Our multicultural health approach

Why a multicultural health action plan matters

The department has a responsibility to improve health equity

It is our responsibility as system steward to ensure the health system is culturally competent, inclusive, accessible and safe.

The department funds a wide range of targeted and tailored services, as well as mainstream services. The breadth and reach of the department’s service footprint means we have a unique opportunity to make a significant and enduring impact on people’s health and wellbeing, but also on their sense of belonging, security, connectedness and trust in our service systems.

Victorian government departments have a longstanding history of promoting and celebrating the benefits of cultural, ethnic, linguistic and religious diversity, reflected in Appendix 2.

The plan enables the department to uphold legislative and policy obligations

This plan enables the department to:

• uphold obligations under the Multicultural Victoria Act 2011
• report annually on progress against the department’s cultural diversity plan
• address culturally competent service delivery to Victoria’s communities.

It also enables the department’s work to be well positioned within many other international, national, state and local legal and policy frameworks, as outlined below and detailed in Appendix 3.

Alignment with broader policies that promote health equity and inclusion

The plan has been developed alongside a number of new departmental policies and strategies to improve health equity including:

• Department of Health strategic plan 2023–27
• Victorian public health and wellbeing plan 2023–27
• Partnering in healthcare: a framework for better care and outcomes
• Victorian cancer plan 2020–2024
• Victorian sexual and reproductive health and viral hepatitis strategy 2022–30
• Policy and funding guidelines for health services 2023–24

New plans and strategies being released shortly including:

• an Aboriginal health and wellbeing partnership agreement and action plan 2023–25
• a Victorian cancer plan 2024–2028
• a Wellbeing in Victoria: a strategy to promote good mental health 2024–34
• a Victorian suicide prevention and response strategy 2024–34
• a Diverse communities mental health and wellbeing framework 2024–34.

The plan builds on, complements and helps progress the actions of the following Victorian Government strategies that promote inclusion:

• Victorian. And proud of it: Victoria’s multicultural policy statement 2017
• Pride in our future: Victoria’s LGBTIQA+ strategy 2022–2032
• Inclusive Victoria: state disability plan 2022–2026
• Our equal state: Victoria’s gender equality strategy and action plan 2023–2027
• Our promise, your future: Victoria’s youth strategy 2022–2027
• Ageing well in Victoria: an action plan for strengthening wellbeing for senior Victorians 2022-2026.

Multicultural communities experience significant health and wellbeing disparities

Compared with the Australian-born population:

• Australians born in some overseas countries have a higher prevalence of dementia, heart disease, stroke, diabetes and kidney disease, particularly for people born in Polynesia, South Asia and the Middle East. Higher rates of chronic disease are associated with low English proficiency and over 10 years of settlement in Australia.²
• Higher potentially preventable hospitalisation rates for people born in Oceania and Antarctica, North Africa and the Middle East compared with the Australian-born population, with over double the average preventable hospitalisation rates for Syria, Somalia, Sudan and Samoa.³
• 89% of refugees experienced traumatic events before arriving in Australia. Over 40% experienced mental health problems in the first five years of settlement.⁴
• Refugee background children and adults have very low immunisation completion rates of 0–19%.^{5, 6}
• People born overseas have a higher prevalence of some infectious diseases, representing 92% of hepatitis B cases⁷, 13% of hepatitis C cases⁸, more than 40% of new diagnoses of HIV9 and over 86% of tuberculosis notifications.10
• People born overseas were 2.5 times more likely to die from COVID-19 in 2022. During the Delta wave, over 70% of people who died from COVID-19 were born overseas.¹¹
• Women born overseas are less likely to have their first antenatal visit in the first trimester (76.2% compared with the Victorian average of 80.7%).¹² Women of refugee background experience barriers in accessing and engaging in antenatal care and have higher rates of stillbirth and perinatal mortality than Australian-born women.^13,14
• Children from a language background other than English are more likely to be developmentally vulnerable than children from an English-only language background (25.3% compared with 20.8%).¹⁵
• People from multicultural communities have a similar level of disability as Australian-born people but much lower disability services utilisation.¹⁶
• People from multicultural communities are more likely to experience vision and hearing loss but less likely to access vision and hearing services.^{17, 18}
• Refugee children and adults experience poorer oral health such as dental caries, missing teeth and periodontal disease.^{19, 20} Predisposing factors and language and cultural barriers compound disparities in oral health care use.²¹
• People born in regions including New Zealand, Oceania, North Africa and the Middle East have higher rates of smoking (16.6 and 16.9% respectively, compared with 15.4% Australian-born average).²²
• People from multicultural communities have lower participation rates in breast, bowel and cervical cancer screening, with poorer mortality and survival outcomes.^{23, 24}
• People from multicultural communities are at higher risk of nutritional deficiencies such as low vitamin D and anaemia due to previous deprivation and food insecurity.²⁵

Pre- and post-settlement challenges affect health and wellbeing

A significant and growing body of research highlights the challenges that can affect health and wellbeing for multicultural communities. These include:

• language barriers, communication issues and diverse cultural understandings of health²⁶
• experiences of stigma, discrimination, racism and exclusion^{27, 28}
• low health literacy, low digital literacy and challenges navigating unfamiliar health and social service systems, both physically and digitally^{29, 30}
• inadequate or restricted access to culturally competent universal health services^31,32, and negative experiences within health and mental health services^{33, 34}
• social isolation and lack of family and community support on arrival in Victoria
• competing priorities in early settlement such as learning English, gaining stable housing and employment, and arranging childcare and/or schooling
• financial stress and vulnerability, as well as food and energy insecurity,³⁵ unstable working conditions, potential for exploitation, violence and risks to safety
• anxiety, distrust or fearfulness of interacting with government services, particularly for at-risk cohorts such as undocumented migrants and humanitarian arrivals³⁶
• unequal impacts of the COVID-19 pandemic on multicultural communities affecting COVID-19 recovery, including emerging evidence that some multicultural communities are at higher risk of long COVID.^{37, 38}

Refugees and people seeking asylum face unique challenges that further affect health outcomes such as:

• a high burden of diseases and illnesses, combined with a history of poor and interrupted health care, prolonged deprivation in extreme living conditions and marginalisation³⁹
• inconsistent or restricted eligibility for Commonwealth safety net supports for people seeking asylum (such as Medicare, income support, Low Income Health Care Card, work rights and casework support)
• social determinants of health including financial vulnerability, destitution, homelessness, job insecurity and risk of exploitation⁴⁰
• mental health impacts of war, torture, trauma, persecution, loss of and/or separation from family, human rights abuses, prolonged uncertainty due to visa processing and detention.^{41, 42}

Our multicultural health approach

Our approach builds on existing multicultural health efforts

Multicultural communities use a combination of mainstream and targeted health services that are funded privately and through a mix of local, state and Commonwealth government funding.

The department funds a range of tailored and targeted multicultural health programs that provide specialised care such as torture and trauma counselling and refugee health nursing.

The department also funds sector coordination, engagement and capability-building activities to complement and build the capacity of mainstream services. These initiatives often connect health professionals in mainstream health settings to specialised multicultural health programs for referral, secondary consultation, partnership, professional development and training.

The department also has policies and programs in place to ensure mainstream health services are accessible and culturally competent. These include language services and access policies to ensure people seeking asylum can access free hospital and ambulance services without a Medicare card.

Key components of Victoria’s multicultural health approach are:

• Tailored and targeted multicultural health programs
• Accessible and culturally competent mainstream health services
• Coordination, engagement and capability-building programs

Targeted multicultural health policies, programs and services are detailed in Appendix 4.

Our approach considers priority populations and intersectional community support needs

Some priority populations will need more targeted and tailored support to respond to the unique circumstances of their migration and settlement experience. These include:

• women experiencing vulnerability such as Woman at Risk visa holders; women on provisional spouse visas who leave violent relationships; women who have been trafficked or subject to exploitation; and pregnant women who have been exposed to trauma and violence
• children and young people, particularly unaccompanied minors and children on bridging visas who have experienced trauma, loss, upheaval and deprivation, and children and young people exposed to child abuse and neglect with significant unmet health needs⁴³
• people who are Lesbian, Gay, Bisexual, Trans and gender diverse, Intersex, Queer, Questioning and Asexual (LGBTIQA+) who may be socially isolated, disconnected and stigmatised by their community, their family and/or the LGBTIQA+ community⁴⁴
• adults and children with pre-existing disability, mental illness, acute or complex health diseases, chronic health conditions or infections (such as latent tuberculosis, HIV or hepatitis B)
• older people from multicultural communities who may experience social isolation due to less opportunity to develop and keep social connections, added communication needs and multiple complex and chronic health issues that impede daily activities^{45, 46}
• people from refugee backgrounds who are not part of the Humanitarian Programme (such as the Family Migration Program) and do not receive casework to connect into essential services
• newly arrived refugees with exposure to torture, trauma or war, such as people evacuated from Afghanistan
• people seeking asylum on bridging visas in the community who have variable access to work rights, Medicare and casework and are not eligible for Commonwealth income support (people who have been in detention for long periods may experience significant mental and physical health impacts, especially children;^47,48 many people seeking asylum have been waiting in the Victorian community more than 10 years for a visa outcome)
• temporary migrants experiencing financial hardship (such as international students, temporary skilled migrants) who have limited access to government health services or income safety nets
• undocumented migrants and people seeking asylum on expired bridging visas who have limited access to services and may fear interacting with government services.