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#Budget2014 risks to ‘closing the gap’ include Indigenous cancer impact

There is growing concern that harsh Federal Budget measures on health and other funding areas will put at risk efforts to close the gap for Aboriginal and Torres Strait Islander health.

In the post below, health researcher Clive Aspin says the Budget will increase the health and social disparities between Indigenous and non-Indigenous peoples. He looks particularly at the likely risks to cancer prevention, detention and treatment for Aboriginal and Torres Strait Islander people.

In other Budget reaction, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) has welcomed new funding for 500 nursing and allied health scholarships for rural and regional Australia, and called for some places to be quarantined for Indigenous nurses and midwives.

“Aboriginal people respond best when they are cared for by people from their own community and health services are crying out for more Aboriginal and Torres Strait Islander nurses and midwives, especially in regional areas,” said CATSINaM President Shane Mohor.

CATSINaM also welcomed the guarantee of a further 12 months of funding for Aboriginal Community Controlled Health Services, but raised concerns the impact on planning and job security of the short-term commitment and about broader cuts to Australia’s health system, and particularly the introduction of the GP co-payment.

“The Federal Budget rips billions of dollars from mainstream health, putting it back on the States and Territories to somehow try and find in their Budgets. They have also targeted Indigenous health specifically, with millions more to come from this area. Cutting these funds is likely to reverse any gains we have made in improving the health of Aboriginal and Torres Strait Islander people.”

Also, don’t miss this analysis of the Budget by Aboriginal writer Siv Parker who has longstanding experience in the health sector and notes:

Because of the diversity of black lives, it would be easier to say look at the whole budget, because it all impacts on Indigenous individuals and communities.

***

Clive Aspin writes:

There are many people in the Australian community who are going to be worse off after the Federal Budget – pensioners, young people, job seekers, university students, people with disabilities – but it’s clear that the biggest losers of all are going to be Aboriginal and Torres Strait Island people.

We just need to look at health announcements to see that the Budget is going to have profound negative implications for the health and well being of Australia’s first people.

Some of the most severe cuts in the budget are to public health, prevention and primary care, three areas of health that can make a real difference to Indigenous health – and possibly contribute to ‘closing the gap’.

Instead, the government’s announcements will increase the health and social disparities between Indigenous and non-Indigenous peoples, and set back the objective of closing of the gap on Indigenous disadvantage within a generation.

For a Prime Minister who has made endless comments about his commitment to improving Indigenous health and wellbeing, as well as saying that he’d spend his first week in office visiting a remote Aboriginal community and then surrounding himself with carefully chosen Aboriginal advisors, it’s beyond belief that he would see any wisdom in implementing measures that will severely restrict people’s access to primary health care.

It’s clear that he hasn’t taken the advice of his special Aboriginal Advisory Committee, because if he had, at least one of the members, Professor Ngiare Brown, a highly respected expert in Aboriginal child health with many years experience of working as a doctor in remote locations, would have most definitely advised him that these budgetary measures would increase the disadvantage gap well into the next generation and beyond.

Almost nowhere in any post-Budget announcements have we seen any reference to the most disadvantaged members of our community, and the impact that budget cuts will have on those who are already excluded from health services because of barriers such as poor access to primary health, lack of access to prevention programs, poor health literacy, and most of all, cost.

Across the board, we know that Aboriginal and Torres Strait Islander people suffer much poorer health than other Australians. In one of the most developed countries in the world, it is shameful that Indigenous people have a life expectancy that is much lower than that of other Australians, and even that of people in some developing nations. It is also shameful that we continue to see diseases such as trachoma that have been eradicated in all other developed nations and are more commonly associated with poorer nations.

Impact on cancer detection, treatment

But to understand more fully the impact of the budget cuts on Aboriginal and Torres Strait Islander health, it’s worth looking at one area of health that can affect any of us at any stage of our lives, cancer.

Cancer is now the leading cause of death, and in 2012, it was responsible for more than 8 million deaths around the world and in that year, 14 million new cases were recorded. The latest report from the WHO has warned that the number of cancer cases is rising dramatically and within 20 years, as many as 13 million people will die of cancer, and 22 million new cases will be recorded. Overwhelmingly, as with other chronic conditions, cancer will continue to have its greatest impact among people and communities that are already poorly served by health and social services.

Aboriginal and Torres Strait Islander people already suffer worse outcomes from cancer than other Australians, and these are guaranteed to increase into the future if the health measures outlined in the government budget are implemented.

Most people can be cured of cancer if the cancer is diagnosed in its early stages. But for this to happen it is essential that early warning signs be picked up by medical experts and this is more likely to happen if a patient has a regular and ongoing relationship with a primary health care provider.

This poses serious problems for indigenous populations because of already poor access to primary health care. As a consequence, late diagnosis of cancer is far more common among Aboriginal and Torres Strait Islander than other Australians, with this leading to poor cancer outcomes, including higher rates of mortality. The rates of late diagnosis of cancer are set to increase dramatically as further barriers to primary health care are increased through co-payments.

For Aboriginal and Torres Strait Islander patients, these barriers to cancer care are further exacerbated by poor access to effective treatment services. Even if an Indigenous patient is able to access cancer care, that patient is more likely to receive a far more conservative and less efficient form of treatment than non-Indigenous patients. Treatments such as radiation, chemotherapy, surgery, including reconstructive surgery are far less likely to be offered to Indigenous patients with cancer than to non-Indigenous patients with cancer.

One of our best hopes of overcoming cancer still remains in our ability to design and disseminate effective prevention programs, another area that is likely to suffer under the provisions of the current Budget. Many cancers are preventable and with correct and timely information, people can implement strategies to prevent the onset of cancer. By cutting funding to agencies such as the Australian National Preventive Health Agency, the government is limiting the ability of prevention agencies to implement cancer prevention programs for those who most need them, especially Aboriginal and Torres Strait Islander people.

Cancer screening programs are an important part of prevention programs but we know that Aboriginal and Torres Strait Islander people are less likely to be recruited to these programs and as a result, are less likely to receive the same health benefits as other people. Funding cuts to prevention programs will only serve to ensure that Aboriginal and Torres Strait Islander people continue to be excluded from screening programs, but in even greater numbers than at present.

Aboriginal and Torres Strait Islander people diagnosed with cancer are 30 per cent more likely to die from their cancer than non-Indigenous Australians with cancer. This can be explained by a number of factors, such as less effective treatment and poor clinical decisions, but a principal cause is the lack of regular access to primary health care. These barriers to effective cancer care are made worse by the high rates of co-morbidities that Aboriginal and Torres Strait Islander people experience, and these too require regular access to primary health care.

The measures outlined in the Budget provide no reason to be optimistic about improved health and well-being of Aboriginal and Torres Strait Islander people, and especially those affected by cancer and other chronic conditions.

Rather than contributing to a reduction in health disparities, this Government appears to be determined to ensure that Australian’s first people remain marginalised and disadvantaged, by imposing further barriers to good care and support. If members of the Government were truly committed to closing the gap on Indigenous disadvantage they would do all they could to improve access to primary health care since this would help to deal with the challenges related to cancer rather than intensify them. Only then could we dare to consider that Indigenous Australians might be winners rather than losers.

Clive Aspin is a Maori health researcher. He lives in Sydney and has worked for many years in indigenous health in both Australia and New Zealand. He is a Co-Director of ATRIO Consulting, a consultancy that brings trans-Tasman and international perspectives to public and indigenous health. He is an affiliate of the Centre for Disability Studies at the University of Sydney.