Close the Gap warning: strategy “effectively abandoned”, needs national leadership

Ahead of the tabling to Parliament today by Prime Minister Malcolm Turnbull of the 2018 Closing the Gap report, the Close the Gap Campaign –  led by more than 40 Aboriginal and Torres Strait Islander and non-Indigenous health and human rights bodies – last week released its 10-year review of the Closing the Gap Strategy.

Media are reporting ahead of the Prime Minister’s statement that there is significant improvement in Closing the Gap targets compared to last year, with the national childhood mortality and early childhood education Closing the Gap targets back on track.

However the review says the Closing the Gap strategy, a 25 year program, was “effectively abandoned” after five years, with the architecture to support it (national approach, national leadership, funding agreements) having “unraveled” by 2014-15. It says:

“Without a recommitment to such ‘architecture’, the nation is now in a situation where the closing the gap targets will measure nothing but the collective failure of Australian governments to work together and to stay the course.”

See also the media release from the National Aboriginal Community Controlled Health Organisation (NACCHO), calling for “urgent and radically different action to Close the Gap”.

That includes increased funding for ACCHOs to expand in regions where there are low access to health services and high levels of disease, and in areas of mental health, disability services and aged care, and for areas where Aboriginal and Torres Strait Islander peoples have a high burden of disease or are particularly vulnerable, like ear health and renal disease , delivered through ACCHOs.

Last Friday, a group of prominent Aboriginal and Torres Strait Islanders were invited by the Federal, State and Territory governments to meet in conjunction with the first Council of Australian Governments (COAG) meeting of 2018 to provide advice on the Closing the Gap refres, which is currently underway. They issued a statement, saying the next phase of the Closing the Gap agenda must be guided by the principles of empowerment and self-determination, and calling for future targets to address:

• Families, children and youth
• Housing
• Justice, including youth justice
• Health
• Economic development
• Culture and language
• Education
• Healing
• Eliminating racism and systemic discrimination

On the weekend, Indigenous Health Minister Ken Wyatt announced that the latest round of funding for the Tackling Indigenous Smoking program had been extended from three to four years funding but concerns remain about the National Partnership on Remote Housing, which is expiring in June this year.

Wyatt suggested on Sunday that the government could still legislate an Indigenous voice to parliament outside the Constitution, backed by Chris Sarra, co-chair of the Prime Minister’s Indigenous Advisory Council, who said that a model to deliver Indigenous Australians a “voice” is still “very much” on the table in negotiations with the Turnbull Government.

Croakey will report later on the Prime Minister’s statement and responses from Indigenous health leaders and groups.

Five major findings

The Close the Gap campaign’s five major findings are:

1. The Close the Gap Statement of Intent (and close the gap approach) has to date only been partially and incoherently implemented via the Closing the Gap Strategy:

• An effective health equality plan was not in place until the release of the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan in 2015 – which has never been funded. 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. There is still yet to be a national plan to address housing and health infrastructure, and social determinants were not connected to health planning until recently and still lack sufficient resources.

• The Closing the Gap Strategy focus on child and maternal health and addressing chronic disease and risk factors – such as smoking through the Tackling Indigenous Smoking Program – are welcomed and should be sustained. However, there wasno complementary systematic focus on building primary health service capacityaccording to need, particularly through the Aboriginal Community Controlled HealthServices and truly shifting Aboriginal and Torres Strait Islander health to a preventivefooting rather than responding ‘after the event’ to health crisis.

2. The Closing the Gap Strategy a 25-year program – was effectively abandonedafter five-years and so cannot be said to have been anything but partially implemented in itself. This is because the ‘architecture’ to support the Closing the Gap Strategy(national approach, national leadership, funding agreements) had unraveled by 2014-2015.

3. A refreshed Closing the Gap Strategy requires a reset which re-builds the requisite ‘architecture’ (national approach, national leadership, outcome-orientated fundingagreements). National priorities like addressing Aboriginal and Torres Strait Islander health inequality have not gone away, are getting worse, and more than ever require anational response. Without a recommitment to such ‘architecture’, the nation is now in asituation where the closing the gap targets will measure nothing but the collective failure of Australian governments to work together and to stay the course.

4. A refreshed Closing the Gap Strategy must be founded on implementing the existing Close the Gap Statement of Intent commitments. In the past ten years, Australian governments have behaved as if the Close the Gap Statement of Intent was of littlerelevance to the Closing the Gap Strategy when in fact it should have fundamentally informed it. It is time to align the two. A refreshed Closing the Gap Strategymust focus on delivering equality of opportunity in relation to health goods and services, especially primary health care, according to need and in relation to health infrastructure (an adequate and capable health workforce, housing, food, water). This should be in addition to the focus on maternal and infant health, chronic disease and other health needs. The social determinants of health inequality (income, education, racism) also must be addressed at a fundamental level.

5. There is a ‘funding myth’ about Aboriginal and Torres Strait Islander health – indeed in many Indigenous Affairs areas – that must be confronted as it impedes progress. That is the idea of dedicated health expenditure being a waste of taxpayer funds. Yet, if Australian governments are serious about achieving Aboriginal and Torres Strait Islander health equality within a generation, a refreshed Closing the Gap Strategy must include commitments to realistic and equitable levels of investment (indexed according to need).Higher spending on Aboriginal and Torres Strait Islander health should hardly be a surprise. Spending on the elderly, for example, is higher than on the young because everyone understands the elderly have greater health needs. Likewise, the Aboriginal and Torres Strait Islander population have, on average, 2.3 times the disease burden of non-Indigenous people.Yet on a per person basis, Australian government health expenditure was $1.38 per Aboriginal and Torres Strait Islander person for every $1.00 spent per non-Indigenous person in 2013-14.So, for the duration of the Closing the Gap Strategy Australian government expenditure was not commensurate with these substantially greater and more complex health needs. This remains the case. Because non-Indigenous Australians rely significantly on private health insurance and private health providers to meet much of their health needs, in addition to government support, the overall situation for Aboriginal and Torres Strait Islander health can be characterised as ‘systemic’ or ‘market failure’. Private sources will not make up the shortfall. Australian government ‘market intervention’ – increased expenditure directed as indicated in the recommendations below – is required to address this. The Close the Gap Campaign believes no Australian government can preside over widening mortality and life expectancy gaps and, yet, maintain targets to close these gaps without additional funding. Indeed, the Campaign believes the position of Australian governments is absolutely untenable in that regard.

Close the Gap recommendations