*** This post was updated several times on 9 May, and also on 10 May ***
This post compiles reaction to health-related measures in the Federal Budget, regarding the social determinants of health, Aboriginal and Torres Strait Islander health, climate change, public health and prevention, healthcare reform, mental health, aged care, rural and remote health, the NDIS, and medical research. It includes statements from 39 organisations.
While there is positive news for some areas (notably aged care, mental health and rural health), all the signs are that the social determinants of health will worsen for many people.
And don’t mention climate change (the Treasurer certainly didn’t).
Also absent is a vision for public and preventive health, while funding for human rights initiatives is slashed, and National Congress has issued a devastating critique of the implications for Aboriginal and Torres Strait Islander people (published in full below).
Compare and contrast the reactions from the Indigenous and social sectors with those of the health and medical sectors in the post below.
Such an analysis might suggest that one reason governments are slow to act on the social determinants of health is the failure of the powerful health and medical lobby to hold them to account for this.
(And the same might be said about the health sector’s almost universal failure to call out the lack of action on climate change in their budget responses).
So many elements of this Budget will make life harder for people who are already doing it tough – and yet the overwhelming sound from health organisations is of grateful applause (with a few notable exceptions).
Perhaps it’s just that the sector has been starved of forward-looking, equity-based policy making for so long that it’s a case of being grateful for small mercies.
The Health budget papers are available here and are covered by Jennifer Doggett in this excellent analysis: Public relations trumps policy.
Social determinants of health
ACOSS said the personal tax cuts would not help the majority of people on low incomes, and will deprive governments of the ability to fund essential services.
CEO Dr Cassandra Goldie said:
“No sooner have we seen five minutes of budget sunshine then the Government has committed itself to seven years of income tax cuts. This is not a disciplined and responsible approach to budgeting. There is a seven year plan for tax cuts, but where’s the seven year plan for reducing poverty among adults and children, guaranteeing growth funding for health care, and closing the gaps in essential services such as mental and dental health and affordable housing?
“It is shameful that the Government has chosen to ignore the overwhelming consensus to help people on the lowest incomes, by increasing the woefully inadequate Newstart and student payments, as a matter of priority.
“Instead the Government has chosen to give away personal income tax cuts for people including the highest income-earners in the country. The maximum benefits of the new tax offset ($11 a week) will go to people earning $48,000 to $90,000, not low income-earners. Higher income earners will be the beneficiaries of lifting the $87K threshold to $90K taxable income. The lowest 40% of individuals by income will receive nothing or very little, up to $4 per week. This first stage of tax cuts alone will cost the budget $13 billion.
“The seven year tax plan hands out increasingly generous tax cuts that will disproportionately benefit higher income-earners. These tax cuts, on top of the corporate tax cuts, will clearly deprive future governments of the revenue we need to guarantee essential services. There are some welcome measures to stem tax avoidance, such as refusing tax deductions for vacant land, modest measures to tackle the use of trusts for tax avoidance purposes, and action to limit profit shifting by multinational corporations. Measures on the black economy are also welcome. However, these measures go nowhere near compensating for the lost revenue from the 7 year tax plan.
“The planned tax cuts and the arbitrary revenue cap of 23.9% to GDP place us in a damaging fiscal straightjacket. Australia is already one of the lowest taxing countries in the OECD, and with tax cuts for years ahead, we clearly could not guarantee essential services and a decent safety net to meet community needs. Tax cuts risk extending user pays for essential services leading to greater out of pocket costs.
“The increase of 14,000 home aged care packages is welcome, and starts to deal with a backlog of 100,000 packages. The focus on quality and transparency is also welcome. However, this aged care package highlights the yawning gaps that remain in essential services, and tonight’s announcement only begins to fill those gaps.
“The $1B increase in hospitals funding is also welcome, but only restores funding cuts that would have otherwise commenced in 2020. Similarly, the Medicare rebate freeze is ending. We cannot afford to keep taking one step forward and another step back in health funding. Adequate growth funds must be guaranteed and a stronger revenue base is the only way to achieve this.
“Other more modest measures that we welcome include the remote housing funding for the Northern Territory ($550 million), a small boost mental health services and continuity of support services for some people not eligible for the NDIS ($92 million).
“Commitments in education, including schools and early childhood funding, are also welcome but do not give the assurances we need that public schools and preschools will be adequately funded into the future.
“The harshest change in this budget affects some of the most vulnerable people in the community: new migrants lacking paid work, who will be left without income support for the first four years. This is not the way to welcome people to this country and help them contribute to its future prosperity.
“There are small changes to one of the harshest existing schemes, the Community Development Program for remote Indigenous communities, including a new wage subsidy scheme and slight reduction in the hours they need to work for their benefits, but the changes do not restore incomes to the thousands of people losing income support when they are penalised under this scheme, and some could make matters worse.
“The proposal to deduct State Government fines from social security payments without their agreement is unnecessary, intrusive, and could leave many people homeless. The ball is in the States’ court to reform the system of court-ordered fines so that people are no longer imprisoned because they can’t afford to pay.
“A responsible budget would strengthen the revenue base so that the government can do its job, especially to provide the essential services people need and protect people from poverty. Unfortunately this budget does the opposite, and the budget mistakes of the 2000s are being repeated.”
The Brotherhood of St Laurence
In this Budget, Brotherhood of St Laurence executive director Conny Lenneberg welcomed additional places for the highly successful Transition to Work program which prepares young people for jobs in their communities.
“I am also pleased to see funding for the Brotherhood to establish a Youth Employment Body to help young people into work with new approaches informed by research and, importantly, harnessing employer effort.” Ms Lenneberg said older Australians were also hit hard by unemployment and new expanded measures would help respond to challenges mature-aged job seekers faced.
“But the Brotherhood remains deeply concerned about Australia’s fraying social safety net, which undermines efforts to get people into jobs,” she said. “The very low rate of the Newstart Allowance acts as a barrier to people securing work and fully participating in Australia’s economy.”
Australia’s ‘long forgotten people’: Newstart recipients
“The long forgotten people of this federal Budget – yet again – are Australians who rely on Newstart to make ends meet,” said Ms Lenneberg. ”After 25 years of economic growth, our country’s unemployment benefit remains far too low.”
Ms Lenneberg said increasing Newstart is not just about being fair – it makes good economic sense. “Newstart is so utterly inadequate – as little as $38.98 a day – that many people on the payment can’t afford to properly conduct their job search. They are struggling to cover the basics of life. The truth is that there are costs involved in looking for work: maintaining a mobile phone, paying for transport and having presentable clothing to attend interviews.
“Disturbingly, housing costs are so high these days that an increasing number of vulnerable people on Newstart are forced into homelessness. Newstart should enable people to get into work, but the unintended consequences of very low rates is that it presents a huge barrier to employment. How can you properly look for a job when you can’t even afford to keep a roof over your head?”
In the lead up to the next federal election, the Brotherhood of St Laurence urges all parties to commit to address this deep flaw in our social security system.
“Fixing Newstart is a moral challenge for our democracy. It is not fair to consign people searching for work to poverty amid such a run of economic prosperity. It is not only welfare groups, but economists and business who are calling for an urgent increase in Newstart. We must share the pie,” Ms Lenneberg said.
Homelessness Australia labelled the Federal Budget ‘short-sighted and heartless’, after it was revealed there will not be any extra funding for either social housing or homelessness services. This is despite the number of people needing homelessness assistance increasing year-on-year.
The budget shows that federal homelessness and housing funding will drop to $1.54 billion next financial year, the lowest level in a decade. HA’s analysis of the Budget papers shows that there has been a 16 per cent decline in federal spending on housing and homelessness over the five years to 2018-19.
“It’s short-sighted and heartless to neglect homelessness services, and to let ageing social housing stock dwindle. We’ll be forced to turn even more people away, many of whom will end up in our hospitals, prisons and mental health facilities; when all they need is a home,” said Jenny Smith, Chair, Homelessness Australia.
“It is irresponsible for government to stand on the sidelines wringing its hands while Rome burns. We need the government to bolster the services that do the heavy lifting, and to build more housing that people on the lowest incomes can afford; it’s as simple, and as difficult, as that.”
Difficult times ahead for Centrelink clients
Aboriginal and Torres Strait Islander health
National Congress and its members are dismayed that the Federal Budget has once again failed to significantly address many of the key concerns of Aboriginal and Torres Strait Islander communities, organisations, and peoples. First Peoples have come last.
The Government’s priority for First Australians focuses primarily on economic prosperity. While many would welcome this outcome, the Government’s roadmap to accomplishing this prosperity is fanciful, incoherent and sorely lacking in the detail necessary for success.
Although the Government has listened to a few of our concerns regarding the Community Development Program, major issues largely remain unresolved in this budget. The harsh and discriminatory penalty system is largely intact. In fact, penalties have worryingly been strengthened in cases involving participants who need the greatest amount of support. For this reason alone we renew our call for the CDP to be replaced with a wage-based program which provides meaningful employment and training for our peoples.
We are deeply concerned by the Government’s proposal to withhold income support payments from individuals who default on fines. This is a recipe for ensuring that the poorest and most vulnerable members of our society will remain so, with unpaid fines likely leading to increased rates of incarceration rather than pathways to prosperity. Our peoples cannot achieve economic prosperity if we cannot meet our basic needs.
In claiming that it will provide $550 million in new funding for remote housing in the Northern Territory, the Government has attempted to hide its abandonment of a national housing strategy. The National Partnership Agreements on Remote Indigenous Housing have expired. Prospects of renewal are slim, particularly if negotiations with state and territory governments are unsuccessful. If Aboriginal and Torres Strait Islander peoples are forced to live in insecure, overcrowded and unsafe homes, or are homeless, the barriers to economic empowerment are overwhelming.
The Federal Budget fails to address the shameful over-incarceration of Aboriginal and Torres Strait Islander peoples. We make up 3% of Australia’s population, but 27% of its prisoners. If anything, the Government’s callous disregard for our basic human rights to equality and quality health, education, housing and employment opportunities makes this problem worse. These factors are also responsible for child removal rates being ten times greater than for non-Indigenous Australians, which threatens to create a new Stolen Generation and perpetuates intergenerational trauma.
Aboriginal and Torres Strait Islander legal services have highlighted gross inadequacies in
government f unding for civil cases. As Centrelink breaches, inability to repay fines and housing tenancy disputes become more commonplace due to Budget measures, thedemand for legal services will only increase and these inadequacies are likely to becomemore severe.
Attempts to Close the Gap appear to have stalled, with Minister Scullion making no
reference to the program in his media release. No new funding has been allocated to the
strategy, despite a dire need for further community consultation and national co-operation
between governments and our organisations. The Government’s failure to Close the Gap
must not be used as an excuse to abandon the targets altogether, lower expectations and
widen the life expectancy gaps or shift responsibilities to state and territory governments.
We note in this budget that $50 million has been allocated for the memorialisation of the
250th Anniversary of Captain Cook’s voyage to Australia. Whilst gaining pockets of local
support, this appears a controversial investment in the Treasurer’s own electorate. Our
preference would be to redirect these funds into community based Closing the Gap
initiatives to address the negative impacts of the European invasion of Australia.
National Congress welcomes the renewal of funding for our health organisations and
In particular, we appreciate the recognition of the crucial role which the Aboriginal
and Torres Strait Islander workforce plays in delivering positive health outcomes for our
peoples. However, we note that the provision of culturally safe and appropriate healthcare
must also be integrated into the mainstream health system. We also acknowledge the
Government’s commitment to provide new funding to aged care, but unless the large gap in
life expectancy is resolved, many of our peoples may not enjoy the longevity to benefit from
We reiterate our call for the Government to work collaboratively with us. The need for an
independent and well funded national representative body to inform Governments is greater
now than ever. Our organisations are in the best position to provide culturally safe and
appropriate services to our peoples. However, we cannot achieve this without adequate
resources and support.
On reflection this budget leaves so many of us uncertain of the true value of our extensive
consultations with Government over the past year. So little of what we have said, like so little
of what we have recommended, has been taken up by this Government in this
Our political leaders have seemingly exhibited an attention deficit; one proportional to the
surplus evident in their own self-interest.
National Aboriginal and Torres Strait Islander Legal Services
While the over-incarceration of Aboriginal and Torres Strait Islander people has been squarely on the Commonwealth’s agenda in 2018, the Federal Budget has not delivered any funding for solutions.
“The Australian Government has ignored the findings from their own Law Reform Commission and Northern Territory Royal Commission inquiries,” said Cheryl Axleby, co-chair of NATSILS. “Instead, they have introduced oppressive, punitive measures which will disproportionately affect Aboriginal and Torres Strait Islander people’s quality of life.”
The recommendations, including introducing national justice targets, support for justice reinvestment and Aboriginal and Torres Strait Islander Legal Services to deliver essential legal help, did not form part of the Budget. Nor did Closing the Gap, despite a year-long refresh agenda.
Yet stringent measures deducting welfare payments from people with unpaid fines and outstanding warrants have been introduced. These measures come in the face of increasing rates of over-representation, and a demonstrated connection between poverty and imprisonment for Aboriginal and Torres Strait Islander people.
“All governments around Australia should immediately abolish imprisonment for unpaid fines, not deduct welfare payments from people who are already oppressed by the system,” said Ms Axleby. “This will likely have a huge impact on Aboriginal and Torres Strait Islander communities. We cannot afford to lose more lives to unpaid fines.”
In addition, a number of Indigenous people accessing Aboriginal and Torres Strait Islander legal Services relate to housing and tenancy issues. Despite this, National Partnerships on Remote Housing remain in doubt in WA, Qld and SA.
“Increases in Indigenous health won’t outweigh the government’s changes to housing and welfare, which will further entrench disadvantage,” said Ms Axleby. “This will lead to more unmet legal need for Aboriginal and Torres Strait Islander legal services, already at crisis level. This need must be comprehensively mapped to determine the gaps in providing essential legal help.”
The concerning welfare measures include extending a punitive demerit point system to Community Development Program (CDP) participants. This cuts and suspends welfare payments for weeks at a time, risking further deep financial disadvantage for a very vulnerable group.
Since the introduction of the CDP, 300,000 financial penalties were applied, despite having only around 33,000 participants. Despite the clear failures of the CDP to date, only minor improvements were introduced, including a new wage subsidy scheme and slight reduction in the hours participants need to work for their benefits.This flies in the face of constant calls for community-led solutions with a holistic, trauma-informed approach.
“The Government has not acted on their commitment to “do things with us, not to us”, once again ignoring the solutions that have been put forward to them by Aboriginal and Torres Strait Islander representative bodies in the 2016 Redfern Statement,” concluded Ms Axleby.
The National Aboriginal Community Controlled Health Organisation (NACCHO) has welcomed the Budget announcement of a new needs based funding formula model for the Indigenous Australians’ Health Program (IAHP). Although this new model requires further refinement, feedback and work.
This new model for our 144 Aboriginal Community Controlled Health Service (ACCHS) provides funding for our primary health care services and now excludes 7 inconsistent data points related to NKPIs.
NACCHO Chair Mr John Singer believes ‘that funding certainty is critical to ACCHSs achieving good health outcomes.
Mr John Singer called on the government to ensure there was no adverse impact on our Model of Care.
NACCHO welcomes the 5-year funding agreements and grandfathering arrangements under this new model.
NACCHO welcomes the new money for preventing and treating complex chronic health conditions such as Eye disease ($34.3 million) hearing loss ($30.0 million) and crusted scabies ($4.8 million).
Acknowledges the new investment in remote renal services and infrastructure with a MBS item for dialysis.
Also, the $105.7 over four years to deliver additional residential aged care places and home care packages in remote Indigenous communities.
The Government has advised that the new funding model can be varied up to July 2019 and NACCHO will continue work in consultation with the Funding Model committees.
Aboriginal controlled health services provide about three million episodes of care each year for about 350,000 people and employ about 6,000 staff.
Meanwhile, the Indigenous health funding announcement included the news that up to $23 million will be provided to the Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation for continued renal support activities in remote Australia, including expansion into eight new communities.
Australian Indigenous Doctors’ Association
The Australian Indigenous Doctors’ Association (AIDA) welcomes the news of increased government investment into Aboriginal and Torres Strait Islander peak workforce organisations of $33.4 million over four years from 2018-2019. We take this as a tangible measure of the genuine commitment of the Turnbull Government to work with us to build the Aboriginal and Torres Strait Islander health workforce.
As the only professional association for both Aboriginal and Torres Strait Islander doctors and medical students, AIDA is committed to improving the health of our people and enriching the health profession by growing the numbers of Indigenous doctors. This renewed funding certainty will allow AIDA, through our strong relationships with key stakeholders, to keep supporting efforts to increase the cultural safety of mainstream medical education and health care systems.
This continued financial support from the government means job security for our employees, increased resourcing for emerging issues and the ability to continue to implement our long-term strategic agenda. This includes:
– Development of our 2018 policy priorities
– Further investment in Indigenous-led health research
– The delivery of a cultural safety program for doctors, by Indigenous doctors
– Ongoing support to our student and doctor member base
Doing things with, not to Aboriginal and Torres Strait Islander Peoples
AIDA encourages the Turnbull Government to maintain its stated commitment to work in a consultative and collaborative way with Aboriginal and Torres Strait Islander Peoples.
We remain concerned that there is no commitment in the 2018/19 Budget to adequately resource the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. AIDA maintains that this is the roadmap for the government to work with us to genuinely redress health disparity and deliver culturally appropriate and needs-based health care to Aboriginal and Torres Strait Islander Peoples. We encourage the government to commit to implementing the social determinants of health framework into future Indigenous health policy development.
AIDA also remains concerned about the lack of targeted funding commitment around Closing the Gap. We maintain that measureable targets, accountability mechanisms and appropriately funded policy design and program delivery are essential to closing the gap on Indigenous disadvantage.
With this renewed funding certainty, AIDA will continue working towards our vision for an Australian health care system that is free of racism, and one that affords Aboriginal and Torres Strait Islander Peoples the health care they have a right to expect and receive.
Reconciliation Australia acknowledges the Federal Government’s continued investment in services and programs for Aboriginal and Torres Strait Islander peoples. However, we are concerned that a crucial opportunity to reset the Closing the Gap strategy will be lost, given the absence of substantial needs-based measures to realise the strategy in the 2018-19 budget.
The budget includes spending on measures that will have a modest impact on areas relevant to improving life outcomes for Aboriginal and Torres Strait Islander people.
However, the budget papers delivered this evening do not outline a coherent and comprehensive funding plan to deliver the Federal Government’s overhaul of the strategy, due in October 2018.
In February, the Close the Gap campaign’s 10-year review said the Closing the Gap strategy had been “effectively abandoned” after $534 million in funding was cut from Aboriginal and Torres Strait Islander programs in 2014-15.
Despite a decade of consistent advice, key recommendations to address the increasing disparity between Aboriginal and Torres Strait Islander people and other Australians are yet to be funded.
For example, the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan has not been funded. Also, the complementary National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 needs an implementation plan and funding as appropriate.
Additionally, there is no funding support to tackle the increasing rate of incarceration of Aboriginal and Torres Strait Islander people, despite recommendations from the Australian Law Reform Commission and the Change the Record campaign.
Reconciliation Australia CEO Karen Mundine said closing the gap was an agreed national priority, yet the budget failed to allocate the funds necessary to realise this commitment.
“Closing the gap is a national priority. Now is the time to invest in outcomes for Aboriginal and Torres Strait Islander people – to set this strategy up to make real progress,” she said.
“To get this right, we need a commitment to ongoing funding that is commensurate with the substantially greater and more complex needs of Aboriginal and Torres Strait Islander people, and is allocated in a way that allows Aboriginal and Torres Strait Islander people to design and develop our own solutions. Yet that’s not what’s been delivered.”
In addition to needs-based funding, Ms Mundine said an effective approach to closing the gap requires partnership with Aboriginal and Torres Strait Islander peoples to develop comprehensive, preventative, long-term approaches to address the issues affecting their communities.
“We welcome the $33.4 million commitment to Aboriginal and Torres Strait Islander health professional organisations to grow the Aboriginal and Torres Strait Islander health workforce, as recommended by the Close the Gap campaign,” she said.
“It’s promising that the government has previously indicated its intention to use a strengths-based approach in its Closing the Gap refresh, in order to empower Aboriginal and Torres Strait Islander communities to make key decisions.”
“However, this intention can’t be realised unless it is backed up with a strong commitment to provide adequate ongoing funding.”
Indigenous Allied Health Australia
Allied Health Undervalued in 2018 Federal Budget: Improving Aboriginal and Torres Strait Islander health and wellbeing must remain a national priority. Action is needed to improve outcomes for Aboriginal and Torres Strait Islander people.
Those actions must involve: a coherent strategy to tackle the causes of disadvantage and enable our people to achieve their potential; governments showing the stamina to address issues that come from generations of trauma and disadvantage; and commitment to work with, hear and respect Aboriginal and Torres Strait Islander people and the knowledge they bring to issues that shape their lives.
IAHA now has a commitment of funding for a further four years. We also have a commitment of $1.55M per year in additional funding to share with our fellow Aboriginal and Torres Strait Islander health workforce peak organisations: AIDA, CATSINAM and NATSIHWA. We have proven our approaches deliver results and build the Aboriginal and Torres Strait Islander health workforce.
IAHA has a significant advocacy role and interest in several other initiatives announced in the 2018-19 Budget, including measures responding to urgent needs across Australian communities, including:
• $105M over four years to improve access to aged care for Aboriginal and Torres Strait Islander people
• $30M over four years for ear health assessment in pre-schools
• $34.3M over four years for eye health and
• Extra commitment to suicide prevention, additional mental health care.
IAHA CEO Donna Murray said “For initiatives to deliver for Aboriginal and Torres Strait Islander people, community must be involved in how those measures are developed and implemented. This applies to new measures and to addressing existing acute allied health shortages in health, disability, aged care and other social services.”
A culturally safe and responsive skilled workforce is critical in working with Aboriginal and Torres Strait Islander people and communities. To ensure the workforce has the skills needed to deliver results, strategies and solutions need to be developed and delivered in partnership with IAHA, our members and communities.
“IAHA’s success thus far in developing and implementing innovative allied health career pathway programs and supports, providing leadership opportunities and development, mentoring, in partnering and in promoting person-centred, multidisciplinary care needs to be leveraged further. We, therefore, welcome a stronger partnership with Government to enable this success to continue and grow”, said Ms Murray.
IAHA chairperson, Nicole Turner,commented: “By leading and facilitating inter-professional approaches that fit with Aboriginal and Torres Strait Islander notions of health and wellbeing, we’ve supported and enabled rapid growth in the Aboriginal and Torres Strait Islander health workforce. But we still represent less than 1 percent of the allied health workforce. Our workforce must continue to grow. Continued funding for IAHA is a vital step in the right direction.”
IAHA welcomes the $550M allocated to the Stronger Rural Health Strategy and the aim of ensuring the right health professionals are available when and where they are needed. However, IAHA remains concerned and disappointed that acute shortages in rural and remote allied health services have been largely ignored, and particularly that there appears to be almost no gain for Aboriginal and Torres Strait Islander communities who have little or no access to allied health services at present.
CEO, Donna Murray, added: “IAHA will continue to advocate for the National Aboriginal and Torres Strait Islander Health Plan and Implementation Plan to be fully funded. IAHA will continue to seek opportunities to work constructively with Government to achieve this result.”
The National Aboriginal and Torres Strait Islander Health Workers Association
The National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) welcomes the 2018 Australian Government budget announcement that signal growth in funding for Aboriginal and Torres Strait Islander workforce organisations.
These organisations (NATSIHWA, CATSINaM, IAHA and AIDA) work together to support the Aboriginal and Torres Strait Islander health workforces and improve health outcomes for Aboriginal and Torres Strait Islander people…
“We thank the Australian government for the continued support of NATSIHWA. This funding will not only enhance the sustainability of our profession, but will also lead to opportunities that promote the recognition and professionalism of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners,” said Ms Josslyn Tully, NATSIHWA Chairperson.
In particular, the budget announcement supports the progression of NATSIHWA’s strategic plan 2017-2020. “Today’s budget announcement presents an important opportunity for NATSIHWA. It will enable us to progress
key strategic priorities, including the development of a National Mentor program to support Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners. This is a very exciting time for our members”, said Mr Karl Briscoe, NATSIHWA CEO.
“NATSIHWA looks forward to progressing these initiatives with our membership, which includes over 750 full members who are qualified Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners across Australia,” said Ms Josslyn Tully.
Public health and prevention
Public Health Association of Australia
The Budget continues to fund the health care systems, but is woefully short on preventative health measures to keep Australians from becoming sick in the first place, according to PHAA Chief Executive Michael Moore AM.
“Despite repeated advice – and repeated commitments in principle – the Government is still not developing a preventative health focus for our health system,” said Mr Moore.
“It’s true there are a few modest measures tonight – including additional vaccinations funded, very welcome measures to promote mental wellbeing, and the Good Sports Program to reduce alcohol consumption in sporting contexts.”
“But Australia’s people will continue to experience avoidable chronic disease in the years ahead. People who should be destined to live healthy lives will not because of the preventable diseases they will suffer. While we need to look after the aged populations and those requiring medical treatment, we need to focus even more heavily on the younger generation we are failing,” Mr Moore said.
“The inevitable cost to Budgets far into the future will be greater than the investments that might have been funded.”
“What is also noticeable is that there are no preventive measures in this budget which impact negatively on industry.”
“Just last week we saw Australia’s first ever dedicated conference of preventative health professionals, with 300 expert Australians gathering in Sydney to debate the way forward to a more preventive approach to health and wellbeing.
“Yet tonight, preventive health has again been relegated to a low priority.”
“Future Health Ministers and Treasurers will rue the mistakes of this generation, including tonight’s Budget, in failing to invest in preventive health.”
Mr Moore also acknowledged Minister for Aged Care and Indigenous Health Ken Wyatt for securing a number of important initiatives in Indigenous health, Australia’s most agonizing continuing health crisis.
The Public Health Association welcomed a number of specific initiatives in tonight’s Budget:
– Improving physical activity with a $50.4m investment to get people moving and expanding other physical activity.
– Funding to expanding four forms of vaccinations, including Pertussis, and a targeted program to address low vaccination rate areas.
– A National Injury Prevention Strategy for children and older people, including a program to prevent water and snow sport injuries
– Additional funding for suicide prevention
Mr Moore also welcomed the government’s focus on quality in aged care.
The Australian Injecting and Illicit Drug Users League
The AIVL has welcomed some additional funding for drug treatment in tonight’s Federal Budget but is disappointed that other key harm reduction measures have missed out.
AIVL is calling on the Australian Government to abandon its planned trial of drug testing for welfare recipients and redirect that funding into frontline services in the wake of the Budget. AIVL is also calling for a stronger focus on people exiting custodial settings to strengthen Australia’s efforts under the new national blood borne virus (BBV) and sexually transmissible infections (STI) strategies.
“While the Government will provide $40M over 3 years to expand GP services ($20M) and provide additional funding for residential rehabilitation services ($20M), further investment will be required to ensure that the alcohol and other drug (AOD) service system is able to meet existing demand.
“Just yesterday, the Government reaffirmed its commitment to implementing a trial of drug testing for welfare recipients in its majority report for the inquiry into the Social Services Legislation Amendment (Drug Testing Trial) Bill 2018. However, the inquiry report is filled with expert testimony urging the Government not to proceed. We would like to see the funding that has been allocated for drug testing of welfare recipients redirected into frontline services,” explained Melanie Walker, Chief Executive Officer (CEO) of AIVL.
“There’s a full suite of evidence-based interventions in the AOD sector but services are currently under-resourced and struggling to keep up with demand. For instance, we already knew from previous studies that investment in Needle and Syringe Programs (NSPs) between 2000 and 2009 prevented nearly 97,000 Hepatitis C infections and 32,050 HIV infections – for every dollar spent on NSPs, more than $4 will be returned in savings to the health system. AIVL recently released a new report looking at ways to enhance the effectiveness of NSPs across the country to address access issues and maximise the public health benefits[ii]. NSPs remain a very cost effective way of preventing the transmission of BBVs – increasing access to NSPs should be a high priority.
“Evidence-based AOD treatment is also a good investment. For every $1 invested in AOD treatment, society gains $7. However, while approximately 200,000 people receive AOD treatment in any one year in Australia, it is estimated that an additional 200,000 – 500,000 people seeking treatment are unable to access it[iii]. People don’t need to be coerced into accessing drug treatment – there just aren’t enough treatment places to meet demand. This Budget will go some way towards addressing unmet need but there’s a long way to go if we are to meet the needs of those individuals, families and communities struggling to address AOD problems.
“It is also important that people entering and exiting custodial contexts are not forgotten. Ensuring access to the full suite of preventive, harm reduction measures – and ensuring that people are able to continue their engagement with AOD and BBV treatments post-release – are tangible ways that we could protect more Australians from contracting BBVs. There is a real need for a national policy to guide prisons in jurisdictions[iv].
“It would be great to see enhanced investment in these types of cost effective harm reduction and demand reduction measures as part of future federal budgets,” said Ms Walker.
AIVL is the national organisation representing people who use/have used illicit drugs and is the peak body for the state and territory peer-based drug user organisations.
The Australasian Injury Prevention Network
The Australasian Injury Prevention Network (AIPN) has welcomed the allocation of $0.9 million over three years to develop a new National Injury Prevention Strategy in the 2018-19 budget.
“The current National Injury Prevention and safety Promotion Plan, 2004-2014, urgently needs to be reviewed and updated,” said AIPN President Rebecca Ivers.
“With injury the leading cause of death and disability in young people and those of working age, the government cannot ignore the impact of preventable injuries on the health of the Australian population and the new budget measures are a much needed support to the relentless work of injury prevention professionals around the country,” Professor Ivers said.
“The AIPN will be talking to government officials to provide input into the new Strategy. In particular we are delighted to hear that the strategy will have a whole-of-population approach and that populations with high rates of injury – including Aboriginal and Torres Strait Islander people, people at socioeconomic disadvantage, people with mental illness, and people living in remote, rural and regional locations – will be specifically addressed through the strategy,” she said.
As well as the development of a new National Injury Prevention Strategy, the budget provides for the expansion of a range of injury prevention initiatives including $6.3 million over four years to sports safety; $15.5 million over five years to water and snow safety and $1.2 million to develop a suicide prevention campaign.
The AIPN will continue to advocate for more support and resources towards injury prevention and provide a united voice to injury prevention professionals from all settings.
General Practice Registrars Australia
The President of General Practice Registrars Australia (GPRA), Dr Melanie Smith said today that one set of initiatives in the Federal Budget 2018 is critically important for protecting the health of Australians into the future.
“The measures listed under ‘supporting the development of preventive health initiatives’ may not get much media attention but they will help turn the tide against unhealthy lifestyles and Australia’s escalating chronic disease burden,” said Dr Smith.
“Of particular note is the intention to encourage healthy lifestyles through increased physical activity and better nutrition,” she said.
“One of the proposed projects is the development of training and educational resources for general practitioners to support their patients to embrace healthy lifestyles.”
“An important next step, to support this initiative, will be to develop an effective way of funding GPs to allocate time to assist patients to make critical lifestyle changes, “ she said.
“Resources are important but we must also ensure that GPs are funded in a way that allows them to be effective change agents and foster the patient behaviours that will improve health outcomes.”
“We must acknowledge and support the cornerstone role of general practice in managing the whole patient and this Budget initiative supports recognition of that role.”
“General practice is the logical home for new initiatives to influence behaviours,” said Dr Smith. “It is the one part of the health system that can take a holistic approach to ensuring the well-being of Australians.”
“Within this context, it is critically important that we continually review the role of GPs, and their training arrangements, if we are to ensure they are highly effective in making a contribution to reducing the burden of chronic disease in Australia and to make sure we get the maximum benefit from key measures funded in the 2018 Federal Budget,” said Dr Melanie Smith.
National Mental Health Commission
The Federal Government’s budget firmly demonstrates a commitment to making the mental health of our nation a top priority, according to the National Mental Health Commission. The Government will invest $338.1 million over the next 4 years in a range of worthy initiatives.
The Commission’s CEO, Dr Peggy Brown AO said the Commission’s annual budget increase of $3.1million will strengthen its important role to identify what’s working and what’s not in the mental health and suicide prevention systems, and to provide advice to government and the community, to achieve better outcomes for people who need mental health support.
“This includes monitoring and reporting on the implementation of the Fifth National Mental Health and Suicide Prevention Plan and aspects of the National Disability Insurance Scheme (NDIS) relating to psychosocial disability,” Dr Brown said.
“The mental health sector is looking for significant improvement from these reforms and it’s important to know whether the desired outcomes are being achieved.”
The Commission’s Chair Lucy Brogden praised the Government’s commitment to the mental health of all Australians and noted that the mental health funding announced in the budget will enable the delivery of improved services and programs.
“The Commission has a suicide target towards zero. The government’s provision of $33.8 million towards Lifeline to significantly boost its telephone service and $37.6 million to beyondblue to provide aftercare following a suicide attempt will provide vital help to many people who have reached a crisis point in their lives,” Mrs Brogden said
“Older Australians in residential care will also benefit from the $82.5 million committed to ensuring that they can receive adequate mental health support when they require it. In addition, those over the age of 75 years living in the community whose mental and physical health are at risk because of social isolation and loneliness will also receive support from a $20 million mental health nurse led service .
“Digital mental health services are a cost-effective treatment option for many people seeking help for mental health issues. Further supporting the Government’s Head to Health service through $4.7 million for an improved telephone service and enhanced portal provides for greater accessibility for anyone seeking help is a welcome investment.”
Dr Brown also commended the much needed focus on mental health research, with $125 million over 10 years going to the Million Minds Mission from the Medical Research Future Fund.
“Ongoing research into the causes, prevention and treatment of mental illness is critical for reducing its prevalence and impact. This initiative will assist an additional one million people who might not otherwise be part of mental health research and clinical trials, to access new approaches to diagnosis, treatment and recovery,” Dr Brown said.
“The needs of rural Australians have not been overlooked, with $20.4 million provided to the Royal Flying Doctor Service to enhance their mental health outreach services. For many Australians who are not otherwise able to access mental health care, this will be a much needed boost,” she said.
Mrs Brogden concluded: “While there remains a high level of need for mental health and suicide prevention services across the nation, the commitment shown by this Government to meeting that need is exemplary.”
Community Mental Health Australia
The measures for mental health are positive, if not unexpected. There is a focus on suicide prevention with more money going to PHNs and the expansion of programs already in operation.
The funding to Lifeline crisis support line had already been announced. Much of the funding is focused more on the crisis side of services, a pattern we are seeing in state and territory budgets as well.
The inclusion of a rural health strategy is a positive; however, there is a not a strong role for the community managed mental health sector articulated and a focus on GPs and doctors.
A comprehensive rural health strategy needs to include all aspects of the workforce, particularly those profession that are more likely to be the ones doing the work on the ground, which often is the community sector. CMHA have called for all parts of the sector to be included in an overall mental health workforce strategy.
The most significant the inclusion for the sector is funding for Continuity of Support arrangements. The funding will go to the PHNs, however, it is unclear at this stage how this will be administered; what will be the eligibility criteria (e.g. do people have to be existing clients in PIR, PHaMs and D2DL or can they have been clients in the past); and what a continuity of support service will look like.
DSS are continuing to argue people have to test their eligibility to access the support. CMHA has stated strongly and will continue to do so that people should not have to test their eligibility and that the intent of the Continuity of Support policy must be applied in that people must be provided with the same level of access to services.
CMHA developed a continuity of support positions statement, which predicted that PHNs would have a role in administering this funding. The statement notes that people whether eligible for the NDIS or not will have to access one of four pools of funding – NDIS, continuity of support, the $80m from the 2017-18 budget, or the PHN flexible pool of mental health funding.
People shouldn’t have to go through an expensive and stressful test of NDIS eligibility in order to access the services they need and are entitled to. Preventing access is against Australia’s obligations under the UN Convention on the Rights of People with Disability.
There is also $64.3 million over four years from 2017‑18 to establish an NDIS Jobs and Market Fund which will invest in targeted ini