1 Taking Control. A case study of the National Aboriginal and Islander Health Organisation (NAIHO). Guy I Gillor A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy February 2012 University of Western Sydney 2 Table of content Abstract 4 Acknowledgements 6 List of images 7 List of tables 7 List of text boxes 8 Acronyms 10 1 Introduction 10 1.1 Overview of the research 10 1.2 The topic and the case study 11 1.3 The gap in literature 13 1.4 The researcher 15 1.5 The research process 18 1.6 Thesis overview 19 2 Frameworks and context 21 2.1 Health and health-care 21 2.2 Aboriginal health in context 29 2.3 Community control 50 3 Methodology 65 3.1 Choosing the methodology 65 3.2 The use of primary sources 72 4 The development of the Aboriginal Medical Service (AMS) in Redfern 85 4.1 Background: ‘Black Power’ in Australia 85 4.2 The Aboriginal Legal Service 88 4.3 Establishing the Aboriginal Medical Service 91 4.4 The first two years 96 4.5 Early years funding: grants and donations 101 4.6 The role of the Aboriginal Medical Service Newsletter 103 4.7 Relationship with the Department of Aboriginal Affairs 105 4.8 Relationship with the Whitlam government and the Opposition 109 4.9 International relations 112 4.10 National spread of the movement 114 5 The National Aboriginal and Islander Health Organisation (NAIHO) 119 5.1 The establishment of NAIHO 119 5.2 NAIHO’s philosophy 124 3 5.3 The Aboriginal Health-Workers: development, education, and philosophy 128 5.4 Funding of services and relationship with the state, 1974-1979 133 5.5 Relationship with other movements, 1974-1979 138 5.6 NAIHO’s involvement with the National Trachoma and Eye Health Program 142 6 The Program Effectiveness Review (PER) and its suppression 146 6.1 The commissioning of the PER 147 6.2 The PER: findings and themes 148 6.3 NAIHO meets Fraser 155 6.4 The Townsville 1980 NAIHO conference 158 6.5 Further meetings and negotiations 162 6.6 “Top Secret Govt P.E.R. Report Unveiled” 165 6.7 United Front with the National Aboriginal Congress (NAC) 168 6.8 The Victorian Working Party on Aboriginal Health 170 6.9 The NSW Task Force on Aboriginal Health (1983) 172 7 NAIHO after the PER 176 7.1 Changes in national structure 176 7.2 Brisbane Commonwealth Game protests (1982) 180 7.3 Relations with the Commonwealth 184 7.4 Relations with the States 188 7.5 International relations 190 7.6 The National Aboriginal Health Strategy (1989) 193 7.7 From NAIHO to NACCHO 198 7.8 1990s onwards 200 7.9 The KordaMentha review (2005) 203 8 Discussion 205 8.1 Primary Health Care and Community Control 205 8.2 Funding and policy formation 215 8.3 The experience of national organising 223 8.4 The movement today 234 9 Conclusions 238 References 242 4 Abstract Social services, such as health, are often at the centre of political struggles, and are often shaped by the actions of social movements. This thesis examines the politics surrounding the development of grassroots health infrastructures in a colonialist context. In particular, this thesis sets out to examine the way in which struggle and resistance in such a context shape health infrastructures and challenge the policy process. The methodology employed is a single-unit case study analysis, focusing on the Aboriginal community-controlled health services (ACCHSs) movement in Australia. The rise of such community-controlled social services during the 1970s was one of the manifestations of the land rights movement. The ACCHSs movement developed around some similar concepts to a global Primary Health Care (PHC) movement, which focused on what is now defined as the social determinants of health. This approach argues that poor health outcomes are often derived from social and political causes. The research relies on a number of primary sources. One such source is activist literature from the time period. Fifty four issues of the AMS Newsletter, produced by the Redfern AMS, from the year 1973 to 1991 were located in the course of the data collection. These newsletters offer precious analysis from the point of view of prominent activists in the movement, and unfold some of its political history and development. Other primary sources explored are a variety of official reports, released and unreleased. This research identifies one unreleased report, the 1980 Program Effectiveness Review on Aboriginal Health, and the battle over its suppression, as a defining experience in the development of the movement. The ACCHSs movement started with the establishment of the Redfern Aboriginal Medical Service (AMS) in 1971. The movement has endured, and today there are over 150 ACCHSs across Australia. However, very little information about the movement’s history and early development is available. This case study focuses on the national aspect of the movement, and in particular, the establishment of a national umbrella organisation, the National Aboriginal and Islander Health Organisation (NAIHO). The findings of this thesis follow the development of the movement from the history of the first ACCHSs in Redfern, 5 through the establishment of NAIHO in the mid 1970s, until its mysterious demise in the late 1980s. NAIHO was eventually replaced by the National Aboriginal Community Controlled Health Organisation (NACCHO) in the early 1990s, which still exists today. The investigation of the development of the movement follows some repeating themes which emerge from the data. Some of the main themes explored include: the theory and practice of community control; the approach of the movement to the social and political determinants of health; the question of funding and its implications to community control; the relationship between the movement and different State and federal departments; and the policy process. The findings of this research trace the political history of the movement, focusing on its national organisation, through periods of development and change. The ACCHSs movement was able to survive the turn to neoliberalism, and the weakening of the wave of social movements from which it emerged. Yet the movement changed in this process. These changes are identified as a shift from a ‘movement’ to a ‘sector’ framework. Furthermore, the findings identify some of the effects such movements have on shaping the policy process. In particular, two competing types of approaches to the policy process are identified: a declaratory process, in which policy is exclusively decided on and dictated by government, and a treaty-like policy process, in which policy is jointly prepared and agreed upon by those affected by the policy. 6 Acknowledgements The undertaking of the research for this thesis was made possible by a University of Western Sydney International Students Scholarship offered by the short-lived Social Justice and Social Change Research Centre at the University of Western Sydney. During the course research, the centre’s operations were terminated, and I received some support from the School of Biomedical and Health Science and the School of Social Science. I wish to thank the principal supervisor of this project, John Macdonald. His approach to supervising, both professionally and personally, has been a tremendous help throughout this journey, and I feel very fortunate to have worked with him. I also wish to thank Mick Houlbrook, who has joined the supervisory panel a year into the project, and offered a different point of view, which enriched the analysis presented in the thesis. Mick has replaced Kay Anderson, who was a member of the initial supervisory panel, but had to withdraw from the project due to workload issues. I wish to thank Kay for her support and advice during the early stages of this research. During the course of the research project, I received very important direction and advice from a number of other people. I wish to thank Mick Adams, for his early support of the project. Mick, former chair of the National Aboriginal Community Controlled Health Organisation (NACCHO), provided great help to access some of the knowledge that helped shape the research process. I wish to further thank Dea Delaney-Thiele and the staff at NACCHO’s offices in Canberra for their help and invitation to carry research in their collection in the early stages of research. I also wish to thank Tim Rowse, who provided some precious help reviewing an early version of the findings chapters of this thesis. A number of other people provided help and guidance, and I wish to thank Oren Yiftachel, Idan Ben Barak, Will Saunders, Kerry Jacobs, and Samar Habib for their advice at different stages of the process. A special thank you goes to Margaret Allan. Proofing my drafts was a tremendous help. But most of all, thank you for your endless support and solidarity. Lastly, thank you Mimi and Ceecee, for the endless affection and inspiration. 7 List of Images Image 1: From the cover of the July-August 1980 AMS Newsletter. 161 Image 2: Cover of the AMS Newsletter, November-December 1980. 163 Image 3: From the cover of the January-February 1981 AMS Newsletter. 166 Image 4: The NAIHO congress. 178 Image 5: Map of NAIHO members in 1982. 181 List of Tables Table 1: The ’Koorie approach’ vs. the ’Biomedical approach’ to health. 40 Table 2: Models of community-controlled health: two definitions. 53 Table 3: Findings of the PER in its comparison between the different types of health services available to Aboriginal people. 152 Table 4: The movement-oriented and the sector-oriented community-controlled health organisation: features and shifts.