NACCHO #CTG10 Press Release:Ongoing commitment required to close the gap

IMG_0475

“It’s good that there have been some positive gains already made in areas like child and maternal health.

“We are still a long way from Aboriginal and Torres Strait Islander people achieving the same health outcomes as other Australians,”

“That’s why it’s absolutely imperative that we continue to see commitments to programs and health care models that work – programs created by Aboriginal people, for Aboriginal people which involve them in their own health and support them to have brighter futures

NACCHO Chairperson, Matthew Cooke

Picture above Prime Minister Malcolm Turnball at the Close the Gap launch Parliament House : Photo Colin Cowell

The expansion of Aboriginal controlled primary health services and programs, the reduction of racism in the health system and investment in the Aboriginal health implementation plan are all key to improving the health outcomes of Aboriginal people now and for future generations.

NACCHO Chairperson, Matthew Cooke, marking 10 years since the launch of the Close the Gap campaign, said this Federal election year would be critical for all parties to reconfirm their commitment to the generational health of Aboriginal people.

Download Report Here

“It’s good that there have been some positive gains already made in areas like child and maternal health.

“We are still a long way from Aboriginal and Torres Strait Islander people achieving the same health outcomes as other Australians,” Mr Cooke said.

“The recent Productivity Commission’s Report on the performance of the National Indigenous Reform Agreement has shown that investment in the mainstream organisations is not the answer.

“That’s why it’s absolutely imperative that we continue to see commitments to programs and health care models that work – programs created by Aboriginal people, for Aboriginal people which involve them in their own health and support them to have brighter futures.

The National Aboriginal Community Controlled Health Organisation (NACCHO) today  supported the recommendations of the 2016 Close the Gap Progress and Priorities Report of the Close the Gap Steering Committee.

“Today’s report supports Aboriginal Community Controlled Health Services as the preferred model for primary health care and that’s because our Services work.”

Mr Cooke called for a range of measures which will help to close the health gap:

  • Ongoing investment in, and expansion of, Aboriginal Community Controlled Health Services to deliver more care, in more areas, to more Aboriginal and Torres Strait Islander people;
  • Funding for the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan;
  • Improvements in the delivery of medicines under the Close the Gap PBS co-payment measure;
  • An improvement in patient coordination between hospitals and primary health care providers and
  • Reworking of the IAS program with a view to ensuring programs that work continue to be supported including measures to reduce tobacco use, mums & bubs programs and other social and emotional wellbeing programs run through Aboriginal Community Controlled Health Services.

“Closing the Gap has enjoyed multi-party support for more than ten years and generational change doesn’t happen overnight.

“Now all levels of government need to step up and make sure we see even greater gains over the next ten years with continued commitment to engage with Aboriginal people and investment in their future.”

CTG Campaign Press Release

Close the Gap campaign calls for renewed commitment from all political parties

“Aboriginal Community Controlled Health Services should be the preferred model for investment as our own Aboriginal Health Services are best placed to deliver primary health care for Aboriginal and Torres Strait Islander peoples in all settings.”

Campaign Co-Chairs Mick Gooda and Dr Jackie Huggins

The Close the Gap Campaign has called on all political parties before the next federal election to renew their commitment to closing the unacceptable health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.

Campaign Co-Chairs Mick Gooda and Dr Jackie Huggins will today release the Close the Gap Progress and priorities report 2016 at a Federal Parliamentary Breakfast event in Canberra.

The report makes a number of recommendations including that each political party, prior to the next federal election, make Aboriginal and Torres Strait Islander health and wellbeing a major priority.

“This year, marks the tenth anniversary of the Close the Gap Campaign and ten years of hard work and achievement,” Mr Gooda said.

“We have seen some encouraging improvements over that time, but without concerted effort across governments and respectful engagement with Aboriginal and Torres Strait Islander peoples we as a nation will fail to close the gap.

“Health inequality has been a stain on our nation for far too long, but this generation has the opportunity to remove the stain and deliver health equality for Australia’s First peoples.”

Dr Huggins, who is also Co-Chair of the National Congress of Australia’s First Peoples, said improvements in some areas of Aboriginal and Torres Strait Islander health provided reason for optimism.

“We have seen improvements in the areas of infant and child health outcomes, the number of health checks being reported and better access to medicines,” Dr Huggins said.

“The long term impact of such improvements on adult health and life expectancy is yet to be seen as this will take time to measure. This should not be cause for complacency because the overall health of Aboriginal and Torres Strait Islander peoples still lags behind the rest of the nation.”

The report advises that due to lead times between the design and roll out of programs, measurable improvements to Aboriginal and Torres Strait Islander life expectancy should not be expected until at least 2018.

Mr Gooda, who is also the Aboriginal and Torres Strait Islander Social Justice Commissioner, said achieving the closing the gap targets within a generation would require a long term reform agenda.

“There is no quick fix for improving Aboriginal and Torres Strait Islander health and wellbeing. We need rock solid commitment with structures in place that will survive terms of government,” Commissioner Gooda said.

The Campaign Co-Chairs said the new Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013–2023) provides government with an immediate opportunity to support closing the gap efforts.

“Funding of the Implementation Plan should be prioritised. We want to see core health service models and associated workforce and funding arrangements urgently developed, with particular focus on regions with relatively poor health and inadequate levels of service,” Dr Huggins said.

“Aboriginal Community Controlled Health Services should be the preferred model for investment as our own Aboriginal Health Services are best placed to deliver primary health care for Aboriginal and Torres Strait Islander peoples in all settings.”

The report also includes recommendations for an additional COAG Closing the Gap Target to reduce imprisonment rates; an increased focus on Aboriginal and Torres Strait Islander people with disability; a national inquiry into racism and institutional racism in health care; and reform of the Indigenous Advancement Strategy.

The report is available at

 

 

NACCHO Aboriginal Health News Alert : AMA says stop the cuts -time for strong investment in health

Brian

The AMA recognises the early progress that is being made to close the gap, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to maintain this momentum for the long term, the Government must improve resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

From the AMA Pre-Budget Submission 2016-17 Download here

Or full AMA indigenous health policy below

The AMA is urging the Government to use the May Budget to invest strongly in the future of the Australian health system to meet growing and changing demand from an ageing population and a surge in chronic and complex conditions, which is afflicting more and more Australians.

Picture above AMA President, Professor Brian Owler with NACCHO chair Matthew Cooke at Closing the Gap 2015

AMA President, Professor Brian Owler, said today that the Government must put a stop to its policies of funding cuts and program cuts from its first two Budgets, and instead invest heavily in the health system to build capacity to meet current and future needs.

Professor Owler said the Government must make public hospitals, primary care, and prevention the centrepiece of its election-year Budget.

“The first steps in the next Health Budget must be to lift the Medicare patient rebate freeze, reverse the cuts to pathology and radiology, and restore public hospital funding to proper levels,” Professor Owler said.

“The Government cannot be allowed to retreat from its responsibilities in funding and managing the core elements of health care delivery in Australia.

“There is an urgent need to put the focus back on the strong foundations of the health system – foundations that have served us well for decades, made our system one of the best in the world, and made the health of Australians among the best in the world.

“We need a strong balance between the public and private systems, properly funded public hospitals, strong investment in general practice, and a focus on prevention.

“When people are sick and injured, we need to provide them with affordable and easily accessible care in hospitals, in aged care, in general practice, in the community, and in their homes.

“And we need to educate and help people to achieve healthier lifestyles by being active, and avoiding harmful habits and substances. This will reduce the strain on health services.

“But our public hospitals are under pressure, and our primary care system, especially general practice, is facing huge challenges as more Australians are experiencing chronic and complex conditions that require ongoing care.

“Significant new health funding is needed, but governments also need to be more strategic about how they spend every health dollar.

“Health is the best investment that governments can make.”

Professor Owler said that Australia’s health spending is not out of control, as claimed by the Government to justify its savage 2014 and 2015 health Budgets.

“The Government’s ongoing justification for its extreme health savings measures, including cuts to public hospital funding, has been that Australia’s health spending is unsustainable,” Professor Owler said.

“This is not backed by the evidence.

“The Commonwealth Government’s total health expenditure is reducing as a percentage of the total Commonwealth Budget.

“In the 2014-15 Commonwealth Budget, health was 16.13 per cent of the total, down from 18.09 per cent in 2006-07.

“It reduced further in the 2015-16 Budget, representing only 15.97 per cent of the total Commonwealth Budget.

“Clearly, total health spending is not out of control. The health sector is doing more than its share to ensure health expenditure is sustainable,” Professor Owler said.

The AMA Pre-Budget Submission 2016-2017 covers the following key areas:

 MBS Indexation;

 Public Hospitals;

 Federation Reform;

 Efficient Medicare Claiming;

 Indigenous Health;

 Medical Workforce and Training;

 Chronic Disease;

 Pharmacists in General Practice;

 Rural GP Infrastructure Grants;

 Medical Care for Dementia, Palliative Care, and Aged Care Patients;

 Climate Change and Health;

 Prevention;

 Methamphetamine (Ice);

 Alcohol;

 Obesity;

 Physical Activity; and

 Immunisation.

The Submission is available at

https://ama.com.au/sites/default/files/budget-submission/Budget_Submission_2016_2017.pdf

INDIGENOUS HEALTH

The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite the commitment to closing the gap.

The AMA recognises the early progress that is being made to close the gap, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to maintain this momentum for the long term, the Government must improve resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

Despite recent health gains for Aboriginal and Torres Strait Islander people, progress is slow and much more needs to be done. A life expectancy gap of around ten years remains between Aboriginal and Torres Strait Islander people and other Australians, with recent data suggesting that Indigenous people experience stubbornly high levels of treatable and preventable conditions, high levels of chronic conditions at comparatively young ages, high levels of undetected and untreated chronic conditions, and higher rates of co-morbidity in chronic disease. This is completely unacceptable.

It is also not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting just three per cent of its citizens. The Government must deliver effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health. Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

AMA POSITION

The Government must strengthen its investment in Aboriginal and Torres Strait Islander health. This must include:

• correcting the under-funding of Aboriginal and Torres Strait Islander health services;

• establishing new or strengthening existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular diseases (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;

increasing investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term; Health – the best investment that governments can make

• developing systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;

• identifying areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;

• instituting funded, national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce;

• implementing measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;

• adopting a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration; and

• appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes.

 

 

NACCHO #CTG10 Reports : NT intervention ‘fails on human rights’ and closing the gap

NT

“There have been some improvements to Indigenous child mortality with this target on track to be met by 2018. However, despite narrowing the gap in life expectancy, the rate of improvement is far too slow to close the gap. The situation is particularly bad for Indigenous people living in the Northern Territory, whose life expectancy is nearly 15 years shorter than non-Indigenous Australians

SEE HEALTH AND LIFE EXPECTANCY REPORT CARD

The Northern Territory intervention has failed to deliver substantial reform in any of the areas covered by the Close the Gap goals and has also failed to meet Australia’s international human rights obligations, an independent report has found.

 in The Guardian reports

Nearly a decade after the Northern Territory intervention, residents of Indigenous town camps in Alice Springs are fighting to regain control of their lives as they wrestle with longstanding social problems

Photo above: Aboriginal children playing at one of the town camps in Alice Springs when the intervention started in 2007. An independent report shows the strategy has failed to deliver substantial reform in any target area. Photograph: Anoek de Groot/AFP/Getty Images

The report, by the Castan Centre for Human Rights at Monash University, rated the intervention, which was rebadged in 2012 and now operates as the “stronger futures” policy, four out of 10 for its general human rights performance and failed it against seven other human rights measures, including the right to self-determination.

It also gave fail marks to every Close the Gap measure except education – which it scored at five out of 10 for improvements in primary school attendance – and urged the government to include incarceration rates as a new Close the Gap target, pointing to an “increasing and inordinate amount of Indigenous Australians being incarcerated”.

Malcolm Turnbull is set to deliver his first update on the Closing the Gap targets on Wednesday.

The national targets were set by the Council of Australian Governments in 2008, a year after the NT intervention began, and, according to the most recent update delivered by the then prime minister Tony Abbott in February 2015, most are not on track to be met.

The target of getting all Indigenous four-year-olds in remote communities into early childhood education was missed in 2013, with just 85% instead of the target of 95% enrolled.

The 2015 update, which Abbott described as “profoundly disappointing”, said the targets of closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation, halving the gap in literacy and numeracy by 2018, and halving the gap in employment outcomes by 2018 were not on track. Literacy and numeracy rates had not improved since 2008 and Indigenous employment had fallen.

Two more targets, to halve the gap in child mortality rates by 2018 and to halve the gap in year 12 completion rates by 2020, were listed as on track.

However, the author of the Castan Centre report said it appeared unlikely that any of the targets would be met in the Territory.

Close the Gap and Closing the Gap – what’s the difference?

Two similarly named programs are working towards the same goal of reducing inequality between Indigenous and non-Indigenous Australians

“The intervention was meant to improve the lives of Indigenous people in the Northern Territory, but at this rate the gap between Indigenous and non-Indigenous people may never close in many areas,” Dr Stephen Gray said.

He urged the government to adopt a new target of reducing Indigenous incarceration rates, as was recommended by the Close the Gap steering committee in 2014.

According to the latest Australian Bureau of Statistics data, Indigenous people made up 3% of the population but 27% of the prison population, and 52% of all young people in detention. In the NT, Aboriginal and Torres Strait Islander peoples make up 86% of the adult prisoner population and 96.9% of young people in detention. Incarceration rates are up 41% since the start of the intervention.

In November, the Australian Medical Association called rates of Indigenous imprisonment a “health and justice crisis”.

“I think there’s a perception that because family violence is such a crisis, because assault rates and child abuse are at such a crisis, we should not be always going on about Aboriginal imprisonment rates,” Gray said. “That sense that you can’t improve one without worsening the other is false.”

Amnesty International agreed, telling Guardian Australia that “any efforts at Closing the Gap cannot ignore these areas of massive inequality and the role that law and justice policy play in disadvantage.”

Reports of child abuse in the NT have decreased since 2010, but there has been a 500% increase in reports of self harm or suicide by Indigenous children and a sharp rise in the number of Indigenous children in care.

Gray said it was difficult to unpick the complicated mass of policy that governed the lives of Indigenous people in the NT, and that made it difficult to evaluate.

The intervention began with bipartisan support under the Howard government in 2007 as a response to a report about horrific levels of child sexual abuse in some Aboriginal communities, and was delivered as a complex suite of laws that altered everything from welfare payments to land tenure.

There was this presumption of rampant child sexual abuse in Aboriginal communities,” Gray told Guardian Australia. “It has been the excuse for a large number of other reforms that don’t really relate to child sexual abuse or family violence at all, like land reforms. It’s got very little to do with the original goals of the intervention.”

In 2008, the Rudd government reshaped it to focus on the new Closing the Gap targets but punitive measures remained, including more police, the removal of customary law and cultural practices from consideration in sentencing, quarantining welfare payments of those judged to have “neglected” their children, and tough penalties for possessing alcohol or pornography, as did the suspension of the Racial Discrimination Act.

The Northern Territory National Emergency Response Act expired in 2012 and was extended by the Gillard government until 2022, under the new name of the Stronger Futures in the Northern Territory Act. The Racial Discrimination Act was reintroduced but the percentage of an individual’s welfare payments that could be quarantined under the BasicsCard increased to 70%, and penalties for possessing porn or alcohol in dry communities, including a single can of beer, increased to six months’ jail.

By then the government had produced 98 reports and seven parliamentary inquiries into the intervention, a weight of information Gray said obscured its negative effects, particularly the impact on human rights.

“There’s a danger that things get out of check because of the swift pace of apparent change,” he said. “Because wheels keep turning, another policy gets rebadged, funding gets moved, but the real pace of life in Aboriginal communities remains the same.”

The result, the report said, was that many of Australia’s international human rights obligations, including the right of Indigenous peoples to self-determination, continued to be “directly and knowingly violated or ignored”.

Prof Jon Altman, from the Alfred Deakin Centre for Citizenship and Globalisation, said the Castan Centre’s evaluation of the intervention was too generous. The government deserved a zero out of 10, he said, for its attempts to improve education, and a negative score on employment rates which had gone backwards since the decision to abolish the community development employment projects (CDEP) program, which employed about 33,000 Indigenous people, particularly in remote communities.

Altman, who has spent 40 years working in Aboriginal communities in the NT in particular, said the services previously delivered by community-led CDEP organisations were now being done by non-Indigenous organisations, while many who had worked under CDEP remained on “passive welfare”.

Aboriginal people are exceptional. When we can all acknowledge that, the gap will close

Chris Sarra

 

Despite the dire outcomes of the Closing the Gap report, there is great potential in Indigenous communities. Our greatest challenge might be in believing that

“The state needs to admit that it’s actually doing worse than Aboriginal community-based organisations,” he said

Altman argued the Close the Gap program should be abolished, saying it was assimilationist, had alienated Aboriginal and Torres Strait Islander people and had produced no significant benefits.

“It’s all based on a policy, an ideology, that progress in closing the gap will require people to adopt western norms,” he told Guardian Australia. “And that’s a pretty hard line. It really doesn’t leave people much wiggle room if they don’t want to be changed.

“My advice to the prime minister is to stop talking about closing the gap and start talking about improving people’s wellbeing and livelihoods, because those things are taking a hammering.”

 

 

NACCHO News Alerts : ATSIC is gone for good, Nigel Scullion tells Noel Pearson

ATSIC

Indigenous Affairs Minister Nigel Scullion has rejected Noel Pearson’s push to replace a dedicated minister and department with an Aboriginal-led institution, saying the Turnbull government would not return to a body such as the Aboriginal and Torres Strait ­Islander Commission.

The Australian  See Also editorial below

Photo above :The chairpersons of ATSIC were Lowitja O’Donoghue (1990-1996), Gatjil Djerrkura (1996-2000), Geoff Clark (2000-2004) and Lionel Quartermaine (2003-2004).Image C0lin Cowell 1992/Koori Mail

The Cape York leader told the National Press Club on Wednesday that indigenous affairs was “in deep crisis” and bureaucracy’s engage­ment with communities had not only failed but dis­empowered ­Aborigines.

Mr Pearson wants the government to introduce his empowered commun­ities model, which would “minimise” the need for a ­dedi­cated minister and department by allowing indigenous people to ­administer services provided for their benefit.

He said he was not advocating the re-establishment of ATSIC, which was abolished by the Howard government in 2005 after collapsing under a mountain of corruption allegations and litigation, but the commission had been “more empowerin­g” than a minister and department.

“Noel Pearson is one of many strong voices in indigenous affairs and I welcome his contribution,” Senator Scullion said.

“However, I strongly believe in the need for a cabinet minister and lead agency solely dedicated to indigenous affairs, and we have no intention of returning to the service-delivery arrangements that existed before, under ATSIC.”

Opposition indigenous affairs spokesman Shayne Neumann said ministerial and departmental oversight was needed. “(It helps) in terms of co-ordin­ation and delivery of policy and government leadership in the area,” he said.

“To hear the voices of Aboriginal organisations and individuals so we can get that funding to the frontline to make a difference in closing the gap.”

Mr Pearson also accused the Coalition of treating his Cape York Institute with “contempt” by failing to respond to his proposal a year after it was handed to the ­Abbott government.

Malcolm Turnbull’s Assistant Minister Alan Tudge said the government would respond “very shortly” to the report, which ­canvassed the “right engagement” between government and the communities. “I think that in some communiti­es the government engage­ment has actually led to a proliferation of services which don’t talk to each other and, at the end of the day, don’t get much progress on the ground,” he told Sky News.

Senator Scullion said the government was working with leaders to determine how to implement the model and believed it had ­“potential to achieve real, lasting change” across Australia.

The Australian Editorial 29 January 2016

In his National Press Club address, Cape York Institute leader Noel Pearson outlined a new model for indigenous affairs ahead of next week’s release of the Closing the Gap report. The report is expected to contain damning results — again — and lead Malcolm Turnbull into an appeal for innovative policy proposals.

Mr Pearson has proposed a model of indigenous empowerment, aiming to foster entrepreneurialism to improve economic productivity, health and education outcomes. As chairman of the Cape York Academy, he works intensively with local communities, producing impressive results in school attendance and numeracy rates among indigenous children. Mr Pearson levels criticism at government, claiming its actions fail to meet the expectations of Aboriginal communities. The problem, he believes, lies with poor governance.

This will concern the Prime Minister given Mr Pearson’s lament that Tony Abbott’s leadership of indigenous affairs was “cut short”. He described Mr Abbott as his “closest friend” in politics. They shared close camaraderie with then parliamentary secretary Alan Tudge, working in concert to form indigenous policy in office.

And so indigenous affairs emerges as yet another area of policy challenge for the Prime Minister. Mr Turnbull will need to take advice from policy experts within government such as Mr Tudge, who served as deputy director of the Cape York Institute. He will have to balance long-term reform agendas with the more immediate needs of indigenous communities while crafting a process for the referendum on indigenous recognition. And he will need to ensure Minister for Indigenous Affairs Nigel Scullion can provide the outcomes-based governance Mr Pearson rightly contends is overdue.

While innovation in indigenous affairs is welcome, it must be more than change for change’s sake. Successive Labor and Liberal regimes have combined grand overtures (The Apology) with controversial programs (Northern Territory intervention) but have failed sufficiently to close the gap between indigenous and non

Indigenous Affairs Minister Nigel Scullion responds to Pearson’s critique, says change can be ‘a little disconcerting’

Federal Minister Nigel Scullion says his department is taking a methodical approach to Indigenous affairs amid criticism from Noel Pearson that Aboriginal people have been disempowered and ignored.

Earlier this week the Cape York leader detailed concerns about the Coalition Government’s approach to the portfolio, the way funding is being distributed, progress towards constitutional recognition and the high rate of Aboriginal imprisonment.

“Make no mistake, Indigenous Affairs is in deep crisis,” Mr Pearson said.

“We are seeing good things in isolated areas but not seeing the tectonic shifts that are needed.”

In a statement Senator Scullion defended his government’s position.

“We are taking a methodical approach to implementing our Indigenous Affairs agenda and while change can be a little disconcerting, communities are front and centre of these reforms,” the statement said.

“Our advice comes directly from communities.”

Senator Scullion said he welcomed Noel Pearson’s contribution as “one of many strong voices in Indigenous Affairs”.

Communities disempowered, Pearson frustrated

Mr Pearson also used his speech to express frustration about the lack of action on the Empowered Communities report that was provided to the Federal Government last year.

The report was a joint document provided by representatives from seven regions across the country, and recommended – among other things – creating an Indigenous Policy Productivity Council.

The council would scrutinise policies and programs that affect Indigenous Australians.

“There has been no proper engagement in the ideas we’ve proposed and the institutions that we believe are necessary,” Mr Pearson told the press club.

“The reforms we propose will in fact minimise the necessity of having a ministry of Aboriginal affairs or indeed eventually a minister.”

But Senator Scullion said the Government had responded to the report and offered a regionally focused approach to the issues it raised.

“I welcomed the report and believe that the proposed new form of engagement and focus on Indigenous responsibility has the potential to achieve real, lasting change in communities across Australia, particularly in critical areas such as school attendance and attainment, economic development and community safety,” the minister said.

“However, I strongly believe in the need for a Cabinet Minister and lead agency solely dedicated to Indigenous affairs and we have no intention of returning to the service delivery arrangements that existed before, under ATSIC.”

In his speech Mr Pearson said he thought the nation had reached the “dead end of Indigenous affairs presided over by a minister and a department”.

“There’s good things happening and there are good people involved, I’m not saying that the people involved are insincere,” he said.

“It is just that the system by which they attempt to deal with our communities is not one that works. It can’t discern excrement from clay.”

 NACCHO CLOSE THE GAP

Aboriginal Health in Aboriginal Hands for Healthy Futures Exhibition and travelling road show 2016

Find out how you can host this exhibition -see application below

Celebrating the 10th Anniversary of the Close the Gap Campaign for the governments of Australia to commit to achieving equality  for Indigenous people in the areas of health and  life expectancy within 25 years.

The National Aboriginal Community Controlled Health Organisation (NACCHO) in partnership with Wayne Quilliam Photography has developed a visual narrative that has been created to foster awareness, exploration and understanding of Aboriginal health in Aboriginal hands.

Our exhibition of 24 photographic images, melded with a series of video interviews embedded within the images will stimulate individual thinking and dialogue relating to the 10th anniversary of ‘Close the Gap’ campaign celebrated in March 2016.

APPLY HERE

NACCHO News Alert: Indigenous drive at ‘dead end’: Warren Mundine and Noel Pearson

Noel

Decades of failure to deliver substantial improvements in the wellbeing of Indigenous Australians have left two of the nation’s senior Aboriginal leaders calling for radical new approaches of the type not seen since the Northern Territory intervention.

Todays report The Australian

Malcolm Turnbull is understood to be urgently seeking novel ideas to break the deadlock ahead of what is expected to be another damning Closing the Gap report, due to be released after parliament resumes next week.

At the first meeting of the Indigenous Advisory Council held under his leadership late last year, the Prime Minister challenged those present to introduce disruptive thinking and innovation to indigenous affairs. Among ideas put forward were significant changes to economic development, welfare and education programs, including coercive meas­ures to penalise state and territory governments for not implementing their rules requiring all children to attend school daily.

In a provocative address to the National Press Club yesterday Cape York leader Noel Pearson identified a “deep crisis” in indig­enous affairs governance, saying the system had remained broadly static for 25 years and that it had failed to meet Aboriginal expectations for half a century. “We have a minister, we have a department, and they do good, but they do not do enough,” Mr Pearson said.

“And a system that’s premised upon kind of bureaucratic determination with ministerial imprimatur and so on is not one that is going to empower our people.

“We’ve reached the kind of dead end of indigenous affairs presided over by a minister and a department.

“Sorry. I’m not saying that the people involved are insincere. It is just that the system by which they attempt to deal with our communities is not one that works.

“It can’t discern excrement from clay. It just cannot.”

He appealed to what he called the “radical centre­” — personified by the likes of Nick Xenophon, Tim Costello and Natasha Stott Despoja — for support.

The Australian can reveal that Mr Turnbull has privately sought advice from indigenous leaders ahead of his forthcoming Closing the Gap statement. He is understood to have encouraged some to think more boldly than they have in the past.

Indigenous Advisory Council chairman Warren Mundine said that unless children were going to school and adults to work regularly — two goals Tony Abbott sought but struggled to realise during his prime ministership — little else could be achieved.

A divergence of views appears to be emerging between Mr Pearson and Mr Mundine on the best way forward.

Mr Pearson favours governance reforms encapsulated by his Empowered Communities model, which would “minimise” the need for a dedicated minister and department by empowering indigenous people to direct and administer services provided for their benefit.

In his speech, Mr Pearson attacke­d politicians, bureaucrats and others he said had failed to give Empowered Communities proper consideration. He likened the experience to “casting pearl under swine” and regretted his own decision not to enter politics, saying he had reached the limit of what could be accomplished by “barking from the outside”.

Mr Mundine said he had largely lost faith in politics and governance reforms, and that exposin­g indigenous people to entrepreneurialism and for-profit private enterprise was key.

“When we talk about the nation­ we talk about having an economic strategy … but when we talk about indigenous affairs it’s always putting lipstick on a pig — trying to dress up welfare,” Mr Mundine said.

“Entrepreneurialism is the only thing that’s going to create jobs. Nothing else does.”

Among the expert opinions offered­ to the Prime Minister is one that cashless welfare, income management, job-creation prog­rams and Empowered Commun­ities, regardless of their value, all have government dependency at their core.

The Indigenous Enterprise Development Fund should be reconfig­ured as an independent venture capital fund closed to not-for-profit and charitable applica­nts, partly to avoid governments picking winners.

Although the Indigenous Procurement Policy has achieved some gains, demand for indigenous ready labour is not yet matched by supply, creating a material risk of employers setting up phony joint ventures and “black cladding” their contracts with ghost staff.

Mr Turnbull has been advised to establish a firm target of getting all indigenous children into daily education by the end of this year.

The Australian has been told school attendance initiatives are being hampered by the failure of states and territories to provide reliable data. It is suggested funding should become conditional on provision of reliable data and that states and territories should be fined for failing to adequately resourc­e schools and for failing to get students to attend regularly.

Kimberley Aboriginal leader Wayne Bergmann praised Mr Abbott’s decision to move the indig­enous affairs portfolio into the Department of Prime Minister and Cabinet. The decision has been criticised by others as overly disruptive.

Another proposal expected to be put before Mr Turnbull would use data to identify and intensively support households believed to be responsible for causing more than their share of trouble in communities.

Noel Pearson ‘regrets’ coup against Tony Abbott, says Indigenous affairs in ‘deep crisis’

ABC Report

Aboriginal leader Noel Pearson says he regrets Tony Abbott’s prime ministership being cut short, given the former leader’s commitment to Indigenous issues.

Key points:

  • Pearson says Abbott would have achieved more in Indigenous areas
  • Says left and right too divided to find policy solutions
  • Slams the speed of progress in Indigenous affairs

Mr Abbott declared himself the “Prime Minister for Indigenous affairs”, visited two remote communities and brought many Indigenous affairs public servants into his department.

Delivering the first National Press Club address of 2016, Mr Pearson also praised current Prime Minister Malcolm Turnbull, but said Mr Abbott had started to make changes and would have achieved more.

“It was cut short. I think there’s been few people more genuinely signed up to our cause than him. I regret his passing,” Mr Pearson said.

“It was essential that a conservative start the kick-off. I’ve always believed that. [Former United States president Richard] Nixon had to go to China and a conservative had to kick this ball along the road.

“We now have the blessing that the current Prime Minister is a long supporter of a new relationship with our people … so in some sense we’ve got the best of both worlds.”

In a wide-ranging address, the eminent Cape York leader declared Indigenous affairs was in “deep crisis”, and urged politicians to strive for the “radical centre” in Australian politics.

Mr Pearson said the left and right of politics were continually at war and could not find policy solutions.

“If politics is necessarily about tension and struggle then the radical centre is the highest compromise,” he said.

“The glaring omission in Australia’s political landscape is the absence of political representation hunting for that centre.

“We need a new democrat with new philosophy, with a higher purpose than simply keeping the bastards honest. We need a great connector between the red and the blue.”

Mr Pearson named South Australian senator Nick Xenophon as the politician closest to his ideal centrist.

He also slammed the speed of progress in Indigenous affairs.

“Make no mistake: Indigenous affairs is in deep crisis,” he said.

“We are seeing good things in isolated areas but not seeing the tectonic shifts that are needed.

“The current situation is one where the investment today in Indigenous affairs is $34 billion per annum sunk through government departments, outsourced to NGOs and for-profit organisations.

“That $34 billion a year is not yielding the kind of return that I saw in ATSIC’s day,” he added, referring to the Aboriginal and Torres Strait Islander Commission abolished under the Howard government.

Make no mistake: Indigenous affairs is in deep crisis. We are seeing good things in isolated areas but not seeing the tectonic shifts that are needed.

Noel Pearson

Mr Pearson said he was very optimistic that Indigenous people would be acknowledged in the constitution.

Mr Pearson is a member of the recently-formed bipartisan Referendum Council that will advise Parliament later this year.

He called for a centrist position to be found that is acceptable to all sides of the recognition debate, including constitutional conservatives.

“Too much left won’t work, too much right won’t work, too much overreach won’t work and too much miserable under-reach will not either,” he said.

“The window of constitutional opportunity is extremely narrow between left and right.

“The challenge is to produce a model and prosecute a politics capable of spearing through that window.”

NACCHO CTG news : Closing the gap? Productivity Commission shows how far there is to go

CTG

“Ultimately the responsibility for driving the Closing the Gap effort lies with the Prime Minister and his Department. Former Prime Minister Tony Abbott was correct to see tackling Indigenous disadvantage as requiring a whole-of-government approach.

However the program disruptions and savage funding cuts simply sent the agenda backwards rather than forwards. While the impacts of these changes on progress in Closing the Gap have yet to flow through in the reporting, they will certainly contribute to yet another failing grade next year.”

Dr Lesley Russell is an adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney.

Last week, the Productivity Commission released the sixth annual report of performance assessments for the ‘Closing the Gap’ targets to address Indigenous disadvantage.

Download the report here

These reports were previously produced by the COAG Reform Council, which was abolished by the Abbott government in 2014. However this lamentable decision has delivered an unexpected benefit: the Productivity Commission has produced a report for 2013-14 that is exemplary for its stark findings, forthright criticisms and thoughtful recommendations for future, more productive reporting and evaluations.

PHOTO and Report :Little progress has been made in addressing the profound and persistent social and economic gaps experienced by Indigenous Australians. Photo: Glenn Campbell

NACCHO Media NOTE:  The views expressed here are those of the author and do not necessarily reflect those NACCHO and member organisation.

The news is depressing. Little progress has been made in addressing the profound and persistent social and economic gaps experienced by Indigenous Australians. Few of the targets set by Australian governments in 2008 will be met and in some cases the gaps have widened. The data present national averages that hide substantial variations in achievements between the states and territories and situations that are worse in more remote areas.

The issues around life expectancy highlight the problems. The target, which will not be met, is to reduce the current gap of 10 years within a generation. Mortality rates are used as a proxy for life expectancy, but these do not take account of the high levels of disability experienced by Indigenous Australians. Mortality rates are not even available for Victoria, South Australia, Tasmania and the ACT due to problems with death registration data. Given that key risk factors like smoking, obesity and suicide remain unacceptably high, there is little likelihood that health outcomes and life expectancy will dramatically improve in the near future.

While infant mortality has improved, the mortality gap between Indigenous and non-Indigenous children aged 1-4 years has widened and Indigenous children face high levels of hearing and vision loss and rheumatic fever rates among the highest in the world. These health problems affect their ability to learn and future job prospects. Up to one half of the health gap is attributable to social determinants and so progress must be made on the full suite of targets, plus others such as housing, incarceration and social justice, in order to see real changes in any one target.

The Productivity Commission makes it clear that the thousands of pages of reports and data published annually by a variety of public and private agencies are too often duplicative and not very useful or informative. Surveys of health and social wellbeing targeted at Indigenous people are done sporadically, not regularly, and often lack future funding. Many of the recent improvements in health data sets are not included in the National Reform Agreement indicators.

The commission is very critical of the fact that current reports deliver little or no evidence about what works. It recommends that the future focus should be on ensuring independent reporting and especially on evaluation. Just 17 per cent of recently completed Indigenous-specific health programs had been evaluated to assess their effectiveness and the evaluation rate is even lower in non-health areas. The report finds that, in the absence of a strong evaluation culture with resources to facilitate this, policymakers will continue to flounder and programs will continue to fail to deliver the expected outcomes.

A system for building the evidence base about what works and does not work in Indigenous programs existed in the Closing the Gap Clearing House, but again, this is now defunded and defunct. The Clearing House had identified a number of key principles that are necessary for effective Indigenous programs and services. These include: flexibility in design and delivery to meet local needs; community involvement in design and decision making; trusting relationships; good governance on the part of all the organisations, communities and governments involved; retention of a well-trained and well-resourced workforce; and continuity and co-ordination of services and support.

There are difficulties in evaluating Indigenous programs but these are not insurmountable, they simply mean that more effort is needed. Too often Indigenous initiatives are time-limited pilots and trials that run their course and cease without any formal public evaluation, thus ensuring the loss of learning opportunities, regardless of the success or failure of the initiative.

Ultimately the responsibility for driving the Closing the Gap effort lies with the Prime Minister and his Department. Former Prime Minister Tony Abbott was correct to see tackling Indigenous disadvantage as requiring a whole-of-government approach. However the program disruptions and savage funding cuts simply sent the agenda backwards rather than forwards. While the impacts of these changes on progress in Closing the Gap have yet to flow through in the reporting, they will certainly contribute to yet another failing grade next year.

As the Productivity Commission makes very clear, Closing the Gap is not about making work for bureaucrats, collecting data and producing reports. It is about a long-term commitment to delivering programs and services in ways that are consultative, meaningful and productive for the very people they are meant to benefit.

The report sums it up this way: “The answer to how to Close the Gap lies in knowing more about what works and why.”

naccho-Video Project

Register here on our NACCHO website

NACCHO NEWS: Government will fail to meet five out of six Closing the Gap targets: Productivity Commission

1919786-3x2-340x227

The Federal Government will not meet the majority of the targets in its program to turn around Indigenous disadvantage

This is the first year the Productivity Commission has produced the National Indigenous Reform Agreement Performance Assessment.

DOWNLOAD THE REPORT HERE

The assessment was previously undertaken by the COAG Reform Council.

Report from the ABC

That is the damning assessment of a Productivity Commission report on the six Closing the Gap targets, which were set back in 2008.

The targets cover life expectancy, child mortality, education and employment.

But the commission’s review shows there has been improvement in just one area — reducing gaps in child mortality.

Improving life expectancy, access to preschool, and reading and numeracy rates are all showing no progress, and the employment target is going backwards.

The Productivity Commission said the Government needed to get serious about evaluating which programs were actually working in Indigenous communities.

“Broadly speaking it seems unlikely they will be met,” commission chairman Peter Harris said.

The Closing the Gap report card is tabled on the first sitting day of Parliament each year, and each year since 2008 there has been an admission that almost no progress has been made to drive down Indigenous disadvantage by 2030.

“Frankly there were wide gaps in some cases between Indigenous employment levels and non-Indigenous employment levels, so a very wide gap to fill anyway,” Mr Harris said.

“The state of the Australian economy today is probably not what it was back when the targets were first established, so there are an array of reasons, but the bottom line is … we’re not getting the result, it’s going backwards and therefore we must do more.”

Getting young Aboriginal men and women into jobs is a major focus for Rodney Carter, Dja Dja Wurrung Clans Aboriginal Corporation chief executive in Victoria.

“The greatest welfare for a person or the freedom from it is to have a form of employment and to be able to have your own money,” he said.

“You can have choices on what you actually do with money and that’s just the way that society’s set up.

“We can’t change that and you can be angry with the world and think, ‘well you know this was our land, largely it’s been taken away’ and get excluded but if we can somehow participate, empower ourselves through having some form of an income, that’s the greatest form of, I call it welfare.

“It seems to improve yourself.”

The Productivity Commission has suggested that more effort be put into evaluating those programs that appear to be working.

“At the moment we have a lot of effort going into reporting the results of performance, and the performance [is] often poor, and much less effort [is] going into evaluating what works,” Mr Harris said.

Productivity Commission PRESS RELEASE

  • Aboriginal and Torres Strait Islander Australians experience profound economic and social disadvantage. It is manifest in many ways, affects both the young and the old, and can span generations.
  • To lend impetus to the task of addressing that disadvantage, COAG has committed to a number of targets for reducing the disparity between Indigenous and non-Indigenous Australians in life expectancy, health, education and employment outcomes.
  • This report is the sixth in a series of performance assessments for the Closing the Gap targets (with assessments made previously by the COAG Reform Council).
    • Like other components of the Indigenous reporting framework, the focus of this report series is on monitoring broad outcomes rather than establishing what works in bridging outcomes gaps. Much less is known about the latter.
    • As well as assessing progress against the targets, the Commission has therefore looked at how the broader reporting framework and policy evaluation efforts could be improved.
  • At the national level, progress in meeting individual gap targets has been mixed.
    • Good progress has been made in reducing outcomes gaps in child mortality and Year 12 (or equivalent) attainment rates. And though the target of providing access to early childhood education for all Indigenous four year olds in remote areas by 2013 was not met, the evidence suggests a positive outcomes picture.
    • But despite considerable effort and investment, little or no progress has been made in closing gaps for life expectancy and reading and numeracy. And employment gaps have increased rather than narrowed.
    • Meeting these latter targets seems an unlikely prospect at this stage.
  • Outcomes at the jurisdictional level have generally been consistent with national outcomes.
  • In many areas, outcomes for Aboriginal and Torres Strait Islander Australians continue to be markedly worse in more remote areas. Even where considerable progress has been made in closing national level gaps, there is still much to do outside of the major population centres.
  • Looking to the future, there is a strong case for rationalising reporting on Indigenous outcomes and disadvantage.
  • While tracking progress towards an outcomes end point can inform policy making, it is not a substitute for examining the role of specific policies in reducing disadvantage, and assessing their cost effectiveness in absolute terms and relative to other approaches.
  • The critical role that robust policy evaluation could, and should, play in improving outcomes for Aboriginal and Torres Strait Islander Australians is widely acknowledged.
    • Though such evaluation can be challenging, a much stronger evaluation culture in the Indigenous policy area should be promoted. It is important that such evaluations consider the effectiveness of mainstream services which account for 80 per cent of Indigenous expenditure.
  • Options for invigorating evaluation include: an overarching review of policy evaluation in the Indigenous area; COAG committing to evaluating policy settings in a target area or a sub-set of policies in a particular area (say education); and adding a procedural, evaluation-focused target to the Closing the Gap initiative

 

A change in approach is needed to improve outcomes for Indigenous Australians

It is becoming increasingly clear that a number of the ‘Closing the Gap’ targets will not be met according to a Productivity Commission report released today.

The Council of Australian Governments (COAG) committed to a number of targets for reducing the disparity in life expectancy, health, education and employment outcomes between Indigenous and non-Indigenous Australians. The report monitors progress against these targets.

Despite considerable effort and investment, little or no progress has been made at the national level in closing gaps for life expectancy and reading and numeracy. Employment gaps have increased rather than narrowed.

‘Meeting the targets for life expectancy, reading and numeracy and employment seems an unlikely prospect at this stage’, Peter Harris, Chair of the Productivity Commission, said.

On the positive side, the report shows that good progress has been made in reducing outcomes gaps in child mortality and Year 12 (or equivalent) attainment rates at the national level.

And while the target of providing access to early childhood education for all Indigenous four years olds in remote areas was not met, the evidence points to positive outcomes.

A much greater emphasis must be placed on policy evaluation, the report states.

‘If we are to see improvements in outcomes for Aboriginal and Torres Strait Islander Australians we need to move further into the detail, examining which policies and programs work better than others and why. Our current focus is on setting targets and monitoring outcomes. This must be complemented by evaluation,’ Productivity Commission Chair Peter Harris said.

The report also states that there is a strong case for rationalising the current framework for reporting on Indigenous outcomes and disadvantage.

‘There is a wide array of information available to tell the story of Indigenous disadvantage, but surely the nature and significance of that disadvantage is not in dispute. Removing some of the duplicate reporting could be a means of freeing up resources for policy evaluation,’ Peter Harris said.

This is the first year the Productivity Commission has produced the National Indigenous Reform Agreement Performance Assessment. The assessment was previously undertaken by the COAG Reform Council.

 

NACCHO NEWS: Commissioner calls for action on Indigenous child protection and disability

New Microsoft Word Document

Aboriginal and Torres Strait Islander Social Justice Commissioner, Mick Gooda, has called for action on the over-representation of Indigenous children and young people in the child protection system, and for greater support for Aboriginal and Torres Strait Islander peoples with disability.

DOWNLOAD THE REPORT

Commissioner Gooda’s Social Justice and Native Title Report 2015, tabled today in Federal Parliament, describes Indigenous child protection as “one of the most challenging issues confronting our communities.”

“Aboriginal and Torres Strait Islander children are approximately nine times more likely than non-Indigenous children to be in out-of-home care,” Commissioner Gooda said.

“Our children are our most precious resource and their innocence and their right to be safe, healthy and free from violence must be protected at all costs.

“We need to empower and support Aboriginal and Torres Strait Islander peoples to break free from the cycle that brings them into contact with child protection authorities in the first place.”

The report calls on state and territory governments to establish Aboriginal and Torres Strait Islander Children’s Commissioners in their jurisdictions to oversee child protection reforms. The Commissioner also wants federal, state and territory governments to establish a National Institute of Indigenous Excellence in Child Wellbeing to coordinate research into Indigenous child protection.

Commissioner Gooda said more needs to be done to ensure the rights of Aboriginal and Torres Strait Islander children to their culture and identity.

“The importance of cultural identity cannot be understated given what we know about culture as a protective factor for our young people,” the Commissioner said.

The Social Justice and Native Title Report 2015 makes 21 recommendations, including six measures to support and protect Aboriginal and Torres Strait Islander people with disability.

The Commissioner said the full extent of disability within the Aboriginal and Torres Strait Islander community must be ascertained, and programs and policies to address their needs must be monitored through a robust evaluation framework.

“Closing the Gap agreements should include a target for Aboriginal and Torres Strait Islander people with disability as an area for future action,” Commissioner Gooda said.

“We need to ensure there is culturally competent and appropriate engagement with Aboriginal and Torres Strait Islander communities in the implementation of the National Disability Insurance Scheme (NDIS). The NDIS should draw on the expertise and experience of Aboriginal and Torres Strait Islander peoples, ensuring that local services and employment is prioritised.”

The report also examines Indigenous social justice and Native Title issues, including the impact of the Indigenous Advancement Strategy, constitutional recognition, welfare and remote communities. It also reflects on progress in land and native title, and provides a voice for Aboriginal and Torres Strait Islander peoples who want a new process of engagement for native title and land ownership.

Read the Social Justice and Native Title Report 2015

 

NACCHO Aboriginal Health News: Latest stats reveal Indigenous imprisonment crisis is worsening

photo

The latest Australian prison statistics released yesterday show the crisis of Indigenous imprisonment in Australia is getting worse.

The Human Rights Law Centre’s Senior Lawyer, Ruth Barson, said the figures, released by the Australian Bureau of Statistics, should be a wake-up call for governments across Australia to abandon costly, punitive policies.

“The Indigenous imprisonment rate is a national crisis. We must take smarter action to address this inequality by addressing the causes of crime – not just the symptoms,” said Ms Barson.

Ms Barson urged governments to embrace proven approaches that prevent crime and lower prison rates.

“Programs like justice reinvestment have shown to reduce Indigenous imprisonment rates, keep the community safer and save taxpayer funds,” said Ms Barson.

The statistics confirm that overall, Indigenous people are locked up at 13 times the rate of non-Indigenous people. Indigenous people account for 28% of the total prisoner population, yet only 2% of the general population.

The statistics show that in the year to June 2015:

  • Indigenous men’s imprisonment rose 5%;
  • Indigenous women’s imprisonment rose 9%;
  • Remand rates (people in prison waiting trial or sentence) increased 11%; and
  • Total imprisonment (Indigenous and non-Indigenous) rose 6%.

“Indigenous women are the fastest growing prisoner demographic in Australia. These women are falling through the gaps. We need targeted, gender and culturally specific action to improve safety and to prevent the cycle of disadvantage,” said Ms Barson.

Executive Officer of the National Aboriginal and Torres Strait Islander Legal Services, Eddie Cubillo, called on the Federal Government to commit to ‘justice targets’ which set benchmarks for reducing Indigenous imprisonment rates.

“The over-imprisonment of Aboriginal and Torres Strait Islander people is an ongoing blight on Australia and the problem is getting worse. We need programs that are appropriate and responsive to the needs of Aboriginal people. Justice targets will ensure that Governments are accountable for addressing this issue. We must close this gap,” said Mr Cubillo.

NATSILS is also urging governments to focus on tackling the underlying social and economic reasons that generate crime.

“Too often we ignore proven, effective policies which improve community safety in favour of populist, blunt and often ineffective responses that see more and more Aboriginal people locked up,” said Mr Cubillo.

Justice reinvestment involves channeling some of the billions of dollars spent on prisons, into targeted community programs in high-need areas to address the underlying causes of offending.

“Justice reinvestment is an evidence-based approach that focuses resources on preventing crime instead of just responding after the damage is done,” said Ms Barson.

Justice reinvestment emerged out of traditionally punitive American states like Texas in response to ballooning prison populations and the associated costs. It has proven transformative in those places. It is now being trialed in NSW, Western Australia and South Australia.

 

NACCHO NEWS ALERT: Why health experts are asking governments to consider the health impacts of all policies

SDOH

The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan, but I  acknowledge it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

Martin Laverty, the chairman of the Social Determinants of Health Alliance

ABC Health & Wellbeing By Bianca Nogrady

‘An ounce of prevention is worth a pound of cure’, Benjamin Franklin is quoted as saying.

But as bang-for-your-buck as prevention may be when it comes to your health, adopting a healthy lifestyle is not as simple as it may sound.

It’s easy enough to say, “don’t smoke and you’re less likely to get cancer”, or “eat healthy food and exercise regularly and you’re less likely to become overweight”. But what if you grew up in a smoking household? What if you don’t have enough money to buy fresh vegetables and don’t have the know-how or time to prepare meals with them? What if your job pays so little, you have to work double shifts just to make ends meet and don’t have time to do any exercise?

Preventive health goes way beyond individual choices, because our health – particularly when it comes to chronic diseases such as type 2 diabetes and heart disease – is influenced by factors that are often far beyond our individual control. These factors are known as the social determinants of health.

Social determinants of health


Social determinants of health are the social and economic factors that contribute to our state of health and wellbeing, such as:

  • how much money we earn
  • what level of education we have
  • where we live and whether we have access to transport
  • our ethnicity.

Addressing these drivers of health is challenging, says Associate Professor Lyndall Strazdins, senior fellow at the National Centre for Epidemiology and Population Health, at the Australian National University.

“Once you move beyond giving people flu shots and that sort thing, then what is it that you have to engage with?” says Strazdins.

“That’s what makes social determinants of health such a difficult policy field because it steps out of what’s considered to be health, which is health care, and moves into the drivers of health, the systems that will move health up or down in a society.”

This means just about any policy or law is likely to have an impact on health; whether it’s paid parental leave, minimum wage, working hours, education, etc. Recognition of this has given rise to a global movement for ‘health in all policies’.

Strazdins says the movement emphasises the importance of policy-makers taking health into account.

One example is the knock-on health impacts of workforce participation policies. Policies that push back the retirement age and keep us in the workforce for longer, reduce the amount of time we have for leisure activity and exercise as we age. As well, some of us are going to be caring for our partners. All this means we’re less able to give any emerging health issues the attention they may need.

Despite this, health is rarely even mentioned in such policies, Strazdins says.

“So here we have health at the heart of [whether] this policy is going to succeed or not, and it’s not mentioned, so the very first step is putting health in,” she said.

“If you come back to even economic analysis, we know these things are costing the country; what we don’t realise is how the way we’re structuring the country could make a huge difference.”

Health in all policies – how does it work?

In 1997, the Swedish Road and Traffic Safety Agency contributed to the introduction of a bill that has had a hugely positive impact on the health of the Swedish population.

The bill aimed for zero fatalities and serious injuries on Swedish roads by 2020, by bringing together transport, justice, environment, health and education sectors to promote, enforce and assist with road safety. So far, this initiative has reduced Sweden’s road fatalities by more than two-thirds.

Thailand has introduced a policy requiring the use of health impact assessments in an effort to reduce the health consequences of environmental hazards such as air pollution. The approach has been taken for developments such as coal mines, biomass power plants, waste management systems and water conservation initiatives.

It is even bringing this into consideration of patent protection laws for pharmaceuticals.

Improving health for all

Martin Laverty, the chairman of the Social Determinants of Health Alliance, says Australia is well-placed to address some of the most important social determinants of health, such as education.

“We’ve got universal access to education, social safety to provide access to income support, social housing scheme, universal access to health care, but despite these levers, people fall through the cracks,” says Laverty, also CEO of the Royal Flying Doctor Service.

“The universal access to health care, education, social safety net of income and housing support is not providing optimal support for those most vulnerable within the community.”

One major Australian initiative attempting to deal with social determinants of health is the Federal Government’s Closing The Gap program.

“In Indigenous affairs we see a social determinants action plan that is informing how we are acting to improve Indigenous life expectancy and improve chronic illness,” Laverty says.

The program has had some wins, particularly in child mortality, but Laverty says the next areas for improvement are in stopping people smoking and boosting Indigenous people’s level of education.

He would also like to see this approach taken to improving the health of all Australians.

“The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan,” he says, but he acknowledges it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

You might also like to read other stories from our Social Determinants of Health series: