Aboriginal health and institutional reform within Australian federalism

Abstract

This paper examines relationships between institutional reform within Australian federalism and Aboriginal health, both historically and in prospect. It begins with a brief historical analysis of government involvement in the general health arena within Australian federalism. It then provides a more extended historical account of government involvement in Aboriginal health and the emergence in the last 25 years of a group of important non-government players, the Aboriginal community-controlled health services. A more normative prescriptive analysis then follows, which identifies lessons from past experiences and enunciates principles for future action. These lessons and principles relate in particular to ideas about complexity and the need for greater role clarification and coordination in institutional arrangements for Aboriginal health. We argue for a view which in large part accepts this complexity and sees a need to draw organisations and their efforts into the Aboriginal health arena, rather than drive them out. We also, however, caution against drawing in all relevant organisations in related fields such as housing, education and infrastructure provision in the name of 'intersectoral collaboration'. A third argument suggests, perhaps counter intuitively, that measuring the success of institutional reform in Aboriginal health should to some extent be disarticulated from changes in substantive Aboriginal health status. A brief penultimate section of the paper looks at current general developments in the health arena. The conclusion of the paper identifies the key challenge and current opportunity for institutional reform within Australian federalism relating to Aboriginal health. This relates to the linking of responsibility sharing within Australian federalism and Aboriginal self-determination.