NACCHO Closing the Gap report: Analysis of provisions in the 2013-14 budget of the Indigenous Chronic Disease Package

dentist

Total government expenditure on Indigenous health has risen significantly since the commencement of the National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes in 2009-10 and now represents about 5.1% of total government health expenditure.

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An analysis of provisions in the 2013‐14 Budget and implementation of the Indigenous Chronic Disease Package

Russell, Lesley
Menzies Centre for Health Policy

ABSTRACT and LINK

This paper presents the author’s analysis of the Indigenous provisions in the Australian Government’s 2013-14 Budget in the context of current and past strategies, policies, programs and funding support. It also looks at the implementation and impact of the Commonwealth’s Indigenous Chronic Disease Package. This work has been done using only materials and data that are publicly available. The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors. This work does not represent the official views of the Menzies Centre for Health Policy, the Australian Primary Health Care Research Institute (APHCRI) or the Commonwealth Department of Health and Ageing which funds APHCRI.

Report summary

This amounted to $4.7 billion in 2010-11; of this, the Commonwealth provided about one-third ($1.6 billion).

However while there is a significant effort underway to close the gap in Indigenous disadvantage and life expectancy, in most areas this effort has yet to show real returns on the investments. The disadvantages that have built up over more than 200 years will not disappear overnight, and sustained and concerted efforts are needed to redress them.

Chronicdiseases, which account for a major part of the life expectancy gap, take time to develop, and equally, it will take time to halt their progress and even longer to prevent their advent in the first place. Programs will need to be sustained over decades if they are to have an impact on improving health outcomes.

On this basis, it is worrying to see that continued funding for the NPA on Closing the Gap in Indigenous Health Outcomes, as announced in April, will be less over each of the next three years than in 2012-13.

At the same time, the Budget Papers show that expenses in the Aboriginal and Torres Strait Islander health sub-function will decline by 2.7% in real terms.

This comes as states such as Queensland and New South Wales have made damaging cuts to health services and Closing the Gap programs.

Education is a significant determinant of health status so it is also concerning to see a reduced level of funding provided for Indigenous education over the next six years, especiallywhen efforts to close the gap in education for indigenous students have stalled. These cuts inhealth and educations commitments cannot be justified by saying that Indigenous Australianscan access mainstream programs. In many cases these are absent, inappropriate, or perceived as culturally insensitive, despite recent efforts to improve these deficits.

It is a strength of the COAG commitment to close the gap on Indigenous disadvantage that it recognises that a whole-of-government approach is needed to deliver improvements in the lives of Indigenous Australians.

However tackling disadvantage is about more than building houses, providing job training, implementing welfare reform, community policing andincreasing access to health services; it requires that governments recognise and respect the complex social and cultural relationships that underlie the housing, economic, health and societal issues present in many Aboriginal

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NACCHO health news:Healing the Fault Lines: uniting politicians, bureaucrats and NGOs for improved outcomes in Aboriginal Health.

olga-havnen

Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between politicians, bureaucrats and NGOs and the Aboriginal Community Controlled Health sector must unite to make a real difference.

A little known positive aspect of the Northern Territory Intervention was a significant increase in resources to Aboriginal Comprehensive Primary Health Care.

This, along with parallel initiatives under Closing the Gap, gave some hope that the decades long demands from our sector for substantial extra resources in primary health care was at last being heard.

However, while we have been making some advances in the Northern Territory, we face the potential for a “race to the bottom” in Aboriginal health where the interests of politicians, bureaucrats and NGOs potentially outweigh the evidence of Aboriginal community control.

 Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between these groups and the Aboriginal Community Controlled Health sector must unite to make a real difference.

Extract from the 16 pages speech which can now be download from NACCHO

I am currently the CEO of Danila Dilba Health Service in Darwin, which has not long ago celebrated its 20th anniversary. We are an Aboriginal Community Controlled Health Service—and part of a broader, national movement of community controlled comprehensive primary health care that has its origins in Redfern some 42 years ago.

At the core of what we have achieved over those many years has been an aggressive approach to basing our work on evidence. Our accumulated achievements have always been based on what works—in clinical as well as social practice.

At the heart of what we have strived to achieve is the development of a practice—both clinical and social—that displays our strong and central commitment to comprehensive primary health care.

This model was codified at an international level at Alma Ata in 1978, and subsequently endorsed by the World Health Organisation (WHO) and the United Nations:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Primary health care is socially and culturally appropriate, universally accessible, scientifically sound, first level care.

You can download  Olga Havnen full speech 16 pages here

PRESS Coverage below and picture from the Australian May 29

REMOTE indigenous communities are suffering from a government culture of “risk intolerance” which has diverted funding from community-led organisations, a leading Aboriginal figure has said.

Olga Havnen, the Northern Territory’s former co-ordinator general for remote services, last night attacked successive governments for choosing large non-government organisations for service delivery ahead of smaller indigenous-led organisations.

Ms Havnen said many community-led service delivery organisations had “disappeared” since the Northern Territory Emergency Response in 2007.

“Aboriginal control of service delivery in many areas has withered on the vine,” she said in the Lowitja O’Donoghue Oration at the University of Adelaide.

“Despite jurisdictional, national and international evidence that community control over service delivery achieves better results, with control being a key element in the social determinants of health, for example, we have gone backwards.”

 Ms Havnen, whose position in the Territory was abolished by the new Country Liberal Party government in October, said there had been a “massive expansion” of NGO involvement in service delivery with “many millions of dollars” flowing to non-indigenous NGOs and multinational NGOs, regardless of their effectiveness.

She said in the past decade, only one new community controlled health service had been established in the Territory and only two remote health clinics handed across to community control.

“It is a process which has allowed government agencies to quarantine themselves from what they too often ascribe as risk in funding Aboriginal organisations,” she said.

“By this I mean that nothing is done, or can be done, that might in any way shape or form come back to haunt politicians or bureaucrats at a Senate estimates hearing or their state and territory equivalents.”

Ms Havnen, who is now chief executive of the Danila Dilba Health Service in Darwin, an Aboriginal community controlled health service, said that there needed to be a fundamental change in the relationship between Aboriginal service delivery in the Territory and elsewhere, and politicians, bureaucrats and NGOs who were involved in the process.

“The politicians and public servants can be agents of innovation and change if they abandon risk intolerance,” she said.

“Similarly, the response of NGOs to the last decade or so of reaping the benefits of government funding into Aboriginal service delivery must also change.

“Risk intolerance cannot be part of Closing the Gap.”

Ms Havnen said she remained concerned about many elements of the 2007 intervention into Northern Territory communities, which would continue to have a psychological impact “for many years”.

NACCHO social policy news:Indigenous Australians a quarter of Australia’s prisoner population. It’s a social policy disaster.But could there be solution!

Prison

Firstly though, politicians and the public alike need to understand and admit that the current policy ethos, and its reliance of incarceration, is a failure, both socially and economically.

Australia spends $2.6 billion a year incarcerating adults

But could there  be  solution!

We invite our members to make comment see below

Reproduced from the DRUM : Paul Simpson and Michael Doyle

The continual rise in incarceration rates of Indigenous Australians represents nothing short of social policy disaster.

jail

If reducing the numbers of those in prison is to be achieved, then we need to end the reliance on incarceration and invest more into new thinking and rigorous research on non-incarceration alternatives.

Marking 20 years of monitoring since the Royal Commission into Aboriginal Deaths in Custody, the Australian Institute of Criminology finally released its ‘deaths in custody‘ report last Friday and the figures reaffirm the increasing over-representation of Indigenous persons in custody.

In 20 years rates have gone from one Indigenous person in seven incarcerated to one in four.

Indigenous persons make up 26 per cent of the prisoner population yet only constitute 2.5 per cent of the Australian population.

The over-representation of Indigenous persons in Western Australian prisons is the highest of any Indigenous group in the OECD.

Addressing Indigenous over-representation in custody requires new thinking and tested approaches to the offender population.

Firstly though, politicians and the public alike need to understand and admit that the current policy ethos, and its reliance of incarceration, is a failure, both socially and economically.

Australia spends $2.6 billion a year incarcerating adults. Punitive penal policies cost Australia big time.

imagesCAI7UQTL

While happy to scrutinise the effectiveness and efficiencies of all other sectors and services, political authorities seem quite content to overlook the billions poured into the prison system.

The return on this ‘investment’ amounts to very little. It simply does not prevent re-offending.

Longitudinal studies show that two-in-five people are re-imprisoned within two-to-five years of release.

Those who advocate for new thinking beyond the current social policy failures have hailed Justice Reinvestment (JR) as one new approach.

Justice Reinvestment was introduced to the US in 2003 by the Open Society Institute and has subsequently been adopted in eleven US states.

It involves identifying geographic areas from where significant numbers of the incarcerated population emanate and investing in services in these areas.

Importantly, at the policy level JR aims to divert funds that would be spent on criminal justice matters (primarily incarceration) back into local communities to fund services that are said to address the underlying causes of crime, thus preventing people from engaging with the criminal justice system.

Detention under this model is seen as a last resort – for only the most dangerous and serious offenders.

The goal is to shift the culture away from imprisonment and to restoration within the community through restorative health, social welfare services, education-employment programs and programs to prevent offending.

The effectiveness of JR was reported on at the First National Summit on JR in Washington in 2010, where lawmakers from several American states discussed how they had enacted policies to avert projected prison growth, saving several hundred million dollars, while decreasing prisoner numbers and recidivism rates.

Australian scholars have reservations about the type of JR model adopted in some US states, specifically querying who controls and receives the funding. Is it the community-sector or another state agency?

Former Aboriginal and Torres Strait Islander Social Justice Commissioner Dr Tom Calma commended JR as a possible solution to Indigenous over-representation in Australia’s criminal justice system. Several other Australian commentators have followed suit.

Despite the increasing popularity of JR, Australia so far lacks evidence to support it beyond its appealing rhetoric and, some might argue, simplistic notion as a viable policy alternative.

Members of the Indigenous Offender Health Research Capacity Building Group (IOHR-CBG) and the Australian Justice Reinvestment Project based at the University of NSW have begun research efforts to address this paucity of information, .

Following two national Justice Reinvestment forums convened by IOHR-CBG member Dr Jill Guthrie, a three-year JR research project has begun at National Centre for Indigenous Studies.

Using a case study approach, the research explores the conditions, governance and cultural appropriateness of reinvesting resources otherwise spent on incarceration, into services to enhance juvenile offenders’ ability to remain in their community.

The Australian Justice Reinvestment Project is currently is examining JR models from overseas in order to provide a sound theoretical and practical foundation for the future development of JR strategies in Australia.\

There is also a Citizens’ Jury research project being run this year by IOHR-CBG researchers aimed at eliciting the values and priorities of a critically informed Australian community with respect to JR.

Citizens’ Juries have been used in various policy fields internationally, including in health in Australia. They involve bringing together group of randomly selected citizens, giving them a variety of evidence-based information on the issues to hand and asking them, as representatives of the community, about their preferences for certain policy options or priorities for resource allocation.

The project also assesses how the results of the Citizens’ Juries might influence the decision making of government policy makers.

Research of this nature is critical in order to imagine and test new and viable alternatives to incarceration. Unfortunately, the current amount invested in such research is minute.

As the recently-emerged adage says, a ‘tough on crime’ approach needs to be replaced by a ‘smart on crime’ approach. A new policy platform to justice is well overdue.

This platform must be informed by evidence and not the tired political populism that exploits the fears of the electorate if we are to ever make inroads in reducing the hugely disproportionate Indigenous incarceration rate in Australia.

Paul Simpson and Michael Doyle are research fellows with the Justice Health Research Program at the Kirby Institute, University of NSW, and are also members of the Indigenous Offender Health Research Capacity Building Group.

We’re Talking About the Smokes:Download the Xmas 2012 edition newsletter:

Christmas_TATS_ELVES_copy

Welcome to the Chrissy edition of the Talking About the Smokes newsletter.

You can download our NEWSLETTER here

A lot has happened since our last newsletter.

We have almost finished our Wave 1 work at nearly 21 health services thanks to all the great local Research Assistants in those sites.

We are also over half way to our goal of involving 40 Aboriginal Community Controlled Health services from around the country.

We have representation from all the states and territories.

It is very exciting to hear about the participants and the work that many people are doing to achieve such great results.

Thank you all for your commitment to this important work.

From all of us on the talking About the Smokes project team, have a very Merry Christmas and may your 2013 be filled with happiness and
success.

David , Darren, Anna, Helen, Josie, Arika and Tav.

You can download our NEWSLETTER here

NACCHO-NAIHO 1982 Aboriginal Health Conference paper- Bruce McGuinness

brucemac

In the first of our NACCHO’s historical series we thank Gary Foley for providing a paper delivered to a Aboriginal Health Conference in 1982  by NACCHO life member  Bruce McGuinness  that “ol Mac Blagic” who sadly passed away in 2003:

“The health of Aboriginal people has improved with the establishment of community controlled health services.

The services they provide either as an actual curative service or as a preventative one, has had a positive and quantifiable effect on those Aboriginal communities.

Give control of our communities lives to our people and the physical and mental health of our nations will improve”

Acknowledgements

1.You can read Essays, Papers & Other Writings by Bruce McGuinness at Koori Web

2.To read full tribute by Gary Foley  Memoriam to my friend and mentor Tracker Magazine 10 October 2012

Extract from Gary’s tribute

“Bruce was also instrumental in the later emergence of the National Aboriginal and Islander Health Organisation (NAIHO) in the 1970s. NAIHO was ostensibly a national ”Umbrella organisation” that had been established to represent the interests of the new national network of community-controlled health services.

“Bruce McGuinness would go on to become one of the most important Aboriginal leaders of his time. He was a founder of a revolutionary education program at Swinburne College that evolved into the Aboriginal Health Worker Training project called Koori College.

He was also the long term Chairman of the Victorian Aboriginal Health Service (VAHS), which led to him becoming one of the founders and key organisers of the National Aboriginal & Islander Health Organisation.

He had also been the first Melbourne Aboriginal elected representative on the first national Aboriginal consultative body, the NACC set up by the Whitlam Government in 1972.

In all of these roles McGuinness was an inspirational leader who had a strong influence on those around him.

HEALTH AND CRIME IN BLACK AUSTRALIA.

Paper delivered to Aboriginal Health Conference 1982

As published:Essays, Papers & Other Writings by Bruce McGuinness
Before I start I would like to give you some background on the National Aboriginal and Islander Health Organization (NAIHO). NAIHO is a collective of some 72 Aboriginal communities from around Australia. The purpose of the organization is to assist communities in their efforts to improve the health status of Aboriginal people and’ to promote concepts of self-determination and community control.

The paper we have prepared for this session purposely has not, included any statistics and has not sought to be, I hope, academic discussion of meaningless figures and-suggestions. Rather I hope it concentrates on the fundamental causes of Aboriginal ill health, as they relate to the criminal justice system and the conundrum, of oppression, which faces Aboriginal people today.

This paper does not purposely draw a cartfull of conclusions. Basically it has drawn one fundamental assumption which I will leave to the end. Hopefully what the paper will do is just start people thinking on questions on Aboriginal health and how it relates to the broader spectrum of Aboriginal affairs and, particularly’, to the criminal justice system.

It is vital that in any discussion of the concerns of Aboriginal people, in which non-Aboriginal people are participating, or which may be used by non-Aboriginal people afterwards, that the parameters which flavour discussions are clearly defined by Aboriginal people themselves.

The National Aboriginal and Islander Health Organization has adopted the following definition, and I shall use this definition for the purpose of this paper:

Health does not mean the physical well being of an individual, but refers
to the social emotional and cultural well being of the whole community.

For Aboriginal people this is seen in terms of the whole- life-view. Health care services should strive to achieve the state where every individual is able to achieve full potential as human beings, and must bring about the total well being of their communities.

In a discussion of Aboriginal health, and of the Australian justice system, the full scope of our definition is activated. We fundamentally must ask ourselves three questions. What is a “law” What purpose do laws serve? And, who makes laws? These three questions we believe are central to our discussions here.

We believe that the primary purpose of law in Aboriginal nations was to ensure survival, both of the collective and individual. The nature of what was to survive was an intricately interwoven mosaic, centering on individual/group relationships, and the respect and reverence for the land as a living member of Aboriginal life-ways.

The law embodied not so much governments, but more so ideals, individuals and groups. The nexus between spiritual and temporal laws were so close, as to refuse separation. Interwoven, overlapping, and infusing each with the other – spiritual and temporal laws provided a foundation of the past, the existence and survival.

The administration of law, which in essence reflected the rights of the individual at the collective Aboriginal unit, was recognized by the Aboriginal nations and was thereby enforceable through all sectors of the community. In all ways law and health, both physical and mental supported each other. Survival in our society required both ability and attitudes.

The law provided both of these. Without ability survival was threatened. Similarly, without proper attitudes survival was threatened. Lifeways shaped by Aboriginal law promoted both good physical and strong mental health, such was the self-perpetuating cycle of Aboriginal life.

The arrival of European colonizers interfered with that cycle. Interestingly and ironically, it was law that started the assault on Aboriginal identity and survival, and has given rise to the appalling health status of our people.

The European law of Terra Nullius was one of the first deliberate actions imposed upon Aboriginal people. The consequence of this imposition scattering and deadly. European colonizers proclaimed “occupation” and in doing so proclaimed the existence of British justice as the law of the land. To Aboriginal people and nations, both proclamations were lies and acts of unprovoked aggression.

It is true that the immediate affects of these proclamations, if not indeed the very presence of, Europeans, instilled a measure of confusion, fear and hatred in the lives of our people. There was no explanation provided to our people that satisfactorily addressed the confusion created by Terra Nullius. There was no attempt to enquire of, respect or participate in Aboriginal law. The confusion and conundrum were compounded.

Aboriginal law and life-ways were stunned by the new boat people and their technological and biological assaults on our nations, our laws, and our survival. From this moment we-have two important references. One, a law was forced on Aboriginal people that contributed no identifiable benefit to Aboriginal life-ways and survival.

A law which created confusion not clarity of life. Secondly, the law did not stem from Aboriginal collective identity. It did not draw its authority from, nor was it recognized by, Aboriginal nations and was therefore not enforceable by them.

The effect of these two references on the health of Aboriginal people is undeniable. The physical well being of the community was under threat, in that the community was placed behind the colonialist, zeal for material gain, which included the ever-accelerating land grab.

The mental health-of the community was under attack also. The Christian, the government official, the lustful, the army, the convict seeking freedom. the greedy and the other perverters that infested the colony assailed the moral, religious and legal standards of Aboriginal society.

Let us deal firstly with the matter of the physical threat to Aboriginal survival and its impact on the health of our people. The traditional economy was impeded initially only at the point of colonization. But with the final spread of the colonial infestation the traditional economy further afield suffered and in many cases collapsed.

Not only did they seek to actively prevent us from collecting food and water on our traditional land, thus seeking to starve us out, they also replaced the land use pattern with a model which hastened the destruction of our capacity ‘to survive. Consequently nutrition suffered, physical illness followed. Death, infirmity and dependence replaced health, independence and sovereignty.

The mental health of our people came under particularly sinister and unrelenting attack. With the continuing exclusion of our people from our lands, the lands which our laws taught us were essential to our continuing Aboriginal survival, the physical manifestations of our culture, our songs, our dance and our ceremonies were curtailed leaving a gap in our life-ways which could only be filled by culturally unmotivating and inappropriate actions. The total of these actions and those of the perverters pushed our people into physical and mental dependency – weakening self-esteem, weakening collective identity and integrity, and imbuing our people with self-doubt and confusion.

In taking a moment to reflect, it is clear that the disregard of the principles and purpose of law have had a negative effect on Aboriginal physical and mental health. The ensuing 196 years of colonization and the continuing existence of physical and. mental ill health in Aboriginal communities is well documented, I need not go into that in detail here. It would, for the purpose of these discussions, appear more fruitful to examine contemporary patterns of ill health, and whether the two original references are valid today.

One of the major health challenges for Aboriginal communities is the continuing efforts of large sections of the Australian community ‘to rob us of our identity and status as Aboriginal people. The sometimes subtle, sometimes overt actions by public and private sector organizations do not in many cases aide the efforts of Aboriginal communities to promote good physical and mental health.

The popularization of the great Black myths by some notable elements within the Australian community; the assertion that our claims to Aboriginal and human rights are more than can be realistically acknowledged; ‘coupled with the actions of some racist groups who have vested interest in maintaining Aboriginal physical and mental ill health, can only serve to continue the disproportionately large numbers of Aboriginal people appearing before the justice system.

Aboriginal people’s appearance before the courts is the result of the conflict between two systems of society, between two national identities. The continual harassment of Aboriginal identity has caused many manifestations of Aboriginal mental health.

Some of these include family breakdowns, nervous disorders, anti-social behavior, low motivation and poor self-esteem, child abuse and many other behavioral disorders. Further, these patterns of mental ill health usually combine with physical illnesses. Indeed most’ of these manifestations lead the individual into contact with the European legal system.

Complicating matters further, the contrast and social put-downs which also flow, reinforce many of the elements present in the original dilemma. The way out of the conundrum is, however, in essence simple. It simply requires the recognition of Aboriginal rights, our status as the indigenous people of this continent, and the guarantee of Aboriginal survival.

Aboriginal people are saying today that a great proportion of the body of legislation and social convention, which makes up the Australian legal system, is in many ways incompatible with our efforts to ensure the survival of our people. These two elements legislation and social convention – which make up the Australian legal system are established, policed and reviewed by non-Aboriginal people.

The capacity of our people to intervene in this process has been minimal. Aboriginal frustration, anger and self-doubt manifest itself in conflict between our two systems. Essentially we must remove the conflict. The jurisdiction of European legal and social standards must recognize Aboriginal law and social ideas, and ratify our sovereignty.

I am not advocating separatism, but more so parallel development. A pattern of development which allows Aboriginal people to be who we are, for we can be no other lest yet we die. Still we would wish to participate in the Australian nation state. Control of our lives and of our society is an essential prerequisite for the solution of the conundrum. Where our people can gain such control, the incidence of violence and anti-social behavior has decreased. Conversely, where the autonomy of Aboriginal communities is being diluted the, incidence of anti-social behavior or violent behavior increases.

Examination of the social impact, for instance, of natural resources development on indigenous peoples has shown that, where the rights of Aboriginal people have not been considered, there is a large increase in conflict between the indigenous and the non-indigenous societies. Usually resulting in Aboriginal people suffering at the hands of the imposed European system. In 1977, Mr. Justice Thomas Berger in his report on the Valley Pipeline Inquiry, said:

I am persuaded that the incidents of these disorders are closely bound up
with the rapid expansion of the industrial system, and with the persistent
intrusion into every path of the Native people’s lives. The more the’ industrial
frontier displaces the homelands in the North, the worse the incidents of crime
and violence will be.

Similar comments can be found in the social impact statements on various uranium mining projects affecting the Aboriginal people in Australia. Studies have shown a marked increase in violent crime in those Aboriginal communities affected by mining. However, in other locations around Australia’, where Aboriginal people have taken control of their communities and lives a reduction in crime, and subsequent contact with European legal system, is notable.

The health of Aboriginal people has improved with the establishment of community controlled health services. The services they provide either as an actual curative service or as a preventative one, has had a positive and quantifiable effect on those Aboriginal communities. Give control of our communities lives to our people and the physical and mental health of our nations will improve. As a consequence, the rate at which Aboriginal people appear before the Australian justice system will also decrease.

I am reminded of a quotation with which you might already be familiar

I sit on a man’s back, choking him and making him carry me, and
yet assure myself that I am sorry for him and wish to lighten his
load by all means possible, except by getting off his back.

Leo Tolstoy 1886

The answer that we propose is that the recognition of Aboriginal rights is the only answer to the dilemma.

NAIHO Collective
©1982

Aboriginal ageing:walking backwards to the future

Dr Mark Wenitong and Graeme Maguire

This is an edited version of an article that appears in the latest issue of Perspectives, an opinion-led journal published by Baker IDI Heart and Diabetes Institute.

The notion of walking backwards into the future describes the value we can derive from remembering and understanding our past, in order to best prepare for a better tomorrow. We can’t do this without properly caring for our elders.

The high prevalence and early onset of chronic diseases such as heart, kidney and lung disease and diabetes in Aboriginal and Torres Strait Islander people is well documented. Aboriginal Australians and Torres Strait Islanders can show common signs of age-related diseases as young as their mid-40s and are more likely than non-Indigenous Australians to face premature death.

But Aboriginal and Torres Strait Islander people do not age at an accelerated rate per se. Rather, they face a greater burden of conditions at an earlier age that lead to the premature onset of complications typically seen with ageing in non-Indigenous Australians.

The ultimate aim of addressing the marked health disparity between Indigenous and non-Indigenous Australians should be the pursuit of an equivalent life expectancy of non-Indigenous Australians into their 80s.

Health-care delivery

The challenges of health-care delivery in remote communities can be significant. Faced with a plethora of health issues, the health workforce may have little awareness of how lifestyle factors such as alcohol, smoking and trauma can influence and accelerate conditions and complications normally seen in much older non-Indigenous Australians.

This lack of recognition can mean Indigenous Australians are less likely to seek medical help and health providers are less able to recognise the development of these complications in a relatively young population.

When problems are recognised, health providers may have a different understanding of disease and impairment compared with the patient, and may have difficulty recognising a culturally appropriate response to illness.

Aged care

A lack of aged care-specific services in remote Australia often means locals face long travel times for medical care. And the clinician may not even speak the patient’s language, understand the nuances of their culture or even have an expert understanding of aged and disability care.

While Australia’s aged care workforce is growing, specialists remain principally confined to large urban centres on the eastern and southern coasts. In Alice Springs, for example, there are currently no resident aged care or rehabilitation specialists, despite a large Aboriginal Australian population and a significant burden of disability related to the premature onset of age-related diseases.

In view of economic, social and environmental disadvantage and varying access to services, families play an important role as the ultimate “safety net”. Nonetheless, even strong families and communities can find it difficult to provide ongoing support for people who struggle to meet their own day-to-day needs.

The issue of “carer burnout” can be multiplied in communities where resource are scarce and the burden of disease is high; carers have limited capacity to shoulder additional responsibilities. This is complicated by the issues of “granny burnout”, where many of the elderly that require care are key carers themselves.


Indigenous Australian face a greater burden of conditions at an earlier age than non-Indigenous Australians. Flickr/strangejourney

Solutions

Like many health challenges, the answer lies first in effective primary prevention strategies to drive behavioural change earlier in life and prepare people for better ageing.

Second, there needs to be high-quality, culturally appropriate, sustainable and accessible aged care and disability services in our remote centres as well as cities and large regional centres, where more than half of Aboriginal and Torres Strait Islander people live.

The ultimate aim, however, must be for all health services to reflect the aspirations of local residents. In the case of aged-care services for Indigenous Australians, this includes close involvement with, and leadership by, Aboriginal and Torres Strait Islander community-controlled health services.

The aged and health-care workforce must also represent Aboriginal and Torres Strait Islander people at all levels. This not only ensures a culturally relevant service, it also facilitates the development of sustainable remote communities through job opportunities and economic activity in areas of traditionally high unemployment.

Importantly, any system must be structured to recognise the value of caregivers and to ensure appropriate support and training for those who seek it.

Future challenges

Of course, such a scenario cannot be achieved immediately. The limited formal educational attainment of many Indigenous Australians, particularly those in remote communities, means additional training to meet aged care needs will still require investment in the foundations of literacy and numeracy.

While the provision of a suitable, locally led aged care workforce, particularly in remote Australia, is still some time away, the unique Indigenous population pyramid, with a large proportion of young people, suggests that it is eminently achievable.

Any new initiatives must also be combined with further roll-out of other remote health strategies. These include a boost to the number skilled primary health providers in remote communities, telehealth, and aged-care and disability-relevant specialist outreach to ensure services can be delivered in the communities where people live.

Dr Mark Wenitong (NACCHO Public Health Medical Officer) and Graeme Maguire This approach, while costly, ensures that Aboriginal and Torres Strait people are able to maintain their familial links and continue to fulfil the important elder role that is so valued in the community.

There must be ongoing investment and innovation to facilitate the delivery of specialised age care and disability services now, while we prepare Aboriginal and Torres Strait Islander children to provide future care. That way we can continue to walk backwards into the future, knowing that there are healthy elders whose knowledge will help to lay the path we cannot see.

This is an edited version of an article that appears in the latest issue of Perspectives, an opinion-led journal published by Baker IDI Heart and Diabetes Institute.