While there has progress in closing the gap between the health status of Indigenous Australians and that of non-Indigenous Australians, there is still much to be done. The Australian Institute of Health and Welfare (AIHW) report Australia’s Health 2014 shows that a large gap in health outcomes between Indigenous and non-Indigenous Australians still exists.
Perhaps the starkest indicator of this is that Indigenous children aged 0-4 years die at twice the rate of their non-Indigenous counterparts. Life expectancy is 10 years lower for Indigenous boys and 9 years lower for Indigenous girls than their non-Indigenous counterparts. One third of Indigenous people have three or more long-term conditions. Incidence of diseases such as asthma and diabetes is significantly higher amongst the Indigenous population.
This fourth instalment of our series on issues in rural health by the NRHA describes why improving the health of Aboriginal and Torres Strait Islander peoples requires commitment, planning and funding security.
From the National Rural Health Alliance:
The greatest and most persistent challenge to Australia’s social policy is improving the health and wellbeing of its Aboriginal and Torres Strait Islander people. It has been a top priority for the NRHA ever since it was established.
The NRHA was represented at the launch of the Close the Gap campaign in April 2007, attended by Cathy Freeman and Ian Thorpe. Since then the NRHA has sought to find the best means to make a meaningful contribution. Its consistent approach has been to look to its Indigenous member bodies, NACCHO, AIDA and IAHA, for leadership.
The NRHA believes that improving Indigenous health and wellbeing is one issue on which there ought to be unequivocal and ongoing bipartisan support at all political levels. Coupled with genuine engagement with Aboriginal and Torres Strait Islander people, this will provide the basis for the generational change and commitment that is clearly necessary in order to deal with the fundamental issues which are the social, economic and cultural determinants of health and wellbeing.
At CouncilFest 2014 it was agreed that one of the most significant current opportunities for Indigenous health is to ensure that there is strong governmental commitment to an operational plan for the National Aboriginal and Torres Strait Islander Health Plan (the Health Plan). The Health Plan was developed in close collaboration with Aboriginal and Torres Strait Islander peoples as part of the Council of Australian Government’s (COAG) approach to Closing the Gap in Indigenous disadvantage. It was launched by the Australian Government in 2013 and is a framework designed to use evidence to guide policies and programs to improve Aboriginal and Torres Strait Islander health over the period to 2023.
The Government re-committed to the Plan in May 2014 and Minister Nash confirmed again last week at Rural Medicine Australia that an Implementation Plan is being developed. The NRHA will be among those waiting eagerly for the Implementation Plan to be announced and then acted on. In its case, the NRHA’s particular interest will be to see that there is appropriate action in the Plan for rural, regional and remote areas.
Generally the health of Aboriginal and Torres Strait Islander people becomes worse with increasing remoteness. There needs to be a more targeted approach to their health and wellbeing in remote and very remote communities, including special programs for housing and related services (eg drinking water), and access to education, income and employment.
The Implementation Plan, like the Health Plan, should adopt a strengths-based approach. It should focus on programs to bolster health, social and emotional wellbeing, and resilience, including through the promotion of positive health behaviours. It should also acknowledge the centrality of culture in the health of Aboriginal and Torres Strait Islander people and the rights of individuals to a safe, healthy and empowered life. There will be resourcing implications that will have to be addressed.
For its success, the Implementation Plan must be developed in partnership with Aboriginal and Torres Strait Islander peoples, including through the National Health Leadership Forum. The Implementation Plan must include measurable performance and outcome-based benchmarks and targets, accountability mechanisms, specified roles and responsibilities, and articulation of how strategies will help close the gap. These elements of the Implementation Plan can provide the basis for the Prime Minister’s Report Card in the first sitting day of Parliament.
Action through the Implementation Plan will help ensure that there is no difference in health provision for Aboriginal and Torres Strait Islander and non-Indigenous people across Australia. The health system should be free from racism and ensure equity of access to all Aboriginal and Torres Strait Islanders.
A matter of immediate importance is the effect on Indigenous health programs of the May 2014 Budget decision to replace more than 150 programs, grants and activities with five broad-based programs under the new Indigenous Advancement Strategy. The five programs are jobs, land and the economy; children and schooling; safety and wellbeing; culture and capability; and remote Australia strategies. There can be no objection to such rationalisation but the Budget papers suggest that Indigenous health programs will lose more than $160 million. Another matter of current concern is that many community programs and positions are vulnerable in rural and remote areas because of the transition from Medicare Locals to Primary Health Networks
It is critical that Aboriginal and Torres Strait Islander community controlled organisations be given funding certainty, particularly for programs that have long lead times (such as smoking cessation programs, which are directly associated with mortality rates and life expectancy). Both the Departments of Health and Prime Minister and Cabinet have precedents for funding beyond three years.
The NRHA hopes that the Implementation Plan will also provide support for what is called a ‘pipeline’ or lifelong approach to further development of a larger Indigenous health workforce, across all professions. Such an approach encompasses recruitment and retention strategies that provide support at all stages, starting with recruitment from high school to university health science courses, and ending with ongoing support and mentoring once graduates are in the workforce.