Fighting for health equity: Aboriginal Community Controlled Health Services in a challenging policy context

• Main Author: Coombs, David
• Format: Doctoral or Postdoctoral Thesis
• Language: unknown
• Published: UNSW Sydney 2019
• Subjects: Aboriginal health; Indigenous health policy; Aboriginal Community Controlled Health Services; New Public Management; Neoliberalism; First Nations
• Online Access: https://dx.doi.org/10.26190/unsworks/21784; http://hdl.handle.net/1959.4/66004

This thesis explores the critically important work of Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. It works from the premise that ACCHS enable Aboriginal self-determination in health. It evaluates the policies and practices of government agencies and non-Indigenous health actors, assessing the degree to which they facilitate or constrain ACCHS in this task. A critical evaluation of the policy context in which ACCHS operate is provided, analysing the political intent and community impact of recent reforms. Making use of political economic theories of settler-colonial domination and neoliberal governance, and policy theories that explain how and why governments deploy symbols and moral language for political purposes, an original explanation of the neo-paternalist market-fundamentalist turn in Indigenous affairs policymaking is presented. Drawing on new evidence gathered through interviews with ACCHS CEOs and managers, the thesis presents an account of ACCHS’ unique role in the health system. It offers a nuanced explanation of First Nations peoples’ health inequities, constructed from interviewees’ theoretical insights and relevant scholarly literature. A key research output is the detailed description and modelling of the ACCHS holistic approach to Aboriginal healthcare. This expands our understanding of what ACCHS do, how they do it, and why it is effective. This examination of the ACCHS model of care is of relevance to all healthcare providers in Australia, as it provides practical examples of how to operationalise the social elements of primary healthcare, such as community participation in service design, and the development and delivery of culturally safe health promotion and education activities. This body of work also identifies and critically analyses the key policy challenges that impede the effective and efficient delivery of services by ACCHS in New South Wales. Key challenges identified include funding shortfalls and restrictions, and severe power imbalances between government actors and “mainstream” health actors, on one side, and ACCHS on the other. An extensive list of practicable policy solutions has been developed, making this thesis a valuable and viable source of guidance for policymakers and professionals working in Indigenous health service delivery.