NACCHO Aboriginal Health #COAG : Indigenous Health Leadership , Ministers @GregHuntMP @KenWyattMP and Australia’s Health Ministers gather in #AliceSprings to shine a spotlight on #Indigenous health


“Australia’s Health Ministers have gathered in Alice Spring to shine a spotlight on Indigenous health, almost 10 years after the Council of Australian Governments (COAG) approved Closing the Gap targets to achieve health equality for First Nations peoples.

While we can reflect on progress – our people, on average, are living longer with fewer dying from chronic conditions – it is equally important to focus on our failure to close the gap in life expectancy, which remains about 10 years.

For sustainable change, however, local family warriors must step up, be respected, acknowledged and encouraged.

The Hon Ken Wyatt Indigenous Health Minister see Part 1 Below

Investigation and investment where it is needed is critical to delivering better health outcomes for First Nations Peoples, to protect lives and save lives

Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.

Kidney disease disproportionately affects Indigenous Australians — research has shown that almost one in five (18 per cent) Aboriginal and Torres Strait Islander people aged over 18 had indicators of chronic kidney disease.

I am delighted that we can announce $327,192 for Monash University to develop a point-of-care test for the diagnosis and management of chronic kidney disease.

Social and emotional well-being was another critical matter for Aboriginal and Torres Strait Islander Australians, especially youth.

The Australian Institute of Health and Welfare has found that the single largest contributor to ill health amongst Aboriginal and Torres Strait Islander Australians is mental health and substance use disorders,” said Minister Hunt.

Five projects across five different states will examine social and emotional well-being issues affecting Aboriginal and Torres Strait Islander infants, children, adolescents and young adults.

They will undertake culturally-informed research looking at the influencing factors, mental health and life-coaching, and fostering wellness.”

Health Minister Greg Hunt see full Press release Part 2

Part 1 Continued from opening quote

For over 65,000 years, First Nations people thrived without a plethora of organisations. We were child, family and community-centred.

Responsibility and authority revolved around a woman, with her key roles as the mother and protector, and equally, around a man, the father and family shield.

This year, I am focusing on five areas – renal health, rheumatic heart disease (RHD), avoidable blindness, avoidable deafness and crusted scabies.

First Nations people experience 7.3 times the burden of chronic kidney disease than other Australians. In the Northern Territory, RHD is 37 times more prevalent and, overall, we endure three times the rate of vision impairment.

Our children suffer, on average, 32 months of hearing loss compared with three months for other Australian children, while remote northern communities have the world’s highest rates of crusted scabies.

We are losing too many lives and not realising the potential of too many more.

In many remote locations, doctors and health workers are joined by fly-in fly-out health practitioners, providing specialist services.

However, we must ensure a local army of individuals on the ground is empowered to monitor for signs of illness.

We need home-based heroes, family warriors, as they were in times past – and still are in functional families.

They need to understand that infections such as skin sores can be precursors to RHD, kidney failure and crusted scabies.

We are not going to fully transform the health of those who are struggling, until they understand with pride and responsibility, the culture that perpetuated healthy lives for thousands of years.

Our mothers and fathers, uncles, aunts and grandparents are the first protectors of our children.

Now extended to 136 communities, the Better Start to Life program is proving the power of engaging with and supporting young parents to understand their responsibilities.

The Turnbull government has invested significantly in these areas but the record $3.9 billion committed to Indigenous health over the next four years will only ever be part of the currency of change.

It’s now time to highlight the heroes within our families, to move from disempowerment to empowerment, away from a deficit model.

I encourage every mother, father, uncle, aunt and Elder to become a warrior for health, joining in and taking responsibility for their own health and the health of their families.

Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.

The Government has committed $23.2 million through the National Health and Medical Research Council (NHMRC) to 28 new projects, and has launched a NHMRC Road Map 3 to help chart the direction for Indigenous health and medical research investment over the next ten years.

New research investment will include targeted renal, cancer and social and emotional wellbeing projects aimed at improving Aboriginal and Torres Strait Islander health outcomes.

The five projects together form the first of a series of targeted calls for research by the NHMRC to address Indigenous health priorities. Other calls will include healthy ageing and nutrition.

Minister for Indigenous Health, Ken Wyatt AM, said the new research projects would help to strengthen work already underway to curb chronic disease.

“The renal point-of-care test will complement the Renal Health Road Map that is currently being compiled,” Minister Wyatt said.

“This exciting new research is focused on making a difference on the ground, from reducing smoking during pregnancy and boosting cancer care, to combating diabetic blindness and improving diets.”

“The five social and emotional wellbeing projects are especially welcome, as we continue working with local communities to reduce the rate of suicide.”

Other key research projects announced today include point-of-care testing for blood-borne diseases and sexually transmitted infections, reducing incarceration rates of young women, improving prisoner mental health, burns care, lung health, scabies testing and reducing unborn baby deaths.

The direction of future First Nations research will be informed by the NHMRC’s Road Map 3, which will include a yearly report card and a commitment to spend at least 5% of annual NHMRC funding on Aboriginal and Torres Strait Islander health and medical research.

“Most importantly, the NHMRC Road Map 3 was developed in consultation with communities, First Nations researchers and the broader health and medical research sector to address Indigenous health issues and encourage and strengthen the capacity of Indigenous researchers, now and into the future,” said Minister Wyatt.

The NHMRC has today also released the Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders as well as Keeping Research on Track II.

The Guidelines provide a set of principles to ensure that research is safe, respectful, responsible, high-quality and of benefit to Aboriginal and Torres Strait Islander people and communities.

NACCHO Aboriginal Health #COAG meeting Alice Springs : Time for COAG Health Council to address the Indigenous funding myth & ‘market failure’ says Ian Ring

 ” COAG Health Ministers will discuss Aboriginal and Torres Strait Island health at their meeting in Alice Springs this week.

There is much to discuss. Ten years on from the start of Closing the Gap, progress is mixed, limited and disappointing, and the life expectancy gap is widening.

This is hardly surprising.

The National Partnership Agreements on Indigenous health, which spelt out the roles, responsibilities and funding of the Commonwealth and state and territory jurisdictions, have not yet been replaced by bilateral agreements.

Formal regional structures and agreements to bring together Aboriginal community controlled health and mainstream services have yet to be formalised nationally. On the broader front, culture, racism and social, political and economic issues cry out for attention.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.”

Ian Ring AO Honorary Professorial Fellow Research and Innovation Division
University of Wollongong

Originally published in Croakey 

Much remains to be done in housing, the justice system is a debacle, and the question of an Aboriginal voice, one of the main priorities of the Uluru Statement from the Heart, remains unresolved.

Critically, the National Aboriginal and Torres Strait islander Health Implementation Plan, which was supposed to be the game changer for health, has become an unfunded plan of words not action and, after almost three years, basic core tasks such as defining service models and filling service gaps remain unfulfilled.

Misleading money myths

While money isn’t the only factor, money myths are playing an important role in the failure to close the gap.

A recent Productivity Commission report found that per capita government spending on Aboriginal and Torres Strait Islander people was twice as high as for the rest of the population.

The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.

But higher spending on Aboriginal and Torres Strait Islander people should hardly be a surprise.

We are not surprised, for example, to find that per capita health spending on the elderly is higher than on the healthier young because the elderly have higher levels of illness.

Nor is it a surprise that welfare spending is higher for Indigenous people who lag considerably in education, employment and income. There would be something very wrong with the system if it were otherwise.

The key question in understanding the relativities of expenditure on Aboriginal and Torres Strait Islander people is equity of total expenditure, both public and private, in relation to need, but the Productivity Commission’s brief is simply to report on public expenditure, and that can be misleading.

Massive market failure

For health services, while state and territory governments spend on average $2 per capita on Indigenous people for every $1 spent on the rest of the population, the Commonwealth spends $1.20 for every $1 spent on the rest of the population, notwithstanding that the burden of disease and illness for Indigenous Australians is 2.3 times the rate of the rest of the population. And total government expenditure on Aboriginal and Torres Strait Islander health is only about 60 per cent of the needs based requirements.

This is massive market failure.

The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

Mortality for the Indigenous population has flatlined since 2008 and the inevitable result is that the life expectancy gap is widening rather than closing.

This is not surprising since the Federal Government’s own reports clearly show that preventable admissions for Indigenous people, funded by the states and territories, are three times as high as for the rest of the population (see graphs below, and sources at the bottom of the post) yet use of the Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS), funded by the Commonwealth, appears at best to be a half and a third respectively of the needs based requirements for Indigenous people.

It is simply impossible for the mortality gaps to close under these conditions.

It is not that the Commonwealth is deliberately underfunding health services for Aboriginal and Torres Strait Islander people. However there are decades of experience establishing beyond all doubt that demand driven services designed to meet the needs of the bulk of the population will not adequately meet the needs of a very small minority of the population with very special needs.

In recognition of that, for over 40 years, the Commonwealth has been funding Aboriginal Community Controlled Health Services (ACCHS), which evidence shows better meet those needs, but the coverage of those services is patchy and needs to be expanded.

It has been shown that the nonviolent death rate for at risk Aboriginal people can be halved in just over three years by systematic application of knowledge we already have. It really is within the grasp of the current government to turn things around and now is the time to do it.

Priorities to address

A key requirement is to address the shortfall in Commonwealth funding for out of hospital services, which is contributing to excessive preventable admissions funded by the states and territories, and to avoidable deaths.

A vital priority is seed funding for the provision of satellite and outreach ACCHSs that Indigenous people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Additional funding is also required for mental health and social and emotional wellbeing services which are neglected in the Closing the Gap initiative.

And much more attention needs to be paid to the quality of services, with much needed investment in the training of clinicians, managers and public servants for the difficult and complex roles they have to play.

The ‘Refresh’: resource-free targets

The danger is that action will be put on hold in the belief that somehow the Closing the Gap ‘Refresh’ is going to solve everything!

The fear is that we have entered the world of magical targets – the kind where you just say what you would like to happen and that’s it, it just magically comes to pass without actually specifying, let alone actually doing all the things that are required to achieve the targets. It’s a bit like painting pictures in the sky: let’s put an end to war and famine without any thought or action about what would need to be done for those desirable things to come to pass.

With the Refresh target setting process, there seems to be a lot of emphasis on data issues while more or less completely overlooking consideration of the investment or services required to achieve the targets.

In an orthodox sensible planning process, target setting is an important element. Targets need to be directly related to overarching goals, and need to relate directly to the services, actions and investments that will be made to achieve the targets.

Timeframes setting out what is to be achieved in say 1 year, 5 years, 10 years etc are crucial, and both process and outcome targets need to be set. In the absence of this kind of process a belief that the Refresh will somehow turn things around may well be illusory.

It is extraordinary that the only response to the finding on the life expectancy target – that it not only won’t be met but is going backwards – is an apparent intent to freeze Commonwealth funding for Indigenous health services!

There is little point in having mortality goals which are clearly in jeopardy – and when the causes are not hard to define and the remedies clear – if there is insufficient action taken to actually achieve them.

The funds required for satellite and outreach ACCHS services to fill the service gaps, together with the other priorities described above, spread over a carefully prepared five year plan, are likely to be modest and would make a real and substantial improvement to the health of Indigenous people.

There is no call for some kind of special deal, but simply the same level of expenditure from both Commonwealth and state and territory governments for Australia’s Indigenous peoples that anyone else in the population with equivalent need would receive.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.