The Victorian Aboriginal Health Service (VAHS), based in Fitzroy, and started by Koori activists in 1973, is threatened by funding shortfalls.
VAHS was formed because the health needs of the Aboriginal community were not being met by other services. For almost a year it operated on a voluntary basis until it received a small amount of funding from the Department of Aboriginal Affairs.
Despite funding cuts over the years, widespread community support has meant that it has grown from a small medical clinic in Gertrude Street to a multi-service community health centre in Nicholson Street.
Most Australians enjoy one of the highest levels of health in the world. Not so for Aboriginal and Torres Strait Islander peoples: their life expectancy remains at around 17 years less than for other Australians.
The Australian Bureau of Statistics estimates that Indigenous Australians suffer two-and-a-half times the burden of disease than do other Australians. Health spending by governments should reflect this reality yet expenditure on health for Indigenous Australians is only 17% higher than that spent on non-Indigenous people.
While the majority of Victoria's 30,800 Indigenous people (2006 Census estimates) live in urban areas, the barriers to them accessing mainstream services remain. This is partly the result of history — for example, maternity hospitals that were directly involved in removing children from their families. But other reasons include racism, perceived negative attitudes towards Aboriginal people, a lack of understanding of the cultural and social conditions of Aboriginal people, a lack of Aboriginal staff in mainstream services, and the dominant "white" culture of mainstream services.
For Aboriginal and Torres Strait Islander peoples, community control is crucial to improving their health. After European invasion, Indigenous people's lives were controlled in every aspect. Today, Indigenous people suffer from the intergenerational effects of this, and also from living in a dominant non-Indigenous culture. The World Health Organisation recommends that community-controlled health services are the best ways to improve a community's health.
The need for Aboriginal participation in, and control over, their health has been recognised by federal governments since 1989, in the National Aboriginal Health Strategy, by the Victorian government in the 1996 Victorian Aboriginal Health Reform Strategy, and by health professionals such as the Royal College of General Practitioners and the Royal College of Physicians.
Indigenous control over their health is also recognised in several of the United Nations declarations and covenants on human rights and social, cultural and Indigenous rights.
Where are the resources to adequately serve the health needs of the Aboriginal and Torres Strait Islander communities?
VAHS CEO Rod Jackson told Green Left Weekly on May 14 that maternal and child health, chronic disease care, alcohol and drug services, oral health and pharmaceutical services are all underfunded. "VAHS is not funded for PBS [Pharmaceutical Benefits Scheme] medicines, so we must outsource pharmaceuticals for community needs", he said.
Oral health is strongly associated with chronic diseases and the dental service at VAHS is severely underfunded. Oral health is also linked to premature birth and low birth weights.
Victorian Aboriginal women have about twice the number of low birth-weight babies and premature babies as non-Indigenous women. Small babies are associated with chronic disease later in life.
Bram Alexander from the Victorian Department of Human Services (DHS) told GLW that for the year 2007-2008, VAHS received state funding of $2.8 million and, in April, recevied a top up of $140,000. The extra funding was suddenly approved after the Melbourne Age started making inquires into the health centre's funding crisis.
The top-up came from DHS and was earmarked specifically for the Maternal and Child Health unit at VAHS. However, Jackson said that this amount did not cover a $360,000 shortfall. A DHS review of MCH had recommended $500,000 to run the service adequately.
Inadequate support for education also affects the running of VAHS. Professor Ian Anderson reported in a lecture at Melbourne University on May 13 that only 1% of the healthcare workforce is Indigenous, and this was a result of barriers in universities for Indigenous people.
At VAHS, when workers attend training they are not replaced. This staff shortage reduces the service's capacity and increases pressure on the remaining staff.
Indigenous health will only improve when the underlying causes of Indigenous ill health are addressed, such as adequate employment, education, housing and real land rights. In the meantime, governments must make funding commitments that recognise the current inequalities and the effects these have on Indigenous health.
[Margaret Cotter works as a midwife at the VAHS and is doing a masters in public health.]