Governance issues: How to strengthen Aboriginal and Torres Strait Islander voices in healthcare

Thursday, March 24, 2016

There are some invisible forces serving to wedge open the gaps in disadvantage between Aboriginal and non-Aboriginal people. My study aims to shed light on those forces and bring them into our vision as we tumble over in the endless political paddle-wheel of policies, strategies and plans that set the public health workforce off into another tide of health promotion interventions. I propose that the very way that paddlewheel is designed, operated and steered has a substantial bearing on the forces for change in the Australian health care system.

I am referring to governance, which is a rather invisible and intangible concept, the most obvious form of which is a committee. Although Aboriginal people sit on many project advisory committees often, the ideas in the policies that come out of Cabinet bear little resemblance to that advice, so Aboriginal people ask, “where is my voice?” And that is difficult to answer.

In my 2004 research on mapping committees and tracking Aboriginal voice, it became quite evident that the Aboriginal specific committees were few in number as well as being mostly on the fringes of the committee network. You can count the number of steps between each committee and is it then any wonder why Aboriginal voice is lost in all the advice flowing to Cabinet?

The methodology of mapping committees is central to my current research project Aboriginal Voice Integration and Diffusion in Public Health Collaboratives (the AVID Study which can be found with relevant diagrams at www.avidstudy.com). The AVID study focuses on the policy principle of ‘integration’ which is ‘There should be collaboration between and within Governments at all levels and their agencies to effectively coordinate programs and services’.2 I wanted to know of integration: how to ‘do’ it, what does it ‘look’ like, who should be involved in it, and what are its key performance indicators?

Committee analysis is one way to investigate ‘integration’. The committees are linked together through their terms of reference where one committee ‘reports to’ the next committee. So visualised in this way it is a giant knowledge diffusion network. I make the challenge that there should be a way to ‘see’ Aboriginal voice in terms of where Aboriginal people are structurally located on committees.

But visualisations are only one aspect of a study which seeks to uncover the multidimensional notion of voice. This complexity is necessary because the notion of ‘voice’ is reflected through people, sound, and words. Eventually, when the committees are mapped, surveys are conducted, interviews transcribed, and literature analysed, I will be able to give you sense of how committee processes may affect the uptake of Aboriginal voices into transmitting cultural values throughout this knowledge diffusion network.

If one is concerned with how Aboriginal peoples’ voices travels into and throughout these committee processes, then it is necessary to determine the structure of the governance process — much like a road map shows the connections between towns, I simply want to see how committees are connected. In so doing, then it is possible to get a bearing on how to improve Aboriginal voice integration throughout governance processes.

Therefore, if the structure of knowledge diffusion networks can be altered to allow more efficient knowledge flows, then the invisible forces that empower the ‘paddle wheel’ can be more inclusive of Aboriginal cultural values. But it must start with detailed, empirical methodology to develop an evidence base. And this is what is missing with Close the Gap — research that targets heath system design. The fact that this has not been applied to the concept of integration leads me to propose that governance could be the wedge preventing us from closing the gaps in Aboriginal disadvantage.

This article was written by Dr Mark Lock for The Health Advocate. Access current and previous editions of The Health Advocate here.