NACCHO Aboriginal Health and the #UluruStatement promoted during #NRW18 and @TheLongWalkOz Thanks to @AMAPresident @EssendonFC @VAHS1972 @quitvic @DeadlyChoices

” What you (Victorian Premier Daniel Andrews ) said about Aboriginal and Torres Strait Islander advancement being led by Aboriginal and Torres Strait Islander people is absolutely right,

The great Australian Chris Sarra said very wisely … governments have got to stop doing things to Aboriginal people and start doing things with them and that is my commitment.”

Prime Minister Malcolm Turnbull has told a Reconciliation event The Long Walk he is committed to following the lead of Indigenous people, less than a year after rejecting their call for an enshrined voice in parliament.

After Premier Daniel Andrews spoke of his government’s efforts to create a state Treaty at the Long Walk event at Melbourne’s Federation Square, Mr Turnbull said the two leaders were “starting to agree on more things all the time”.

During a summit at Uluru in May 2017, Indigenous leaders rejected symbolic constitutional recognition in favour of an elected parliamentary advisory body and a treaty.

But in October, Mr Turnbull said a new representative body was not desirable or capable of winning acceptance at a referendum

NACCHO Aboriginal Health #treaty : #Uluru Summit calls for the establishment of a First Nations Voice enshrined in the Constitution

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart: It was a fairly clear-cut decision for us to make.

We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population.

And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. “

The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer . See full interview and AMA press release Part 1 and 2 below

 

 ” Politicians, footballers and campaigners have joined thousands of Australians in the Long Walk event to support moves to improve Indigenous health and celebrate Aboriginal and Torres Strait Islander culture.

It has been 14 years since AFL champion Michael Long’s momentous journey from his home in Melbourne to the Prime Minister to get the lives of Aboriginal and Torres Strait Islander people back on the national agenda.

Indigenous health is focal point of this year’s walk, with the Victorian Aboriginal Health Service Australian Medical Association (AMA) and Quit Victoria both throwing their support behind the event.

Ill health forced Essendon great Michael Long to miss this year’s Long Walk.

Part 1 : Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart

The AMA Federal Council has endorsed the Uluru Statement from the Heart, which calls for a First Nations’ voice in the Australian Constitution.

AMA President, Dr Tony Bartone, said today that the AMA has for many years supported Indigenous recognition in the Australian Constitution, and that the Uluru Statement is another significant step in making that recognition a reality.

“The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people in regard to self-determination and status in their own country,” Dr Bartone said.

“The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

“Closing the gap in health services and outcomes requires a multi-faceted approach.

“Cooperation and unity of purpose from all Australian governments is needed if we are to achieve meaningful and lasting improvements.

“This will involve addressing the social determinants of health – the conditions in which people are born, grow, live, work, and age.

“Constitutional recognition can underpin all these endeavours, as we work to improve the physical and mental health of Indigenous Australians.”

Dr Bartone said the AMA was proud to announce its endorsement of the Uluru Statement during National Reconciliation Week.

Part 2 :The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer

ELIZABETH JACKSON: Within the next couple of years, your local doctor’s surgery could be adorned with posters supporting Indigenous Constitutional change. The highly influential

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart. The peak body says including Aboriginal and Torres Strait Islander people in the nation’s founding document could help make Indigenous patients healthier. The AMA’s President Tony Bartone has told our political reporter Dan Conifer the organisation is unequivocal in its support.

TONY BARTONE: It was a fairly clear-cut decision for us to make. We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population. And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

DAN CONIFER: Can you just explain for us how something like the Uluru Statement from the Heart, and the changes that it calls for, would support health outcomes, would improve life expectancy and so on?

TONY BARTONE: They’re fairly fundamental aspirations that are part of the Uluru Statement, and those aspirations and recognitions really speak to a number of emotional, physical, and broader social, environmental issues that really will address, as we say, the social determinants of health. We can’t really seek to close the gap when it comes to health outcomes until we address the fundamental building blocks.

DAN CONIFER: Now, one of the key elements of the Uluru Statement is about involving Aboriginal and Torres Strait Islander Australians in decision-making processes. In the medical profession, how has involving Indigenous Australians driven improvements?

TONY BARTONE: The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. Put another way, it recognises the inherent qualities and behavioural patterns of our Indigenous population, and that is different from a traditional Western-type setting which we’ve become experienced with.

DAN CONIFER: And if a referendum were to be held on any of the elements of the Uluru Statement, how would the AMA, individual doctors and specialists around the country, take part or be involved in that campaign?

TONY BARTONE: We would use all avenues open to us, both in terms of our advocacy and communication with our members, to ensure that the information and the sharing of that information, in terms of the wider community, patients who come to our surgery, the access points that we do have, are used to the fullest in terms of ensuring a proper address of the Statement’s initiatives.

DAN CONIFER: So we could see Vote Yes posters or pamphlets or badges in GP surgeries when this, or if this comes to a vote?

TONY BARTONE: What we’d see is the Association taking a front foot in our communication and advocacy on behalf of members. Of course, each individual member is free and would be wanting to participate to perhaps even a fuller extent, which would lead to putting up of posters and sharing that material in a surgery environment. But we would take a front foot more at an Association level to ensure that we communicate with our stakeholders, with our leaders in Parliament, and with the community in general through our media connectivity to communicate that wish and desire.

Part 3 The Long Walk ,VAHS and Quit Victoria promotes Indigenous health

Smoking rates among Aboriginal and Torres Strait Islander people are almost three times the national average of non-Indigenous people, although the prevalence in Indigenous communities is falling steadily.

In Victoria, 41 per cent of the Aboriginal and Torres Strait Islander population are smokers.

Quit Victoria’s Aboriginal Tobacco Control Program Coordinator Jethro Pumirri Calma-Holt told SBS News the health of Indigenous Australians should be kept at the top of the agenda.

“Indigenous health is something that needs to be invested in by everyone and that’s part of national reconciliation week.”

“What Michael Long did all those years ago has created a really big legacy for everyone to follow in his footsteps,” he said

Check it out the legend himself Anthony McDonald-Tipungwuti wearing the VAHS Deadly Choices Shirt out during the warm up for Dream Time at the G. The other players also wore the shirts as well… What a moment !

If you want your very own VAHS Deadly Choices Shirt just like Tippa the only way you can get one is to complete a health check at VAHS. So call us and book your health check on 03 9419 3000

 

 

 

NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 

 ” It is unacceptable that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting Aboriginal and Torres Strait Islander people, who comprise just three per cent of the population. Funding for Aboriginal and Torres Strait Islander Health is inadequate to meet the burden of illness.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health ”

Extract from

AMA Budget Submission 2018-19

AMA President, Dr Michael Gannon, said today that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Releasing the AMA’s Pre-Budget Submission 2018-19, Dr Gannon said the key for the Government is to look at all health policies as investments in a healthier and more productive population.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.

“There is now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner … or vote loser.

“Our Submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make,” Dr Gannon said.

The AMA Pre-Budget Submission 2018-19 covers:

·         General Practice and Primary Care;

·         Public Hospitals;

·         Private Health Insurance;

·         Medicare Benefits Schedule (MBS) Review;

·         Preventive Health;

·         Diagnostic Imaging;

·         Pathology;

·         Mental Health and the NDIS;

·         Medical Care for Older Australians;

·         My Health Record;

·         Rural Health;

·         Indigenous Health;

·         Medical Workforce;

·         Climate Change and Health; and

·         Veterans’ Health.

 The AMA Pre-Budget Submission 2018-19 is at https://ama.com.au/ama-pre-budget-submission

This Submission was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

Part 2 The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite a decade of commitments to closing the gap.

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

The AMA values the progress being made in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. But if the Government is serious about building on this early but slow progress, it must create sustainable, long-term improvements by increasing funding and resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people. It must also increase and properly resource the health workforce.

Many of the chronic health conditions experienced by Aboriginal and Torres Strait Islander people should not be endemic in a highly-developed country like Australia. Chronic diseases are known to be the main cause of the life expectancy gap between Indigenous and non- Indigenous Australians.

Despite some recent health gains for Aboriginal and Torres Strait Islander people, awareness and political will is frustratingly slow-moving. There is an urgent need for the Commonwealth to deliver on the well-documented research and national strategies showing how to tackle health inequalities and the social determinants of health.

Closing the gap in health outcomes means addressing: poverty; unhygienic, overcrowded conditions; poor food security and access to potable drinking water; lack of transport; and an absence of health services.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health.

AMA POSITION

The AMA calls on the Government to:

• prioritise Indigenous health funding in the 2018-19 Budget and fund Aboriginal and Torres Strait Islander health services according to need;

• support measures to increase the uptake of MBS and PBS items;

• fund and implement the National Aboriginal and Torres Strait Islander Health Plan;

• adopt the recommendations in the AMA’s Report Cards on Indigenous Health, in particular the recommendations in the 2016 Report Card calling for a target to eradicate new cases of Rheumatic Heart Disease (RHD); and the recommendations in the 2017 Report Card to address ear health (otitis media);

• given the strong link between health and incarceration, support the justice reinvestment approach to health by appropriately funding services that divert Aboriginal and Torres Strait Islander people from prison;

• commit to the principles of the Redfern Statement, which calls on all political parties to make Aboriginal and Torres Strait Islander affairs a key election priority;

• meaningfully address the disadvantage experienced by Aboriginal and Torres Strait Islander people by reversing cuts to the Indigenous Affairs portfolio;

• reinvest in health, justice, early childhood, and disability services, as well as services to prevent violence;

• increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations to build their capacity to be sustainable over the long term;

• recognise that chronic disease in Indigenous communities is inextricably connected to the social determinants of health such as: poverty; inappropriately designed, unhygienic, overcrowded housing conditions; inadequate access to affordable food and potable water supplies; and an absence of health services;

• acknowledge the wealth of existing reports, Parliamentary inquiries, strategies, and plans to improve Indigenous health and close the gap, and start to fund and implement them; and

• fund national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce.

 

NACCHO Aboriginal Health News Alert @AMApresident speech National Press Club -Time for heavy lifting in Health

 

” Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our annual Indigenous Health Report card, which focused on Rheumatic Heart Disease.

In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure.

It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

RHD is perhaps the classic example of a Social Determinant of Health.

It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

Dr Michael Gannon  : Pictured above after speaking at the National Press Club , meeting two new members of the NACCHO Communications and Digital Team Wendy Brookman and Oliver Tye

Beyond the Medicare freeze – Time for heavy lifting in Health

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

Good afternoon. It is a great honour to address the National Press Club for a second time as AMA President.

There have been many changes over the last twelve months.

There is no more talk of co-payments.

The cuts to pathology and diagnostic imaging bulk billing incentives have been reversed.

The general practice pathology rents issue has, for the most part, been resolved.

The Medicare freeze has a ‘use by date’. It can’t come soon enough.

The AMA wanted an immediate end to the freeze right across the Medicare Benefits Schedule. We did not get it.

But in 300 days’ time we will see a return to annual indexation of patient rebates to see GPs and other specialists.

The extended freeze has been a major contributor to out-of-pocket expenses when patients see doctors.

We have a new Health Minister – Greg Hunt. He has been consultative and highly engaged with the health sector. He and I speak most weeks. He is a good listener.

He genuinely wants to be across the complexities of his portfolio.

The same can be said of Shadow Minister Catherine King and Greens Leader Richard Di Natale. They get health. They know how health policy affects people’s lives.

This is why Greg Hunt has played a key role in repairing the Government’s relationship with the major stakeholders in health – with the backing of the Prime Minister.

The health policy environment is much calmer, but this does not mean that everything has been fixed. Far from it. There is plenty of heavy lifting to do.

The lifting of the freeze has raised the curtain to allow a greater focus on the other health priorities that require Government action ahead of the next election. 2

These include long-standing structural issues around public hospital funding, private health insurance, the Review of the Medicare Benefits Schedule, and the My Health Record.

The AMA’s priorities extend to Indigenous Health, medical training and workforce, the Pharmaceutical Benefits Scheme, and the many public health issues facing the Australian community – most notably tobacco, immunisation, obesity, and alcohol abuse.

I have called for the establishment of a no-fault compensation scheme for the very small number of individuals injured by vaccines.

I have called on the other States and Territories to mirror the Western Australian law, which exempts treating doctors from mandatory reporting and stops them getting help.

We also need to deal with ongoing problems in aged care, palliative care, mental health, euthanasia, and the scope of practice of other health professions.

In the past 12 months, the AMA has released statements on infant nutrition, female genital mutilation, and addiction.

In coming months, we will have more to say on cost of living, homelessness, elder abuse, and road safety, to name but a few.

Then there are the prominent highly political and social issues that have a health dimension, and require an AMA position and AMA comment.

All these things have health impacts.

As the peak health and medical advocacy group in the country, the community expects us to have a view and to make public comment. And we do.

Not everybody agrees with us. But our positions are based on evidence, in medical science, and our unique knowledge and experience of medicine and human health.

Health policy is ever-evolving. Health reform never sleeps.

I cannot and will not cover all these issues in my prepared speech today. There is not time. I will highlight a few of the most pressing.

Health Economics

As I have stated many times, health is the best investment that governments can make.

Health should never be considered just an expensive line item in a budget – it is an investment in the welfare, wellbeing, and productivity of the Australian people.

Despite constant claims to the contrary, often from governments, Australia’s health budget is not experiencing an expenditure crisis.

Commonwealth health expenditure is actually reducing as a percentage of the total Commonwealth Budget. 3

In the 2016-17 Budget, health was 15.8 per cent of the total, down from 18 per cent in 2006-07.

While health spending has reached a 10 per cent share of GDP, this is less than comparable countries.

France, Sweden, Germany, and Switzerland all spend 11 per cent.

The United States, with their managed care system of private medicine demands more than 17 per cent of GDP to provide worse health outcomes.

Our system may be the envy of many other countries, but that doesn’t mean we can’t or shouldn’t seek to improve it.

Public Hospitals

Our health system cannot improve without properly-resourced public hospitals.

The doctors, nurses, and other staff who work in them are some of the most skilled in the world.

In 2015-16, there were more than 6 million episodes of admitted patient care in Australia’s public hospitals.

Between 2011-12 and 2015-16, the number of separations rose by 3.3 per cent on average each year.

This was greater than the average growth in population over this period, which was 1.6 per cent.

In 2015-16, public hospitals managed 92 per cent of emergency admissions.

They provide services in a time of need. But they need support.

We are not meeting critical targets.

Against key measures, the performance of our hospitals is stagnant or declining.

Bed number ratios have remained static despite the celebrated opening of multiple shiny new hospitals.

Emergency Department waiting times have worsened and, in most cases, they remain well below the target set by governments to be achieved by 2012-13.

The percentage of ED patients treated in four hours has not moved over the past three years.

It is well below our target of 90 per cent. Elective surgery waiting times have worsened.

So when we talk about the need for secure, long-term, and adequate funding, we need to remember what that funding is for. 4

Only last month, it was suggested that there wasn’t enough ‘competition’ between public hospitals.

Competition? I can’t imagine the mother of a young child with suspected meningitis checking the internet at midnight to see which hospital might provide the most competitive offer.

No, that family would be rushing that child to the nearest ED.

We hear more and more about the idea of ‘docking’ funding to hospitals for what are deemed ‘avoidable readmissions’ and ‘acquired complications’.

Doctors take an oath to look after patients. They take it seriously.

They train their entire careers with the primary purpose to heal people. To make them better.

The idea that a financial disincentive, applied against the hospital, will somehow ‘encourage’ doctors to take better care of patients than they already do is ludicrous.

Unfortunately, some complications are unavoidable.

Where there are errors, or where targets are not met, these are almost always due to not having the resources, the staff, or the time.

Taking funding away from hospitals would make things worse.

We need greater certainty and an increase in funding.

We call on the Federal Government and the States and Territories to listen to doctors in the lead-up to 2018 negotiations.

The concept of a 10-year funding agreement sounds attractive. But it must not become a plan to simply lock in chronic underfunding.

Private Health

Our public hospitals would not survive without the support of our private health system.

As a private practitioner who works in the public system, I am well placed to comment on the relationship between these two pillars of our health system.

Australia’s health system relies on the dual system of public and private health. The two complement each other.

Nearly 70 per cent of elective surgery occurs in private hospitals.

We often talk about private health offering choice – choice of doctor, choice of hospital. It’s why people take out insurance policies.

We talk about private health offering shorter waiting times – it’s a major benefit of the system. 5

But we also need to talk about private health as a critical component of taking pressure off the public system.

As a forceful advocate for public hospitals and those Australians who do not have the luxury of a choice, I am therefore an advocate for private health.

However, I am concerned. Very concerned.

If we do not get reforms to private health insurance right – and soon – we may see essential parts of health care disappear from the private sector.

Doctors have a complicated relationship with private health insurance. Indeed, private health insurance itself is complicated.

There are more than 20,000 policy variations around the country.

They are littered with inconsistent terminology and a bewildering array of exclusions, caveats, carve-outs, and excesses.

There are policies out there that offer inappropriate cover.

There are cases where removal of metal is not covered. So, you have had your head caved in. A surgeon repairs the fracture and inserts a plate at midnight on a Saturday night. All covered by health insurance.

But they do not cover removal of that plate at a later date.

We have seen cases where mothers covered for pregnancy have been told their newborn baby cannot be looked after in the special care nursery.

We are calling for pregnancy cover to be included in all levels of policies, adding it to the risk equalisation pool.

It’s a natural part of life. Two thirds of pregnancies are unplanned. So let’s cover it properly, spread the cost appropriately, and make it affordable for more people.

The same applies to mental health services. Suffering anxiety, depression, or a situational crisis are all too common ‘speed bumps’ in life. They are not predictable. This is why we need insurance.

We need to put the concept of value back into private health insurance.

Market power has dramatically shifted in favour of the private health insurers.

They are deciding who can provide what treatment, and where they can provide it.

We have situations where clinical decision-making is being questioned, and overridden, in some cases, by insurers.

If this shift is allowed to flourish, it will undermine both the private and public systems. 6

Insurers are also insisting practitioners agree to the publication of their details, their fees, and allowing customer testimonials that they do not get to verify.

This is dangerous territory.

The consideration of clinical performance and the years of training to improve safety and quality cannot be captured in a customer ‘star rating system’.

Joint replacement surgery is a bit more nuanced and complicated than an Uber ride.

We note also that contracting arrangements with hospitals have ‘no pay’ clauses for adverse events.

Insurers should not interfere with the established safety and quality system that is achieved via the independent accreditation agencies.

The AMA will fight this deliberate drift towards United States style managed care – a system that performs worse than ours according to nearly every metric.

In the last decade we have seen the PHI industry move from one that was dominated by Mutual insurers, who have members, to for-profits, who have policy-holders and, of course, shareholders.

Private health insurance should serve the needs of health consumers who have paid for it.

Patients should not have health care options available to them curtailed for profits.

We see premiums rise five to six per cent every year, at the same time that people are facing increasing cost of living pressures.

It is no surprise that we see people downgrading or dropping their cover.

This has to stop. It requires careful Government action.

Doctors are not the affordability problem.

Too often we hear misguided and misinformed claims – usually from the very big, very powerful health funds – that doctors’ fees are the reason that premiums are rising. This is an appalling and deliberate lie.

As soon as a doctor charges one cent above the insurers’ scheduled fee or, where it exists, their known gap arrangement, the insurer reverts to paying only 25 per cent of the MBS scheduled fee.

That’s about $330 for a hip replacement, $170 for delivering a baby. The insurers actually save money!

In an admission to hospital that might cost $30,000, do you really think the doctor’s fee is the affordability problem in PHI?

The other argument is that doctor fees are creating out-of-pockets – and a disincentive to private health insurance. 7

But the statistics again disprove it. Doctors’ fees are only 16 per cent of insurer outlays.

Australian Prudential Regulation Authority (APRA) statistics show that 88.1 per cent of services are charged at no gap. That is, nothing to pay – zero dollars. The patient’s health insurance covers it.

A further 6.9 per cent are at a known gap of $500 or less.

Now reflect on the fact that the MBS hasn’t been indexed since 2013. Nor have the insurers indexed their payment schedules anywhere near health inflation, if at all.

APRA recently reported that insurers’ profits were up 17 per cent to $1.8 billion before tax for the 2016-17 financial year.

So governments and insurers set the underlying price for a service – and that price has largely been stagnant.

As a private practitioner, I can promise you that my insurance, my rent, my electricity, my staff wages, my supplies, are all increasing in cost.

Doctors have absorbed these costs. Just look at the combined no-gap and known-gap rate of 95 per cent.

Let’s have a look at the out-of-pockets.

The average known-gap cost for Anaesthesia is $96. So, a specialist doctor with 10 years of training and potentially 30 years of experience comes in to help out with an emergency Caesarean Section at 3.00am in the morning. Try getting your plumbing fixed for that price.

Look at the bulk billing rates in general practice. They too have held firm.

The medical profession has done its utmost best to protect patient access to affordable care.

But unless the ‘payers’ in the system start to work with us, it is simply not sustainable.

When we get instability, patients suffer. They lose access. They lose supply. They lose the quality of care they have a right to.

We will continue to participate in the Ministerial Advisory Committee.

But our patients need and deserve certainty. And so do doctors.

Medical Indemnity

An area of great concern to the medical profession has recently re-emerged.

I am talking about medical indemnity. Some of you may remember the indemnity crisis more than a decade ago. 8

The reforms and protections put in place by then Health Minister Tony Abbott are showing signs of stress.

While back in the UK recently, I saw what could happen here again without intelligent policy.

Medical indemnity in the UK is becoming unstable. The two major providers have pulled out of private Obstetrics. There is talk of pulling out of coverage in other high risk areas.

More than a decade ago, the AMA advocated tirelessly, brought together the profession, and worked with the Government to design a series of schemes that have been a resounding policy success.

They promote stability. They provide affordable insurance, which flows through to affordable care.

That has been the AMA’s strong message heading into the current review of indemnity insurance.

Thankfully, the Government has been receptive to our advice, and I am grateful to Minister Hunt for listening.

He was surprised to hear that annual premiums got as high as $126,000 a few years ago. And that’s after the support schemes’ contributions are taken into account.

We now have a review that is focussed on improving and building on the current policy success. It is not a savings exercise.

It removes a threat to a stable medical workforce.

Medical Workforce

For many Australians, access to a doctor remains a problem. People in rural Australia often find it difficult to access care in a timely fashion.

But the problem is not that we don’t have enough doctors. We have more doctors per head of population than the OECD average.

We are graduating record numbers of medical students, putting us well above the OECD average. But we are not providing enough prevocational and specialist training places for our medical graduates.

We must address workforce shortages in particular specialty areas.

Many people think that medical training finishes at the medical school gates. However, medical training is a much longer journey.

It requires an internship, a period of prevocational training and, ultimately, specialist training, which can last upwards of seven years.

I wrote recently that my training took seventeen and a half years, half my life when I opened my practice on my 35th birthday. 9

With record medical graduate numbers, the pressure this is placing on the medical training pipeline is widely acknowledged.

Next year we face a shortage of 569 first year advanced specialist training places.

The bottleneck of doctors in training waiting to get on to a specialist training program is growing, and the projections suggest it will only get worse.

This has implications for the community’s access to services, and the career aspirations of our best and brightest.

We do not need more medical school places. The focus needs to be further downstream.

Unfortunately, we are seeing Universities continuing to ignore community need and lobbying for new medical schools or extra places.

This is a totally arrogant and irresponsible approach, fuelled by a desire for the prestige of a medical school and their bottom line.

Macquarie University is just the latest case in point.

With a looming oversupply of doctors, they have developed a $250,000 medical degree for those who are wealthy enough to be able to afford it.

With that kind of debt, their graduates will not work in areas where they are needed.

They will opt for more lucrative specialties in major metropolitan locations – assuming they can get a job at all.

It’s an example of greed trumping need, and governments need to work with the AMA to stop this from happening.

The evidence clearly shows that, if you select doctors from a rural background, or provide them with opportunities to train in rural areas, they are much more likely to work in a rural area.

We support Minister Gillespie and his idea for training hubs in the regions.

We will keep arguing about the problems with Bonding. We hope that more graduates will choose general practice or rural practice, or both. We will continue to argue for measures that will work.

General Practice

General practice is under pressure, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care, and remain the most cost effective part of our health system. But they still work long and hard, often under enormous pressure. 10

The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.

But the Government needs to do much more to recognise and reward quality general practice.

The Government is proceeding with its Health Care Homes trial and, while we share the vision of the trial, it is not without problems.

Significant questions also remain over the adequacy of funding for the trial, given the Government is asking GPs to do more for patients, but with no additional investment.

It will be a number of years before we learn what impact the trial has had for patients, health costs, and whether it relieves pressure on our hospital system.

General practice can’t wait that long. It is already under pressure and needs new investment now.

We must have everything funded and connected – strong primary care, led by general practice; properly resourced public hospitals; and a complementary private hospital sector underpinned by a stable private health insurance industry.

This is a handy ‘to do’ list for the Government.

I turn now to a couple of topics that have put the AMA is a different sort of spotlight.

Marriage Equality

The AMA gets accused of being too conservative.

So, it was not totally surprising to see the reaction to the launch of our new Position Statement on Marriage Equality a few months back.

The AMA position generated significant coverage in both mainstream and social media.

It also generated interest within our membership, the medical profession more broadly, and with the general public.

We received overwhelming support – in line with public opinion polls which indicate the majority of Australians support marriage equality.

Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage.

Things like bullying, harassment, victimisation, depression, fear, exclusion, and discrimination, all impact on physical and mental health.

I received correspondence from AMA members and the general public. The overwhelming majority applauded the AMA position.

Those who opposed the AMA stance said that we were being too progressive, and wading into areas of social policy. 11

The AMA will from time to time weigh in on social issues. We should call out discrimination and inequity in all forms, especially when their consequences affect people’s health and wellbeing.

It is not our place to determine how we achieve marriage equality. That is for our legislators.

We hope this process goes ahead with honesty and respect.

Euthanasia and Physician Assisted Suicide

Last year, we released an updated Position Statement on Euthanasia and Physician Assisted Suicide.

It came at a time when a number of States, most notably South Australia and Victoria, were considering voluntary euthanasia legislation.

There was an expectation in some quarters that the AMA would come out with a radical new direction. We didn’t.

The AMA maintains its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life.

This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia.

Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity.

We are always there to provide compassionate care for each of our dying patients so they can end the last chapter of their lives without suffering.

We believe that governments must do all they can to improve end of life care for all Australians.

They must properly resource palliative care services and advance care planning, and produce clear legislation to protect doctors who are providing good end of life care in accordance with the law.

Of course, euthanasia is a matter for society and its Parliaments.

However, if new legislation does come into effect, doctors must be involved in the development of the legislation, regulations, and guidelines.

We must protect doctors acting within the law, vulnerable patients, those who do not want to participate, and the wider health system.

The AMA recognises that good quality end of life care can alleviate pain and other causes of suffering for the overwhelming majority of people. 12

There is already a lot that doctors can ethically and legally do to care for dying patients experiencing pain or other causes of suffering.

This includes giving treatment with the intention of stopping pain and suffering, but which may have the secondary effect of hastening death.

I reiterated all of this yesterday in an address to 40 MPs in Victoria, imploring them to legislate protections according to this ‘doctrine of double effect’.

Bills in South Australia and Tasmania have been defeated. I encourage politicians in Victoria to ‘put the horse before the cart’ and focus on the everyday issues in end of life care.

Our position does not appeal to everyone, least of all high profile euthanasia campaigners and their enthusiastic supporters in the media.

We also have members who differ in their view.

But our position, supported by the overwhelming majority of our Federal Council, is supported by the bulk of the medical profession.

There are medical, ethical, and moral responsibilities at the heart of the doctor-patient relationship, and we all take them and our oath, the Declaration of Geneva, very seriously indeed.

Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our annual Indigenous Health Report card, which focused on Rheumatic Heart Disease.

In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure.

It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

RHD is perhaps the classic example of a Social Determinant of Health.

It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

The significance of challenging social issues like Indigenous health, marriage equality, and euthanasia is that they highlight the unique position and strengths of the AMA.

We are completely independent of governments. 13

We rely near totally on member subscription income to survive. I can promise you, as a Board member, it is often a concern.

But unlike many other lobby groups, inside and outside the health industry, this gives us a total legitimacy to speak honestly, robustly, and without fear or favour in line with our mission – to lead Australia’s doctors, to promote the health of all Australians.

We have strong public support and respect as the peak medical organisation.

The AMA was recently ranked the most ethical organisation in the country in the Ethics Index produced by the Governance Institute of Australia.

People want and expect us to have a view, an opinion. Sometimes a second opinion.

The media demand that we have an opinion. And not just on bread and butter health issues. But also on social issues that have an impact on health.

Our view is never knee-jerk.

We consult our members and the broader medical profession. Often we encourage feedback from other health professionals – the ones who provide quality health care with us in teams.

We attract public feedback whether we like it or not. I can promise you that social media has taken this to a whole new level.

In the last year I have been criticised by the Pharmacy Guild, the College of Midwives, the Greens, One Nation, the ALP, the Coalition, pro-Euthanasia campaigners, E-cigarette enthusiasts, Anti-Vaccination campaigners, shareholders in Medicinal Cannabis enterprises, and the occasional celebrity chef.

And that is before I get home to my 13 year old daughter.

All of our consultation and engagement informs our policies, our views, our opinions.

Our opinions are not designed to be popular.

Many feel uncomfortable when we talk about healthcare standards for asylum seekers and refugees on Nauru and Manus Island.

We make Australians feel uncomfortable when we ask them to reflect on the amount they drink and the fact that licit drugs like tobacco and alcohol cause far more carnage than Ice ever will.

People might not like it when we use scientific evidence to inform our views on the limitations on the usefulness of Medicinal Cannabis, climate change and health, air quality, expanding adult and child vaccination programs, restricting Codeine use, or call for a tax on sugar-sweetened beverages.

But we believe we get it right most of the time. 14

We are the only body that can possibly represent the whole medical profession – from medical student to retired doctor, from Psychiatrist to Vascular Surgeon to Paediatrician, whether trained in Mumbai or at Monash.

From Busselton to Bundaberg, we will continue to fight for the health of our patients and their communities.

That is why governments take notice of our policies. They are informed by what our patients and what our members tell us, based on what is happening at the front line of health service delivery.

Conclusion

I want to finish today with a message to our political leaders.

Last year we had a very close election, and health policy was a major factor in the closeness of the result.

The Coalition very nearly ended up in Opposition because of its poor health policies.

Labor ran a very effective Mediscare campaign.

As I have noted, the Government appears to have learnt its lesson on health, and is now more engaged and consultative – with the AMA and other health groups.

The next election is due in two years. There could possibly be one earlier. A lot earlier.

As we head to the next election, I ask that we try to take some of the ideology and hard-nosed politicking out of health.

I talked today about some of the structural pillars of our health system – public hospitals, private health, the balance between the two systems, primary care, the need to invest in health prevention.

Let’s make these bipartisan. Let’s take the point scoring out of them.

Both sides should publicly commit to supporting and funding these foundations.

The public – our patients – expect no less.

 

NACCHO Aboriginal Health @amapresident says Treat Dependence And Addiction As Chronic Brain Disease

Behavioural addictions – such as pathological gambling, compulsive buying, or being addicted to exercise or the internet – and substance dependence are recognised as chronic diseases of the brain’s reward, motivation, memory, and related circuitry,

Substance abuse is widespread in Australia. Almost one in seven Australians over the age of 14 have used an illicit substance in the past 12 months, and about the same number report drinking 11 or more standard alcoholic drinks in a single session.

Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.”

AMA President, Dr Michael Gannon pictured above with NACCHO Chair on a recent visit to NT ACCHO Danila Dilba

Read view over 170 Articles last 5 years NACCHO Alcohol and other drugs

Substance dependence and behavioural addictions are chronic brain diseases, and people affected by them should be treated like any other patient with a serious illness, the AMA says.

Releasing the AMA’s Harmful Substance Use, Dependence, and Behavioural Addiction (Addiction) 2017 Position Statement today, AMA President, Dr Michael Gannon, said that dependence and addiction often led to death or disability in patients, yet support and treatment services were severely under-resourced.

Download copy Harmful Substance Use, Dependence and Behavioural Addiction (Addiction) – 2017 – AMA position statement

“Substance use does not inevitably lead to dependence or addiction. A patient’s progression can be influenced by many factors – genetic and biological factors, the age at which the use first started, psychological history, family and peer dynamics, stress, and access to support.

“The costs of untreated dependence and addictions are staggering. Alcohol-related harm alone is estimated to cost $36 billion a year.

“Those affected by dependence and addictions are more likely to have physical and mental health concerns, and their finances, careers, education, and personal relationships can be severely disrupted.

“Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.

“About one in 10 people in our jails is there because of a drug-related crime.

“Given the consequences of substance dependence and behavioural addictions, the AMA believes it is time for a mature and open discussion about policies and responses that reduce consumption, and that also prevent and reduce the harms associated with drug use and control.

“Services for people with substance dependence and behavioural addiction are severely under-resourced. Being able to access treatment at the right time is vital, yet the demand for services outweighs availability in most instances.

“Waiting for extended periods of time to access treatment can reduce an individual’s motivation to engage in treatment.

“While the Government responded quickly to concerns about crystal methamphetamine use with the National Ice Action Strategy, broader drug policy appears to be a lower priority.

“The recently-released National Drug Strategy 2017-2026 again lists methamphetamine as the highest priority substance for Australia, despite the Strategy noting that only 1.4 per cent of Australians over the age of 14 had ever tried the drug.

“The Strategy also notes that alcohol is associated with 5,000 deaths and more than 150,000 hospitalisations each year, yet the Strategy puts it as a lower priority than ice.

“The updated National Drug Strategy is disappointing. The fact that no additional funding has been allocated to the Strategy to date means that any measures that require funding support are unlikely to occur in the short to medium term.

“The Government must focus on those dependencies and addictions that cause the greatest harm, including alcohol, regardless of whether some substances are more socially acceptable than others.

“General practitioners are a highly trusted source of advice, and they play an important role in the prevention, detection, and management of substance dependence and behavioural addictions. Unfortunately, limited access to suitable treatment can undermine GPs’ efforts in these areas.”

 

NACCHO #WeAreIndigenous on International Day of the World’s Indigenous Peoples AMA calls for a whole-of- Government approach to close our health inequalities

AMA 1

“Aboriginal and Torres Strait Islander people will not achieve equal health outcomes until their educational, economic, and social disadvantages have been eliminated.

“We still have much work to do as a nation to close the gap in life expectancy and the overall health of Indigenous Australians compared with the rest of the community.

“The AMA remains committed to improving the health outcomes for Indigenous people by working in partnership with Aboriginal and Torres Strait Islander groups to advocate for greater Government investment and cohesive coordinated strategies.”

AMA President, Dr Michael Gannon

On International Day of the World’s Indigenous Peoples, the AMA is calling for a whole-of- Government approach to close the health inequalities that exist for Aboriginal and Torres Strait Islander peoples.

This year’s International Day of the World’s Indigenous Peoples is dedicated to supporting the right to education.

AMA President, Dr Michael Gannon, said today that we need genuine collaborative action to improve health and education outcomes for Aboriginal and Torres Strait Islander people.

“There are clear links between education and health,” Dr Gannon said.

“We know closing the gap and improving the health outcomes for Aboriginal and Torres Strait Islander people also means closing the gap in education and literacy.

“Now is the time to develop a whole-of-Government approach to improve access to education and provide health services in culturally appropriate ways to improve the physical and mental wellbeing of Aboriginal and Torres Strait Islander peoples.

“All current and future policies addressing education, employment, poverty, housing, taxation, transport, the environment, and social security should be assessed according to their impact on health and equity.

The AMA strongly endorses the UN Declaration on the Rights of Indigenous People and the goal of equal access to all education and training for Indigenous peoples.

 

 

NACCHO #IndigenousVotes : AMA Indigenous #Healthelection16 platform launched

Page 13

“Achieving health equality for Aboriginal and Torres Strait Islander people is a priority for the Australian Medical Association (AMA).

It is simply not acceptable that in 2016, Australia’s Indigenous people continue to experience poorer health and a significantly lower life expectancy than their non-Indigenous peers.

Health is intricately woven within the social determinants of health.

The wider community’s limited understanding of Indigenous culture, and the history of the relationship between Australia’s first peoples and non-Indigenous Australians are issues that have yet to be adequately addressed.

For the AMA, Indigenous health has been and will remain a priority. It is a responsibility to advocate for better health outcomes for Australia’s Indigenous people.”

Dr Michael Gannon AMA President

See Page 13 Aboriginal Health News 24 Page FREE Download HERE

Over recent decades, we have seen some progress in improving Indigenous health and life expectancy, but there is still much more to be done. While there has been some success in reducing childhood mortality and smoking rates, the high levels of chronic disease among Aboriginal and Torres Strait Islander people continues to be of grave concern.

Chronic disease (primarily cardiovascular disease, cancer, diabetes, respiratory disease and kidney disease) accounts for two-thirds of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. With chronic disease being such a major impact on the health and life expectancy of Indigenous Australians, the AMA sees government investment in resourcing for culturally appropriate primary health care as paramount.

It is not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting its first people who make up just three per cent of its population. It is not good enough to keep hearing the excuses and well-meaning, but unsupported, words of successive governments.

The next Federal Government must commit to and deliver, effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health.  Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

The AMA, along with many others working in Indigenous health, has been campaigning for long-term funding and commitments from the Commonwealth to improve the health and wellbeing of Aboriginal and Torres Strait Islander people.

My predecessor, Professor Brian Owler, travelled to remote Aboriginal communities, as well as attending the Gama Festival in East Arnhem Land, to better understand the health issues and problems many Aboriginal and Torres Strait Islander people experience. Following his trip to Central Australia earlier this year, the AMA engaged with a number of key stakeholders on addressing diabetes and supporting the health services working in remote communities. This is something that the AMA will continue to do.

I have family roots in rural Western Australia and attended both primary school and high school with Aboriginal students. Sadly as an Obstetrician, I have broad personal experience of the increased burden of perinatal morbidity and mortality suffered by Aboriginal women in both my clinical work and my service on the Perinatal and Infant Mortality Committee (Health Department of WA).

Health is intricately woven within the social determinants of health.

The wider community’s limited understanding of Indigenous culture, and the history of the relationship between Australia’s first peoples and non-Indigenous Australians are issues that have yet to be adequately addressed.

For the AMA, Indigenous health has been and will remain a priority. It is a responsibility to advocate for better health outcomes for Australia’s Indigenous people.

Indigenous health issues were a prominent theme at the 2016 AMA National Conference and will continue to be a focus for many years to come.

The AMA benefits from the expert advice on Aboriginal and Torres Strait Islander health that comes through its Taskforce on Indigenous Health, from visiting Indigenous communities, and by partnering with groups such as the Close the Gap Campaign, NACCHO, and many others.

As a member of the Close the Gap Steering Committee, the AMA is supporting their election priorities and issues. One of these issues is to call on the next Federal Government to establish a closing the gap target to reduce the rates of Aboriginal and Torres Strait Islander people coming into contact with the justice system. This issue was a key recommendation of the AMA 2015 Report Card on Indigenous Health which highlighted the strong connection between health and incarceration.

Recently, the AMA also became a signatory to the Close the Gap Campaign’s Redfern Statement which called on the next Federal Government to meaningfully address the disadvantage experienced by Aboriginal and Torres Strait Islander people.

This reaffirms the AMA’s strong commitment to Indigenous health issues. The AMA set out its position on the health of Aboriginal and Torres Strait Islander People in its Key Health Issues for the 2016 Federal Election document delivered at the start of the 2016 election campaign. If we are to close the gap between Indigenous and non-Indigenous Australians, the next Government must strengthen their investment in Aboriginal and Torres Strait Islander health and make a genuine commitment to the following measures:

  • correcting the under-funding of Aboriginal and Torres Strait Islander health services;
  • establishing new or strengthening existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular disease (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increasing investment in Aboriginal and Torres Strait Islander community controlled health organisations.  Such investment must support services to build their capacity and be sustainable over the long term;
  • developing systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identifying areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • instituting funded, national training programs to support more Aboriginal and Torres Strait Islander people become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implementing measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopting a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between poor health and incarceration;
  • increase funding for family violence and frontline legal services for Aboriginal and Torres Strait Islander people;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support for a Central Australia Academic Health Science Centre.  This part of Australia faces unique and complex health issues that require specific research, training and clinical practice to properly manage and treat and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

Closing the gap in health and life expectancy between Indigenous and non-Indigenous Australians is an achievable task. It is also an agreed on national priority.

With more than 200,000 Australians supporting action to close the gap, it is evident that the Australian public demand that government, in partnership with Aboriginal and Torres Strait Islander peoples and their representatives, meet this challenge.

The next government must ramp up its ambition to achieve health equality and take further steps in building on the existing platform.

In particular, the challenges of operationalising the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan, the work of the Primary Health Networks and strengthening the Closing the Gap Strategy.

These remain key tests of our nation’s future and our shared intergenerational will and commitment to Aboriginal and Torres Strait Islander peoples and their health and wellbeing.

Download Aboriginal Health Newspaper Here

Redfern Statement

 

 

NACCHO #HealthElection16 The AGE and AMA editorials : We must embrace Indigenous Health in the Federal election

AMA

“Well Indigenous health is one of those areas impacted by things like the freeze as well, so I think people need to understand that when we talk about the impacts of the freeze, and just like we did when we talked about the $7 co-payment, that system actually also deals with many Indigenous people, whether it be through traditional or mainstream general practice, or through Aboriginal community controlled health services or AMSs, so they are impacted by these sorts of things as well.”

Brian Owler President AMS Speaking on #IHMayday16

“Indigenous disadvantage is a reality that must be confronted and owned by the entire nation. But we perceive a real danger in this election campaign that the many issues affecting Indigenous people will be swept aside or tritely agglomerated into a single issue – recognition in the constitution. Recognition is a worthy aim, and The Age supports it. But it will not and cannot, by itself, resolve practical disadvantage.”

The Age Editorial May 12

Photo above : Doctor John Boffa ‎Chief Medical Officer Public Health at Central Australian Aboriginal Congress Aboriginal Corporation – Professor Brian Owler , Congress Chair William Tilmouth and Hon Warren Snowdon Local Federal Member


QUESTION:  Professor Owler it’s Indigenous Health May Day today. Do you believe there’s elements of racism in the health system?

BRIAN OWLER:  Well, I mean racism is a word that needs to be used cautiously, but there is no doubt that there is an element in terms of how we deal with Indigenous people. Now it’s not to say that the people in the system are racist, it is about the way that we recognise and provide culturally appropriate care.

Now, if you go to somewhere like Alice Springs Hospital, for instance, you can see the way that the hospital deals with Indigenous people is very, very different.

They have a much more culturally sensitive way of dealing with Indigenous people, which means they’re more likely to engage in the health system. So other hospitals that still have significant numbers of Indigenous people as patients, or health care centres, are probably less understanding, and less well equipped to deal with the cultural issues that Indigenous people have as well. So I think in that way, yes, there is an element of racism, and those are the sorts of things that we need to deal with.

But you know, I don’t think people should understand that the people in the system itself are racist, it’s the way that the system needs to change and develop to make sure that we look after Indigenous people in the way that is more appropriate, safer in terms of culture, and that is likely to engage them more and deliver much better outcomes.

QUESTION:  We know the gaps aren’t being closed despite the billions of dollars we spend. Does either side of politics need to spend more money or promise more money during this election campaign?

BRIAN OWLER: Well Indigenous health is one of those areas impacted by things like the freeze as well, so I think people need to understand that when we talk about the impacts of the freeze, and just like we did when we talked about the $7 co-payment, that system actually also deals with many Indigenous people, whether it be through traditional or mainstream general practice, or through aboriginal community controlled health services or AMSs, so they are impacted by these sorts of things as well.

But having toured central Australia and the Northern Territory, and spoken to people that work in this field, they have seen a cut in Indigenous health over the past few years. It has been less obvious and less talked about than some of the other cuts that have been made, and while we’ve made ground in Indigenous health, there is so much more to do. And it’s easy for people to get tired about this issue. But when you go and talk to people, when you see the realities on the ground, the issues that are being faced by Indigenous people, particularly in remote and rural communities and regional Australia, you can see that there’s so much more that needs to be done.

I talked earlier about the fact that we say now there’s a ten year difference in life expectancy for Indigenous people compared to non-indigenous people, but actually in many parts of Australia there’s a 26 year difference in life expectancy. We have seven-year-olds developing type 2 diabetes because of the social determinants of health, because of their living arrangements and other issues, infections, et cetera, that occur because of the environment, and that is probably the lowest age of any person in the world that develops type 2 diabetes as a result of these things. So, there are a lot of things that we need to be looking at, particularly in terms of the social determinants of health, for Indigenous people as well as their health care services themselves

No 6 NT kids

We must embrace Indigenous issues in the 2016 Federal elections The Age comment editorial

How will our children judge the strength of our nation? Will it be through the mighty defence of our borders, or the vitality of our engagement with the world? Will it be measured in terms of economic output or the strength of our financial markets, by the accumulation of personal wealth or the diversity of cities we have developed?

Will future generations see this as a generous period? Or will they consider it yet another long and inexcusable era of procrastination and apathy, a period in which Australia, its federal and state governments, failed to make headway on what we, at The Age, consider one of the profound and pressing issues facing the nation: the multi-faceted disadvantage affecting Aboriginal and Torres Strait Islander people?

We raise these questions because rarely do Indigenous issues come to the fore in election campaigns. They might light the agenda for a day, trigger a flurry of ping-pong responses from political leaders, and fill a few lines of small print in budget papers. But too soon, eyes turn away, hearts grow cold and the inequity rolls on. Such apathy has festered in Australia for more than two centuries, and it cannot and must not continue.

Like it or not, Australia is judged by the world in terms of how it treats its first people, and on so many levels we are failing. The evidence is abundant. Aboriginal and Torres Strait Islander people face a deficit of economic opportunities, as well as below average outcomes in life expectancy, general health and education.

The Closing the Gap report, released  this year, showed the Indigenous child mortality rate is improving but efforts to narrow the gap in life expectancy have fallen behind. That the goals in terms of literacy and numeracy are pitched in terms of halving the gap, not closing it, underscores the enormousness of the task.

And then there are the imprisonment rates. It is 25 years since the royal commission examining Aboriginal deaths in custody exposed the travesty of disproportionate rates of incarceration. Yet the situation has worsened dramatically. A person of Aboriginal or Torres Strait Islander background is 15.5 times more likely to end up in detention than any other member of the community (compared with seven at the time of the royal commission), and Indigenous children aged 10 to 14  are 30 times more likely to be incarcerated.

Thirty times. You read that correctly. The Commonwealth spent millions of dollars on a commission that came up with powerful findings and hundreds of potentially game-changing recommendations. Why has this nation not improved on those awful lessons?

Indigenous disadvantage is a reality that must be confronted and owned by the entire nation. But we perceive a real danger in this election campaign that the many issues affecting Indigenous people will be swept aside or tritely agglomerated into a single issue – recognition in the constitution. Recognition is a worthy aim, and The Age supports it. But it will not and cannot, by itself, resolve practical disadvantage.

Mandatory imprisonment in Western Australia and the Northern Territory for offences that could be managed through alternative methods of justice is contributing to poor social outcomes. Imprisonment destroys a person’s hope and hardens their grievances. It exacerbates underlying mental health issues. It erodes families and, thus, contributes to social dysfunction. As the royal commission urged, jail must be the last resort.

Incremental advances are being made, but progress is slow. It is imperative in this election that the major political parties elevate the issues affecting Aboriginal and Torres Strait Islander people to a leading priority and not render them a patronising afterthought.

 

NACCHO Aboriginal Health #CTG10 alert :AMA says multi- partisan commitment needed to truly Close the Gap

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“It is encouraging that the number of Aboriginal and Torres Strait Islander Health Checks have increased, Indigenous peoples’ access to medicines has improved, and there have been improvements in infant and child health outcomes.”

“There must be genuine engagement with Aboriginal Community Controlled Health Services in the delivery of health services for Aboriginal and Torres Strait Islander peoples.”

AMA President, Professor Brian Owler discussing

Close the Gap Progress and Priorities Report 2016

Download the Report

The AMA is pleased to see some improvement in a number of key indicators for Aboriginal and Torres Strait Islander Health, but warns that a long-term commitment across all political parties is needed if targets for closing the health gap are to be met within a generation.

The Close the Gap Steering Committee Progress and Priorities Report 2016 was released this morning, on the 10th anniversary of the Closing the Gap Campaign.

AMA President, Professor Brian Owler, said today that it is encouraging that the number of Aboriginal and Torres Strait Islander Health Checks have increased, Indigenous peoples’ access to medicines has improved, and there have been improvements in infant and child health outcomes.

“The latest Report shows that there has been a mixed bag on progress in some of the health and social determinants of health indicators,” Professor Owler said.

“Work to improve year 12 attainment rates by 2020 is on track, but halving the gap in reading, writing, and numeracy is falling behind.

“Halving the gap in employment outcomes by 2018 is not on track, while halving the mortality rate gap for young children by 2018 is on track.

“It is disappointing that the target to close the gap in life expectancy by 2013 is not on track.

“This is a clear signal that we have to put politics aside, and work together to reach this important milestone.

“We need a long-term, multi-partisan, whole-of-government approach to once and for all close the gap,” Professor Owler said.

Professor Owler said the AMA wants the Government to fully fund the new Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013-2013), which would be a catalyst for speeding up action on closing the gap initiatives.

“Above all, we need consistent funding and support from all governments to reach Close the Gap targets,” Professor Owler said.

“And there must be genuine engagement with Aboriginal Community Controlled Health Services in the delivery of health services for Aboriginal and Torres Strait Islander peoples.”

Professor Owler said the Government should reverse recent Budget cuts to programs such as the Indigenous Advancement Strategy and the Indigenous Australian Health Programme, and there should be a new Closing the Gap target to reduce Indigenous imprisonment rates.

 

NACCHO Aboriginal Health News Alert : AMA says stop the cuts -time for strong investment in health

Brian

The AMA recognises the early progress that is being made to close the gap, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to maintain this momentum for the long term, the Government must improve resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

From the AMA Pre-Budget Submission 2016-17 Download here

Or full AMA indigenous health policy below

The AMA is urging the Government to use the May Budget to invest strongly in the future of the Australian health system to meet growing and changing demand from an ageing population and a surge in chronic and complex conditions, which is afflicting more and more Australians.

Picture above AMA President, Professor Brian Owler with NACCHO chair Matthew Cooke at Closing the Gap 2015

AMA President, Professor Brian Owler, said today that the Government must put a stop to its policies of funding cuts and program cuts from its first two Budgets, and instead invest heavily in the health system to build capacity to meet current and future needs.

Professor Owler said the Government must make public hospitals, primary care, and prevention the centrepiece of its election-year Budget.

“The first steps in the next Health Budget must be to lift the Medicare patient rebate freeze, reverse the cuts to pathology and radiology, and restore public hospital funding to proper levels,” Professor Owler said.

“The Government cannot be allowed to retreat from its responsibilities in funding and managing the core elements of health care delivery in Australia.

“There is an urgent need to put the focus back on the strong foundations of the health system – foundations that have served us well for decades, made our system one of the best in the world, and made the health of Australians among the best in the world.

“We need a strong balance between the public and private systems, properly funded public hospitals, strong investment in general practice, and a focus on prevention.

“When people are sick and injured, we need to provide them with affordable and easily accessible care in hospitals, in aged care, in general practice, in the community, and in their homes.

“And we need to educate and help people to achieve healthier lifestyles by being active, and avoiding harmful habits and substances. This will reduce the strain on health services.

“But our public hospitals are under pressure, and our primary care system, especially general practice, is facing huge challenges as more Australians are experiencing chronic and complex conditions that require ongoing care.

“Significant new health funding is needed, but governments also need to be more strategic about how they spend every health dollar.

“Health is the best investment that governments can make.”

Professor Owler said that Australia’s health spending is not out of control, as claimed by the Government to justify its savage 2014 and 2015 health Budgets.

“The Government’s ongoing justification for its extreme health savings measures, including cuts to public hospital funding, has been that Australia’s health spending is unsustainable,” Professor Owler said.

“This is not backed by the evidence.

“The Commonwealth Government’s total health expenditure is reducing as a percentage of the total Commonwealth Budget.

“In the 2014-15 Commonwealth Budget, health was 16.13 per cent of the total, down from 18.09 per cent in 2006-07.

“It reduced further in the 2015-16 Budget, representing only 15.97 per cent of the total Commonwealth Budget.

“Clearly, total health spending is not out of control. The health sector is doing more than its share to ensure health expenditure is sustainable,” Professor Owler said.

The AMA Pre-Budget Submission 2016-2017 covers the following key areas:

 MBS Indexation;

 Public Hospitals;

 Federation Reform;

 Efficient Medicare Claiming;

 Indigenous Health;

 Medical Workforce and Training;

 Chronic Disease;

 Pharmacists in General Practice;

 Rural GP Infrastructure Grants;

 Medical Care for Dementia, Palliative Care, and Aged Care Patients;

 Climate Change and Health;

 Prevention;

 Methamphetamine (Ice);

 Alcohol;

 Obesity;

 Physical Activity; and

 Immunisation.

The Submission is available at

https://ama.com.au/sites/default/files/budget-submission/Budget_Submission_2016_2017.pdf

INDIGENOUS HEALTH

The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite the commitment to closing the gap.

The AMA recognises the early progress that is being made to close the gap, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to maintain this momentum for the long term, the Government must improve resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

Despite recent health gains for Aboriginal and Torres Strait Islander people, progress is slow and much more needs to be done. A life expectancy gap of around ten years remains between Aboriginal and Torres Strait Islander people and other Australians, with recent data suggesting that Indigenous people experience stubbornly high levels of treatable and preventable conditions, high levels of chronic conditions at comparatively young ages, high levels of undetected and untreated chronic conditions, and higher rates of co-morbidity in chronic disease. This is completely unacceptable.

It is also not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting just three per cent of its citizens. The Government must deliver effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health. Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

AMA POSITION

The Government must strengthen its investment in Aboriginal and Torres Strait Islander health. This must include:

• correcting the under-funding of Aboriginal and Torres Strait Islander health services;

• establishing new or strengthening existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular diseases (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;

increasing investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term; Health – the best investment that governments can make

• developing systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;

• identifying areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;

• instituting funded, national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce;

• implementing measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;

• adopting a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration; and

• appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes.

 

 

NACCHO Health News: AMA speech “Social Determinants and Aboriginal Health”

Brian

Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people. Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.”

AMA PRESIDENT A/PROF BRIAN OWLER (pictured above with Matthew Cooke NACCHO chair at recent Parliamentary event )

SPEECH TO BMA SYMPOSIUM The Role of Physicians and National Medical Associations in Addressing the Social Determinants of Health and Increasing Health Equity LONDON 24 MARCH 2015

The Social Determinants of Health: the Australian Perspective

The Australian connotation of the words ‘social determinants’ in relation to health immediately conjure images of the issues faced by Australia’s first people, our Australian Aborigines and Torres Strait Islanders.

And this is rightly so. The social determinants of health are major issues for Australia as a nation in its attempts to ‘close the gap’ for disadvantage of Indigenous people in relation to a range of outcomes, including health.

The implications of the social determinants are not bound by race, although race might be thought of as a social determinant in itself. Social determinants are important to health outcomes for all Australians.

The issues are much more complex than whether someone has a roof over the head, whether they have access to clean water and nutritious food. What I want to talk about, from the Australian perspective, are two issues.

First, there are deeper issues that underlay the social determinants of health. This comes from a sense of physical, social, and emotional wellbeing, the origins of which have deep spiritual roots for Australia’s Indigenous people.

The second is that the term ‘social determinants of health’ is somewhat misleading. While I know many here understand this, we must not forget that health is a determinant of social and other outcomes.

Australian Indigenous peoples represent about 3 per cent of the Australian population. Indigenous Australians experience poor health outcomes. We have a gap between Indigenous and non-Indigenous Australians in terms of health, but also in many other aspects of life. Indeed, the health outcomes are poorer compared to the Indigenous populations of other nations.

Life expectancy of Indigenous Australians is 10.6 years less for men, and 9.5 years for women. This gap in life expectancy is a serious blight on our nation, and remains unacceptable.

The AMA sees that addressing this issue is a core responsibility of the AMA and the medical profession.

While the gap in life expectancy remains unacceptable, there have been gains in Indigenous health. Life expectancy has increased by 1.6 years and 0.6 years for men and women respectively over the past five years. Mortality rates for Indigenous Australians declined by 9 per cent between 2001 and 2012.

So, what are the main contributors to the gap in life expectancy?  Chronic diseases are the main contributors to the mortality ‘gap’ between Indigenous and non-Indigenous Australians.

Four groups of chronic conditions account for about two-thirds of the gap in mortality: circulatory disease, endocrine, metabolic and nutritional disorders, cancer, and respiratory diseases.

Another major contributor to the gap in life expectancy is the Indigenous infant and child mortality rate. These rates remain well above that of the non-Indigenous population.

The infant mortality rate remains high at around five deaths per 1000 live births, compared to 3.3 per 1000 for non-Indigenous children.

External causes, such as injury and poisoning, account for around half of all deaths of children aged 1–4 years. External causes, mainly injury, are also the most common cause of death among Indigenous children aged 5–14, and account for half of the deaths in that age group.

The trend data for most States show a 57 per cent decline in the Indigenous infant mortality rate between 2001 and 2012, and a 26 per cent decline in the non-Indigenous rate.

There has been progress here, but clearly there is much more to do.

Suicide was the third leading cause of death among Indigenous males, at six per cent.

The rate of suicide is about two times higher for males and 1.9 for females, compared to non-Indigenous Australians. Suicide also occurs at a younger age. This is not consistent with Aboriginal culture, in which suicide was thought to be rare.

These sorts of reports highlight several important issues.

First, as is already known, non-communicable diseases, in particular circulatory disease and diabetes, remain very significant issues for the Australian Indigenous people.

Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people.

Second, the rate of suicide, particularly among young Indigenous males, is unacceptably high. This speaks to something much more difficult to address.

It is an issue of how we address mental health, the need to focus on drug and alcohol problems, but it also raises questions about why so many Indigenous people take their own lives.

Third, our child and infant mortality rates are too high, but are improving. What is disturbing is that many of the deaths remain preventable. That is, they are caused by trauma or injury. Some of these injuries will be non-accidental.

While those with chronic disease need to be cared for, prevention, particularly in the early part of life, is the key if we are going to see a generational change in health outcomes.

As a nation, Australia is conscious of the need to improve the health of Indigenous Australians – to Close the Gap.

Each year, the Prime Minister, in the first week that Federal Parliament sits, delivers a report on Closing the Gap.

In 2008, the Council of Australian Governments, or COAG, set six targets aimed at reducing Indigenous disadvantage in relation to health and education.

The Closing the Gap targets are to:

  • close the life expectancy gap within a generation (by 2031);
  • halve the gap in mortality rates for Indigenous children under five within a decade (by 2018);
  • ensure access to early childhood education for all Indigenous four year olds in remote communities within five years (by 2013);
  • halve the gap in reading, writing and numeracy achievements for children within a decade (by 2018);
  • halve the gap for Indigenous students in year 12 attainment rates (by 2020); and
  • halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018).

Despite good intention and considerable investment by successive Governments, the disparity in outcomes remains.

As expressed in this year’s Closing the Gap statement by the Prime Minister: ‘It is profoundly disappointing that most Closing the Gap targets are not on track to be met’.

Closing the Gap is an incredibly difficult task, and it is fair to say that Australia and Australians have learnt much about how to Close the Gap over a number of decades.

There were many mistakes, not only in Closing the Gap, but also in how modern Australia has treated Indigenous Australians. These issues have had to be confronted in order to advance efforts to Close the Gap.

For example, from 1910 to 1970, it is estimated that 100,000 Indigenous children were taken from their families and raised in institutions or fostered to non-Indigenous families.

The ‘Stolen Generation’, as they are termed, was disastrous in its outcome, however well-intentioned it may have been – separating families, but also alienating individuals from their own culture and families.

There have been many examples of Governments trying to address the social determinants of health – but often they have failed. For example, the Australian Government attempted to improve the living conditions of Indigenous people by building houses.

The houses were often inappropriate for the location. The plumbing would block because of the hardness of the water. They would fall into disrepair, and they did not serve the needs of the communities. These initiatives were well meaning, but improvements in health outcomes were somewhat marginal.

We have learnt, unfortunately by mistake, but also through partnership with Indigenous Australians. When it comes to health, there is much more to improving Indigenous health than building houses and sending people to school.

The concept of health for Indigenous Australians is very different from that of Western culture. There is no word for health in many Aboriginal languages. Rather, health is more of a concept of social and emotional wellbeing than of physical health.

Even that statement is a generalisation.

Before the arrival of Europeans, Australia was inhabited not by a uniform nation of Aboriginal people, but rather hundreds of ‘Indigenous nations’, whose language varied tremendously, along with their culture and beliefs.

Despite this variation, a unifying theme in terms of that ‘social and emotional wellbeing’ is the connection of Indigenous people with their land.

Australia’s first peoples have been continuously sustained, both physically and spiritually, by their land for 50,000 years of more. They have a deep connection with the land, and it is an important component of maintaining their spiritual wellbeing.

The close connection with the land also means that Indigenous people often live in remote regions. These remote communities present challenges in delivering health care as well as infrastructure and services that improve the social determinants of health.

For Indigenous Australians, their very existence, let alone their lifestyle, was threatened by European settlement as late as 1788. For Indigenous Australians, the arrival of Captain Cook in 1770, and subsequently the First Fleet in 1788, is not seen as European settlement, but rather as a modern invasion.

It signified displacement, imprisonment, forced adoption and much worse. It has left both emotional and spiritual wounds open and unable to heal. Modern economic solutions will continue to fail until these much more deeply seated issues are confronted.

There have been important steps in our young nation’s history that have attempted to approach these issues.

As I mentioned, the attachment to land is an important part of Indigenous culture. For each Indigenous ‘nation’, certain places hold spiritual importance.

From the land stemmed the basis of Aboriginal ‘dreamtime’, the spiritual conceptualisation of the universe and the basis of human existence for Aboriginal peoples. One might say that their landscape was their religion.

Recognition of the longstanding connection to the land came through a series of legislative changes that largely started under the Whitlam Government in 1972. Whitlam established the Aboriginal Land Rights (or Woodward) Commission to examine the possibility of establishing land rights in the Northern Territory.

In 1975, the Whitlam Government purchased traditional land and handed it back to the Gurindji people. In a now famous gesture, Whitlam poured sand into the hands of Vincent Lingiari, an Elder of the Gurindji people.

The Aboriginal Land Rights Act was passed by the Fraser Government in 1976, and established land rights for traditional Aboriginal landowners in the Northern Territory.

In 1992, the doctrine of terra nullius was overruled by the High Court of Australia in Mabo v Queensland, which recognised the Meriam People of Murray Island in the Torres Strait as native title holders over part of their traditional lands.

The Native Title Act was legislated the following year, 1993, by the Keating Government.

Not only did this provide the legal acknowledgement that Indigenous Australians sought, it also provided a source of revenue. The use of land for mining purposes, for example, provided significant funding to Aboriginal people through regional land councils.

More has been done since, but these are important issues to address that underlay social and emotional wellbeing and, therefore, the health of Indigenous people.

In 2008, Prime Minister Kevin Rudd issued a formal apology to Indigenous people for the stolen generation. It had enormous symbolism for Indigenous Australians.

The next likely step is to recognise Australia’s first people in our Constitution.

Constitutional recognition is a vital step towards making Aboriginal and Torres Strait Islander people feel historically and integrally part of the modern Australian nation.

Recognising Indigenous people in the Constitution will improve their self-esteem, their wellbeing, and their physical and mental health.

The AMA is a proud supporter of the Recognise campaign, and is a Foundation Signatory of the campaign.

In 2013, the Abbott Government was elected. Prime Minister Abbott had spent significant amounts of time with Indigenous people, often living for a week at a time in Indigenous communities.

In Government, he ‘ran the country’ for a week from a remote Indigenous community in Arnhem Land of the Northern Territory.

Prime Minister Abbott also took over the responsibilities for many Indigenous policy areas. The coalescence of these responsibilities into the Department of Prime Minister and Cabinet coincided with the reduction of the number of Indigenous programs into five main areas.

The Indigenous Advancement Strategy, or IAS, that began on 1 July 2014 now embodies these aims. The IAS outlines a number of priority areas – getting children to school, adults to work, and making communities safer.

The IAS replaced more than 150 individual programs with five broad programs – Jobs, Land and Economy; Children and Schooling; Safety and Wellbeing; Culture and Capability; and Remote Australia Strategies.

These are all worthy aims. They remain important.

But what is missing from the core of the IAS is a focus on health.

Health, in a modern sense, underpins many of these outcomes. We need to get the balance right and we, the AMA, need to ensure that health is seen as a foundation to these outcomes.

So, what is our role as a national medical association? Our role is to guide politicians and their policies; to shape the national narrative and debate.

The AMA’s Indigenous Health Taskforce, which I chair, draws experts in Indigenous Health together. It highlights the AMA’s commitment to working, in partnership with Indigenous Australians, to improve the health of Indigenous Australians.

Not only do we highlight the problems, but the AMA works on solutions and to highlight the successes as well.

The AMA regularly publishes the AMA Indigenous Report Card.

Last year, we highlighted the importance of a healthy early start to life.

My predecessor, Dr Steve Hambleton stated that: “Robust and properly targeted and sustained investment in healthy early childhood development is one of the keys to breaking the cycle of ill health and premature death among Aboriginal peoples and Torres Strait Islanders.”

Gains can be made by focusing on antenatal care.

In the Pitinjarra lands of north western South Australia there have been major gains in antenatal care, with 75 per cent of all pregnant women seen in the first trimester.

The proportion of children under three years of age with significant growth failure has fallen from 25 per cent in the 1990s to less than 3 per cent today. Immunisation rates approach 100 per cent.

This year, the AMA Report Card will focus on the bigger picture of the importance of health in underpinning the outcomes of education, training, and employment.

We will also focus on the issues of Indigenous incarceration rates, which have continued to escalate.

Law and order policies and health policies are often interlinked. Incarceration leads to a multitude of poorer physical and emotional health outcomes.

Poor health, and a poor start to life, is likely to increase the chances of incarceration. The AMA will be working with the Law Council of Australia on this issue.

To change the health of an entire population is an enormously difficult task. It is too easy for Governments to ignore health, to focus on the economics. Education and economics alone are not sufficient. Health is the cornerstone on which education and economics are built.

If you can’t go to school because you or your family are sick, truancy officers won’t work. If you can’t hear because of otitis media, you won’t learn. If you miss training opportunities because of depression or ill health, you won’t progress to employment. You can’t hold down a job if you keep having sick days.

Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.

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