Author: Emma George
George, Emma, 2020 “Bandaid for a bullet wound”: the inconsistent recognition of Indigenous rights and social determinants of Indigenous health in ‘Closing the Gap’ policy implementation in early childhood, Flinders University, College of Medicine and Public Health
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In this thesis I examine the Australian government’s ‘Closing the Gap’ (CTG) strategy in early childhood and how it has been implemented to answer the following questions:
1. To what extent are Indigenous rights prioritised and acted on within the ‘Closing the Gap’ strategy in early childhood?
2. To what extent are social determinants of Indigenous health recognised and acted on within the implementation of the ‘Closing the Gap’ strategy in early childhood?
3. How does the experience of the ‘Closing the Gap’ strategy in early childhood compare in Shepparton (Victoria) and Southern Adelaide (South Australia)?
4. To what extent has a decolonising approach to health equity been implemented through the ‘Closing the Gap’ strategy in early childhood?
There is evidence that even when Indigenous rights, including self-determination, and social determinants of Indigenous health are mentioned in policy documents, they are not consistently enacted during implementation. Criticism of the CTG strategy is that, like past policies, it is deficit based and problematises Aboriginal and Torres Strait Islander people. My review of the literature identified that understanding policy implementation and the recognition and action on Indigenous rights and social determinants of Indigenous health in early childhood was a gap in knowledge.
Drawing on a decolonising approach to research at the interface of knowledge, critical social constructivism, and an institutionalist framework, I analysed 12 CTG policy documents relevant to early childhood. Then I conducted semi-structured in-depth interviews in Shepparton and Southern Adelaide with 16 participants in each case study to explore the way that policy had been implemented. In Shepparton, the presence of a large Aboriginal community-controlled health organisation influenced policy implementation. In Southern Adelaide, policy was implemented through mainstream services with targeted programs for Aboriginal children and families.
My finding suggest that Indigenous rights can be named and recognised, implied, or undermined and ignored in policy. Implementation of early childhood services occurs through those offered by Aboriginal people for Aboriginal people, by other services with targeted programs, and in mainstream services that are universally accessible. Policy actors reported some influence over how policy is implemented by prioritising culture, identity and belonging, even though these social determinants of Indigenous health were not always recognised in policy. Despite local influence on policy implementation, these actions did not change the deficit discourse, colonial power relations, or the representation of Aboriginal people as a problem in policy documents. Therefore, the CTG strategy was compared to a “Bandaid for a bullet wound” in the way that policy actions could not heal wounds caused by ongoing colonisation and exertion of power over Aboriginal people. Despite the limitations of the CTG strategy, Indigenous sovereignty, hope, and advocacy for the right to an Aboriginal childhood remain. In discussing implications of the research, I advocate for moving beyond the rhetoric of “working with” Aboriginal people towards self-determination, and I highlight the importance of Aboriginal community-controlled organisations in early childhood.
As a non-Indigenous researcher, this research required transformational unlearning to unravel my thinking so that I could weave in new knowledge. I finish this thesis with my reflection on conducting research at the interface of knowledge.
Keywords: Indigneous rights, Social Determinants of Indigenous Health, Policy Implementation, Closing the Gap
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Prof Fran Baum