Jeremy Lasek – PHAA
After a long and distinguished career of public service, Dr Dawn Casey PSM, while a relatively late arrival on the public health scene, is now recognised as a national leader and inspiration for her active and passionate protection and promotion of public health within Australia.
Her nomination for the prestigious Sidney Sax Medal, awarded each year to an individual who has made an outstanding contribution in the field of health services policy, organisation, delivery and research, highlights Dr Casey’s instrumental role in Australia’s COVID-19 response, with particular focus on the serious public health risk for Aboriginal and Torres Strait Islander peoples.
While previous pandemic planning failed to identify or include Aboriginal and Torres Strait Islander people as a priority population group, through her roles as co-chair of the Australian Government’s COVID-19 Indigenous Advisory Committee and Deputy CEO at the National Aboriginal Community Controlled Health Organisation (NACCHO), Dr Casey has been critical to the success of the COVID-19 response among Australia’s First Nations.
“Dawn has led the meaningful engagement of Aboriginal and Torres Strait Islander public health practitioners and researchers in identifying pivotal issues, setting priorities and suggesting solutions for culturally-informed strategies to minimise the harms of COVID across the country,” her nominator said.
The Sidney Sax legacy
In accepting the award presented during the 2021 Australian Public Health Conference, Dr Casey acknowledged the ground-breaking work of Sidney Sax, after whom the medal is named. Any assessment of Australia’s health system must recognise the extraordinary contribution of Dr Sax over four decades, as a trusted adviser for the Whitlam, Fraser, and Hawke governments, and as a key architect of universal health insurance. Many regard Dr Sax as Australia’s first health planner, now a recognised health professional discipline.
“It was said that behind his unassuming manner lay a ‘fierce radical’,” Dr Casey said.
‘With foresight, he identified the need for strategic action on:
- Health inequity
- Social determinants of health
- Regional health planning
- And the importance of navigating the ‘strife of interests’ in health care.
“He recognised that considerable effort is required to bring everyone together to row in the same direction for the public’s health.
“It is interesting to note that it took decades for governments to progress many of the areas Sax had identified for action. But for me this is not new. There were many gains made in the eighties that were lost in the following decade.
“The state of mind of Aboriginal and Torres Strait Islander peoples went from one of elation to feelings of utter betrayal by the then Labor Government. Hawke’s commitment to negotiate a treaty was reduced to a process of reconciliation and national land rights legislation was abandoned. This was followed by the Howard’s government decision to dismantle ATSIC.
“While Sax was pursuing the reduction of socioeconomic inequalities and increased emphasis on the management of chronic disease, Aboriginal and Torres Strait Islanders were establishing NAIHO which is now known as NACCHO and our first Aboriginal Community Controlled Health Service, the Redfern Aboriginal Medical Service which is celebrating its 50th anniversary this year. Both the need and the strong desire by our Aboriginal and Torres Strait Islander peoples to pursue culturally safe healthcare for our communities has resulted in there being some 143 Aboriginal and Torres Strait Islander Community Controlled health services across Australia delivering around three million episodes of care per year through 550 clinics and outreach services.
A strong, proactive response
“Our sector is the third largest employer of Aboriginal and Torres Strait Islander peoples. In my view it is this longevity, connectedness and resilience that has enabled the strong and proactive response to the COVID-19 pandemic.
“Australia’s COVID-19 story is one you might know well. However, you may not know the full story of the community-controlled sector’s response.
“Our sector mobilised quickly. Because we knew we had to.
“Already, in January 2020, Apunipima, in Northern Queensland was preparing a response to protect Aboriginal and Torres Strait Islander peoples in that region.
“In early March, at NACCHO, we convened a meeting in Canberra which included CEOs and Aboriginal Doctors from several of our Community Controlled Health Services, Affiliate CEOS and Public Health Medical Officers to get our heads around this new virus.
“The Commonwealth joined this meeting and subsequently established the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 and included State and Territory government officials. As Deputy CEO of NACCHO, I continue to co-chair this Advisory Group with Dr Lucas de Toca from the Commonwealth Department of Health. It links to the Communicable Diseases Network of Australia and reports to the Australian Health Protection Principal Committee.
An on the ground response
“From that day to this, the sector was out on the ground informing communities about the facts.
“We advocated early with the Territory Land Councils for border closures and protective biosecurity measures to keep our communities safe.
“Supporting communities with local pandemic planning.
“Using social media, radio and local leaders to spread the word.
“Developing appropriate rules for funerals and sorry business.
“Working out how to get medications to people in quarantine, and we introduced daily health monitoring systems for anyone at high risk.
“While the sector was busy responding on the ground, we were also front-and-centre in national pandemic policy. Our sector ensured:
- Legislative changes including the Biosecurity Act to enable the necessary restrictions to be put in place quickly.
- National Aboriginal and Torres Strait Islander public health guidelines including evacuation criteria, standards for isolation and quarantine, social support, clinical care and community-wide COVID-19 screening
- Immediate Telehealth uptake that kept people well
- Rapid PCR testing in over 80 remote communities
- Workforce surge capacity planning and infectious disease modelling.”
A successful COVID response
Dr Casey said those efforts worked.
“Throughout 2020, the sector’s mobilisation meant a much lower rate of COVID-19 infection among Aboriginal and Torres Strait Islander peoples,” she said.
“Last year, there was not one death from COVID-19 among Aboriginal and Torres Strait Islander people.
“In 2021, however, a new variant of COVID-19 and the deeply-embedded social determinants of health have taken their toll. This year, there have been four Aboriginal people that we are aware of who have died because of COVID. Notwithstanding, this battle against the COVID pandemic is now in its eighteenth month, our sector continues to deal with the challenges thrown at us.
“The most significant enabler in our response nationally has been the recognition by the Commonwealth Government of the Aboriginal Community Controlled Health Sector as a key plank in the health architecture of Australia delivering primary health care and in particular for the response to COVID.
“The Government is allocating vaccines direct to our Aboriginal Health Services and at the last count, 177 clinics in the sector were delivering the vaccine across the country and had ordered over 300,000 doses of vaccine since the start of the rollout.
“As of 13 September 2021, a total of 233,800 (39.55 per cent) Aboriginal and Torres Strait Islander peoples have received at least one dose of a COVID-19 vaccine.
“As of 13 September 2021, 131,092 (22.18 per cent) Aboriginal and Torres Strait Islander people are fully vaccinated and in excess of $29m has been provided to NACCHO to fund ACCHOs and other Indigenous organisations to assist them with the response and vaccine roll out. What is important however, is it was granted in a way that allowed flexibility thereby enabling the programs to be designed to meet the needs of the community at the local level.
The ongoing burden of disease
“This partnership with Government must continue if Australia is to reduce the burden of disease for Indigenous Australians which is 2.3 times that of other Australians and in remote areas 6 times.
“We can’t rely on the whim of whoever is in government and individuals, and to this end NACCHO and other members of the Coalition of Peak Indigenous Organisations will assiduously pursue the implementation of the National Agreement on Closing the Gap. And how can we not, given the challenges we still face.
“Cancer is now the leading cause of death for Aboriginal and Torres Strait Islander peoples. We have a higher rate of cancer diagnosis and are approximately 40 per cent more likely to die from cancer than non-Indigenous Australians.
“The highest cancer incidence rates for Aboriginal and Torres Strait Islander people are lung cancer, breast cancer, colorectal cancer, and prostate cancers.
“Other significant challenges for our sector in meeting the health needs of Aboriginal and Torres Strait Islander peoples include mental health and suicide, road safety fatalities and non-communicable diseases like heart disease.
“Mental health and suicide affect us every day. Eleven percent of presentations at emergency departments across the country are Aboriginal and Torres Strait Islander people yet we are only 3 per cent of the population. And in 2010, suicide was 2.6 times more likely to be the cause of death than for non-Indigenous Australians. It is significantly higher for males under 25 years of age.
“The number of Aboriginal and Torres Strait Islander people involved in road accidents and fatalities is disproportionately high. We are 2.7 times more likely to die, and 1.4 times more likely to suffer serious injury because of a motor vehicle crash compared to other Australians.
A model of trust
“Our sector’s model of primary health care integrates health promotion, community development and social action with clinical services and individual health care is delivering primary health care that others only dream of.
“Continuity of care in community-controlled services decreases rates of hospitalisation. Communities direct us. Communities trust us.
“One major study concluded that 50 per cent more ‘health gain’ could be achieved if health programs were delivered to Aboriginal populations via Aboriginal community control, compared to the return on investment if the same programs were delivered via mainstream primary care services.
“Very recently, a planned transition of a remote primary health care service from government management to community control increased utilisation of primary health care by 408 per cent. This transition accelerated immunisation rates. It reduced the proportion of low-birth weight babies to less than 10 per cent of the entire birth cohort. It increased employment of qualified Aboriginal and Torres Strait Islander people.”
Dr Casey said she felt deeply honoured and ‘quite embarrassed’ to be receiving the 2021 Medal “given how many others nationally, in my view, have done so much” in the COVID effort.
“In accepting this Sidney Sax Medal, I would like to recognize the amazing work of the Aboriginal and Torres Strait peoples, past and present who are part of our community-controlled health sector. Our services were established out of a need for our people to have not only access to health care but also care that is culturally safe,” Dr Casey said.
“Our sector is fiercely radical too. Our model is an act of self-determination.”