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


“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


“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


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


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.


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”


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.


New Microsoft Publisher Document (3)

Follow the AMA Media on Twitter: Follow the AMA President on Twitter: Follow Australian Medicine on Twitter: Like the AMA on Facebook


NACCHO Aboriginal Health : Senator Nova Peris pushes campaign on alcohol-related domestic violence

2014-03-04 10.52.05

Senator Peris said in the Northern Territory an indigenous woman is 80 times more likely to be hospitalised for assault than other Territorians.

“I shudder inside whenever I quote that fact because it makes me picture the battered and bloodied women we see far too often in our hospitals.

“Every single night our emergency departments in the Northern Territory overflow with women who have been bashed.”

Picture above :Senator Nova Peris along with Opposition colleagues  addressing the NACCHO board at Parliament House Canberra this week

LABOR’S first indigenous MP Nova Peris has challenged the Australian Medical Association to advocate for more action in tackling alcohol-related domestic violence.

In a powerful speech, Senator Peris said alcohol-related domestic violence was on the rise and ruining the lives of Aboriginal women.

She told the launch of the AMA’s national women’s health policy that the AMA must use its high standing in the community to “advocate for more action in tackling alcohol-related domestic violence”.

Report from PATRICIA KARVELAS   The Australian

SEE AMA Position Statement on Women’s Health below

“Today I call on the AMA to formally adopt a policy position that supports the principle that people who have committed alcohol-related domestic violence be banned from purchasing alcohol at the point of sale.

“The technology to implement point-of-sale bans exists; it is cost effective and has been proven to work.”

Senator Peris said in the Northern Territory an indigenous woman is 80 times more likely to be hospitalised for assault than other Territorians.

“I shudder inside whenever I quote that fact because it makes me picture the battered and bloodied women we see far too often in our hospitals.

“Every single night our emergency departments in the Northern Territory overflow with women who have been bashed.”

In 2013, domestic violence assaults increased in the Northern Territory by 22 per cent, she said.

She criticised the incoming NT government’s August 2012 decision to scrapped the banned drinker register.

“For those of you who may not be familiar with the banned drinker register, or BDR as it is also known, it was an electronic identification system which was rolled out across the Northern Territory.

“This system prevented anyone with court-ordered bans from purchasing takeaway alcohol — including people with a history of domestic violence.

“Around twenty-five hundred people were on the banned drinker register when it was scrapped. “Domestic violence perpetrators were again free to buy as much alcohol as they liked. As predicted by police, lawyers and doctors, domestic violence rates soared.”

Senator Peris said she had met with doctors, nurses and staff from the emergency department in Alice Springs and they confirmed these statistics represent the true predicament they faced every day.

“Every night the place is awash with the victims of alcohol fuelled violence, with the vast majority of victims being women.”

She said the Northern Territory faces enormous issues with foetal alcohol spectrum disorder.

“We have such high rates of sexually transmitted infections, especially and tragically, with children.

“Rates of smoking are far too high, and diets are poor and heart disease is widespread.”

Senator Peris’s speech was well received by the AMA, which committed to taking on her challenge.


AMA Position Statement on Women’s Health 2014

The AMA today released the updated AMA Position Statement on Women’s Health.

The Position Statement was launched at Parliament House in Canberra by the Minister Assisting the Prime Minister for Women, Senator Michaelia Cash, Senator for the Northern Territory, Nova Peris, and AMA President, Dr Steve Hambleton.

Dr Hambleton said that all women have the right to the highest attainable standard of physical and mental health.

“The AMA has always placed a high priority on women’s health, and this is reflected in the breadth and diversity of our Position Statement,” Dr Hambleton said.

“We examine biological, social and cultural factors, along with socioeconomic circumstances and other determinants of health, exposure to health risks, access to health information and health services, and health outcomes.

“And we shine a light on contemporary and controversial issues in women’s health.

“There is a focus on violence against women, including through domestic and family violence and sexual assault.

“These are significant public health issues that have serious and long-lasting detrimental consequences for women’s health.

“It is estimated that more than half of Australian women have experienced some form of physical or sexual violence in their lifetimes.

“The AMA wants all Australian governments to work together on a coordinated, effective, and appropriately resourced national approach to prevent violence against women.

“We need a system that provides accessible health service pathways and support for women and their families who become victims of violence.

“It is vital that the National Plan to Reduce Violence against Women and their Children is implemented and adequately funded.”

Dr Hambleton said the updated AMA Position Statement also highlights areas of women’s health that are seriously under-addressed.

“This includes improving the health outcomes for disadvantaged groups of women, including Aboriginal and Torres Strait Islander women, rural women, single mothers, and women from refugee and culturally and linguistically diverse backgrounds,” Dr Hambleton said.

“We also highlight the unique health issues experienced by lesbian and bisexual women in the community.”

Dr Hambleton said that the AMA recognises the important work of Australian governments over many years to raise the national importance of women’s health, including the National Women’s Health Policy.

“There has been ground-breaking policy in recent decades, but much more needs to be done if we are to achieve high quality equitable health care that serves the diverse needs of Australian women,” Dr Hambleton said.

“Although women as a group have a higher life expectancy than men, they experience a higher burden of chronic disease and tend to live more years with a disability.

“Because they tend to live longer than men, women represent a growing proportion of older people, and the corresponding growth in chronic disease and disability has implications for health policy planning and service demand.”

The Position Statement contains AMA recommendations about the need to factor in gender considerations and the needs of women across a range of areas in health, including:

  •  health promotion, disease prevention and early intervention;
  •  sexual and reproductive health;
  •  chronic disease management and the ageing process;
  •  mental health and suicide;
  •  inequities between different sub-populations of Australian women, and their different needs;
  •  health services and workforce; and
  •  health research, data collection and program evaluation.


  • cardiovascular disease – including heart attack, stroke, and other heart and blood vessel diseases – is the leading cause of death in women;
  •  for women under 34 years of age, suicide is the leading cause of death; and
  • in general, women report more episodes of ill health, consult medical practitioners and other health professionals more frequently, and take medication more often than men.

The AMA Position Statement on Women’s Health 2014 is at

NT alcohol crackdown makes gains, but questions over mandatory rehabilitation remain

By Michael Coggan NT ABC

It appears that stationing police officers outside bottle shops in regional towns in the Northern Territory has had a significant impact on alcohol consumption.

The latest figures show consumption has dropped to the lowest level on record, but the statistics do not include the impact of the mandatory rehabilitation policy or punitive protection orders.

The ABC has investigated the situation as a new federal parliamentary inquiry is promising to test the evidence.

On a weeknight in Darwin’s city centre, locals and tourists mingle at Monsoons, one of the pub precinct’s busy watering holes.

Less than a block away, six women have found their own drinking place under the entrance of an office building, sheltered from monsoonal rain.

Most of them are visiting from Indigenous communities on Groote Eylandt in the Gulf of Carpentaria. They’re “long-grassing” – living rough on the city streets.

Northern Territory Labor Senator Nova Peris is here to talk to them.

One of the women, from the Torres Strait Islands, tells the Senator how she is trying to get through a catering course while struggling with homelessness and alcoholism.

“I am doing it. I’m trying to get up and I’m finding it hard,” she said.

In an interview after talking to the “long-grassers”, Senator Peris emphasised how homelessness makes alcohol abuse among Aboriginal people more obvious than alcohol use in the non-Indigenous community in Darwin.

“Those ladies, they weren’t from Darwin, they were from communities that came in, so they’re homeless and they drink when they come into town and it’s easy to get alcohol [in town].”

Senator Peris also blames alcohol abuse for much of the poor health in Aboriginal communities.

“When you look at alcohol-related violence, when you look at foetal alcohol syndrome, when you look at all the chronic diseases, it goes back to the one thing and it’s commonly known as the ‘white man’s poison’,” she said.

Alcohol-related hospital admissions increase, senator says

The Northern Territory has long grappled with the highest levels of alcohol abuse in the country, but figures released recently by the Northern Territory Government show the estimated per capita consumption of pure alcohol dropped below 13 litres last financial year for the first time since records started in the 1990s.

Territory Country Liberals Chief Minister Adam Giles believes a more targeted response by police has made a difference.

But Senator Peris says data released last week tells a different story.

Senator Peris has quoted figures showing an 80 per cent increase in alcohol-related hospital admissions over the past 14 months as evidence that the previous Labor government’s banned drinker register was working.

The Territory Government scrapped the BDR when it won power in September 2012.

Alice Springs-based associate professor John Boffa from the Peoples Alcohol Action Coalition wants to see the consumption figures verified.

“If it’s true, it’s very welcome news and it would reflect the success of the police presence on all of the takeaway outlets across the territory,” he said.

Parties, police association at odds

In regional towns where alcohol-fuelled violence is high, police have been stationed outside bottle shops to check identification.

Anyone living in one of the many Aboriginal communities or town camps where drinking is banned faces the prospect of having their takeaway alcohol seized and tipped out.

Northern Territory Police Association president Vince Kelly believes police resources are being concentrated on doing the alcohol industry’s work.

Mr Kelly has also questioned the will of the two major political parties to introduce long-term alcohol supply reduction measures since it was revealed that the Australian Hotels Association made $150,000 donations in the lead-up to the last Territory election.

“No-one I know gives away $150,000 to someone and doesn’t expect something back in return,” he said.

But Mr Giles dismisses Mr Kelly’s view.

“I don’t respond to any comment by Vince Kelly from the Police Association, I think that he plays politics rather than trying to provide a positive outcome to change people’s lives in the territory,” he said.

Giles stands by alcohol rehab program

The Federal Indigenous Affairs Minister has asked a parliamentary committee to investigate the harmful use of alcohol in Indigenous communities across the country.

The committee is expected to examine the application of new policies in the Territory, including mandatory alcohol treatment that was introduced in July 2013.

People taken into police protective custody more than three times in two months can be ordered to go through a mandatory three-month alcohol rehabilitation program.

The figures showing a drop in consumption pre-date the introduction of mandatory rehabilitation but Mr Giles believes the policy is making a difference.

So far there is not enough evidence to convince Professor Boffa that mandatory treatment is making any difference.

“We just don’t have publically available data on the numbers of people who have completed treatment, [or] how long people who have completed treatment have remained off alcohol,” he said.

One of the women from Groote Eylandt explained how she had been locked up to go through the mandatory treatment program but was now back on the grog.

“I was there for three months and we didn’t like it,” he said.

The Chief Minister’s political stablemate, Indigenous Affairs Minister Nigel Scullion, has commended the Territory Government for using a mix of police intervention and mandatory rehabilitation, but says jail is not the solution.

“We can’t keep treating people who are sick as criminals. However annoying they might be, people who are alcoholics are ill,” he said.

Alcohol Protection Orders seen to criminalise alcoholism

Police were given the power to issue Alcohol Protection Orders to anyone arrested for an alcohol-related offence, attracting a jail sentence of six months or more.

Aboriginal legal aid services have criticised the orders for criminalising alcoholism.

Priscilla Collins from the North Australian Aboriginal Justice Agency says the orders are predominantly being handed out to Aboriginal people, threatening jail time if they are breached.

“Alcohol protection orders are really being issued out like lolly paper out on the streets. You can be issued one just for drinking on the street, for drink driving. We’ve already had 500 handed out this year,” she said.

Mr Kelly has welcomed the introduction of APOs as a useful tool but has questioned what they will achieve.

“The community and the Government and everybody else needs to ask itself what the end game is,” he said.

“Are we going to end up with even fuller jails? No matter what legislation we introduce we’re not going to arrest our way out of alcohol abuse and Aboriginal disadvantage in the Northern Territory.”

Do you know more? Email




You can hear more about Aboriginal women’s health  at the NACCHO SUMMIT


The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.




NACCHO health news : Making Medicare relevant in the 21st Century: AMA and Catherine King


AMA President Dr Steve Hambleton (pictured right with NACCHO chair Justin Mohamed at a recent Canberra Event) ,

AHHA Medicare Anniversary Roundtable

Making Medicare Relevant in the 21st Century

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

The future of Medicare

I want to speculate about Medicare’s future today – and the key role of doctors, particularly GPs, in that future.

I will make some suggestions about how Medicare can improve its relevance in a changing environment, and how it can best serve the Australian people by continuing to deliver quality, affordable and accessible health services.

As you know, I am not the only person into Medicare speculation recently.

December and January are traditionally the silly season in the Australian media.

The news is full of sport and celebrations … and stories that are recycled, and stories that normally would not see the light of day.

For health, it has been a very silly season.

We have recently seen many opinions about the health system and health financing

People are speculating about the changes to be made to ensure we have a sustainable health care system.

These opinions became stories that inevitably focused on Medicare – because for most Australians Medicare is the Australian health system.

The most notable proposal was the oft-recycled patient co-payment.

The AMA does not support this concept and we have made our view very well known.

There are better ways.

It is interesting that this speculation has come at a time when a new Lancet Commission, when considering global health up to 2035, has recommend that countries should lower the barriers to early use of health services and increase access to disease prevention and minimise the impact of medical expenses.

While I acknowledge the growth in Medicare expenditure, it is important that any changes do not throw the baby out with the bath water.

Any changes must be in the context of the long term goal to improve population health, which will deliver real cost savings.

In terms of spending on medical services, via the Medicare Benefits Schedule, doctors have done their bit over the past decade on containing costs.

As I have said in other fora, medical services costs are not the problem.

Let’s once again set the record straight.

Here are the facts …

Health expenditure

The proportion of health expenditure on medical services was 18.8 per cent in 2001-02 compared to 18.1 per cent in 2011-12.

The average annual growth in total health expenditure on medical services in the decade to 2011-12 was four per cent, compared to growth in PBS expenditure of 6 per cent and 9.3 per cent for products at the pharmacy.

The growth in average health expenditure by individuals on medical services in the decade to 2011-12 was four per cent, compared to 5.3 per cent for PBS medicines and 7.5 per cent for products at the pharmacy.

The average growth in Medicare benefits paid per service in the decade to 2012-13 was 4.7 per cent, less than the real growth in total health spending of 5.4 per cent in the decade to 2011-12.

It is clear that the MBS – combined with the private health insurers’ schedules – is an effective price dampener for medical services.  At least that is what my members keep telling me!

In terms of access to care – despite the low growth in the Medicare Rebate, today, 81 per cent of GP consultations are bulk billed.

And 89 per cent of privately insured in-hospital medical services are charged according to the patient’s private health insurer’s schedule of medical benefits.

This means that patients had no out-of-pocket cost for their doctor’s fee for 93.5 million GP consultations in 2012-13, and over 26 million privately insured in-hospital services.

When Governments get nervous about spending in health, they have three options: reduce the price they pay; spend more wisely; or collect more revenue.

I think that the recent focus on price, in terms of the Medicare Benefits Schedule, is a bit misdirected.

The focus should be on spending that money wisely.  Today, Minister Dutton is quoted as saying that we need to invest in the areas of greatest benefit.

The medical profession stands ready to do its bit in this regard, too.

Australia must change the way it provides health care, where it provides care, and when it is provided for the major driver of health care costs – non-communicable diseases.

Medicare needs to facilitate this.

With the rapid increase in medical knowledge and the rate of change of best practice care, evaluation and change must be part of the medical practitioner DNA.

In terms of our clinical practice, we are going to have to translate what we know into what we do – and we need the tools to do it.

We will need to do this in a structured way so that we stop doing the things we do that don’t provide real outcomes for the patient.

Our clinical practice must be about doing the right things at the right time in the right part of the health system.

Once people get to hospital, their care becomes very expensive.

Keeping people out of hospital is cheaper and it frees up resources, but it might need an increased investment from Medicare, not a decrease.

That investment must be sufficient to improve the coordination of primary care services.

Population Health in the Community – Medicare Locals

The AMA understands the need for community-based health care organisations to improve the coordination of health care outside of the hospital environment.

Such organisations can help to break down the silos in the non-hospital space, build better links between the hospital sector and community based care, support improved population health, and address gaps in the delivery of primary care services.

The former Government set up 61 Medicare Locals to undertake this role.

Despite now having been in operation for a number of years, few Australians understand what Medicare Locals do.

Many GPs feel disenfranchised by them – and so do almost all community-based medical specialists.

We have welcomed the incoming Government’s review and have made a strong submission, based on frontline medical practitioner input.

We believe the former Government pursued the wrong governance model.

They substituted or downplayed the role of GP leaders in Medicare Locals and in their decision-making structures.

They made the same mistakes that the New Zealand Government made in 2001 when it decided to implement ‘skills based boards’ that excluded GPs.

These boards were initially made up of people who, while experienced in governance, did not understand the complexity of health care delivery.

Clinical leadership was absent in many areas in New Zealand and the models failed to deliver.

The leadership role of GPs has now been restored.

The PHOs in New Zealand are now playing a more meaningful role in support of improved health outcomes for local communities.

In New Zealand, the PHOs are now:

  • supporting GPs to focus on population health;
  • supporting improved quality in general practice by facilitating information sharing among GPs;
  • supporting pro-active management of chronic disease;
  • supporting e-health initiatives;
  • funding specific initiatives to keep people out of hospital; and
  • helping support more sustainable general practice by building improved IT and delivering business support.

These are initiatives that are being built from the ground up and led by GPs, not imposed from the top down.

We are calling on the Abbott Government to overhaul the Medicare Locals model to make them responsive to local health needs and to be fully engaged with GPs, who are the engine room of non-hospital based care.

But enough about Medicare Locals, which have got nothing to do with Medicare.

That is why we have suggested a name change.

Complex and chronic disease

The challenges for primary care are growing with our ageing population.

Complex and chronic disease represents a huge burden to the health system.

It accounts for about 70 per cent of the allocated health expenditure on disease and is estimated to increase significantly in the immediate future.

This is both a threat and an opportunity for the Medicare of tomorrow.

Current Medicare-funded chronic disease management arrangements are limited, can be difficult for patients to access, and involve considerable red tape and bureaucracy.

We need less red tape and more streamlined arrangements allowing GPs to refer patients to appropriate Medicare-funded allied health services.

We need a more structured, pro-active approach to managing patients with complex and chronic disease.

The Department of Veterans Affairs is doing some great work in this area with its Coordinated Veterans Care (CVC) Program.

DVA is supporting GPs to provide comprehensive planned and coordinated care to eligible veterans with the support of a practice nurse or community nurse contracted by the Department.

The CVC program is a proactive interactive approach to the management of high acuity chronic and complex diseases.

It supports GPs to spend more time on these patients on a longitudinal basis.  This is something that Medicare currently works against.

The CVC program recognises the non-face-to-face work required, including regular follow-up to see how patients are going without relying on the patient returning to the surgery.

We need to look at how we can roll out this type of pro-active approach more broadly.

It would allow us to invest in a healthier future with better disease management, and prevention of avoidable costly hospital admissions.

The overall message is that if we as a nation do not wish to spend more on health – and that is the clear message coming from the new Government – than we must spend smarter.

We must invest in the things that work.

We must share the knowledge that our various organisations gather from the coalface of health service delivery.

Above all, we must be spending more time building on the things we agree on – and there are a lot of things that we agree on.

Doctors are ready to be a major part of the solution.

GPs are the foundation of primary care – and they save the health system money.

The GP role in population wellness and, ultimately, cost control must be enhanced by Medicare – not eroded or substituted.

The AMA strongly believes that 2014 and beyond must be the years of the GP who can deliver the right care at the right time to the right person.

Medicare must rise to the challenge.






Thank you Alison Verhoeven for that introduction, and thank you for the invitation to make this address today.

May I also acknowledge AMA President Steve Hambleton, Con Costa the President of the Doctors Reform Society, Stephen Duckett from the Grattan Institute, John Glover and all of the other esteemed speakers and guests here with us today.

When Bob Hawke introduced Medicare 30 years ago he warned that without it, two million Australians ‘faced potential financial ruin in the event of major illness’. Today more than 39% of Australia’s population is under 30 – that’s more than eight and a half million Australians who are growing up without knowing what healthcare in Australia looks like without Medicare.

And of the two million Australians who faced potential financial ruin in 1984, it’s worth considering just how many hundreds of thousands of people have had their lives changed thanks to Medicare. It’s quite an achievement, particularly given how hard Labor has had to fight not just to introduce, or reintroduce, the architecture of a universal healthcare system, but to protect it.

That we are celebrating Medicare’s 30th birthday is particularly commendable when a comparison is made of international health systems.  No one health system is perfect, but on this 30th anniversary it is right to be celebrating and reflecting on what is important about our health system.

It’s also important that we focus on what needs to be done to preserve the fundamental principles on which it is based:

  • Universal access
  • Overcoming health inequality
  • Access to new medicines and treatments
  • And prevention.


For the millions of Australians who have grown up with Medicare it must be difficult to appreciate how different Australia’s healthcare system was in 1984 compared with the system of universal care we are afforded today.

Of course the Medicare we know is different from the scheme that was originally introduced. Gough Whitlam introduced Medibank in August 1974 only to have Malcolm Fraser and his government overturn it in 1976. The legislation for Medibank had been blocked in the Senate, and was one of the key issues Labor campaigned on during the 1974 election – indeed it was one of the measures on which the Governor-General granted a double dissolution.

At the time, Whitlam argued that the conservatives had:

‘Preserved the inequity, inefficiency and injustice of an antiquated health scheme. They have prevented one million of our fellow-citizens from having any protection against hospital and medical charges.’

Whitlam’s victory in ’74 would prove to be one of the most important steps in achieving a system of universal healthcare but it would not be a decisive one. It took two Labor governments more than two decades to embed what is now Medicare.

When Neal Blewett, the reforming health minister in the Hawke government, introduced the legislation that would re-establish a system of universal care he told the parliament:

“In a society as wealthy as ours there should not be people putting off treatment because they cannot afford the bills. Basic health care should be the right of every Australian.”

It’s a statement that says everything about what Labor stood for 30 years ago and it says everything about what Labor stands for today.

Bulk billing and co-payments

It’s appropriate therefore to focus on some of the achievements of the past two terms in government. When Labor left office bulk billing rates were at more than 80%. This is an achievement I’m very proud of but also something that also causes me deep concern. The increase in bulk billing rates to this historical high did not happen by accident.

The incentives my colleague Tanya Plibersek introduced, and before her Nicola Roxon, for GPs to bulk bill, particularly to bulk bill concessional patients, have made it easier for all Australians to get to see a doctor, but in particular they have benefited those members of the community who most need the assistance Medicare affords. Over the past month we’ve seen the government repeatedly refuse to rule out the introduction of a Medicare co-payment. This would end bulk billing and put considerable pressure on some of the most vulnerable Australians, many of whom already have very low access to GPs.

Labor’s legacy

To strengthen primary care Labor established a network of 61 Medicare Locals servicing every region. Medicare Locals are intended to save money on secondary care and prevent hospital admissions. They are also one of the important ways Labor strengthened Medicare when in government by refocussing on the importance of primary care.

The benefits of the work Medicare Locals are undertaking are already being seen in communities across Australia. Medicare Locals are identifying specific needs for local services and planning for services to address these gaps, such as through the engagement of additional nurses and other allied health professionals at GP clinics, as well as the provision of after-hours GP services.

But most importantly Labor made funding available to ensure these services could be delivered effectively.  Medicare Locals provide the architecture for a stronger reengagement of the Commonwealth in local primary care and planning. Medicare Locals for example are working to increase breastfeeding rates in areas where breastfeeding rates are low; in areas where smoking rates are high there are programs tailored specifically to those communities to reduce smoking rates, as there are programs to reduce rates of type two diabetes in communities that have a significant prevalence of this disease.

Despite the rhetoric of the new government, the vast majority of people employed by Medicare Locals are directly responsible for providing care and improving health services in local regions.

Viability of Medicare

As the demands on the MBS and PBS continue, it’s important to ensure governments get the best value for money on health expenditure and that all Australians continue to get access to the best quality medical care. The sustainability of Medicare is about much more than purely academic arguments.  It’s important that new policies be pragmatic and can actually be implemented by governments. A good example of this is the price disclosure reforms we pursued when in government.

But it’s important to acknowledge too the challenges that had to be met to implement this policy.  I am concerned however that some of the rhetoric of the past few months is more about softening the Australian public and media up for an assault on the universality of Medicare and a further move towards a two tiered health system. Today for example we have seen the Health Minister use a Productivity Commission report as an excuse to talk about cutting ‘waste’ in health.

On its record to date it’s difficult to trust this government, and I fear the Minister is only using this rhetoric as an opportunity to justify cuts to satisfy the Prime Minister’s agenda. Over the next couple of years I am particularly interested in working with you to develop new ways we can ensure greater equity in our health system and make sure the Medicare of the 21st century is something its original architects and the Labor party that introduced it, can be proud of today.

Private Health Insurance

It’s important to acknowledge that the private health insurance industry does play an important role in healthcare in Australia. Labor’s position remains that governments have a responsibility to ensure that the private health insurance industry remains sustainable and that private health insurance is affordable and provides good value. The means testing of the private health insurance rebate that Labor introduced in government meant a number of the health programs and infrastructure projects I’ve already mentioned could be delivered.

Despite the criticism at the time we did not see tens of thousands of Australians giving up their cover as was claimed would occur. On the contrary, the number of people with both general and hospital cover is at the highest rate ever and continues to grow. For the first time ever, 55% of Australians have general cover, with 47% having hospital treatment cover.

The challenge for the government now is to ensure the cost of private health insurance is kept as low as possible and that the system does not undermine Medicare. At the end of last year Minister Dutton announced the largest increase to private health insurance premiums in a decade. In government, we had always taken several months to agree on premium increases, often going back to individual insurers several times to ensure consumers received the smallest increase possible. This was a particularly cynical announcement by this government and one that would be a mistake to repeat.

I want to mention briefly the government’s intention to sell Medibank Private.  Labor has reservations about what the sale of Medibank will do for competition in the sector and what this will mean for consumers. Having a government-owned insurer has had a balancing factor in the sector which would be lost should Medibank be sold.  More concerning again is the new government’s rhetoric about the move of the private health insurance industry into general practice.

I am interested from a policy perspective in good models of care. I am interested in how there can be a stronger role for prevention and more integrated case management, better consumer health literacy, more consumer engagement. There are very good examples across the country, including some of the work private health insurers are doing with their captured population of patients.

But I remain fundamentally concerned as a Labor Shadow Health Minister about health inequality and my very real fear is that there is a genuine danger of a shift toward a two tiered health system.


Today, some 30 years since the introduction of our universal health system – Medicare – debates about its structure, its funding, its principles and its implementation continue. But it is clear that Australians value it and that it is embedded as a fundamental aspect of our society.

I want to wish you well in your deliberations today.

I wish to congratulate the AHHA on pulling together speakers who have been responsible for the establishment, implementation and defence of Medicare.

Labor stands for a system of universal care.

As Neal Blewett told parliament 30 years ago, basic healthcare should be the right of every Australian.

30 years later, it is.

Medicare is a system worth defending and we will do exactly that.

NACCHO scholarship alert: Aboriginal Medical Students encouraged to apply for $9,000 scholarship


AMA President, Dr Steve Hambleton, today encouraged Indigenous medical students to apply for the 2013 AMA Indigenous Peoples’ Medical Scholarship.

Dr Hambleton said that an important part of closing the Indigenous health and life expectancy gap is to build an adequate workforce that includes Indigenous doctors and health professionals.

“There is evidence that there is a greater chance of improved health outcomes when Indigenous people are treated by Indigenous doctors and health professionals,” Dr Hambleton said.

“The numbers of Indigenous doctors are steadily increasing, but every effort needs to be made

to help make it possible for Indigenous people to study medicine.

“This is why the AMA offers the Indigenous Peoples’ Medical Scholarship of $9000 per

annum for aspiring Indigenous doctors.

“The scholarship has assisted many Indigenous men and women who may not have otherwise

had the financial resources to study medicine.

The scholarship was established in 1995 with a contribution from the Australian Government

to help increase the number of Indigenous doctors in Australia.

Applications for the scholarship must be in by 10 May 2012.

To be eligible for the scholarship, students must currently be enrolled full time at an Australian

medical school and be eligible for ABSTUDY.

For further information on how to apply for the 2013 AMA Indigenous Peoples’ Medical

Scholarship visit here