Update, Sept 14: Warren Snowdon will retain his portfolio of Indigenous health after a last-minute change to the Ministry line-up. From what the Cabinet health minister Nicola Roxon told Lateline last night, Snowdon is happy about this, and so is Roxon and the PM. According to the posts below, from yesterday, some Indigenous groups will also be pleased. However, the National Aboriginal Community Controlled Health Organisation (NACCHO) will presumably not be quite so chuffed, given its statement yesterday welcoming the opportunity for Roxon to play a more direct role in Indigenous health in the absence of a separate Ministry. Meanwhile, Croakey can’t yet work out whether Snowdon will retain his previous roles as responsible for rural and regional health. It doesn’t look like it though…
What does the new Ministry mean for health?
So, we know the shape of the new Ministry.
Apart from the re-appointment of Minister Nicola Roxon, there are some other appointments that may be of interest to those concerned about health:
• Mark Butler, Minister for Mental Health and Ageing
• Peter Garrett, as well as being Minister for Schools, is also Minister for Early Childhood and Youth
• Mark Arbib, Minister for Indigenous Employment and Economic Development, Minister for Social Housing and Homelessness
• Catherine King, Parliamentary Secretary, Health and Ageing, Infrastructure and Transport. Don’t know her? See here…
The new ministry raises a few questions for the health sector:
The PM promised to make mental health a priority if re-elected. How does a junior minister who is not part of Cabinet in any way say “priority”?
Nicola Roxon did say that mental health, together with aged care and dental services, would be an important second term health agenda. Her focus will be “on the better delivery of health services through improved GP clinics, modernised hospitals, an expanded medical and nursing workforce, better after hours services and unleashing the benefits of e-health and telemedicine”. All of these are, of course, important to mental health care, but ….
No doubt there are pros and cons to separating specific areas of health from the main Ministry. Will it reduce or increase the clout of mental health?
On the other side of this ledger is the abolition of Warren Snowdon’s gig as the first Minister for Indigenous Health, Rural and Regional Health & Regional Services Delivery. Will Indigenous and rural and remote health benefit from being “mainstreamed” or do they risk losing voice?
The National Aboriginal Community Controlled Health Organisation (NACCHO) thinks Indigenous health will be better off to be part of the main portfolio. (see bottom of this post for extract of statement).
But the Close the Gap campaign and Australians for Native Title and Reconciliation are not happy (see bottom of this post for extracts of statement from Mick Gooda and ANTaR)
The Rural Doctors Association of Australia is also displeased. President Dr Nola Maxfield says the axing of Snowdon’s former portfolio is “extremely disappointing and of serious concern”.
“While we assume Prime Minister Gillard believes rural, regional and Indigenous health will fall within the new Regional Australia and Regional Development portfolio of which Simon Crean will be Minister, we are very worried about losing the dedicated portfolio for Indigenous, rural and regional health after just one term of government,” Dr Maxfield said in a statement.
No doubt some of these questions will be addressed when Minister Roxon fronts Leigh Sales at Lateline tonight…
Either way, I’d be interested to hear from any Croakey contributors interested in examining these or other related issues.
Spelling out rural inequities
Meanwhile, a few points that may be of interest to those metropolitan media commentators who feel hardly done by as a result of the new focus on regional Australia.
The NRHA has done a five-page summary of rural-metropolitan inequities.
The NRHA says: “There is an overwhelming case for greater equity to be provided for rural, regional and remote people through investments by the Australian Government in health, education, telecommunications and infrastructure.
“Over the last two decades – a period when the Australian Government was benefiting from economic surpluses generated largely by the mining boom – investments in infrastructure and outlays on services in non-metropolitan areas have lagged dangerously behind those in the major cities. This has resulted in substantial inequities in vital areas like health, education, basic infrastructure and telecommunications.”
In summary, the inequities outlined in the document are:
• Inequity in life expectancy
It has been estimated, for example, that a white man born in the Central Darling Shire in Far West New South Wales could expect 11 years less life than one born in Mosman in Sydney.
• Inequity in access to Medicare-funded services
• Inequity in health workforce
• Inequity in the effectiveness of health promotion
For example, smoking rates remain at over 20 per cent in inner regional areas, over 25 per cent in outer regional and 27.3 per cent in remote areas.
• Inequity in survival rates – cancer as an example
A NSW study reported in the Medical Journal of Australia in 2004 found that people with cancer in regional areas were 35 per cent more likely to die within five years of diagnosis than patients in cities. The further from a metropolitan centre patients with cancer live, the more likely they are to die within five years of diagnosis. For some cancers, remote patients were up to three times more likely to die within five years of diagnosis.
These lower rates of survival are likely to be due to later diagnosis due largely to poorer access to specialised cancer services.
• Inequity in education and educational outcomes
In 2006, 72 per cent of 19 year olds in Australia overall had completed Year 12 but the figure for 19-year-olds in Very Remote areas was less than 40 per cent. People living in rural and remote areas are significantly under-represented in higher education. They comprise 32 per cent of Australia’s population but only 18 per cent of tertiary students.
• Inequity in access to infrastructure
There is a range of measures of investment in infrastructure, with much of the recent focus having been on a major investments such as ports and rail associated with the mining sector.
• Inequity in communications
The tyranny of distance has a pervasive influence on lifestyles in rural areas. The difficulties of physical and other forms of communication are well known. Telecommunications are poorer and more expensive in the bush. In 2006, 66 per cent of dwellings in major cities had access to the Internet and 46 per cent to broadband. The comparable rates for dwellings in Inner Regional, Outer Regional, Remote and Very Remote areas dropped off until for Very Remote areas they were 42 and 24 per cent respectively.
• Inequity in cost of access to services
Research released in November 2009 entitled Essential services in urban and regional Australia, conducted by the National Institute of Industry and Economic Research, found that, on average, it costs rural residents two to ten times as much to access a range of essential services (including education and health services, and aged care) as it does metropolitan residents.
The other side of the coin, as some media reports have mentioned, is that there are also many benefits to life outside the big smokes. Croakey thinks so, anyway…
Extract of statement from The Close the Gap coalition
Co-Chair of the Close the Gap Campaign Steering Committee Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda said that he was concerned that the role had been abolished without any clear indication as to how the focus on Indigenous health would be maintained.
“The creation of the Indigenous Health Minister role in 2009 was a welcome signal that there would be dedicated attention to achieving Indigenous health equality by 2030,” Mr Gooda said.
“It is vital that this focus be maintained, as we cannot allow Aboriginal and Torres Strait Islander health to be forgotten in the push to establish the Health and Hospitals Network.”
Mr Gooda also said that the Close the Gap coalition members were concerned that a national plan for achieving Indigenous health equality by 2030 has still not been developed, and that no indication has been given as to when or how such planning will commence.
Extract of statement from ANTaR
Responding to the announcement of the new Labor Government Ministry, ANTaR has expressed concern at the loss of a dedicated minister for Indigenous health.
“The abolition of a dedicated Indigenous Health Minister sends a worrying signal about the priority accorded to Indigenous health by the new Government”, said Dr Janet Hunt, ANTaR President.
“A stand-alone Indigenous Health Minister helped to ensure that the Close the Gap agenda remained a key focus for the Government and provided an important point of contact for Indigenous health organisations and communities. We urge the Prime Minister to review her decision to abolish this important portfolio. Indigenous health remains a major national issue.
“At the very least, the Government must ensure that there is a very strong focus on Indigenous health within the broader health portfolio and ensure effective mechanisms to engage with the Indigenous health sector.”
NACCHO statement (added after initial post)
“The opportunity to deal directly again with a cabinet minister, Health Minister Nicola Roxon, about the priorities in Aboriginal health should be a welcome result of Prime Minister Gillard’s reshuffle” says Mr Justin Mohamed, Chair of National Aboriginal Community Controlled Health Organisation (NACCHO), the peak body in Aboriginal health.
“We thank former Indigenous Health Minister Warren Snowdon for his efforts over the last 15 months as the first, and perhaps last, Minister for Indigenous Health.
“Mr Snowdon provided a regular point of contact with the government on Aboriginal health and was an experienced, knowledgeable sounding board for ideas. He helped to lay the groundwork for a better partnership with the government in Aboriginal health.
“However it was always Minister Roxon, not her junior minister, in control of the Health Department and health policy affecting Aboriginal peoples.
“The Prime Minister was also a great advocate of Aboriginal health when she was shadow health minister. NACCHO assumes that the Prime Minister’s aim in the reshuffle is to again have that direct contact between the Aboriginal health advocates and the Health Minister.
“I am sure the Prime Minister understands that if her government let Aboriginal health slip in its priorities, not giving it the appropriate attention and commitment, it will have drastic consequences not only for the current Aboriginal generation but for generations to come.
“NACCHO looks forward to again meeting with Minister Roxon and creating a productive partnership. While Minister Roxon may not be as available as Minister Snowdon was, we see direct contact with the Health Minister as very important.”