Overview
Measures under Goal 13 have varied in performance
In 2023, the proportion of Aboriginal survey respondents who reported that they experienced racism in a health care setting decreased. However, the proportion remains more than double the proportion for non-Aboriginal respondents.
In 2023-24, the rate of hospitalisations where Aboriginal patients left against medical advice increased to the highest rate recorded between 2011-12 to 2023-24 and is over five times the rate for non-Aboriginal people.
New data on Measure 13.1.2 Proportion reporting positive client experience of GP services is not comparable to data from previous reports.
Closing the Gap – Relevant Outcomes and Targets for Goal 13
The National Agreement does not contain outcomes and targets that align with this VAAF goal. Victoria is pursuing more ambitious and comprehensive goals under the VAAF, which are reported on in this chapter and the Data Dashboard.
Closing the Gap - How Victoria is tracking nationally
Not applicable.
Data Note
The following measures rely on datasets that are infrequently collected. No new data was available at the time of reporting.
- Measure 13.1.4 Number and proportion of Aboriginal people employed in the health or social services sector
Historical data for this measure is available on the First Peoples – State Relations website
13.1 Increase the cultural safety and responsiveness of services
Measure 13.1.1 Proportion reporting experiences of racism in the health system
In 2023, 34.5 per cent of Aboriginal survey respondents reported that they experienced racism in a healthcare setting in the past 12 months. This is more than double the proportion for non-Aboriginal respondents (14.2 per cent). Compared to 2017, the proportion has decreased by 2.4 percentage points for Aboriginal respondents and increased by 3.4 percentage points for non-Aboriginal respondents. People who experience racism are much more likely to have poor mental and physical health.
The greater the frequency of racism, the worse the health outcomes. Research shows that First Peoples are more likely to delay seeking health services, leave hospital early, and not seek medical treatment when it is needed. This may be due to past personal, family or community experiences of negative treatment in health services. [23] Victoria’s anti-racism strategy 2024-2029 is the Victorian Government’s plan to tackle racism and discrimination to build a safer, fairer and more inclusive state.
Measure 13.1.2 Proportion reporting positive client experience of GP services
In 2022-23, 89.7 per cent of Aboriginal Victorian reported always/usually having positive experiences with general practitioners where the practitioners respected culture, traditions, customs and beliefs. In the same year, 8.3 per cent of Aboriginal Victorians reported sometimes/rarely experiencing positive experiences with general practitioners. Cultural safety is a fundamental human right. The Aboriginal and Torres Strait Islander cultural safety framework has been developed to help mainstream Victorian health, human and community services and the Department of Health to create culturally safe environments, services and workplaces.[24]
Measure 13.1.3 Hospitalisations where patients left against medical advice/ were discharged at own risk
In 2023-24, the rate of hospitalisations where Aboriginal patients left against medical advice grew to 16.4 per 1,000 Aboriginal patients. This is the highest rate recorded between 2011-12 to 2023-24 and is over five times the rate for non-Aboriginal people. Compared to 2011-12, the proportion of hospitalisations where patients left against medical advice more than doubled for Aboriginal and non-Aboriginal patients. The causes of patients leaving against medical advice vary across patients. Contributing factors may include lack of culturally safe services, racism and trauma.
Escalating Aboriginal voices in the development of community programs
Self-determination Enabler 4. Transfer power and resources to communities
VACCHO is delivering the “Culture and Kinship to improve the health and wellbeing of Aboriginal Victorians” program as part of the 2024-25 State Budget process. This successfully secured $9.764 million in funding over four years focussed on creating, strengthening or restoring connections to Culture, Kinship, Community and Country, all of which are known protective factors for Aboriginal health and wellbeing.
The model was originally piloted with four regional ACCOs to design their own programs, including Budja Budja’s Gariwerd Youth Project to engage children in knowledge sharing and cultural practices, and Goolum Goolum’s initiative to bring pregnant women and new mothers together in weekly gatherings to learn to make possum skin cloaks from their female Elders. The pilot was reviewed by external consultants and found to be highly effective with a ‘social rate on return’ for the investment, delivering $8.29 for every dollar spent.
The 2024-25 State Budget proposal for the Aboriginal Health in Aboriginal Hands initiative saw an expansion of the Culture and Kinship program in up to 16 ACCOs.
The Department of Health has also drawn from Aboriginal-led models of care to attract investment on behalf of the Victorian Aboriginal community. These include:
- A $35 million investment in Urgent Care Pathways from the 2023-24 State Budget aimed at reducing potentially preventable hospitalisations for Aboriginal peoples
- A $3.9 million investment for a dedicated Aboriginal-led Early Parenting Centre (EPC) in Frankston, the first of its kind in Australia.
Early Intervention Investment Framework Cultural Safety Framework
In the 2023-24 State Budget the Victorian Government announced that the Department of Treasury and Finance would develop a Cultural Safety Framework to underpin the Early Intervention Investment Framework (EIIF), following stakeholder feedback.
The two key objectives of the EIIF Cultural Safety Framework were to:
- Listen and learn from the experiences of First Peoples on how to embed cultural safety in the EIIF
- Identify and implement actions that can better support cultural safety and self-determination within the EIIF.
By doing this, the EIIF Cultural Safety Framework aims to improve outcomes for First Peoples, including through supporting culturally safe partnerships, improving the design and implementation of EIIF programs, and contributing to advancing self-determination.
DTF and the Victorian Aboriginal Child and Community Agency (VACCA) worked in partnership for over 14 months to scope and develop the EIIF Cultural Safety Framework, consulting a range of ACCOs and Victorian Government departments engaged in EIIF.
Recognising the expertise and skills VACCA and the Department of Treasury and Finance each brought to the table helped to build trust through this partnership. These combined perspectives contributed to the integrity of the EIIF Cultural Safety Framework through genuine collaboration built on equally shared resources, workload, and two-way learning.
The findings that emerged from the consultation and development process underpinned the actions set out in the EIIF Cultural Safety Framework, which were grouped under three key domains:
- Working in partnership
- Recognising the Aboriginal evidence base
- Supporting effective implementation
The development of the EIIF Cultural Safety Framework has been a learning process, but its establishment is just the beginning of the journey. DTF will continue to listen and work with First Peoples, ACCOs and departmental stakeholders to embed the Cultural Safety Framework, including developing additional resources, undertaking enabling activities, and looking for opportunities to share learnings more broadly. DTF will also aim to measure success across a range of indicators over time, including trialling high-level public reporting.
Footnotes
[23] Victoria’s anti-racism strategy 2024-2029, Victorian Government
[24] Aboriginal and Torres Strait Islander cultural safety, Victorian Government
Health and Wellbeing
Improving health outcomes and having a good quality of life will ensure all Victorian Aboriginal communities can thrive.
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