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The Voice to Parliament – what a ‘yes’ vote would mean for Indigenous eye health

With the Voice to Parliament referendum taking place Saturday 14 October 2023, Insight asks what would a ‘yes’ vote mean for Indigenous eye health.

In recent months, many organisations and associations in the eyecare sector have publicly shared their support for the Uluru Statement from the Heart and its call for a Voice to Parliament.

This includes, but is not limited to, the Indigenous Eye Health Unit (IEHU) in The University of Melbourne, Australian College of Optometry (ACO), the National Aboriginal Community Controlled Health Organisation (NACCHO), Orthoptics Australia, Royal Australian and New Zealand College of Ophthalmologists (RANZCO), Fred Hollows Foundation and Vision 2020 Australia.

A referendum on the Voice to Parliament, taking place this year, will ask voters to approve an alteration to the Australian Constitution, creating the Aboriginal and Torres Strait Islander Voice (an independent and permanent advisory body) to represent Indigenous Australians to the parliament and federal government on matters of Indigenous affairs – including their health.

For Mitchell Anjou, it’s a cause close to his heart. An optometrist and self-described ‘white fella’, Anjou is Associate Professor and now Director of IEHU in the University of Melbourne’s School of Population and Global Health, and sits on several eye health advisory boards.

He wears a ‘vote Yes’ badge on his lapel and actively encourages conversations about the Voice at every opportunity. He and his colleagues have also been proactive in encouraging eyecare-affiliated organisations, including the IEHU, to adopt a public position supporting a Voice, Treaty, and Truth.

“I think eyecare can potentially be improved by a Voice to Parliament and certainly by the sector supporting our Aboriginal colleagues in advancing their self-determination,” he says.

As a sector, Anjou says eye health has made progress which, in his words, is not exemplary but is demonstrable, and evidenced through the Australian Institute of Health and Welfare (AIHW) reporting.

“There’s been significant changes over the last decade showing improvement in the number of eyecare services provided, improvement in access to subsidised spectacle schemes, improvement in screening rates for people with diabetes, support for screening in primary health care and improvement in surgery rates for Aboriginal and Torres Strait Islander people,” he says.

The 2008 National Indigenous Eye Health Survey (NIEHS) and 2016 National Eye Health Survey (NEHS) confirmed the gap, or inequity, in eye health and that Aboriginal and Torres Strait Islander people are three times more likely to have vision impairment or be blind than other Australians.

“There’s another survey being conducted at the moment – the data probably won’t be available until 2024 or 2025 – but we are hoping that it shows a further improvement or reduction in the relative rates of vision loss and blindness between Aboriginal people and non-Aboriginal people,” Anjou says.

According to the latest Ahpra data, Anjou says, there are 12 Aboriginal and/or Torres Strait Islander registered optometrists out of 6,000, and only one ophthalmologist, which is well below population parity.

In First Nations hands

A consistent outcome from evaluating IEHU’s Roadmap to Close the Gap for Vision through 2019 to 2021, conducted by two independent consultants, has been that Indigenous eye health needs to be in Indigenous hands.

“There is a recurring message around supporting self-determination, supporting leadership, and supporting greater involvement of Aboriginal people in Aboriginal and Torres Strait Islander eye health,” Anjou says.

As a result, the IEHU has continued to shift its internal structures to reflect this approach.

“The IEHU Advisory Board now has a majority of Aboriginal and Torres Strait Islander people on it. Our chair, Aunty Pat Anderson, and deputy chair, Karl Briscoe, are First Nations people. Half our staff are Aboriginal and Torres Strait Islander, and since the retirement of Professor Hugh Taylor in 2022 we also had opportunity to establish a leadership group that has a majority of Aboriginal and Torres Strait Islander people.”

Anjou says the IEHU team are also encouraging regional stakeholder groups in the eye health sector to have Indigenous leadership and Indigenous voices ‘front and centre’, and supporting organisations in the sector to implement Reconciliation Action Plans.

“A genuine question for the sector is how to elevate Indigenous voices, and provide space for Indigenous leaders to propose an opinion or view or express their thoughts around an issue, which is what the Voice to Parliament is proposing. In the case of the eye health sector, organisations need to listen to what Indigenous people say in a meaningful and real way,” he says.

“I see Aboriginal voice as being a key objective to be introduced into the agencies and the way the eyecare sector operates.”

Leading the way, an Aboriginal and Torres Strait Islander reference group, established originally for an IEHU project, has morphed into the National Experts Group for Aboriginal and Torres Strait Islander Eye Health (NEGATSIEH) which, in turn, has provided the leadership of the National Aboriginal and Torres Strait Islander Eye Health Conference for the last two years.

NEGATSIEH has since supported the establishment of the First Nations Eye Health Alliance (FNEHA) and released Vision 2030, a report which details, from the perspective of Aboriginal and Torres Strait Islander eye health professionals, the vision and future efforts needed to eliminate avoidable vision loss and blindness in Aboriginal and Torres Strait communities by 2030.

“This is Aboriginal and Torres Strait Islander people who are involved in eye health coming together and forming organisations where they can provide important voice and leadership into what is happening in the eyecare sector. We white fellas need to get out of the way and find a meaningful role as allies,” Anjou says.

“If the referendum is successful, I hope that eyecare is able to reflect the change of empowering Aboriginal people to have genuine voice into how the eyecare sector works and operates.”

In the field

In May this year, Dr Josephine Li attended the National Aboriginal and Torres Strait Islander Eye Health Conference in Western Sydney with Anjou and Professor Hugh Taylor, and about 240 delegates from across Australia.

The trio participated in a session at the conference to talk about the yes vote, and how it could impact medical practice, and how to improve the quality of health care for people in the Indigenous community. 

Li, a qualified optometrist, is general manager of Victorian Eyecare Service (VES) and outreach programs at the Australian College of Optometry (ACO), based in Melbourne.

“I think it is a very important step for Aboriginal communities to have a representation in the parliament, which could potentially address a range of issues,” she says.

“If the yes vote is successful, I think there will be more people from Indigenous communities willing to come forward and contribute to their community. I think there’ll be more people trying to raise awareness of eyecare or healthcare and it can help us to close the gap, maybe using a different approach,” Li says.

The ACO receives funding from the Victorian Department of Health to run the Victorian Eyecare Service (VES), and within it, the Victorian Aboriginal Spectacles Subsidy Scheme (VASSS).

Through the VASSS program, Aboriginal and/or Torres Strait Islander communities in Victoria are eligible to obtain spectacles for a co-payment of $10.

“That applies to all our Australian College of Optometry branches, including our seven metro clinics, plus our main clinic in Carlton. We also have visiting optometrists conducting eye tests at the Victorian Aboriginal Health Service in Fitzroy twice a week,” Li says.

In addition, the ACO receives Australian Government Rural Workforce Agency Victoria (RWAV) funding to provide outreach eyecare services to metropolitan and rural health centres for Indigenous communities.

“On top of that we have over 30 rural private optometry practices that have signed up for VASSS, so that allows people living in rural communities to access the scheme.” 

The ACO also hosts students from varies universities for outreach and Indigenous eyecare placement. This allows early exposure to future optometrists to be ready to practice under different cultural settings. 

“The ACO has also adopted a Reconciliation Action Plan, and has one Indigenous staff member who is working in the optical dispenser lab,” Li says.   

Fixing a leaky pipe

Retired Professor Hugh Taylor, a strong proponent of the Voice, says his five decades spent working on eye health in Indigenous communities shows the need for a permanent Voice to Parliament.

Early in his career, after completing his ophthalmology training, Taylor was appointed assistant director of the National Trachoma and Eye Health Program led by Professor Fred Hollows. At the time, the program found the rate of blindness in Indigenous Australians was 10 times higher than in non-Indigenous Australians.

In 2008, he established the Indigenous Eye Health Unit (IEHU) in the Melbourne School of Population and Global Health, whose aim was to end avoidable blindness and vision loss and close the gap for vision. Taylor likened the care pathway for Indigenous patients to a ‘leaky pipe with many cracks and gaps where people would fall out of the system’. 

Working closely with communities and leaders, the IEHU launched the Roadmap to Close the Gap for Vision in 2012, and established 64 regional groups nationwide to coordinate and provide eyecare; two-thirds of those are Indigenous-led.

“Overall, our work has achieved real improvements in eyecare provision that are now reported each year by the Australian Institute of Health and Welfare,” Taylor wrote in an opinion piece on the University of Melbourne’s multi-media platform, Pursuit.

“The gap for blindness has been halved and the rates of eye exams or cataract surgery increased three-fold.”

He says this success involved many people but would have been impossible without strong Indigenous community advice, support and leadership. 

“An independent review of this work highlighted the importance of allyship, the need for cultural safety, and the development, strengthening and support of Indigenous leadership. This showed the importance of putting Indigenous eye health into Indigenous hands,” he wrote.

Taylor says the value of community consultation and leadership was made clear during NACCHO’s handling of COVID.

“We have to listen to and support Indigenous communities and leadership. That is why the Voice is so important. It is clear that decisions for First Nations people need to be made with them, not for them.”

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