“Doctors are seeing high rates of mortality in Aboriginal and Torres Strait Islander people and this is largely attributable to chronic disease,
The Federal Government must provide long-term funding certainty for the Medical Outreach Indigenous Chronic Disease Program, which is focused on preventing, detecting and managing chronic disease for Aboriginal and Torres Strait Islander people.”
RACP President Dr Catherine Yelland
Download the full submission here or read Aboriginal health extracts below
Historical background RACP Associate Professor Noel Hayman
“I’ve been working in the field of Indigenous health for 20 years now. The major changes, trends that I’ve seen over the years, has been improvements in infant mortality. But the one that contrasts that is the worsening mortality in middle age—we see high rates of mortality in Aboriginal people in their 40s and 50s. And this is due to chronic disease, particularly diabetes, ischaemic heart disease and chronic kidney disease.
And this accounts for about 70% of Indigenous mortality. But it’s not all gloom and doom. I think if we all work strongly together, I do believe we can improve Aboriginal and Torres Strait Islander health significantly. For example, what we’ve been able to do is we’ve actually got Aboriginal people to attend primary care. But more importantly now, my aim is to integrate specialist care.
So now we have a visiting endocrinologist, we’ve got a paediatrician, we’ve got a cardiologist, we’ve got a registrar from rehabilitation medicine, we’ve got an ophthalmologist. So private physicians and also hospital-based physicians, and the ones that are hospital-based, they come out here. The cardiologist, for example he does two sessions a month. He does his echocardiograms here and also exercise stress tests.
To me, integrating specialist care into a centre of excellence is to me is a “one stop shop” and Aboriginal people are more likely to attend. And we’ve actually shown that. And we’ve got better outcomes and we’ve got data on that through continuous quality improvement.”
Associate Professor Noel Hayman, Clinical Director of the Inala Indigenous Health Service in Brisbane.
He was the first Aboriginal GP in Queensland, and the first Aboriginal and Torres Strait Islander person to become a Fellow of the Australasian Faculty of Public Health Medicine at the RACP.
RACP Press Release
The RACP recommends that the Australian government :
Aboriginal and Torres Strait Islander Health
• Allocate secure long-term funding to progress the strategies and actions identified in the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) Implementation Plan.
• Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).
• Build and support the capacity of Aboriginal and Torres Strait Islander health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.
• Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, in line with the recommendations of the Fifth National Mental Health and Suicide Prevention Plan. Allocate sufficient funding for the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Strategy.
• Fund the syphilis outbreak short-term action plan and coordinate this response with long term strategies.
• Allocate long-term funding for primary health care and community- led sexual health programs to embed STI/BBV services as core primary health care (PHC) activity, and to ensure timely and culturally supported access to specialist care when needed, to achieve low rates of STIs and good sexual health care for all Australians.
• Invest in and support a long-term multi-disciplinary sexual health workforce and integrate with PHC to build longstanding trust with communities.
• Allocate funding for STI and HIV point of care testing (POCT) devices, the development of guidelines for POCT devices and Medicare funding for the use of POCT devices.
Extract from Pre budget submission
Aboriginal and Torres Strait Islander Health
Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians.
The latest ‘Closing the Gap’ report found that Australia is not on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.
The gap for deaths from cancer between Aboriginal and Torres Strait Islander and non-Indigenous Australians has in fact widened in recent years, with Aboriginal and Torres Strait Islander cancer death rates increasing by 21 percent between 1998 and 2015, while there was a 13 per cent decline for non-Indigenous Australians in the same period8.
To address these inequities and improve access to care, continuing and strengthened focus and appropriate long-term funding is required. It is imperative that there is secure funding for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan.
Funding uncertainty and frequent changes create significant issues that impact the continuity of services to patients and organisations in their ability to retain and build their capacity.
Press release continued
The RACP strongly supports existing programs that improve access to specialist care, including the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP). The RACP recommends that the Australian Government continue its investment in these programs, undertaking evaluation to ensure the programs are targeted at the most appropriate issues and achieving positive health outcomes for Aboriginal and Torres Strait Islander peoples.
Aboriginal and Torres Strait Islander health leadership and authentic community engagement is crucial to achieving improved health outcomes. The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, culturally safe care to Australia’s First Peoples; and service development and provision should be led by Aboriginal and Torres Strait Islander health organisations where ever possible. The sector must have long-term, sufficient and secure funding to both retain and grow their capacity.
Given the recent focus by the Australian government on improving mental health and reducing suicide rates in Aboriginal and Torres Strait Islander communities, The RACP supports the analysis, reporting and implementation of evidence-based solutions, with input from and led by these communities, to improve the quality and delivery of mental health promotion and suicide prevention services. The RACP recommends the establishment of clearinghouses which enable effective access to relevant, high quality information and resources to support these efforts.
There continue to be ongoing outbreaks of infectious syphilis across Australia affecting Aboriginal and Torres Strait Islander people, which has occurred in the context of increasing rates of other Sexually Transmitted Infections (STIs) and some Blood Borne Viruses (BBVs) in some Aboriginal and Torres Strait Islander communities. STIs are endemic in some regions; an unprecedented syphilis epidemic in Queensland began in 2011 and extended to the Northern Territory, Western Australia and South Australia.
Since 2011 there have been six fatalities in Northern Australia from congenital syphilis, and a further three babies are living with serious birth defects in the Northern Territory. In addition, there has been one reported case of congenital syphilis so far in 2017 in South Australia. Despite the existence of a number of Federal and state-level sexual health strategies, the situation remains dire.
Appropriate funding needs to be allocated to the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses and Sexually Transmissible Infections Strategy
A Healthy Future for all Australians: RACP Pre-Budget Submission 2018-19 13
and sexual health services; particularly to ensure sufficient capacity for the delivery of core STI/BBV services within models of care that provide comprehensive primary health care services (particularly Aboriginal and Torres Strait Islander community controlled health services). People should have access to specialist care when needed, through integration with comprehensive primary health care services to ensure sustainable and culturally appropriate service provision.
We welcome the plans to activate a short-term response across the state and territories on the continuing syphilis outbreaks, coordinated by the Federal Department of Health. However, whilst this Action Plan and short-term funding is urgently needed; the short-term activities need to be coordinated with and contribute to longer-term strategies and investments.