In 2011 the Centre for Aboriginal Health (CAH), a unit of the Ministry of Health in Sydney, Australia, was struggling to develop a 10-year Aboriginal health plan for New South Wales. To develop the report, CAH partnered with the Aboriginal Health and Medical Research Council, which represents the Aboriginal community–controlled health sector. In particular CAH wanted the 10-year plan to challenge orthodox planning approaches and generate creative thinking that would lead to new action and energy in addressing Aboriginal health issues.
CAH was conscious of the Australian Government Strategic Review of Indigenous Expenditure that was conducted in 2009, commenting that “past approaches to remedying Indigenous disadvantage have clearly failed, and new approaches are needed for the future”.
The state of New South Wales has the largest population of Aboriginal people of the Australian states. In New South Wales, the life expectancy of Aboriginal people is still significantly lower than that of the general population (9.4 years lower for Aboriginal men and 9.2 years lower for Aboriginal women). Aboriginal people also experience poorer health at much younger ages across most disease areas. The inability to achieve long-term improvement in Aboriginal health outcomes stems from social, historical, policy, and cultural complexities.
These complexities are entrenched in social inequalities and cultural misunderstanding, and tensions arising from the arrival of western people in Australia. Over the years, different and incompatible definitions of health and inappropriate top-down models of policy implementation have undermined strategies and plans to markedly change the situation.
Changing the Course of Aboriginal Health in New South Wales
In this difficult and complex social and health context, CAH invited Reos Partners in Australia to initiate the process of developing the 10-year health plan, with the goal of changing the course of Aboriginal health in New South Wales. The Reos Partners team included Steve Atkinson, Leigh Gassner, and Mark Yettica-Paulson, the latter an Indigenous man who is an expert in intercultural communication and engagement.
The process started with the development of a convening question: “How can we, together, transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people across New South Wales over the next 10 years?” Based on this question, Reos Partners conducted 30 deep-dive dialogue interviews with key stakeholders in the health system across New South Wales.
These conversations were designed to unearth and focus on the core concerns in the system as a whole and also provide a landscape of the culturally diverse perspectives driving the system’s complexity. The interviewees were representative of the system, including key decision-makers in the Ministry of Health, service providers, and officials in the healthcare industry and social sector. The interview designers found it important to include Aboriginal leaders and community members in remote, rural, and metropolitan areas from across the system.
Based on the responses to these dialogue interviews, Reos convened a series of eight one-day Change Lab workshops across New South Wales with more than 200 participants in total. These events enabled participants as a group to understand the core concerns and dynamics, and identify the key areas of intervention, also known as leverage points, for change within the system. Together they found new perspectives that enabled them to see their system differently and that could lead to new and different action. The collective shift was best captured by a remark of one of the participants, who reported now seeing “the same challenges through new eyes.”
In many of these workshops, people’s initial suspicion and tension invariably turned to compassion and insight. The Change Labs balanced sensitivity to Aboriginal culture and communities, the integrity of social methodologies, and the importance of working together toward an implementable and practical health plan.
Through systems thinking exercises, dialogue, and a creative visioning process using drawing, the newly aligned groups “dreamed” of their collective future, leveraging a 40,000-year-old tradition that is still alive in Aboriginal communities. Through these carefully designed processes, the stakeholders came to understand the dynamics of their system and to identify new avenues for addressing the region’s health concerns at their root.
The workshops incorporated Aboriginal understandings of health and wellness into the cultural language of white Australians. A shared sense of responsibility and possibility emerged, and the driving forces of the groups shifted, enabling the emergence of a deeper mode of collaboration, insight, and communication geared toward transforming the health system.
Building Blocks for the Future
Based on these initial workshops, the Reos team distilled the findings into seven “Building Blocks for the Future”, as well as a new set of principles to guide the implementation of these building blocks. These ideas and the diverse alliances that brought them into being will underpin and drive the content and activity of the strategic plan in a new and systemic way for the next decade.
In the next phase of the work, the team brought the regional findings before a Ministerial Forum, a high-level group of leaders and stakeholders from within the Ministry of Health. The forum was rich with learning, excitement, and possibility. The CEO of one hospital commented, “ Wouldn’t it be extraordinary if the white population adopted the Aboriginal definition of health, and we had that as a precedent for building our whole health system?” The Aboriginal definition of health in Australia includes not only physical health, but also the mental, emotional, and spiritual well-being of oneself, one’s community, and one’s country.
The Ministry’s new strategic plan goes far beyond addressing the symptoms of the Aboriginal health crisis in New South Wales. For the first time, the strategy will address the systemic drivers of health system effectiveness: it will aim to bring about new worldviews, new relationships, and new governance, funding, and measurement structures, all of which aim to develop a culture that recognises the importance of Aboriginal tradition and connection in determining a community’s long-term health and well being.