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What does the evidence say about how to improve Indigenous health? A challenge to current policy

As previously reported at Croakey, an important study assessing the cost effectiveness of various prevention and treatment interventions was recently released.

One of the many interesting aspects of the ACE-Prevention study was that it included analyses specific to Indigenous Australians.

I asked the authors if they could explain the implications of their findings for Indigenous health policy. Thanks to Katherine Ong, from the Centre for Health Policy, Programs & Economics, in the School of Population Health at the University of Melbourne, for providing the analysis below. She is one of the researchers who worked on the Indigenous component of the project.

The bottom line, it seems from Ong’s piece, is that we should be investing far more in Indigenous primary health care services. Yet much of the talk at a Public Health Association of Australia workshop on Indigenous health, held in Adelaide on Sunday, was that the community controlled sector is being sidelined under the Closing the Gap initiatives. A number of speakers said that most of the Closing the Gap funding is going to mainstream general practice rather than the community controlled sector.

Katherine Ong writes:

A newly released report provides new evidence quantifying the costs and benefits of targeted primary health care services for Australia’s Aboriginal and Torres Strait Islander (or Indigenous) population.

It is not news that the health of Australia’s Indigenous population is worse than that of non-Indigenous Australians. It is also well documented that one key solution lies in the optimal delivery of primary health care services to Indigenous Australians via Indigenous health services (epitomised by Aboriginal Community Controlled Health Services (ACCHSs)).

However, there has been uncertainty surrounding the size of the benefit associated with ACCHSs, and the amount of resources needed to adequately fund these. As a result, ACCHSs continue to receive insufficient funds and more investment is required.

The Assessing Cost-Effectiveness in Prevention (ACE-Prevention) project report was released on 8th September. This study was funded by the National Health and Medical Research Council of Australia with additional support from the Lowitja Institute (formally the Cooperative Research Centre for Aboriginal Health).

Having run over five years, the project was led by project leaders Professor Theo Vos (The University of Queensland) and Professor Rob Carter (Deakin University) in conjunction with Professor Ian Anderson (Onemda VicHealth Koori Health Unit, The University of Melbourne).

The report details the value for money of 123 illness prevention measures to assist funding decisions in Australia. This project has focused not only on disease prevention in the general Australian population, but also in Indigenous Australians.

The main findings of the Indigenous component of the project are that up to 50% more health gain or benefit can be achieved if health programs are delivered to the Indigenous population via ACCHSs, compared to if the same programs are delivered via mainstream primary care services.

Therefore Indigenous health services are an important means by which the Indigenous health gap can be addressed, irrespective of the types of interventions applied. Yet the comprehensive nature of ACCHSs means that the costs of health service delivery are also higher, so greater investments are required.

Due to data limitations, only a small number of specific health programs were assessed for the Indigenous population, and therefore the range of programs evaluated has not been comprehensive.

However, interventions found to have a potentially significant impact on Indigenous health include a greater emphasis on screening for pre-diabetes and chronic kidney disease, and introduction of a ‘polypill’ in the prevention of cardiovascular disease.

Implications for current policy and practice are that Indigenous health services themselves need to be seen as an important means to improve Indigenous health, rather than purely as a vehicle to deliver health programs.

Therefore, funding needs to shift from the piecemeal approach of individual program grants to more consolidated funding of Indigenous health services.

At a technical level, caution is also required in the interpretation of economic appraisals when applied to disadvantaged groups, where not only value for money, but also the additional resources required to address equity needs to be taken into account.

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