Closing the Gap is a long-term plan in Aboriginal Health

Smoking,life expectancy and overall mortality

Ian Ring is professorial fellow,

Australian Health Services Research Institute, University of Wollongong.

First appeared Canberra Times 6 July 20121

Everyone would like the gap to be closing. However, many politicians and public servants are not aware that while we can see whether the gap was closing before 2010, it is just too early to tell whether the $4.6 billion Closing the Gap programs are working or not. The key point is that most of the information that is now available relates to the period before the Closing the Gap funding hit the ground.

The relative lack of progress in the Prime Minister’s annual report to Parliament and the recent report of the Council of Australian Governments Reform Council tells us about what was happening in the run-up to the commencement of these historic initiatives for Indigenous Australians in health, housing, education, employment and services for remote areas. They tell us why those initiatives to close the gap were necessary, not whether they have already produced results.

The initial four years’ funding started in 2009-10 and runs until 2012-13. As is the way with major new programs, funding was small in the first year and built up over the next three years. For example, funding for smoking was $4.2 million in 2009-10 and built up to about 10 times that amount ($41.1 million) in 2012-13.

So, for example, when might we hope to see the effects of Closing the Gap anti-smoking funding and programs?

There is always a lag between funding and program delivery. Staff have to be recruited, trained and deployed. In practice it is impossible for new staff to hit the ground at maximum efficiency, so at best, smoking programs might start to have early effects in, say 2012-13 and build up from there. Smoking is a deeply entrenched behaviour and doesn’t change overnight.

It is thought that at the end of the Second World War about 70 per cent of Australian males smoked and it took until the late 2000s for that to drop to about 20 per cent. This does not mean that with current knowledge and methods it will take that long for Aboriginal smoking rates to fall to the level of the rest of the population, but it does indicate that rapid change is a big ask and unlikely to happen.

Smoking surveys for Aboriginal people are conducted six-yearly and the next one is due at the end of this year with data likely to be available in 2014. It takes a while for changes in smoking behaviour to be reflected in reductions in disease and the lag period varies for different conditions – a few years for cardiovascular conditions and decades for smoking- related cancers. There is also a time lag between change in a disease and the availability of information on hospitalisation and mortality. So the earliest time to see the impact of the new programs on smoking is likely to be in 2014, but there will be a better picture from survey results in 2018.

As for reductions in diseases, it may be that surveys in 2019 with results in 2020 may give valuable information. This is long-haul stuff and we have to stay the course. The temptation when funds are tight is to look at the money going into Aboriginal programs and see the current relative lack of progress and conclude that the money may be wasted.

Not so. Remember, the data we are looking at now are mainly telling us what was happening before the commencement of the Closing the Gap funding. And there are many problems with the data. As far as Aboriginal health is concerned, it is likely that the health of children has been improving, although whether the child mortality target can be achieved with the continuing levels of low birth weight babies remains an open question.

For life expectancy and overall mortality, despite what the reports say, there are solid grounds for believing that progress reflected in the data available now has been slow and uncertain. But that doesn’t mean the programs are not having an effect. Rather, the lack of progress up until 2010 provides even more weight, if any were needed, for the need for the Closing the Gap programs.

The set of Closing the Gap policies and the funding that goes with them, represent a long overdue, but nonetheless remarkable turnaround in government policies – supported on a bipartisan basis. Policies and funding are one thing and implementation another, and there are many challenges and controversies about the implementation. The hope is that the lessons from the past four years’ initial steps in this most difficult field will be learnt and reflected in changes in future programs and funding, because otherwise there are real grounds for believing the government’s policy aims may not be achieved.

The good news is that the government is committed to a partnership approach with Aboriginal people in the preparation of the comprehensive long-term action plan promised in the Statement of Intent.

But we need to understand the time it takes to roll out programs, for them to have optimal effect and for the information about results to become available. And that still lies ahead of us.

We thank Ian Ring professorial fellow, Australian Health Services Research Institute, University of Wollongong.

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