This Social Lab aims to develop a 10-year strategy for turning around the systemic health crisis among the Aboriginal peoples of New South Wales, Australia. At the core of the crisis is the deeply entrenched, multigenerational legacy of colonialism, with all the misunderstandings, mistrust, and resentments that entails.
Dialogue Interviews across the system were followed by a series of eight one-day labs around New South Wales. While the labs were initially fraught with suspicion, apathy, and aggression, a shared sense of responsibility and possibility emerged. Participants transformed their understanding of what was possible, forging new relationships with people that they had never before met or worked with. The lab findings sparked a process of reflection at the state’s Ministry for Health or the Centre for Aboriginal Health, Ministry of Health—a process we facilitated at a forum that began to articulate next steps.
This lab forged and continues to forge insights and cultural alliances that are laying a transformational path for the Ministry for Health or the Centre for Aboriginal Health, Ministry of Health—and potentially for the wider health system, which some participants thought could benefit from the holistic Aboriginal worldview. As the CEO of one major 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?”
In 2011, Reos Partners was approached by the Ministry for Health or the Centre for Aboriginal Health, Ministry of Health and the Aboriginal Health & Medical Research Council (AH&MRC) of the State of New South Wales, Australia, to help them develop a strategic plan for their next 10 years of work on Aboriginal health. Their attempts to address the issues had failed for many years, and they were ready to try something new.
Despite the expansive health infrastructure in New South Wales, including more than $3 billion going into the Aboriginal health system annually, the health of the state’s Aboriginal peoples is in crisis. Diabetes, obesity, addiction, lung cancer, illicit drug use, maternal health issues, and infant mortality are all disproportionally prevalent. The average life expectancy is 10 years less than for white Australians.
At the heart of the issue is a daunting complexity and history. The health crisis is an extension of colonialism. Poverty and disease are long-term results of entrenched, multigenerational social inequalities, cultural differences, and tensions. The situation is an example of generative complexity: cause and effect are far apart in time and space. Interventions in this systemic crisis therefore may take years or generations to bear fruit.
Attempts by Aboriginals and whites to work together on these issues have also been sabotaged by deep cultural barriers, different and incompatible definitions of and approaches to health, and inappropriate, top-down development models that have been ignorant of or insensitive to Aboriginal culture and the needs of Aboriginal communities.
- What’s currently blocking the system?
- What do we need to get rid of?
- What do we need to do more of?
- And what else is needed?
Given the entrenched, multigenerational nature of the issues, any movement on consciousness and attitudes is real progress. Lab exit interviews (see below) revealed new understanding, tolerance, hope, and empowerment among participants. As one Aboriginal elder said, “These are the same challenges seen through new eyes.”
7 Building Blocks of the Future
Reos synthesized the Social Lab work into “7 Building Blocks of the Future”—key strategic elements that address leverage points in the system. These elements make up the core of a 10-year strategy that includes Aboriginal voices and encompasses leadership, governance, and accountability.
A high-level forum
We presented the “building blocks,” along with a set of principles that had also been distilled from the lab work, at a forum with the state Ministry for Health or the Centre for Aboriginal Health, Ministry of Health and other high-level stakeholders. Deep cultural divisions that had mired progress on the issues were brought to the surface. Various breakout groups took the building blocks a step further, articulating next steps for the system as a whole.
Exploring the definition of health
The Aboriginal definition of health includes not only physical health, but also mental, emotional, and spiritual well-being—of self, community, and country. Further, it considers the familial relationship of the community to the land. This Social Lab has opened, for white Australians, the opportunity to try on a more holistic worldview, with potentially transforming implications for the health system and beyond.
“Support each other and mean it”
“I need to be more patient and build my resilience. I have also learnt that I need to control my cynical attitude towards government. I need to continue building trusting relationships. For us all, lateral thinking and flexibility in service delivery models is very important. Respect, regard, recognition. Lead by example, breakdown barriers and silos. Support each other and mean it. We need to unite as a group and act as one.”
“We need this space”
“I see us as leaders, we as all Australians. I went out and sat beside a lizard, he was peaceful, I thought that’s what it’s about. We need this space. I’ve been around so long, I’ve been getting angry. I have an opportunity to influence and do something about this.”
“More patience and tolerance and understanding”
“More patience and tolerance and understanding, where I work I have to be more patient of non-Aboriginal people when they try to help us. I want to be more patient. From us—to work together, communication, networking, understanding each others’ values.”
“What can I learn rather, than what can I teach?”
“I struggle with how I see racism within my organization—how I’m exposed to it, and how I contribute. There are more questions than resolutions. How do I challenge myself to view Aboriginal people from a strength focus? How do I communicate in a better way that focuses on strengths? How do I use cultural supervision? What does that look like for me and us? What can I learn, rather than what can I teach?”
“More of this is what is needed”
“More of this is what is needed. In the three years I’ve been in the Aboriginal Medical Services [AMS], we haven’t done something as detailed and meaningful. Great there is a mix of people, not just AMS, also health services. We all want the same thing in the end. What’s needed of me is not to be so cynical and hope good things will come of it.”