NACCHO Media Release: Aboriginal community controlled health services are the key to reducing Hep C rates

22 January 2015

Aboriginal community controlled health services are the key to reducing Hep C rates

The peak Aboriginal health organisation will today tell a Senate inquiry today that more must be done to reduce the high rate of Hepatitis C infection among Aboriginal people.

National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Lisa Briggs said the rate of new Hepatitis C infection continues to rise in Aboriginal populations even though it is falling for other Australians, and that Aboriginal Community Controlled Health Services are the are key to reducing infection rates.

“Mainstream services are clearly failing Aboriginal people, who are three times as likely to become infected with Hepatitis C as other Australians,” said Ms Briggs.

“It is clear that more prevention and treatment programs are needed that meet the needs of Aboriginal people,” said Ms Briggs.

She said the main contributors to the increased rate of infection for Aboriginal people are higher rates of unsafe injecting drug use and higher rates of incarceration, with the prevalence of the disease in prisoners who inject drugs above 50%.

“Aboriginal Community Controlled Health Services should play a bigger role in Hepatitis C prevention and treatment programs because they have proven to be the most effective providers of primary health care to Aboriginal people.

“These services need the funds and resources so they can provide prevention programs including needle exchange programs and opiate replacement therapy.

“A commitment to more outreach programs by Aboriginal Community Controlled Health Services into prisons will also help with infection rates in these populations.

“Hepatitis C rarely occurs in isolation.  Many patients are likely to have multiple health issues including mental illness, drug and alcohol addiction and type two diabetes. Aboriginal Community Controlled Health Services have proven time and time again to be the best model to provide comprehensive primary health care for these complex needs.

“Hepatitis C infections are decreasing among other Australians and we want to see them decreasing among Aboriginal people, too.

“We look forward to working with the Government to ensure our Aboriginal medical services have the funds and resources to make this happen.”

Aboriginal health services concerned about lack of transparency in GP co-payment discussions


Aboriginal health services today called on the Federal Government to consult more widely on the impact of the GP co-payment before it is put to the Senate.

The National Aboriginal Community Controlled Health Organisation (NACCHO) Deputy Chairperson Matthew Cooke said the dealing apparently going on behind closed doors without input from the Aboriginal health sector was cause for concern.

“The fact is, the introduction of a GP co-payment is poor health policy for all Australians,” Mr Cooke said.

“Abolishing free universal health care will introduce a dangerous disincentive for people to seek the medical attention they need until their health conditions are advanced and need more invasive and costly attention.

“When applied to Aboriginal health its impact is likely to be magnified.

“We have made some gains in improving the health of Aboriginal people but we still have a long way to go to close the appalling health gap between Aboriginal and other Australians.

“We need our pregnant women to attend check ups, we need our children to be immunized, we need our young men to have access to mental health services.

“We simply can’t put any barriers in the way of Aboriginal people seeking health care or we risk the gains we are making in Aboriginal health. The GP co-payment is a significant barrier.”

Mr Cooke said speculation about exemptions from the GP co-payment for particular groups would only go part of the way to addressing the issues.

“Although we applaud the AMA’s efforts to work with the Federal Government to resolve the impact of a GP co-payment on vulnerable Australians, an exemption for Aboriginal Medical Services is not the silver bullet.

“The majority of our Services would have waived the co-payment for their patients, which would effectively have meant a cut in their funding, so in this regard it would be of benefit for our Services.”

“However, many Aboriginal people do not have access to Aboriginal Community Controlled Health Services because of where they live.

“There are 150 Aboriginal Community Controlled Health Services across Australia, providing primary health care to over half Australia’s Aboriginal population.

“But we don’t have national coverage so that would leave a lot of Aboriginal people using mainstream services still subject to the GP co-payment.”

Mr Cooke said he was also concerned about the additional pressures on Aboriginal Community Controlled Health Services if the exemption only applied to these Services.

“Demand for our Services is growing at a rate of about six per cent a year. Aboriginal people are already travelling large distances to seek out our Services as they prefer to be treated by someone who understands their culture and community.

“The co-payment exemption is likely to increase demand even further and would be a challenge for our Services to manage within their existing budgets and resources.”

COAG Reform Council speech NACCHO Summit: Health outcomes for Indigenous people


John Brumby

Indigenous Australians should enjoy the same health, education and employment outcomes as other Australians. But, instead there remains a persistent and terrible gap between the two in major areas.

Closing the gap between Indigenous and non-Indigenous Australians is a priority for all Australian governments. But closing the gap is a long-term challenge—one which requires enduring vigilance and resources”

John Brumby Chair NACCHO reform Council Speaking at the NACCHO SUMMIT

I would like to begin by acknowledging the traditional owners and custodians of the land on which we meet today, the Wurundjeri people of the Kulin nation. I pay my respects to their Elders both past and present.

It is my pleasure to be with you today to report on national progress in indigenous health.

As you know, the COAG Reform Council was established by COAG in 2006 to report on Australia’s national reform progress.

Our job is to hold all nine Australian governments accountable for implementing national reforms that began rolling out in 2008.

Importantly, we publicly report our findings to the Australian people.

In 2008, COAG agreed to goals on healthcare, education, skills and workforce development, disability, housing and closing the gap on Indigenous disadvantage.

That was six years ago.

Today I will be launching a supplement that focuses on the health outcomes for Indigenous people. The supplement draws on the findings we have made in two reports that we provide to the Council of Australian Governments (COAG) each year – the National Healthcare Agreement and the National Indigenous Reform Agreement.


Indigenous Australians should enjoy the same health, education and employment outcomes as other Australians. But, instead there remains a persistent and terrible gap between the two in major areas.

Closing the gap between Indigenous and non-Indigenous Australians is a priority for all Australian governments. But closing the gap is a long-term challenge—one which requires enduring vigilance and resources.

The Genesis of Closing the Gap

The genesis of the closing the gap campaign was a report in 2005 by Dr Tom Calma, the then Aboriginal and Torres Strait Islander Social Justice Commissioner.

The report called on the governments of Australia to commit to achieving health equality for Indigenous people within a generation.

This report sparked the National Indigenous Health Equality Campaign in 2006 that culminated in a formal launch of the close the gap campaign in Sydney in April 2007, where NACCHO was a leading voice calling for action.

NACCHO’s very name—National Aboriginal Community Controlled Health Organisation—reflects the campaign for self-determination … the wish of Indigenous Australians to have their own representative bodies.

On 20 December 2007, the Council of Australian Governments answered the call of NACCHO, ANTAR, Oxfam Australia and many other organisations and pledged to close the life expectancy gap between Indigenous and other Australians within a generation.

In March 2008, the Indigenous Health Equality Summit released a statement of intent which committed the Australian government, among other things, to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.

NACCHO was a signatory to that statement. The parties also agreed to use benchmarks and targets to measure, monitor and report.

COAG & Closing the Gap

In November 2008, our nation’s leaders committed to closing the gap within a generation (25 years) in the National Indigenous Reform Agreement (NIRA).

Importantly, COAG agreed to be accountable for closing these gaps and appointed the COAG Reform Council to monitor progress.

As you well know, COAG has six targets as part of its objective of closing the gap.

  1. To close the life expectancy gap within a generation, by 2031.
  2. To halve the gap in mortality rates for Indigenous children under five within a decade, by 2018.
  3. To provide access to early childhood education for all Indigenous four-year olds in remote communities within five years, by 2013.
  4. To halve the gap in reading, writing and numeracy within a decade, by 2018.
  5. To halve the gap in the rate of Year 12 or equivalent attainment, by 2020.
  6. And, finally, to halve the gap in employment outcomes within a decade by 2018.

For the past five years, the COAG Reform Council has dissected the data, measured progress and independently reported on whether Australian governments are achieving these targets in both our NIRA report and our report under the National Healthcare Agreement.

Indigenous Supplement to Healthcare in Australia 2012–13

What we have found under the NIRA report, the National Healthcare agreement and the supplement I am releasing today is that the health of Indigenous Australians continues to be poorer than non-Indigenous Australians.

We found that Indigenous life expectancy at birth was 69.1 years for men and 73.7 years for women. This equates to a gap between Indigenous and non-Indigenous life expectancy of 10.6 years for men and 9.5 years for women.

Although the national gap in life expectancy did slightly narrow over the last five years, it is extremely unlikely that governments will be able meet the target to close the life expectancy gap within a generation (that is, by 2031).

The life expectancy gap and potentially avoidable death

Closing the gap on life expectancy is complex and requires action on a range of fronts.

We report on a range of indicators and targets about many things that may help to achieve improvements in Indigenous health. These include indicators relating to preventative health, primary care, hospitals and the medical workforce.

I would like to focus today on the results we have found in regards to death from potentially avoidable causes – either through prevention, or through early intervention via primary or community care.

In regards to deaths from potentially avoidable causes – we measure according to whether they could have been potentially prevented or potentially treated.

Deaths from potentially preventable causes are avoidable through primary healthcare (such as the care provided by a GP or community care), health promotion (such as by improving healthy habits and behaviours) and preventative health (such as vaccination against some diseases or help to quit smoking).

Deaths from potentially treatable causes are avoidable through appropriate therapeutic interventions, such as surgery or medication, before a condition worsens. This is often the case where diseases are prevented early, such as through screening programs.

What we found was that Indigenous people were three times as likely to die of an avoidable cause. This means that three-quarters of deaths of Indigenous people aged under 75 were avoidable either through early prevention or treatment.

By way of comparison, two-thirds of all Australians died from avoidable causes.

It is a tragedy to think of all of those taken before their time purely because they did not receive care early enough, or did not make the lifestyle changes to prevent disease.

Early intervention is vital

This finding underlines two things that NACCHO well knows if we are to close this terrible gap in life expectancy:

  1. Good access to primary or community care is vital.
  2. Prevention is better than cure.

There have been large increases in the rates of indigenous people having health checks claimable from Medicare over time, and this was true of all age groups.

The rate of child health checks has more than doubled, from 87.9 per 1000 in 2009-10 to 193.0 per 1000 in 2012-13. This is an average annual increase of 35.7 checks per 1000 children aged 0 to 14 years.

In the 15-54 years age group, the rate of health checks more than doubled from 74.5 per 1000 in 2009-10 to 196.0 per 1000 in 2012-13. This equated to an average annual increase of 40.3 checks per 1000 people.

In the 55 years or over age group, the rate of health checks more than doubled from 137.5 checks per 1000 people in 2009-10 to 304.6 per 1000 indigenous people in 2012-13. This equates to an annual average increase of 54.8 checks per 100 people from 2009-10 to 2012-13.

In child health we have also seen some pleasing improvement.

The rate of Indigenous child deaths decreased by 35% to 164.7 deaths per 100,000 Indigenous children compared to 77.2 per 100,000 for non-Indigenous children, and death rates are falling more quickly.

This means that the gap in the child death rate between Indigenous and non-Indigenous children decreased by 38% from 1998 to 2012, and we are on track to reach the current 2018 target.

This is a resounding achievement and is partly due to increases in immunisation rates and health checks:

  • In 2012, immunisation rates for Indigenous children aged 2 years and 5 years were the same as for all children. However, rates at 1 year still lag behind.
  • And, the rate of child (0–14 years) health checks doubled between 2009–10 and 2012–13

These results in access to immunisation and health checks are very positive and reflect the hard work and what can be achieved when governments and community stakeholders, such as NACCHO and others work together.

We should ensure that these gains are not undone.

As you know, the cost of healthcare is very topical at the moment. Australians are being asked to consider what they would pay for access to a primary care physician.

What we found in our results for this report was that one in eight (12%) indigenous people already delayed or did not go to a GP as a result of cost. More than two out of five (43.9%) Indigenous people delayed or did not see a dental professional due to cost. And one-third (34.6%) delayed or did not fill a prescription also due to cost.

When people start to avoid going to their primary or community care provider because of cost or other reasons, they often end up in hospital.

And, what we found was that rates of potentially preventable hospitalisations for Indigenous people were already three to four times higher than rates for other Australians.

These results provide context for governments when they are considering policies around access to primary care. Governments should be careful that they do not put up barriers to healthcare access for Indigenous people as it may undo the good work that has been done in this space over five years and end up creating a different burden on the hospital system.

Prevention is better than cure

The other component that we will need focus on to close the gap in life expectancy is prevention – particularly prevention of circulatory diseases, endocrine disorders (like diabetes) and some cancers.

The results we found this year show significantly more work needs to be done.

The heart attack rate for Indigenous people in 2011 was two and a half times higher than that of other people.

And Indigenous Australians are more than five times more likely to die of endocrine diseases (like diabetes), and one and a half times as likely to die from a circulatory disease or cancer.

One of the primary drivers in rates of heart attacks and endocrine disorders are rates of excess body weight.

Around 70% of adult Indigenous Australians have excess body weight, meaning that they are either overweight or obese. The rate of obesity by itself was 42%.

This compares poorly to the broader Australian population, where 63% of all adults had excess body weight and 27% were obese.

This high rate is extremely concerning. Particularly when you consider the increased risks it poses for chronic diseases and early death.

Finally, I would like to turn to lung cancer. In 2010, the rates of lung cancer for Indigenous Australians was nearly double the rate for non-Indigenous Australians.

What is most tragic about lung cancer is how preventable it is. Lung cancer is very strongly linked with whether or not a person smokes. We found that the Indigenous adult smoking rate is more than double the non-Indigenous rate (41.1% vs 16.0%).

So, that is a brief summary of the health report.

Without a doubt, the results are still not good enough to close the gap in many of the health outcomes for indigenous people.

We continue to have too many Indigenous people dying before their time, of preventable diseases and conditions.

However, there are green shoots; we have seen increases in access to primary care, and most pleasingly we are on track to close the gap in child deaths.

The social determinants of health

I think it is important to recognise that these health outcomes will also be critically determined by non-health factors, what’s referred to as the ‘social determinants of health.’ The recognition of these social determinants has, in the words of the National Rural Health Alliance, become a ‘rejuvenated agenda.’

Our working conditions — whether that be our incomes, job stability, or workplace safety — and factors like education and housing among many others, each make meaningful contributions to our health.

To draw on the words of Dr Margaret Chan, the Director General of the World Health Organisation:

‘…the social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one.’

So, I would also like to discuss some results from our latest National Indigenous Reform Agreement report with you – particularly the results from education and employment.

We launched our latest NIRA report on government’s achievement against these targets in May.

We found that in literacy, numeracy and year 12 education, outcomes for Indigenous Australians are catching up with those of non-Indigenous Australians.

Between 2008 and 2013, the gap in the proportion of Indigenous and non-Indigenous students who met the national minimum standard narrowed in reading in all years and in Years 3 and 5 in numeracy.

In reading, the gap reduced most, by over 10 percentage points in Years 3 and 5. There were smaller reductions in Years 7 and 9 (1 to 3 percentage points).

In numeracy, the gap narrowed by 2 to 3 percentage points in Years 3 and 5 but widened in Year 9 by 4 percentage points. The gap widened in Year 7 by less than 1%.

The gap in the proportion of Indigenous and non-Indigenous 20–24 year olds who attained Year 12 or equivalent decreased significantly—by 12.2 percentage points .

And, over the past four years, the proportion of Indigenous Australians with or working towards a post school qualification increased from 33.1% to 42.3 %.

More work needed on childhood education, school attendance and employment

While most of this is heartening, our report also found that better results are needed in early childhood education, school attendance and in employment to meet COAG targets.

Early childhood education is a critical time for development as a successful learner. In 2012, 88% of Indigenous children in remote communities were enrolled in a preschool program in the year before school compared to 70% in major cities.

Similarly, 77% of children in remote areas attended a preschool program compared to 67% in major cities.

Another area of real concern we highlight is the falling rate of school attendance by Indigenous students in most year levels.

It’s very disappointing that—over four years—falls in Indigenous students’ attendance have outstripped any improvements made.

The worst drops in attendance were in South Australia the ACT and the Northern Territory, where attendance fell as much as 14 percentage points.

Only New South Wales and Victoria saw attendance rates improve and the gap narrow overall but even so, improvements were small —1 percentage point for most year levels.

Regular school attendance is vital for developing core skills in literacy and numeracy, and for successfully completing secondary education.

A slump in school attendance rates in all jurisdictions in the later years of compulsory schooling is particularly concerning given its potential to impact long-term economic participation.

Which leads me to employment – Australia is not on track to halve the gap in employment outcomes by 2018.

Since 2008, the gap between Indigenous and non-Indigenous employment outcomes has widened over the past five years by almost seven percentage points.

To give you some examples, we found just over 60% of Indigenous Australians were participating in the labour force, compared to almost 80% of non-Indigenous Australians.

And the overall unemployment rate for Indigenous Australians was four times that of non-Indigenous Australians—almost 22% compared to 5%.

Lower Indigenous employment and workforce participation has an impact right across the reform agenda, and must be prioritised for attention by COAG.

We, at the council, are pleased to see some positive outcomes under the Indigenous Reform Agreement, but are wary that there is still hard work and monitoring to be done in key areas.

Performance reporting matters

As you may be aware, the COAG Reform Council is being wound up on June 30, so we will no longer be reporting on these outcomes in the future.

In response to the news of the COAG Reform Council being abolished, Mick Gooda said:

“If we don’t have decisions made on the basis of the best evidence that we have available to us, we might as well be just making up things on the back of beer coasters again.”

The reports we release on Indigenous outcomes have not only enabled governments to monitor their performance. They have also equipped the public, and organisations such as NACCHO and the other peak bodies that are here today, with the information they need to hold governments to account for promises they have made in regards to Indigenous Australians.

Our reporting has provided the impetus for more focused effort to improve Indigenous health, education and economic participation and has highlighted important progress – reassuring governments and the community that change is indeed possible.

And after five years of reporting on governments’ performance, our reports have shown that we are still only at the beginning of the change required over a generation to close the gap.

I’ve been fortunate in my public life to have served in both federal and state parliaments, in opposition and in government.

And after all these years, I can honestly say that accountability—keeping governments honest—and evidence-based reform are not simply important ingredients  – they are absolutely essential to getting results and keeping governments on track.

Although we do not know for sure who will be reporting on the targets to close the gap in the future, it has been suggested that the Prime Minister’s department will report on achievement of targets.

I have a great deal of respect for the Department of Prime Minister & Cabinet and I’m sure there are people with the skills to do that in PM&C.

However, what the COAG Reform Council did that was particularly special was hold governments to account on the promises they have made, but did so independently of any one government.

We report independently on the progress of all nine of Australia’s governments—the Commonwealth, the States and the Territories—in closing the gap.

That independence ensured that our reporting was impartial and objective.

Who will do this in the future?

We need to consider how to increase the effectiveness of our independent public reporting on government progress, such as improving the quality of indicators, and accessing better data.

It is important in the future that someone, or some organisation, will be there to properly measure what governments are achieving with the billions of dollars in taxpayers’ money they are spending.

Crucially, it is important that any future design of performance reporting frameworks and targets must involve indigenous stakeholders as equal partners.

Consultation with governments is required under the IGA. It should extend to key Indigenous stakeholders such as the Closing the Gap coalition.

With a tri-lateral coalition of the Commonwealth, State governments, and Indigenous representatives – we truly have a real chance of closing the gap.

So, in my last week as chairman of the COAG Reform Council, allow me to pay tribute to the work of NACCHO and extend my best wishes for the future of Indigenous health reform.

Your voice matters and I know it will shape a better future for Indigenous Australians. Thank you.

Media enquiries

All media enquiries can be directed to:

Julia Johnston
Phone: 02 8229 7368
Mobile: 0419 346 890

Aboriginal Health Summit: ongoing investment needed to close the gap


Successes in improving the health of Aboriginal people, to be showcased over the next three days at an Aboriginal health summit in Melbourne, will highlight the importance of ongoing investment in Aboriginal Community Controlled Health Services and programs.

Justin Mohamed, Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) said the 2014 NACCHO Health Summit will feature innovative and creative approaches to Aboriginal health, driven by Aboriginal people, which are achieving results.

“The Federal Budget has taken a huge chunk of funding out of Aboriginal health programs,” Mr Mohamed said.
“Given the incredible work being done by our sector to improve the lives of Aboriginal and Torres Strait Islander people, through prevention, early detection and health promotion, it simply doesn’t make economic sense to cut front line Aboriginal health programs.
“We still have a long way to go close the huge gap in life expectancy between Aboriginal and other Australians but we are on the right track to reaching our targets by 2031.
“It’s critical we maintain the momentum and continue to give Aboriginal people control over their own health – funding programs run by Aboriginal people – since that is where we will have the biggest effect.”
Mr Mohamed said some of the examples which will be shared at the 2014 NACCHO Health Summit include:
• The Victorian Aboriginal Health Services Healthy Lifestyles and Tackling Tobacco Team has implemented a range of different health promotion strategies to engage members of the community from children to elders in physical activity, quit and healthy lifestyles programs. Successful initiatives over the last 12 months include: fun runs, yoga, hypnotherapy, social marketing, a comedy show and more recently the VAHS Tram taking the Australian public along for the ride.
• Wuchopperen Health Service ‘Community Controlled Health Services have to prove their value contribution in an increasingly competitive landscape. Wuchopperen has survived three decades of funding uncertainty. Wuchopperen has enacted a multi-faceted strategy to ensure long term sustainability and self-determination – with self-sufficiency a possible endpoint within a decade. Leveraging MBS income streams Wuchopperen has facilitated an increase in staff numbers from 135 to 180 over three years, maintaining a proportion of 80 per cent Aboriginal and Torres Strait Islander Staff. All funds generated have been reinvested into further services to the community, including expanded allied health services and optometric care facilitating on-site eye-testing and dispensing of spectacles.’
• ABS presentation (funded by ABS/ Dept of Health/ National Heart Foundation) ‘The 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) is the largest and most comprehensive survey of the Aboriginal and Torres Strait Islander community ever undertaken. This survey provides a platform for a range of new research into health determinants and patters, supporting assessment of of progress in closing the gap in health outcomes.’
• Walgett AMS Accreditation Experience, Fifteen Years and Still Going Strong ‘In 1987 the CEO and Board of WAMS became concerned about changes to AMS funding conditions. In order to prepare for the possibility WAMS investigated agencies which accredited health services. In 2013 WAMS gained it’s fifth round of accreditation and in 2014 will work to bring it’s Dental Clinic into the process. Accreditation assists in improving client services and also enables the service to stand as equals with other Health Services and Medicare Locals’.
• John Patterson AMSANT CQI ‘The life expectancy gap between Aboriginal and other Australians in the NT is the widest in the nation, but it is also closing at the fastest rate. NT is the only jurisdiction on track to close the life expectancy gap by 2031. AMSANT believe that the implementation of the CQI programs has been pivotal to improving the Aboriginal PHC contribution to closing the gap.’
Mr Mohamed said “The summit will be the Centre of Excellence in Aboriginal Community Controlled Health and the best demonstration of Aboriginal Health in Aboriginal Hands.”
Media contacts: Olivia Greentree 0439 411 774 / Jane Garcia 0434 489 533

Fears Tony Abbott will widen Indigenous health gap


THE deputy chairman of Tony Abbott’s indigenous advisory council, doctor Ngiare Brown, has denounced budget cuts to indigenous affairs and says the $7 GP co-payment will hurt indigenous people and other vulnerable Australians who desperately need help to close the health gap.

Professor Brown will use next week’s meeting of the council to warn that the cuts to indigenous health will inevitably affect frontline services.

She told The Australian she would use her role on the council to push for reconsideration of the co-payment scheme and exemptions for vulnerable Australians and indigenous people based on income and burden of disease.

On overall cuts to the indigenous budget, she said she was determined to get detailed answers on where the cuts would come from and what they would affect.

“There have been anticipated cuts across the board for each portfolio and department,” Professor Brown said. “But what is most concerning is that there is talk about cuts to essential portfolios like health and education but currently there is no clarity on what this means.

“The Coalition claim they want to cut red tape, duplication and the bureaucracy, for example, but I’m concerned there are actually going to be cuts to frontline services, which we were promised would absolutely not be the case”.

On the cuts to preventative programs such as indigenous smoking campaigns, Professor Brown, one of the first group of Aboriginal medical graduates in Australia, said she considered this a frontline service.

“Public health and … prevention are absolutely frontline services, particularly in comprehensive primary care contexts like Aboriginal and Torres Strait Islander health,” she said. “So whether they are specific smoking programs or whether they are brief interventions delivered by our health workers, nurses and general practitioners, public health prevention programs are absolutely frontline services.

“How will departments define what a frontline service is, and then how will they make consistent determinations about what gets funded and what doesn’t.”

Indigenous Affairs Minister Nigel Scullion has vowed that the $239 million being cut from the general indigenous affairs budget will be achieved through “efficiencies” and less red tape and duplication — and not reductions to frontline services.

But with an additional $165m being cut from indigenous health, peak indigenous lobby groups fear that efforts to close the gap are being compromised.

Warren Mundine, chairman of the Prime Minister’s indigenous council, has said the Coalition originally intended to cut the portfolio’s budget by 10 per cent. The eventual 4.5 per cent cut announced in last week’s budget would come from ‘inefficiencies”, not frontline services, he said.

Professor Brown, who was previously the Australian Medical Association’s indigenous health adviser, said she was also concerned that the impact of the GP co-payment on indigenous people and closing the gap had not been taken into consideration.

“I don’t think there has been consideration of any kind for the financial, economic or social impacts or the intended and unintended consequences of co-payments,” she said. “Obviously the most vulnerable are going to be the ones that are hit the hardest: the young, the old and those with chronic diseases in particular. People needing multiple visits over long periods to manage their chronic disease or palliative care or children with special needs or disabilities for example — how are they going to afford multiple consultations at $7 a pop?

“One of my greatest concerns is not only that the most vulnerable will bear the brunt of a poorly conceived co-payment initiative, but that the health care system will not cope.

“The policy makers need to think very carefully about whether to go ahead with the co-payment and if they do, who will pay and who will have exemptions.

“It is already difficult enough for the Aboriginal community-controlled health sector to provide comprehensive care on the limited resources that we have. If you couple charging co-payments, which we may or may not collect, and getting less money in to the sector for public health and clinical care, then that is an extraordinary additional burden bear, particularly when we were promised that there would be no cuts to the frontline in health and education.”

Call out for Health Heroes!

The Department of Health are looking for ‘Health Heroes’ and are sending a call out to health professionals and students who would like to come down to the Careers Expos listed below to be a speaker and assist in promoting careers within indigenous health.

If you or know someone who would be interested in attending to be a speaker please contact

Jessica Lowe on 02 8354 0866     E:

Further information available at :


Dates & Locations

Brisbane, Convention and Exhibition Centre – 23 May between 9 and 3:30pm and 24 May 2014 between 10am and 4pm

Sydney, Moore Park – 29 May – 1 June between 10am and 3pm

Sydney, Olympic Park – 19 – 22 June between 9am and 3pm

Darwin, Convention Centre – 13 and 14 August times TBC

Alice Springs, Convention Centre – 21 and 22 August times TBC


Further information available at :

NACCHO Aboriginal Health #IHmayday : Funding system for Aboriginal health in dire need of reform


” The limited evidence available suggests that Aboriginal Community Controlled Health Services (ACCHS) outperforms mainstream services in terms of monitoring of risk factors, management of hypertension and implementation of systematic care for prevention and chronic disease.

Further, in terms of the broader government agenda of the Abbott government, ACCHS services are one of the largest employers of Aboriginal people in Australia, with clear benefits in terms of skill development, and a significant factor for regional development.”

Ian Ring is a professorial fellow at the Australian Health Services Research Institute at the University of Wollongong

 Published 23  April 2014 Canberra Times Illustration: Andrew Dyson

Declaring a Twitter MAY day (May 1) of action – and listening – for Aboriginal and Torres Strait Islander health

#IHmayday (see below for details)

There have been many significant developments in Aboriginal and Torres Strait island health in Australia in recent years, and perhaps the most significant has been the national Close the Gap initiative. A total of $1.6 billion has been directed to Aboriginal health in the four years ending June 2013, as part of a broader suite of initiatives also including employment, housing, education and remote services.

Progress however, as reported earlier in the year by Prime Minister Tony Abbott, has been patchy, and a new report, Economic Value of Aboriginal Community Controlled Health Services, launched recently at the National Press Club, highlights several funding issues that need urgent attention. Who would have thought that while funding for health services for Australians as a whole was uncapped and growing, funding for specific health services for Aboriginal people had been cut by the previous government in 2012-13, and was projected to fall further in real terms in the next four years?


How do you “Close the Gap” by reducing funding for those with the worst health, while funding for the comparatively well-resourced majority of the population continues to increase with rising demand?

It turns out that funding for Aboriginal health services as a whole, almost uniquely among government programs, bears no relation to population size, the growth in the population, service demand or inflation

Worse, funding among states seems to have been driven largely by bid-driven processes, rather than any rational basis in terms of population size or health need, and on the face of it appears to be grossly inequitable – particularly for the majority of indigenous people who live in NSW and Queensland. Perhaps of even greater significance is the lack of any formal process for assessing which individual regions have poor indigenous health outcomes and a relative lack of services.

In short, the present funding system for indigenous health might be seen as somewhat amateurish and counterproductive in terms of closing the gap. This is not the fault of the administration, as the funding system seems to have been that way more or less from the start. But the administration has the opportunity, and the responsibility, to put the system on a rational basis – and in so doing, would reap big gains in terms of best use of public funds and in achieving the Close the Gap goals.

But why invest in specific services for Aboriginal people? Surely the mainstream services provided for the rest of the population would suffice?

Well, manifestly not. If they did, there would be no need for the Close the Gap initiative in the first place and indigenous health would be far better than it is. It is unrealistic to expect that mainstream treatment and preventative services for the rest of the population could deal adequately with the needs of a very small minority with particular health and cultural needs. Most GPs see no Aboriginal patients or, at most, a handful each year, whereas services designed by and for Aboriginal people promote better access to services and offer a much more comprehensive range of services for them, tailored specifically to their needs.

And the limited evidence available suggests that Aboriginal Community Controlled Health Services (ACCHS) outperforms mainstream services in terms of monitoring of risk factors, management of hypertension and implementation of systematic care for prevention and chronic disease.

Further, in terms of the broader government agenda of the Abbott government, ACCHS services are one of the largest employers of Aboriginal people in Australia, with clear benefits in terms of skill development, and a significant factor for regional development.

The report calls for fundamental reform of the funding mechanisms for Aboriginal health services so that in future funding is indexed to the size of the indigenous population, inflation, and demand for services. It wants funding in under-resourced states and territories to be brought up to an equitable level (but not by reducing funding to those states with more adequate funding), and for funding to be made available to provide the necessary services in areas which now have poor health outcomes and inadequate services. And of course, it is untenable national policy to cut funds for ACCHS services when such services produce the best results, are preferred by many Aboriginal people, provide a significant proportion of health services for them, but are now inadequately funded and poorly distributed.

There is nothing remarkable in these recommendations, which are long overdue, but addressing them would pay real dividends in terms of closing the gap and in terms of the broader government agendas of employment, education and regional development for Australia’s indigenous people.


Declaring a Twitter day of action – and listening – for Aboriginal and Torres Strait Islander health

The Twitterverse is an endless source of news and conversations about Aboriginal and Torres Strait Islander health.

In recognition of the vibrancy of the Indigenous health Twittersphere, Croakey is supporting an idea to declare May 1 as a day of Twitter action for Indigenous health.

The idea is the brainchild of Dr Lynore Geia, a Bwgcolman woman and nursing academic from James Cook University in Townsville and a former guest tweeter for @WePublicHealth. 

Dr Geia invites Croakey readers to follow the discussion at  #IHMayDay on May 1 – a timely event given widespread concern about expected federal budget cutbacks and funding uncertainty for Aboriginal Community Controlled Health Organisations.

It will be a day for Aboriginal and Torres Strait Islander people to tweet about health issues – whether they are patients, community members, students, health professionals, researchers, working in NGOs or government or elsewhere.

Thanks to Professor Marc Tennant from the University of Western Australia for suggesting that it also be a day of listening –  the idea being that non-Indigenous Australians can join in by listening and RT-ing.


The discussions will be moderated around general themes during the day. These arrangements are still being confirmed but at this stage include:

• Journalist Amy McGuire will focus discussions on media coverage and health.

• Social worker Dameyon Bonson will guide discussions about the portrayal of Indigenous men in health/human service provision promotional materials, and the lack of positive/empowering imagery. Also, how “behavioural change” programs contribute to negative stereotype and assumptions, and how promoting programs as “behavioural enhancement” is more strengths based.  He will also talk about the Indigenous LGBQTI community.

(If you are interested in moderating some of the day’s discussions, please get in touch. Details of other moderators will be added here as they are confirmed…)

Thanks to Dr Geia for kicking off some of the discussions by previewing below some of the issues that she’d also like to see discussed:

• What have been the health impacts of the 2007 NTER/ Intervention? Has it led to any health gains – and what have been the social costs?

• Since the election of the Newman and Abbott governments, there has been upheaval and uncertainty in Indigenous health. The real gap in Indigenous health is the gap between the governments’ rhetoric about wanting to build Aboriginal health – versus the national Indigenous health discourse and the reality of on the ground service delivery.

• Models of care and service delivery are still being developed without genuine transparency and partnerships in communities.

• Health care services need to do so much more work around cultural competency, and governments need to recognise health outcomes in communities strongly related community control and delivered services;

• The proposed amendments to the RDA and the Constitution seems incongruent to closing the gap in health. The importance of tackling racism – and retaining the RDA – for improving health and wellbeing.

• Defining what health is using NACCHO definition –

• The Australian Indigenous population profile is opposite to the aging Australian mainstream population – health programs to meet the needs of Indigenous youth are paramount.

• Cyclone Ita highlighted that lack of road infrastructure is an issue for Indigenous communities like Wudjal Wudjal and Hopevale


NACCHO at the National Press Club


Yesterday NACCHO’s Chair Justin Mohamed gave an address to a packed room and national television audience at the National Press Club about the economic value of Aboriginal Community Controlled Health Organisations.

His speech focused on, among other things, what needs to be done to close the gap, how ACCHOs can help close that gap, and called on the Federal Government to renew funding with appropriate indexation in the May Budget. He also called on the Government to carefully consider the implications of any changes to the Racial Discrimination Act.


Lots of media covered the event including the following:

Indigenous-run clinics in plea for mercy on federal cuts

The Australian
By Patricia Karvelas

832502-73c1b800-ba27-11e3-a72e-6df7cab5700aDoctor Nadeem Siddiqui with Sharney Fernando and her daughters Kyarna, 2, and Jayla, 1, at the Winnunga clinic in Canberra. Picture: Gary Ramage   Source: News Corp Australia

INDIGENOUS-run health services provide jobs for more than 3200 Aboriginal people and are the main source of Aboriginal employment in many communities, a new report has found.

The report says the 150 Aboriginal community controlled health organisations provide pay rates above the average for Aboriginal Australians, offer genuine career paths and boost education levels thanks to on-site training.

The chairman of the National Aboriginal Community Controlled Health Organisation, Justin Mohamed, said the centres were “major contributors to closing the appalling health gap ­between Aboriginal and non-­Aboriginal Australians’’.

“The ripple effect of healthy Aboriginal communities cannot be underestimated,’’ he said. “Healthy communities keep our kids in school, keep our adults in the workforce and provide a greater opportunity for particip­ation in broader society.

“Ultimately, that means redu­cing welfare dependency, reducing criminal justice rates and diverting people from the need for more expensive healthcare such as hospital admissions.”

Mr Mohamed urged the federal government to quarantine such centres from any cuts in next month’s budget as about $300 million of funding ends this financial year.

“Today’s report provides the evidence that Aboriginal community controlled health organisations have important eco­-nomic benefits well beyond the, not insignificant, primary purpose of providing healthcare to Aboriginal people,” he said.

“Yet our funding is insecure, reporting requirements onerous and any new health funding for Aboriginal health is often diverted into mainstream services which ­simply don’t have the same runs on the board with Aboriginal health as our services do.’’

Mr Mohamed called on Tony Abbott to revive a now-expired national partnership agreement with the states and territories on indigenous health. There was an economic incentive for all governments to help indigenous people become healthier, he said.

There is a life expectancy gap — of 10.6 years for men and 9.5 years for women — between indigenous and non-indigenous Australians.

Lifting life expectancy rates over 20 years would result in a $11.9 billion net increase in government revenue, mainly from tax payments, including a $4.7bn saving in social security and health costs.

The Prime Minister’s Indigenous Advisory Council is looking at what fat can be trimmed from federal government spending on Aboriginal programs.

Earlier yesterday, the chairman of the advisory council, Warren Mundine, said money matters were on the agenda at the council’s meeting with Indigenous Affairs Minister Nigel Scullion in Sydney.

Mr Mundine urged the Abbott government to quarantine from possible cuts programs relating to indigenous mental health issues and smoking.

The report released yesterday highlights the Winnunga health service in Canberra, a large primary healthcare service provider catering for the region’s Aboriginal population.

Capacity constraints hamper service delivery and limit medical specialist services. The report says there is a strong case for a second clinic in north Canberra, based on rapid Aboriginal population growth and health needs.

Winnunga chief executive Julie Tong said the clinic was overwhelmed, with the client base rising from 80 to 129 a day because of population growth.

“An Aboriginal community health service gives ownership to the community,” she said. “We’ve built the service on ­client need.”

Aboriginal health group warns against changes to Racial Discrimination Act

By Anna Henderson

Indigenous health groups have levelled a warning at the Federal Government that planned changes to federal race discrimination laws could impact on the health of Aboriginal patients.

The Government wants to ban racial vilification but remove the provisions making it unlawful for someone to publicly offend, insult, or humiliate others based on their race.

In a speech at the National Press Club in Canberra, Justin Mohamed, the chairman of the National Aboriginal Community Controlled Health Organisation (NACCHO), called for the Government to re-think the changes.

“Racism does contribute to poor health outcomes for our people,” he said, arguing it particularly impacted on mental health.

He said Aboriginal staff and patients experience racism within the health system and they should be protected under the existing law.

“I would like to take this moment to remind the Prime Minister of the commitment he made to the Aboriginal and Torres Strait Islander people,” he said.

“Carefully consider the broader implications of any changes that weaken protections against racist behaviour in this country.”

Calls for Indigenous medical services to be quarantined from budget cuts

Indigenous health advocates maintain the May budget will reveal whether the government is truly committed to Indigenous affairs.

Future funding for 150 Aboriginal medical services across the country remains in limbo with the existing agreement due to expire in June.

Mr Mohamed said health services must be quarantined from budget cuts, and the funding uncertainty is affecting staff and patients.

“There is a ripple effect. When you’ve got that financial cloud over your head it’s hard to deliver,” he said.

Aboriginal medical services operate in urban, regional and remote communities and NACCHO says it received $300 million in federal funding this financial year.

Mr Mohamed said “funding is not keeping up with demand”.

He also urged the Federal Government to acknowledge the Aboriginal health workforce that is employed through the medical services.

The services employ over 5,000 people nationwide, including 3,500 Aboriginal or Torres Strait Islanders.


NACCHO at National Press Club April 2 : Investing in Aboriginal community controlled health makes economic $ense

NACCHO0032 Press Club Brochure Concept2__190314_Page_1

On 2 April the NACCHO chair Justin Mohamed will be appearing at the National Press Club in Canberra

Watch live on ABC-TV at 12.30 pm (see below)


New Microsoft Word Document (5)



“Investing in Aboriginal Community Control makes economic $ense”

The good news is that ACCHS deliver the goods – not only health gains, but also substantial economic gains.

 In all the rhetoric about Closing the Gap, what is missing from the picture is this —  the ACCHS network of clinics, community health centres and health-based co-operatives throughout Australia generates substantial  economic value for Aboriginal people and their  communities. ACCHS are a large-scale employer of Aboriginal people. This provides  real income and economic independence for many people. They contribute enormously to raising the education and skill levels of the Aboriginal workforce.

Investing in ACCHS is a good business proposition. It provides value for money and is highly cost-effective for four main reasons:

ACCHS deliver primary health care that delivers results

 Like your local GP does but more effectively for Aboriginal people because  the ACCHS model combines the best of clinical know-how with culturally enriched local knowledge and wisdom. It takes care of the whole person, not separate body parts. People work as part of a team that includes Aboriginal Health Workers, allied health,  and social and emotional wellbeing counsellors   in the front line. GPs as well, although not always. It runs health promotion and health screening to identify and treat health problems before they get serious. It organises access to medical specialists and hospitals if necessary. The ACCHS model considers individuals and families as part of a community and it responds effectively to community-based needs and issues.

This model of health care works for Aboriginal people. Evidence-based inquiries and reports show that ACCHS outperform mainstream services in terms of treatment and prevention. They reduce the need for highly expensive hospital-based services. And they  save lives.

ACCHS employment boosts Aboriginal education and training levels

 ACCHS employ people with high skill levels. Most have tertiary level qualifications and several have multiple qualifications. This increases the  education and skill base of the Aboriginal workforce.  Organisational  pathways in ACCHS are based on continuing and further education.  The message is that ACCHS have education benefits. A single investment by government in ACCHS  deals effectively with the  two main problems in Aboriginal communities – high unemployment and low levels of education.


NACCHO Close the Gap Day : Warren Mundine: “The Future of Aboriginal Health” Address To Lowitja Institute


“Decades of Indigenous controlled health service delivery have seen the Aboriginal community controlled health sector become a leading provider of primary health care services and a significant employer of Aboriginal and Torres Strait Islander peoples.

This sector has mature organisations with a depth of expertise and capabilities, particularly in remote and regional areas, surpassing the level of mainstream health services in some areas.

I see no reason why organisations in these positions should not be able to leverage their capabilities and positioning to provide health services more broadly, thereby expanding their ability to generate extra income and funding. Opening the door to entrepreneurship, independence and self-sufficiency could present great opportunities.”

Opening Address by Nyunggai Warren Mundine:

“The Future of Aboriginal & Torres Strait Islander Health”

Pictured above with  Lowitja O’Donoghue

Thank you Aunty Di Kerr for the Welcome to Country on behalf of the Wurundjeri Nation.

I too would like to acknowledge and pay respect to the traditional owners of the land on which we meet and also to acknowledge and pay respect to my own Bundjalung, Gumbaynggirr, Yuin and Irish ancestors.

I wish also to thank you the Lowitja Institute for inviting me to give the Keynote Address at this Congress and to Lowitja O’Donoghue for her introduction.

And thank you Deborah Cheetham and the Indigenous Dance Troupe, Koori Youth Will Shake Spear, for your terrific performances.

I also acknowledge the Deputy Chair of the Prime Minister’s Indigenous Advisory Council, Professor Ngiare Brown.

I am honoured to be here today addressing you.

The Future of Aboriginal & Torres Strait Islander Health? The short answer is the Prime Minister’s Indigenous Advisory Council sees a healthy and prosperous future for Aboriginal & Torres Strait Islander health. I see great leadership, innovation and vision when I look at the community controlled Aboriginal & Torres Strait Islander Medical Services and their national advocacy organisation, the National Aboriginal Community Controlled Health Organisation, and the Australian Indigenous Doctors’ Association.

As people would appreciate, after reviewing the recent “Closing the Gap” report there is much more work to be done.

To get an understanding of the Council and the work of the Council I’ll give a brief outline.

The Prime Minister’s Indigenous Advisory Council was created to provide advice to the Federal Government on Aboriginal & Torres Strait Islander Affairs, with a focus on practical changes to improve the lives of Aboriginal and Torres Strait Islander people.

The Council provides ongoing advice to the Government on emerging policy and implementation issues related to Aboriginal & Torres Strait Islander Affairs covering, but not limited to:

  • improving school attendance and educational attainment
  • creating lasting employment opportunities in the real economy
  • reviewing land ownership and other drivers of economic development
  • preserving Aboriginal and Torres Strait Islander cultures
  • building reconciliation and creating a new partnership between black and white Australians
  • empowering Aboriginal and Torres Strait Islander communities, including through more flexible and outcome-focussed programme design and delivery
  • building the capacity of communities, service providers and governments
  • promoting better evaluation to inform government decision-making
  • supporting greater shared responsibility and reducing dependence on government within Aboriginal and Torres Strait Islander communities
  • achieving constitutional recognition of Aboriginal and Torres Strait Islander people.

The Council also has another role of being the Deregulation Committee for Prime Minister and Cabinet as part of the review by Parliamentary Secretary to the Prime Minister, Josh Frydenberg into deregulation including cutting red tape and addressing the overburden of compliance costs.

The Council is supported by a Secretariat based within Prime Minister and Cabinet.

The Chair meets at least monthly with the PM, currently I have weekly conversations with the Prime Minister, the Minister for Indigenous Affairs and other Ministers. The Council meets 4 to 6 times a year. Our 3rd meeting is being held in Sydney on the 2nd April.

As you can see, the Council has a broad Terms of Reference and is an independent body that gives advice. That means we give advice whether the Government agrees or not. A good example of this is the Anti-Discrimination Act Section 18C debate. Council members didn’t agree with the policy taken to the last election by the Coalition and we gave advice to the Prime Minister of our views not to repeal Section 18C. The Government and the general public are very aware of the Council’s view on this matter.

The Council is the Prime Minister’s advisory group not an elected representative body. It is an advisory group like the Commission of Audit, the Gonski Education Review, the Henry Tax Review, the Banking Inquiry Review and many such other bodies. So, when people say we are not an elected body, we don’t represent Aboriginal and Torres Strait Islander people – I say “correct”. We are a group of people who bring a range of expertise, skills and experiences together to advise the Prime Minister and Government. Council meetings are full of robust and frank discussion and new ways of thinking and that is reflected in the advice we give to the Prime Minister.

The Prime Minister wants the Council to focus primarily on the three areas of Jobs, Education and One rule for all. The third area is essentially around upholding community standards and the rule of law in all communities. My term for this is “social stability”.

Broadly, the Council operates within a reform agenda based with an economic and commerce focus. We want to see a focus on outcomes and on the experience of the people who receiving or relying on services; we look for innovative and entrepreneurial approaches; we want service delivery that is integrated and eliminates duplication; we expect service deliverers – including States and Territories – to be accountable and we will hold them to their accountabilities; we want to see less red tape more Bang for the Buck and efficiencies in cost and delivery; we also want to see investment in Indigenous communities. Above all, we want to see simple and practical approaches that really deliver.

That is the lens through which all or our deliberations and recommendations are made and it is the lens through which I will talk about the future of Indigenous Health this morning.

*              *              *

In preparing this speech I received a detailed briefing with pages and pages of statistics on Indigenous health and health risk factors. And these were just a sample. I am all too familiar with the data which paints a dire picture of Indigenous health and wellbeing in Australia.

Of course, for Aboriginal and Torres Strait Islander people it’s not just about statistics; it’s about our family, friends and communities; it’s about our parents and our children and our own selves. It’s my sister who died at aged 50 from heart disease. It’s the man who was stabbed in front of me enraged with alcohol and drugs Musgrave Park when I was a youth. It’s the regular emails I receive letting me know about “sorry business”. It’s the fact that almost every Indigenous person I know over the age of 40 has Type 2 diabetes. It’s my own brush with death in 2012 from cardio-vascular disease.

Indigenous people live these statistics every day and we experience the real impact – not just on individuals and their specific health problems – but also on our communities and families who are being hollowed out by things like low life expectancy, chronic and communicable diseases, and mental health problems, alcohol related disease and assaults, Foetal Alcohol Spectrum Disorder, suicide and child mortality. These problems have an ongoing social, cultural and psychological impact on communities and families.

When it comes to Indigenous health policy and health services, the greatest challenge is bureaucracy, waste and red tape.

Health is one of the most governed of all the public services. Constitutionally, health services are provided by the States. However, the Federal government has considerable influence and control because it provides substantial funding.

Indigenous health policy and the delivery of health services to Indigenous people involves multiple administrators and decision makers at multiple levels. There are at least two portfolios – health and Indigenous affairs – in the Commonwealth and in each State and often other relevant portfolios such as community services and human services. Each portfolio has a Minister and a department and often Assistant Ministers or Parliamentary Secretaries as well.  All of this is before you get to the front line health services, such as State operated hospitals and other medical services and specialised Indigenous health services such as Aboriginal community controlled health services, each of which has their own administrative staff and obligations.

The previous Federal government also had a Minister for Indigenous Health. Prime Minister Abbott chose not to continue with this portfolio and these responsibilities have been rolled into the Department of Health and the Department of the Prime Minister and Cabinet which is responsible for Indigenous affairs.

Some people criticised this, arguing that not having a dedicated Indigenous health portfolio would set back Indigenous health policy and delivery. I disagree. One of the reasons we are spending billions on Indigenous people and not achieving material improvements in closing the gap is because the funding is poorly targeted and wasted on red tape and bureaucracy. The most recent Productivity Commission indicates that the majority of funding allotted specifically to Indigenous Australians is spent on bureaucrats, advisers, contractors and the like, many of whom are non-Indigenous. Shortly after the last election Minister Scullion and I did a preliminary review of the spending figures and we estimated that at least a third of Government funding for Indigenous programs doesn’t even make it past the front doors of office buildings in Canberra and other cities.

Every additional Minister and department or other entity involved in Indigenous health results in additional reporting, handoffs and intra-government dealings. The different groups have to consult and report to each other and handle demarcation issues and duplication. Inevitably this means funding must be being consumed by bureaucratic process.

I recently saw a rerun of an episode of Yes Minister called “The Economy Drive”. In it, Sir Humphrey, Permanent Secretary of the fictional Department of Administrative Affairs, must deal with Minister Hackett wanting to eliminate waste and improve efficiency. Explaining to the more junior public servant, Bernard Woolley, why this is a bad thing, Sir Humphrey explains:

“There has to be some way to measure success in the Civil Service. British Leyland can measure success by the size of their profits, or rather they measure their failure by the size of their losses. We don’t make profits or losses so we have to measure our success by the size of our staff and our budget. By definition, Bernard, a big department is more successful than a small one.”

Even though it is fiction and satire, the scary thing about Yes Minister is that people who have worked in Government very much relate to it.

Whenever funding cuts to Indigenous services or programs are made, the vocal protest and criticism simply assumes that defunding will undoubtedly lead to bad outcomes for Indigenous people. In doing so they are measuring success by the size of budgets and staffing. But if funding to date has not had a material positive impact on Closing the Gap statistics, we can’t simply assume that a funding cut will have an adverse impact. It depends whether what is being cut is actually contributing to improvements or if it is wasted spend. Knee-jerk reactions of outrage without regard to the actual outcomes (if any) the defunded services have achieved, ultimately weaken the voice of criticism.

To me it is a very simple proposition. The success of government service delivery in Indigenous health should be measured by the outcomes achieved.

It’s not about the volume of services or who provides them or how much the Government is spending or how many people are involved or how much activity occurring on a day to day basis. It’s not about the size of the department or how many departments there are or whether we have a dedicated Minister for Indigenous Health. It’s about the outcomes and results achieved for Indigenous people.

We need to get bang for our buck. I do not want to see a single cent of funding wasted on administration, bureaucracy, reporting or other red tape that isn’t contributing to outcomes. Every cent wasted is a cent denied to Indigenous people and not being used to close the gap.

In this country we pride ourselves on our universal health system – a system where everyone gets access to top rate medical treatment in public hospitals with delivery prioritised based on health needs, not on ability to pay or other factors. No one wants to see a two-tiered health system, one for Indigenous people and one for non-Indigenous people. Our health system should deliver the world class medical services to everyone and Indigenous people should benefit from that as much as everyone else. The purpose of special Indigenous health services and policy is to close the health gaps between Indigenous and non-Indigenous people.

In the current Federal ministerial structure we have one Health Minister who is responsible for the funding and funding arrangements for health for everyone.

The job of the Department of Prime Minister & Cabinet (which houses the Indigenous Affairs portfolio) is to focus on what is needed in addition to the mainstream health system to close the gap between Indigenous and non-Indigenous health. This may involve funding additional health services or bodies. It also involves looking at the totality of different services and resources that are targeted towards, or that impact, Indigenous health – including housing, sanitation – and holding States, Territories and other bodies to account to deliver real outcomes.

Groups like the National Aboriginal Community Controlled Health Organisation are critical to delivering health services that cater to the additional needs of Indigenous people and communities to close the gap and recognise the importance of having Indigenous involvement in health policy and service delivery. The Indigenous Advisory Council’s Deputy Chair, Professor Ngiare Brown, who is a doctor, is an Executive Research Manager at NACCHO.

Decades of Indigenous controlled health service delivery have seen the Aboriginal community controlled health sector become a leading provider of primary health care services and a significant employer of Aboriginal and Torres Strait Islander peoples. This sector has mature organisations with a depth of expertise and capabilities, particularly in remote and regional areas, surpassing the level of mainstream health services in some areas. I see no reason why organisations in these positions should not be able to leverage their capabilities and positioning to provide health services more broadly, thereby expanding their ability to generate extra income and funding. Opening the door to entrepreneurship, independence and self-sufficiency could present great opportunities.

*              *              *

At one level, it is very easy to become overwhelmed by Indigenous health statistics, not only the data itself but also the immensely complex interconnectedness of health problems, health risk factors and social issues.

At another level, Indigenous health problems are not complex to understand at all. If you step back from the tangled web of data and statistics, what you are really looking at is poverty.

Across the world, the conditions under which people are born, grow up, live, work and age shape their health.  As the World Health Organisation points out: ‘the poorest of the poor have the worst health’. Most Indigenous people of my generation, and many of those in the generations after that, grew up in poverty or not far above it. Poverty is both a cause and a consequence of poor health.

It is estimated that socioeconomic disadvantage – in things like education, employment and income – account for one-third to one-half of the health gap between Indigenous and non-Indigenous Australians.

If we only achieved two things – eliminating poverty and eliminating smoking – we would close the gap in Indigenous health for good.

It is very important to remember this as we talk about Indigenous health service provision and health policy. Both are vitally important. But even the best policy and the best service provision will not close the gap if Indigenous people continue to live in poverty, or indeed if we make choices, like the choice to smoke, which damage our health.

The solution to poverty is not a mystery. Poverty is solved by economic development and commerce. Between 1990 and 2010 the number of people living in extreme poverty globally halved. That’s one billion people lifted out of poverty in just 2 decades. Two-thirds of poverty reduction comes from economic growth. The most astonishing example is China. Since it began economic reform 30 years ago its extreme-poverty rate fell from 84% to 10%.

For economic development we need our people to be educated and get into jobs and we need social stability in our communities or people will never invest in them.

So – the reason why I talk so much about economic and commercial development, about getting kids to school, about getting Indigenous people into real jobs and about safe communities, is because these are the key to eliminating poverty and therefore they are key to closing the gap in health. And therefore they are priority areas for the Prime Minister’s Indigenous Advisory Council and for the future of Indigenous Health.

Nyunggai Warren Mundine is Executive Chairman of the Australian Indigenous Chamber of Commerce

You can hear more about Aboriginal health and Close the Gap at the NACCHO SUMMIT


The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.