Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia

Abstract

Background Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. Methods The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. Conclusions This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

Access to Aboriginal Community-Controlled Primary Health Organizations Can Explain Some of the Higher Pap Test Participation Among Aboriginal and Torres Strait Islander Women in North Queensland, Australia

“…The key goal of ACCHOs is to deliver comprehensive and culturally competent primary health care that is accessible and appropriate to the needs of Aboriginal and Torres Strait Islander people ( 17 , 37 ). ACCHOs often employ Aboriginal and Torres Strait Islander health workers ( 37 ) and facilitate increased local community involvement, empowerment, and self-determination ( 16 , 18 ).…”

“…It is likely that ACCHOs in remote areas employ more female health practitioners ( 16 , 17 ) than urban areas. Greater availability of female especially Indigenous health practitioners and women’s only health clinics have also been identified as enablers of cervical screening among Aboriginal and Torres Strait Islander women ( 22 , 23 , 39 ).…”

“…Compared to the Rest of Queensland, North Queensland has a higher proportion of the population who are identified as Aboriginal and/or Torres Strait Islander people ( 12 ) or who live in regional, remote, or disadvantaged areas ( 13 ). It also has a higher population coverage ( 14 , 15 ) of Australian government-funded Aboriginal and Torres Strait Islander Community-Controlled Health Organisations (ACCHOs) ( 16 ). Ratios of ACCHO locations to populations are higher in north and western parts of Queensland and lower in the eastern parts of the state, particularly so for the south-east corner of the state ( 14 ).…”

“…ACCHOs provide comprehensive, culturally appropriate, and accessible primary health care specifically for Aboriginal and Torres Strait Islander people ( 17 , 18 ). They aim to be responsive to the needs of the local community and enable Aboriginal and Torres Strait Islander people’s self-determination and empowerment ( 16 , 18 ).…”

The Barriers and Enablers of Primary Healthcare Service Transition From Government to Community Control in Yarrabah: A Grounded Theory Study

“…Non-Indigenous people are also cared for in these clinics, but First Nations people represent 82% of all clients (11). Through their cultural-centredness, and comprehensive and flexible approach to primary healthcare, ACCHOs are similar to Indigenous health services internationally (24).…”