Wood Lisa, Shilton Trevor, Dimer Lyn, Smith Julie, Leahy Timothy
Centre for the Built Environment and Health, School of Population Health, The University of Western Australia, Crawley, WA 6009, Australia.
Aust J Prim Health. 2011;17(4):384-94. doi: 10.1071/PY11057.
The prevailing disparities in Aboriginal health in Australia are a sobering reminder of failed health reforms, compounded by inadequate attention to the social determinants shaping health and well-being. Discourse around health reform often focuses on the role of government, health professionals and health institutions. However, not-for-profit health organisations are also playing an increasing role in health policy, research and program delivery across the prevention to treatment spectrum. This paper describes the journey of the National Heart Foundation of Australia in West Australia (Heart Foundation WA hereafter) with Aboriginal employees and the Aboriginal community in taking a more proactive role in reducing Aboriginal health disparities, focusing in particular on lessons learnt that are applicable to other non-government organisations. Although the Heart Foundation WA has employed and worked with Aboriginal people and has long identified the Aboriginal community as a priority population, recent years have seen greater embedding of this within its organisational culture, governance, policies and programs. In turn, this has shaped the organisation's response to external health reforms and issues. Responses have included the development of an action plan to eliminate disparities of cardiovascular care in the hospital system, and collaboration and engagement with health professional groups involved in delivery of care to Aboriginal people. Examples of governance measures are also described in this paper. Although strategies and the lessons learnt have been in the context of cardiovascular health disparities, they are applicable to other organisations across the health sector. Moreover, the most powerful lesson learnt is universal in its relevance; individual programs, policies and reforms are more likely to succeed when they are underpinned by whole of organisation ownership and internalisation of the need to redress disparities in health.
澳大利亚原住民健康方面普遍存在的差距，严峻地提醒着人们健康改革的失败，而对影响健康和福祉的社会决定因素缺乏足够关注更是雪上加霜。围绕健康改革的讨论往往聚焦于政府、医疗专业人员和医疗机构的作用。然而，非营利性健康组织在从预防到治疗的整个健康政策、研究和项目实施过程中也发挥着越来越重要的作用。本文描述了澳大利亚国家心脏基金会西澳大利亚分会（以下简称西澳心脏基金会）与原住民员工及原住民社区一道，在更积极地减少原住民健康差距方面所走过的历程，特别关注那些适用于其他非政府组织的经验教训。尽管西澳心脏基金会长期以来一直雇佣原住民并与他们合作，且早就将原住民社区视为重点人群，但近年来，这一理念在其组织文化、治理、政策和项目中得到了更深入的体现。相应地，这也塑造了该组织对外部健康改革和问题的应对方式。应对措施包括制定一项消除医院系统中心血管护理差距的行动计划，以及与参与为原住民提供护理的医疗专业团体开展合作与互动。本文还介绍了治理措施的实例。尽管所采取的策略和经验教训是围绕心血管健康差距展开的，但它们适用于整个卫生部门的其他组织。此外，所汲取的最有力的经验教训具有普遍的相关性；当整个组织都认同并将纠正健康差距的必要性内化为自身行动时，各个项目、政策和改革更有可能取得成功。
