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?

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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.

Moderators

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 – http://www.naccho.org.au/aboriginal-health/definitions/

• 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