginal bloke about people’s attitude towards culture, I say ‘I don’t care whether people like me or hate me, what I care about is how they behave’,” he says.

“I would like them to behave in a way that is mindful and respectful of my culture. And in services provided by the public purse, we should be able to make that so.”