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.

The role of sovereignty in Indigenous community‐based health interventions: A qualitative metasynthesis

“…For Indigenous peoples—and any community that has suffered from colonization and imperialism—settler colonialism and racism are intertwined. Although Indigenous peoples consistently identify colonialism as being one of the most significant determinants of their health and well‐being, it is not typically accounted for as such in academic literature or in western healthcare praxis (Greenwood et al, 2018; Reading & Wien, 2009). The refusal of western healthcare to engage with the myriad impacts of settler colonialism and systemic racism on Indigenous health and well‐being makes it obvious that these systems have never and will never be able to adequately prevent or treat widespread illness or support the healing of Indigenous communities and people (Rowe et al, 2020).…”

Strengthening approaches to respond to the social and emotional well-being needs of Aboriginal and Torres Strait Islander people: the Cultural Pathways Program

“…Consultations with ACCHOs have highlighted key principles which inform holistic approaches to the social determinants of health including self-determination, accessible and culturally safe care and strong partnerships that support clients to navigate social services (CREATE, 2020). A recent document analysis of 67 ACCHO annual reports found that all services were working to improve clients' intermediary social determinants of health, specifically material circumstances, biological, behavioural and psychosocial factors (Pearson et al, 2020). Whilst structured and funded Aboriginal and Torres Strait Islander health assessments for preventative care are widely implemented, these assessments are limited by a biomedical focus that inadequately addresses social and cultural factors (Bailie et al, 2019).…”