NACCHO Aboriginal Health #refreshtheCTGRefresh 2 of 2 : Download the #COAG 9 page statement on the #ClosingTheGap refresh

 ” One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples.

We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh “

From the COAG Statement

1.Download CTG COAG 6 Page Statement

2.Download CTG  COAG 3 Page Draft Targets Outcomes

3. Download COAG Communique Dec 12

Where we actually let Aboriginal and Torres Strait Islander Australians lead the discussion, determine the outcome, own the outcome,”

The Victorian premier, Daniel Andrews, said the partnership provided a meaningful opportunity, the “likes of which we’ve not seen before”. From The Guardian 

“We can’t close the gap unless we do this in partnership with Aboriginal people,” he told reporters on Wednesday.

“I think the wording of what we’re doing so far on Closing the Gap is good but we have to talk funding at some stage.”

The Northern Territory chief minister, Michael Gunner, said on Wednesday it was a vital partnership and initiative could not afford to “go off the rails again”.

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

NACCHO Chief Executive Officer Pat Turner AM see NACCHO Press Release HERE

In December 2016, the Council of Australian Governments (COAG) agreed to refresh the Closing the Gap agenda ahead of the tenth anniversary of the agreement and four of the seven targets expiring in 2018.

In June 2017, COAG agreed to a strengths-based approach and to ensure Aboriginal and Torres Strait Islander peoples were at the heart of the development and implementation of the next phase of Closing the Gap.

In 2018, a Special Gathering of prominent Aboriginal and Torres Strait Islander Australians presented COAG with a statement setting out priorities for a new Closing the Gap agenda. The statement called for the next phase of Closing the Gap to be guided by the principles of empowerment and self-determination and deliver a community-led, strengths-based strategy that enables Aboriginal and Torres Strait Islander peoples to move beyond surviving to thriving.

Since the Special Gathering identified priorities, all governments have worked together to develop a set of outcomes and measures for inclusion in the Closing the Gap Refresh. COAG has now agreed draft targets for further consultation to ensure they align with Aboriginal and Torres Strait Islander peoples and communities’ priorities and ambition as a basis for developing action plans.

PARTNERSHIPS WITH ABORIGINAL AND TORRES STRAIT ISLANDER AUSTRALIA

COAG recognises that in order to effect real change, governments must work collaboratively and in genuine, formal partnership with Aboriginal and Torres Strait Islander peoples as they are the essential agents of change.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation will be the preferred pathway to productive and effective agreements. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

COAG will ensure that the design and implementation of the next phase of Closing the Gap is a true partnership. Governments and Aboriginal and Torres Strait Islander people will share ownership of and responsibility for a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda.

The refreshed Closing the Gap agenda recognises and builds on the strength and resilience of Aboriginal and Torres Strait Islander peoples and communities.

CLOSING THE GAP – A VISION FOR THE FUTURE

Closing the Gap requires us to raise our sights from a focus on problems and deficits, to actively supporting and realising the full participation of Aboriginal and Torres Strait Islander peoples in the social and economic life of the nation. COAG recognises there is a need for a cohesive national agenda focussed on important priorities for enabling Aboriginal and Torres Strait Islander families, children and communities to thrive.

COAG has listened to Aboriginal and Torres Strait Islander communities and stakeholders. COAG has heard there is a need to focus on the long term and on future generations, to strengthen prevention and early intervention initiatives that help build strong families and communities, and to prioritise the most important events over the course of a person’s life and the surrounding environment.

COAG acknowledges Closing the Gap builds on the foundation of existing policies and commitments within the Commonwealth and each state and territory. Closing the Gap does not replace these policies, but provides a people and community centred approach to accelerate outcomes.

COMMUNITY PRIORITIES FOR THE NEXT TEN YEARS

The Special Gathering Statement to COAG in February 2018 recommended the priority areas for the next phase of Closing the Gap:

 Families, children and youth

 Housing

 Justice, including youth justice

 Health

 Economic development

 Culture and language

 Education

 Healing

 Eliminating racism and systemic discrimination.

All priority areas are important and interconnected, and COAG is committed to achieving positive progress in all areas.

The Commonwealth, states and territories have consulted widely on these priorities. Aboriginal and Torres Strait Islander peoples and communities, peak bodies, service providers, technical experts and members of the public had the opportunity to provide their views on the future of Closing the Gap.

In considering where to set targets, there was a focus on the priority areas that lend themselves to the design of specific, measurable, achievable, relevant and time-bound targets. This focus on evidence and data enables COAG to effectively track progress over time.

CROSS SYSTEM PRIORITIES

Governments must deepen their relationships with Aboriginal and Torres Strait Islander peoples. This means understanding what matters to communities and continuing to build capability for genuine collaboration and partnership, acknowledging the differing priorities and challenges in different places across urban, regional and remote Australia.

All Australian governments are committed to working cooperatively in partnership with Aboriginal and Torres Strait Islander peoples, and their communities, to positively transform life outcomes for Aboriginal and Torres Strait Islander peoples.

COAG recognises that progress reports over the past decade confirm that closing the gap in remote Australia requires particular focus, recognising the rich cultural strengths as well as the need for targeted approaches to address disadvantage in these areas.

COAG acknowledges that culture is fundamental to Aboriginal and Torres Strait Islander peoples’ strength and identity. COAG further acknowledges the impacts of historical wrongs and trauma faced by Aboriginal and Torres Strait Islander peoples and families.

All Australian governments recognise the need to address intergenerational change, racism, discrimination and social inclusion (including in relation to disability, gender and LGBTIQ+), healing and trauma, and the promotion of culture and language for Aboriginal and Torres Strait Islander peoples. These will be taken into account as cross system priorities for all policy areas of the Closing the Gap agenda. Cross system priorities require action across multiple targets.

REFRESHED TARGETS

The Commonwealth, states and territories share accountability for the refreshed Closing the Gap agenda and are jointly accountable outcomes for Aboriginal and Torres Strait Islander peoples. COAG commits to working together to improve outcomes in every priority area of the Closing the Gap Refresh.

The refreshed Closing the Gap agenda will commit to targets that all governments will be accountable to the community for achieving. This approach reflects the roles and responsibilities as set out by the National Indigenous Reform Agreement (NIRA), and specified in respective National Agreements, National Partnerships and other relevant bilateral agreements.

While overall accountability for the framework is shared, different levels of government will have lead responsibility for specific targets. The lead jurisdiction is the level of government responsible for monitoring reports against progress and initiating further action if that target is not on track, including through relevant COAG bodies.

The refreshed framework recognises that one level of government may have a greater role in policy and program delivery in relation to a particular target while another level of government may play a greater role in funding, legislative or regulatory functions. Meeting specific targets will require the collaborative efforts of the Commonwealth, states and territories, regardless of which level of government has lead responsibility. Commonwealth, state and territory actions for each target will be set out in jurisdictional action plans, and may vary between jurisdictions. COAG acknowledges that all priority areas have interdependent social, economic and health determinants that impact the achievement of outcomes and targets.

Through a co-design approach, jurisdictional action plans will be developed in genuine partnership with Aboriginal and Torres Strait Islander communities, setting out the progress that needs to be made nationally and in each jurisdiction for the targets to be met. Action plans will clearly specify what actions each level of government is accountable for, inform jurisdictional trajectories for each target and establish how all levels of government will work together and with communities, organisations and other stakeholders to achieve the targets. Starting points, past trends and local circumstances differ, so jurisdictions’ trajectories will vary and may have different end-points.

COAG recognises that promoting opportunities for Aboriginal and Torres Strait Islander peoples to be involved in business activities contributes to economic and social outcomes for families and communities, and has committed to publishing jurisdiction specific procurement policies, and Aboriginal and Torres Strait Islander employment and business outcomes annually.

PUBLIC ACCOUNTABILITY

Closing the Gap is a whole-of-government agenda for the Commonwealth and each state and territory. To provide direct accountability to Aboriginal and Torres Strait Islander peoples and the Australian public as a whole, each jurisdiction will report publicly each year on its Closing the Gap strategy. The Prime Minister will make an annual statement to parliament.

Governments will engage with the community to develop a meaningful framework for transparently tracking and reporting progress with Aboriginal and Torres Strait Islander leaders.

INDEPENDENT REVIEW

The Productivity Commission’s Indigenous Commissioner will conduct an independent review of progress nationally and in each jurisdiction every three years. All governments will provide input into the Productivity Commission’s review, taking into account differences between urban, regional and remote areas.

The Closing the Gap targets may be subject to refinement, where appropriate, through the review of the NIRA and periodic Productivity Commission reviews.

WHERE WE ARE GOING FROM HERE

A new formal partnership with Aboriginal and Torres Strait Islander peoples, through their representatives, will be established by the end of February 2019.

Building on the work undertaken to date, working through this new partnership, the Commonwealth, and states and territories, will by mid 2019:

 finalise all draft targets;

 review the NIRA; and

 work with the Productivity Commission’s Indigenous Commissioner to develop an independent, Aboriginal and Torres Strait Islander-led approach to the three-yearly comprehensive evaluation and review of progress nationally and in each jurisdiction.

One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples. We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments are committed to broadening and deepening their partnerships with Aboriginal and Torres Strait Islander peoples and communities over the lifetime of the refreshed agenda. This includes strengthening mechanisms to ensure Aboriginal and Torres Strait Islander peoples have an integral role in decision making and accountability processes at the national, regional and local levels, building on existing arrangements and directions within different jurisdictions.

To guide the development of Commonwealth, state and territory action plans by mid-2019, COAG has endorsed a set of Implementation Principles informed by Aboriginal and Torres Strait Islander communities:

Shared Decision-Making – Implementation of the Closing the Gap framework, and the policy actions that fall out of it, must be undertaken in partnership with Aboriginal and Torres Strait Islander peoples. Governments and communities should build their capability to work in collaboration and form strong, genuine partnerships in which

Aboriginal and Torres Strait Islander peoples can be an integral part of the decisions that affect their communities.

Place-based Responses and Regional Decision Making – Programs and investments should be culturally responsive and tailored to place. Each community and region has its own unique history and circumstances. Community members, Elders and regional governance structures are critical partners and an essential source of knowledge and authority on the needs, opportunities, priorities and aspirations of their communities.

Evidence, Evaluation and Accountability – All policies and programs should be developed on evidence-based principles, be rigorously evaluated, and have clear accountabilities based on acknowledged roles and responsibilities. Governments and communities should have a shared understanding of evidence, evaluation and accountability.

Targeted investment – Government investments should contribute to achieving the Closing the Gap targets through strategic prioritisation of efforts based on rigorous evaluation and input from Aboriginal and Torres Strait Islander communities, especially as it relates to policy formation, outcomes and service commissioning.

Integrated Systems – There should be collaboration between and within Governments, communities and other stakeholders in a given place to effectively coordinate efforts, supported by improvements in transparency and accountability.

WHERE WE HAVE COME FROM – TEN YEARS OF CLOSING THE GAP

In 2008, COAG agreed to the NIRA to implement the Closing the Gap agenda. In signing the agreement, governments acknowledged that a concerted national effort was needed to address Aboriginal and Torres Strait Islander disadvantage in key areas.

At the time, Closing the Gap was the most ambitious commitment ever made by governments to improve outcomes for Aboriginal and Torres Strait Islander peoples. However, the agreement was negotiated with little to no input from Aboriginal and Torres Strait Islander peoples, and without an adequate understanding of the mechanisms and timeframes needed to deliver lasting change. It also perpetuated a deficit-based view that framed Aboriginal and Torres Strait Islander policy as a series of responses to disadvantage and inequality, and under-emphasised the strength and agency of Aboriginal and Torres Strait Islander peoples.

While some progress has been made to improve outcomes for Aboriginal and Torres Strait Islander peoples with respect to life expectancy, child mortality, educational achievement, employment and early childhood education, only three of the seven current targets were on track at the agreement’s ten-year anniversary in 2018. There is a shared view among Aboriginal and Torres Strait Islander peoples, the broader Australian community and Australian governments that we must do better.

PUBLIC ENGAGEMENT

Public engagement on the Refresh has been led by the Commonwealth at the national level, and by states and territories at the local and regional levels.

COAG Public Discussion Paper and Consultation Website:

In December 2017 the COAG public discussion paper and Closing the Gap Refresh consultation website were launched, with the website open for feedback and submissions from the public until the end of April

  1. Feedback from the website, including over 170 major submissions, was collated and used to inform the technical workshop process and COAG’s consideration of target areas for the next phase of the agenda.

Special Gathering of Prominent Aboriginal and Torres Strait Islander Australians:

In February 2018, COAG leaders agreed that the priority areas identified in the statement of the Special Gathering would form the basis for remaining community consultations on the Refresh. The Special Gathering priority areas were tested in the national roundtables and other engagement processes led by the Commonwealth from February 2018 and have been strongly supported by stakeholders.

Consultations: The Commonwealth held 18 national roundtables in state capitals and regional centres across the country, ending with a national peaks workshop in Canberra in April. Roundtables sought feedback from participants on the priorities identified in the Special Gathering statement. Over 1,000 people were directly engaged through the meetings and roundtables hosted by the Commonwealth in this first phase of public engagement.

In May and June 2018 the Commonwealth hosted a series of technical workshops to develop potential targets and indicators for the refreshed agenda. The workshops brought together academics, business and Aboriginal and Torres Strait Islander community experts and data custodians with Commonwealth and state officials in a co-design process structured around the Special Gathering priority areas. The first technical workshop in May was attended by officials from all jurisdictions and over 70 subject matter experts, including representatives from Aboriginal and Torres Strait Islander organisations and communities, academics and practitioners. A similar number attended the second technical workshop in June, which had a stronger emphasis on data issues and technical design.

A second series of national roundtables were conducted to test the analysis arising from the initial consultations, submissions and technical workshops. This phase of consultation sought to return to stakeholders who had previously been engaged in the process or lodged submissions to the public consultation website, including members of the Redfern Alliance, national peak bodies, national service providers, and other individuals and organisations. The outcomes of this phase of consultations were fed into discussions between governments in the lead up to the COAG meeting in December 2018.

States and territories held consultations over the same period to ensure views from across the country were heard and incorporated into the Refresh.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh

National Aboriginal Community Controlled Health Organisation (NACCHO) and peak bodies welcome #COAG announcement to a formal partnership approach to the #ClosingtheGap Refresh #RefreshtheCTGRefresh

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

We are pleased that the Prime Minister and COAG have finally recognised that Aboriginal and Torres Strait Islander people must play an integral part in the making of the decisions that affect their lives – and it’s the only way forward to closing the gap.”

NACCHO Chief Executive Officer Pat Turner AM see COAG full communique Part 1 below

Pictures above and below taken in PM office last Thursday 6 December meeting the peaks

Download full COAG communique HERE

COAG Communique 5 Pages 12 December

The National Aboriginal Community Controlled Health Organisation (NACCHO) has today welcomed COAG’s announcement to a formal partnership approach to the Closing the Gap Refresh.

Following the tireless campaigning from NACCHO and other Aboriginal and Torres Strait Islander peak bodies across Australia, Prime Minister Scott Morrison last week agreed to a full partnership approach between Indigenous people and governments to agree the Closing the Gap framework and targets and to put it to COAG for their consideration.

Before the Aboriginal and Torres Strait Islander peak bodies intervened, COAG was due to settle a new Closing the Gap framework and targets without the full involvement and agreement of Aboriginal and Torres Strait Islander people through their representatives.

The details of formal partnership between COAG and Aboriginal and Torres Strait Islander peoples will be settled in February 2019. It will include a Ministerial Council on Closing the Gap with expanded membership to include representation from COAG and Aboriginal and Torres Strait Islander peoples through their peak bodies.

Part 1 Closing the Gap COAG Communique

Press Conference at close of COAG today

COAG is listening to Aboriginal and Torres Strait Islander peoples, communities and their peak and governing bodies. Leaders are committed to ensuring that the finalisation of targets and implementation of the Closing the Gap framework occurs through a genuine, formal partnership between the Commonwealth, state and territory governments and Aboriginal and Torres Strait Islander people through their representatives.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation is the preferred pathway to productive and effective outcomes. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

Today, COAG issued a statement outlining a strengths based framework, which prioritises intergenerational change and the aspirations and priorities of Aboriginal and Torres Strait Islander peoples across all Australian communities.

The finalisation of this framework and associated draft targets will be agreed through a formal partnership.

Governments and Aboriginal and Torres Strait Islander representatives will share ownership of, and responsibility for, a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda. This will include an Aboriginal and Torres Strait Islander-led three yearly comprehensive evaluation of the framework and progress.

The arrangements of the formal partnership between COAG and Aboriginal and Torres Strait Islander representation will be settled by the end of February 2019, and will include a Ministerial Council on Closing the Gap, with Ministers nominated by jurisdictions and representation from Aboriginal and Torres Strait Islander peoples.

The framework and draft targets will be finalised through this Council by mid-2019, ahead of endorsement by COAG. A review of the National Indigenous Reform Agreement will be informed by the framework.

Joint Select Committee on Constitutional Recognition

COAG acknowledged the release of the Report of the Joint Select Committee on Constitutional Recognition and endorsed the concept of co-design recommended by the Committee.  COAG looks forward to discussing the work on co-design at its next meeting.

 

NACCHO Aboriginal Health #SocialDeterminants #refreshtheCTGRefresh @KenWyattMP announces 4 year$18.6 million evaluation into Aboriginal and Torres Strait Islander primary healthcare : Designed for faster progress in #Closingthegap in health equality.

” A top priority has been placed on ensuring local communities that are involved in receiving and providing primary healthcare have a strong voice throughout the process,’

Federal Minister for Indigenous Health Ken Wyatt

From Dr Evelyn Lewin RACGP NewsGP 

A four-year $18.6 million evaluation into Aboriginal and Torres Strait Islander primary healthcare aims to produce sustained improvements in service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples.

A main focus of the Federal Government program will be considering how Commonwealth investment in the Indigenous Australians’ Health Programme (IAHP) links with the broader health system.

This is designed to help improve healthcare access and drive faster progress in closing the gap in health equality.

With $3.6 billion being invested in the IAHP across four years (2018–19 to 2021–22), this evaluation will help maximise the value and impact of health funding and guide program design.

The evaluation also aims to learn how well the primary healthcare system is working for Aboriginal and Torres Strait Islander peoples, demonstrate the difference the IAHP makes, and inform efforts to accelerate improvement in health and wellbeing for Aboriginal and Torres Strait Islander peoples.

The evaluation will establish up to 20 location-based studies to collect information from various Aboriginal and Torres Strait Islander health services around the country.

‘The project is another important step in assessing the impact on First Peoples’ health from the provision of effective, high-quality, culturally appropriate healthcare,’ Minister Wyatt said.

According to a report by the Australian Institute of Health and Welfare’s (AIHW), The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015, 3% of the Australian population (just over 760,000 people) are Aboriginal or Torres Strait Islander peoples.

The report states that one in four (24%) of Aboriginal and Torres Strait Islander peoples aged 15 and over assessed their health as ‘fair or poor’ in 2012–13, making them 2.1 times as likely as non-Indigenous Australians to report such results.

The AIHW report also noted that 39% of the gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians health outcomes can be explained by social determinants

NACCHO Aboriginal Health we need to #refreshtheCTGRefresh to #closethegap : At COAG on December 12 : Which states and territories will support a formal partnership with Aboriginal and Torres Strait Islander peoples ?

“ We understand that at this stage it is intended that new Closing the Gap targets will be settled at COAG’s December meeting,

We are calling on COAG to hold off doing this and instead put in place a proper partnership mechanism with us. The new targets haven’t been published and Indigenous peaks are uncertain what the targets will be and therefore we cannot provide our support.

NACCHO and the peak bodies engaged with the process, took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year. But we can’t see how our input has been taken into account,

As a first step we propose a meeting with COAG representatives and the peak bodies to discuss a way forward that includes a genuine partnership approach.

Aboriginal people need to be at the centre of the Closing the Gap Refresh policy; the gap won’t close without our full engagement and involvement.

Having Aboriginal people involved in the design of the Refresh and proposed revised targets will lead to Aboriginal people taking greater responsibility for the outcomes. It’s been proven that Aboriginal community control is vital and delivers better outcomes for our people.” 

NACCHO Chief Executive Pat Turner AM see interview Part 3 below 

Download the NACCHO Press Release Here

NACCHO media release Refresh The CTG Refresh

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal peak bodies across Australia have written to COAG First Ministers seeking a full partnership approach between Indigenous people and governments in refreshing the Closing the Gap Strategy, scheduled to be put to COAG for consideration in Adelaide on 12 December.

The letter, signed by 13 peak bodies, proposes an urgent meeting of Aboriginal and Torres Strait Islander peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed Closing the Gap strategy.

It’s the second letter the group has written to COAG after failing to receive a response to their initial letter in early October from any government except the Northern Territory.

Part 2 Letter to Council of Australian Government First Ministers

Dear Council of Australian Government First Ministers 16/11/2018

We write again, further to our letter of 4 October 2018, concerning the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG), to seek a formal partnership mechanism between Aboriginal and Torres Strait Islander peoples and governments in the Closing the Gap Refresh policy. We have only received a response from the Northern Territory Government.

As stated in our original letter, all of us believe it is essential that agreement is reached on the Closing the Gap Refresh policy between Indigenous organisations, on behalf of communities across Australia and Australian governments. What we propose is entirely consistent with the commitment made by COAG to set a new relationship with our communities based on a partnership.

If governments alone, continue to make decisions about the Closing the Gap, without an opportunity for us to be at the table, it will not be possible to advocate with any confidence or motivate our communities to support Closing the Gap and to take joint responsibility with governments for achieving the targets.

 

Pictures above and below from our #refreshtheCTGRefresh Campaign

The evidence is strong that when Indigenous people are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. We are certain that Indigenous peoples need to be at the centre of the Closing the Gap Refresh policy: the gap won’t close without our full involvement and COAG First Ministers, who are responsible for the Closing the Gap framework, cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

We have proposed a reasonable way forward to Australian Governments in our original letter without making it public to give everyone a reasonable opportunity to consider it. However, we understand that it is the intention of Australian Governments to still settle on targets at the forthcoming meeting of COAG on 12 December 2018.

We also understand that implementation arrangements are to be left over for COAG to agree in 2019. We make the points that neither ourselves nor anyone else outside government have seen the proposed targets which we think is way short of being partners and transparent and we cannot see how the targets can be agreed without considering at the same time how they are to be achieved.

 

We assume that Australian Governments will justify agreeing to targets by referring to the consultations earlier this year. Those consultations were demonstrably inadequate. They were conducted at a very superficial level without an opportunity for Indigenous interests to be prepared for the workshops held across Australia.

They were based on a discussion paper produced by the Department of the Prime Minister and Cabinet in December 2017 and which stated that only one of the seven targets was on track which two months later was contradicted by the former Prime Minister who said that three targets were on track. Critical elements of the original Closing the Gap framework, particularly COAG’s National Indigenous Reform Agreement, were not referred to at all in the consultations and the focus was on new targets instead of how we could make sure that this time around they were achieved.

There was no independent report prepared on the outcomes of the consultations and there is no way of telling if what was said in the consultations is reflected in the proposed Refresh policy including the targets.

The consultations started far too late which has left us with 4 targets having expired in June 2018. We do not accept that we have been properly consulted let alone given the opportunity to negotiate a mechanism that allows a proper partnership to be put in place in relation to the design, delivery and monitoring of Closing the Gap.

 

There is a now a significant opportunity to put this disappointing process back on track and in particular to establish a robust Closing the Gap framework founded on a genuine partnership between Indigenous people and governments.

It is open to governments on 12 December 2018, to endorse a partnership approach and establish a mechanism to initiate negotiations between representatives of COAG and Peak organisations with a view to developing a genuine partnership as part of the Closing the Gap Refresh. This would be endorsed by the Peak Organisations across Australia.

Subject to COAG endorsing a partnership approach, we propose a meeting of Aboriginal and Torres Strait Islander Peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed closing the gap strategy.

We stand ready to do this quickly and would work with COAG on having a partnership framework in place in early 2019 with a revised approach agreed by the middle of the year.

Ms Pat Turner AM, the CEO of the National Aboriginal Community Controlled Health Organisation, is our contact for the purpose of responding to this vital matter and we ask that you contact her.

We look forward to working with you on the Closing the Gap Refresh through an established partnership mechanism.

Yours sincerely,

 

Part 3 Going backwards’: Aboriginal bodies take aim at Closing the Gap

Aboriginal peak organisations have slammed federal, state and territory governments for failing to give Indigenous leaders an effective role in re-energising the faltering Closing the Gap process.

In a letter written jointly to Prime Minister Scott Morrison, chief ministers and premiers, the leaders of the 13 peak bodies say they have been shut out of meaningful consultation about refreshed targets to overcome Aboriginal disadvantage.

By Deborah Snow SMH 19 November

Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said "it's all gone backwards".
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said “it’s all gone backwards”. CREDIT:GLENN CAMPBELL

And they want the Coalition of Australian Governments – due to consider an update to Closing the Gap next month – to defer setting new targets until a fresh pact is hammered out giving “full partnership” to Aboriginal bodies.

“I think it’s all gone backwards,” the chief executive of the National Aboriginal Community Controlled Health Organisation (NACCHO), Pat Turner,  told the Herald.

“In the last few years, governments seem to have dropped the ball a lot. I hope they are giving serious consideration to our letter. They can’t go on having two bob each-way. They are there to lead and they have to have a bit of backbone. [The state of] Aboriginal affairs is a national shame, it is something that they should be wanting to get fixed.”

Ms Turner said only one government – the Northern Territory – had bothered replying to the group when they first wrote a letter a month ago seeking better consultation over new targets and implementation strategies.

“NACCHO and the peak [Indigenous] bodies engaged with the process took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year” she said. “But we can’t see how our input has been taken into account.”

The peak bodies decided on Sunday to release a second letter they wrote to all governments at the end of last week.

The letter says the “disappointing” Closing the Gap process has to be put “back on track” with Indigenous people taking part in the design and delivery of services on the basis of “genuine partnership”.

“As a first step we propose a meeting with COAG representatives and the peak bodies to discuss [such an] approach” Ms Turner said.

The Herald sought a response from Aboriginal Affairs minister Nigel Scullion but was unable to contact his office on Sunday.

Closing the Gap was first conceived of a decade ago as a way to measure Aboriginal disadvantage and set clear targets to redress it.

Earlier this year a report from the Department of Prime Minister and Cabinet said three of seven targets were “on track”: to halve the gap in year 12 attainment and halve the gap in child mortality by 2018, and to have 95 per cent of Indigenous four-year-olds enrolled in early childhood education by 2025.

However it said that other targets, including halving the gap in reading and numeracy, and halving the gap in employment, as well as closing the gap on life expectancy, were not on track.

NACCHO Aboriginal Health #refreshtheCTGRefresh : @NACCHOchair Welcomes the release of the @AMAPresident 2018 Report Card on Indigenous Health and joins its call for rebuilding the #ClosingtheGap health strategy from the ground up

It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031

But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Closing the Gap Strategy is unravelling, and must be rebuilt from the ground up to have any chance of closing the life expectancy gap between Indigenous and non-Indigenous Australians, AMA President, Dr Tony Bartone said today at the launch of the AMA report at the ATSICHS ACCHO in Brisbane : Interview with The Guardian Part 3 Below 

Download the 24 Page AMA Report 

AMA Indigenous Health Report Card 2018 (2)

Dr Tony Bartone (left ) and Ms Donnella Mills ( Second left ) on tour of ATSICHS

We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

Urgent and systematic action is needed to reverse these failures and to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy by 2031

NACCHO calls for the immediate adoption of the Report Card’s recommendations.

We are seeking a formal partnership between Aboriginal and Torres Strait Islander peoples and governments to be included in the Closing the Gap Refresh policy , Aboriginal people need to be at the centre of Closing the Gap strategies; the gap won’t close without our full engagement and involvement.

The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up. See full NACCHO Press Release HERE 

It doesn’t mean that things aren’t improving, because health outcomes for our people are improving

The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland. see Part 3 below or in full here 

Busting the myth that Indigenous-led organisations ‘don’t deliver’

Dr Bartone today launched the AMA Indigenous Health Report Card 2018, the AMA’s annual analysis of an area of Aboriginal and Torres Strait Islander health across the nation.

This year’s Report Card scrutinises the 10-year-old Closing the Gap Strategy, and recent efforts to “refresh” the Strategy.

“It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031,” Dr Bartone said.

“But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

“The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

“The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Report Card outlines six targets to rebuild the Strategy:

  • committing to equitable, needs-based expenditure;
  • systematically costing, funding, and implementing the Closing the Gap health and mental health plans;
  • identifying and filling primary health care service gaps;
  • addressing environmental health and housing;
  • addressing the social determinants of health inequality; and
  • placing Aboriginal health in Aboriginal hands.

“It is time to address the myth that it is some form of special treatment to provide additional health funding to address additional health needs in the Aboriginal and Torres Strait Islander population,” Dr Bartone said.

“Government spend proportionally more on the health of older Australians when compared to young Australians, simply because elderly people’s health needs are proportionally greater.

“The same principle should be applied when assessing what equitable Indigenous health spending is, relative to non-Indigenous health expenditure.

“The Australian Institute of Health and Welfare estimates that the Aboriginal and Torres Strait Islander burden of disease is 2.3 times greater than the non-Indigenous burden, meaning that the Indigenous population has 2.3 times the health needs of the non-Indigenous population.

“This means that for every $1 spent on health care for a non-Indigenous person, $2.30 should be spent on care for an Indigenous person.

“But this is not the case. For every $1 spent by the Commonwealth on primary health care, including Medicare, for a non-Indigenous person, only 90 cents is spent on an Indigenous person – a 61 per cent shortfall.

“For the Pharmaceutical Benefits Scheme, the gap is even greater – 63 cents for every dollar, or a 73 per cent shortfall from the equitable spend.

“Spending less per capita on those with worse health, and particularly on their primary health care services, is dysfunctional national policy. It leads to us spending six times more on hospital care for Indigenous Australians than we do on prevention-oriented care from GPs and other doctors.

“We will not close the gap until we provide equitable levels of health funding. We need our political leaders and commentators to tackle the irresponsible equating of equitable expenditure with ‘special treatment’ that has hindered efforts to secure the level of funding needed to close the health and life expectancy gap.”

AMA Media Coverage 

The AMA 2018 Indigenous Health Report Card is at https://ama.com.au/article/2018-ama-report-card-indigenous-health-rebuilding-closing-gap-health-strategy-and-review

Part 2 : The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up.

Download the full NACCHO Press Release HERE

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Ms Donnella Mills said, “We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

The AMA estimate that the Commonwealth government spend on Aboriginal and Torres Strait Islander health is only 53% of needs-based requirements. Aboriginal and Torres Strait Islander peoples have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

“This underspend represents a significant failure” Ms Mills said. “Genuine commitment by Australian governments to Closing the Gap requires equitable funding.”

The funding shortfall is particularly important for primary health care services where big gains could be made in improving health, keeping people out of hospital and preventing premature deaths. Funding for Aboriginal Community Controlled Health Services, which deliver accessible, culturally safe, comprehensive primary health care across Australia, is not keeping up with need.

Alongside the increased funding for Aboriginal Community Controlled Health Service there is an urgent need for government to address the environmental health, housing and other social determinants of health inequality.

NACCHO, its Affiliates and members will continue to work with the AMA to urge the adoption of the Report Card’s recommendations by Australian governments.

Part 3 Busting the myth that Indigenous-led organisations ‘don’t deliver’

From NITV

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland.

He urged governments to place more trust in Indigenous-led organisations to deliver services.

“This country’s still got a crisis in terms of its relationship with the First People,” Mr Carson told NITV News.

“The narrative’s a negative one, it’s always deficit-based, but we turn around and look at what parts of our sector are doing… we’re actually coming up with improved health outcomes within our community – they’re actually solutions that could benefit the whole country.

So this whole idea that somehow our communities can’t be trusted, or that we don’t have the capacity to deliver, is a myth.”

Mr Carson said while he welcomed the AMA’s report, it was important to take a proactive approach rather than dwelling on negative statistics.

“It doesn’t mean that things aren’t improving, because health outcomes for our people are improving,” he said.

“The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

“So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Part 4 The Guardian Interview

The Australian Medical Association says the Closing the Gap strategy has “all but unravelled” and insists that the policy needs to be rebuilt from the ground up, starting with boosting health expenditure on Indigenous Australians and putting Aboriginal healthcare in Aboriginal hands.

A refresh of the program is expected to be considered at the December meeting of the Council of Australian Governments, but the AMA president, Tony Bartone, says Closing the Gap needs root-and-branch reform, not changes “without adequate funding and commitment from all governments to a national approach”.

Read in full 

 

 

NACCHO Aboriginal Health and #refreshtheCTGRefresh Campaign : 13 peak Aboriginal and Torres Strait Islander bodies propose meeting  with COAG reps to determine a framework for reaching agreement on a refreshed #ClosingtheGap strategy

We understand that at this stage it is intended that new Closing the Gap targets will be settled at COAG’s December meeting,

We are calling on COAG to hold off doing this and instead put in place a proper partnership mechanism with us. The new targets haven’t been published and Indigenous peaks are uncertain what the targets will be and therefore we cannot provide our support.

NACCHO and the peak bodies engaged with the process, took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year. But we can’t see how our input has been taken into account,

As a first step we propose a meeting with COAG representatives and the peak bodies to discuss a way forward that includes a genuine partnership approach.

Aboriginal people need to be at the centre of the Closing the Gap Refresh policy; the gap won’t close without our full engagement and involvement.

Having Aboriginal people involved in the design of the Refresh and proposed revised targets will lead to Aboriginal people taking greater responsibility for the outcomes. It’s been proven that Aboriginal community control is vital and delivers better outcomes for our people.” 

NACCHO Chief Executive Pat Turner AM see interview Part 3 below 

Download the NACCHO Press Release Here

NACCHO media release Refresh The CTG Refresh

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal peak bodies across Australia have written to COAG First Ministers seeking a full partnership approach between Indigenous people and governments in refreshing the Closing the Gap Strategy, scheduled to be put to COAG for consideration in Adelaide on 12 December.

The letter, signed by 13 peak bodies, proposes an urgent meeting of Aboriginal and Torres Strait Islander peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed Closing the Gap strategy.

It’s the second letter the group has written to COAG after failing to receive a response to their initial letter in early October from any government except the Northern Territory.

Part 2 Letter to Council of Australian Government First Ministers

Dear Council of Australian Government First Ministers 16/11/2018

We write again, further to our letter of 4 October 2018, concerning the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG), to seek a formal partnership mechanism between Aboriginal and Torres Strait Islander peoples and governments in the Closing the Gap Refresh policy. We have only received a response from the Northern Territory Government.

As stated in our original letter, all of us believe it is essential that agreement is reached on the Closing the Gap Refresh policy between Indigenous organisations, on behalf of communities across Australia and Australian governments. What we propose is entirely consistent with the commitment made by COAG to set a new relationship with our communities based on a partnership.

If governments alone, continue to make decisions about the Closing the Gap, without an opportunity for us to be at the table, it will not be possible to advocate with any confidence or motivate our communities to support Closing the Gap and to take joint responsibility with governments for achieving the targets.

Pictures above and below from our #refreshtheCTGRefresh Campaign

The evidence is strong that when Indigenous people are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. We are certain that Indigenous peoples need to be at the centre of the Closing the Gap Refresh policy: the gap won’t close without our full involvement and COAG First Ministers, who are responsible for the Closing the Gap framework, cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

We have proposed a reasonable way forward to Australian Governments in our original letter without making it public to give everyone a reasonable opportunity to consider it. However, we understand that it is the intention of Australian Governments to still settle on targets at the forthcoming meeting of COAG on 12 December 2018.

We also understand that implementation arrangements are to be left over for COAG to agree in 2019. We make the points that neither ourselves nor anyone else outside government have seen the proposed targets which we think is way short of being partners and transparent and we cannot see how the targets can be agreed without considering at the same time how they are to be achieved.

We assume that Australian Governments will justify agreeing to targets by referring to the consultations earlier this year. Those consultations were demonstrably inadequate. They were conducted at a very superficial level without an opportunity for Indigenous interests to be prepared for the workshops held across Australia.

They were based on a discussion paper produced by the Department of the Prime Minister and Cabinet in December 2017 and which stated that only one of the seven targets was on track which two months later was contradicted by the former Prime Minister who said that three targets were on track. Critical elements of the original Closing the Gap framework, particularly COAG’s National Indigenous Reform Agreement, were not referred to at all in the consultations and the focus was on new targets instead of how we could make sure that this time around they were achieved.

There was no independent report prepared on the outcomes of the consultations and there is no way of telling if what was said in the consultations is reflected in the proposed Refresh policy including the targets.

The consultations started far too late which has left us with 4 targets having expired in June 2018. We do not accept that we have been properly consulted let alone given the opportunity to negotiate a mechanism that allows a proper partnership to be put in place in relation to the design, delivery and monitoring of Closing the Gap.

There is a now a significant opportunity to put this disappointing process back on track and in particular to establish a robust Closing the Gap framework founded on a genuine partnership between Indigenous people and governments.

It is open to governments on 12 December 2018, to endorse a partnership approach and establish a mechanism to initiate negotiations between representatives of COAG and Peak organisations with a view to developing a genuine partnership as part of the Closing the Gap Refresh. This would be endorsed by the Peak Organisations across Australia.

Subject to COAG endorsing a partnership approach, we propose a meeting of Aboriginal and Torres Strait Islander Peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed closing the gap strategy.

We stand ready to do this quickly and would work with COAG on having a partnership framework in place in early 2019 with a revised approach agreed by the middle of the year.

Ms Pat Turner AM, the CEO of the National Aboriginal Community Controlled Health Organisation, is our contact for the purpose of responding to this vital matter and we ask that you contact her.

We look forward to working with you on the Closing the Gap Refresh through an established partnership mechanism.

Yours sincerely,

 

Part 3 Going backwards’: Aboriginal bodies take aim at Closing the Gap

Aboriginal peak organisations have slammed federal, state and territory governments for failing to give Indigenous leaders an effective role in re-energising the faltering Closing the Gap process.

In a letter written jointly to Prime Minister Scott Morrison, chief ministers and premiers, the leaders of the 13 peak bodies say they have been shut out of meaningful consultation about refreshed targets to overcome Aboriginal disadvantage.

By Deborah Snow SMH 19 November

Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said "it's all gone backwards".
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said “it’s all gone backwards”. CREDIT:GLENN CAMPBELL

And they want the Coalition of Australian Governments – due to consider an update to Closing the Gap next month – to defer setting new targets until a fresh pact is hammered out giving “full partnership” to Aboriginal bodies.

“I think it’s all gone backwards,” the chief executive of the National Aboriginal Community Controlled Health Organisation (NACCHO), Pat Turner,  told the Herald.

“In the last few years, governments seem to have dropped the ball a lot. I hope they are giving serious consideration to our letter. They can’t go on having two bob each-way. They are there to lead and they have to have a bit of backbone. [The state of] Aboriginal affairs is a national shame, it is something that they should be wanting to get fixed.”

Ms Turner said only one government – the Northern Territory – had bothered replying to the group when they first wrote a letter a month ago seeking better consultation over new targets and implementation strategies.

“NACCHO and the peak [Indigenous] bodies engaged with the process took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year” she said. “But we can’t see how our input has been taken into account.”

The peak bodies decided on Sunday to release a second letter they wrote to all governments at the end of last week.

The letter says the “disappointing” Closing the Gap process has to be put “back on track” with Indigenous people taking part in the design and delivery of services on the basis of “genuine partnership”.

“As a first step we propose a meeting with COAG representatives and the peak bodies to discuss [such an] approach” Ms Turner said.

The Herald sought a response from Aboriginal Affairs minister Nigel Scullion but was unable to contact his office on Sunday.

Closing the Gap was first conceived of a decade ago as a way to measure Aboriginal disadvantage and set clear targets to redress it.

Earlier this year a report from the Department of Prime Minister and Cabinet said three of seven targets were “on track”: to halve the gap in year 12 attainment and halve the gap in child mortality by 2018, and to have 95 per cent of Indigenous four-year-olds enrolled in early childhood education by 2025.

However it said that other targets, including halving the gap in reading and numeracy, and halving the gap in employment, as well as closing the gap on life expectancy, were not on track.

 

 

 

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.

Sources: