A peak Aboriginal health organisation has slammed reported changes to employment policy in remote communities calling it bad policy developed in isolation from the reality of community life and likely to worsen already poor health outcomes for Aboriginal people.
“This is poor policy, as thin as the paper it’s written on, and as remote from our people’s lives as Canberra is from the bush,” said Justin Mohamed Chair of National Aboriginal Community Controlled Health Organisation (NACCHO).
“Forcing Aboriginal people to work in “work-like” dole activities to supposedly replicate “real work” means the government is admitting what we all know, that there is a drastic shortage of jobs in these remote areas.
“Jobs will not magically appear because a policy changes.
“What is needed is investment in better infrastructure through local communities to work as the lever to create jobs.
“Adding more punitive measures for non-compliance is also likely to further entrench poverty in remote communities and impact on health – extending the life expectancy gap between Aboriginal and non-Aboriginal people.
“We already witness appallingly high rates of mental health and suicide in these communities and there is no evidence that forcing individuals to do meaningless work for the sake of it does anything to improve their health outcomes.
“This proposed policy thinly resembles a back-to-the future CDEP (Community Development Employment Program) but is bereft of the broader understanding of how community and development influence employment.
“We again see no evidence of understanding the interconnection between social, cultural, health, education and economic factors, and people’s ability to engage in work.
“The biggest employer in many communities is the Aboriginal Community Controlled Health Organisation. ACCCOs provide real employment and on the job training and is the biggest employer of Aboriginal people in some communities.
“A larger investment in infrastructure such as ACCHOs, and expanding them into more communities, will improve health and will also contribute towards the multifaceted employment challenges in remote communities.
“Without this recognition of the systemic and infrastructural barriers to achieving good health and workforce participation in remote communities this policy is unlikely to help Aboriginal employment opportunities in any way.”
The Australian Government is taking another important step towards securing health equality for Aboriginal and Torres Strait Islander people.
Assistant Minister for Health Fiona Nash has asked for work to begin on developing a plan for implementing the National Aboriginal and Torres Strait Islander Health Plan.
“The implementation plan is about ensuring we deliver real outcomes on the ground,” Minister Nash said at the National Aboriginal Community Controlled Health Organisation Summit at the Melbourne Convention and Exhibition Centre yesterday.
The Government is updating the Health Plan to reflect the Coalition’s approach and priorities in Indigenous affairs. In particular, the updated Plan will recognise the links between health and the key social determinants of education, employment and community safety.
“Higher education attainment, paid employment and safe communities are all connected with better health, and the Government is striving to ensure that these are delivered to improve the lives of Indigenous people nationally,” Minister Nash said.
“The Health Plan provides a useful framework to guide policy and programme development. However, Indigenous health will only be improved by concrete action on the ground.”
“The Government announced in the Budget that through a $94 million investment in Better Start to Life the Government will expand efforts in child and maternal health to support Indigenous children to be healthy and go to school”.
“The Government is committed to closing the gap by ending the cycle of disadvantage which starts with poor child health,” Minister Nash said.
“Focussing on the critical early years means Aboriginal and Torres Strait Islander children will get a positive foundation for life.”
As outlined in the Budget, the Australian Government will invest $3.1 billion in Indigenous specific health programmes and activities from 2014-15 to 2017-18 – an increase of more than $500 million compared to 2009-10 to 2012-13.
The report, Health expenditure Australia 2011-12, shows health spending was estimated to be $140.2 billion in 2011-12-up from $132.6 billion in 2010-11 and from $82.9 billion 10 years earlier in 2001-02 (after adjusting for inflation).
Almost 70% of total health expenditure during 2011-12 was funded by governments, with the Australian Government contributing 42.4%, and state and territory governments contributing 27.3%. The remaining 30.3% was funded by individuals, private health insurers, and other non-government sources.
As a proportion of Australia’s gross domestic product (GDP), health spending was 9.5% in 2011-12, up from 9.3% in 2010-11 and 8.4% in 2001-02.
‘Over the decade from 2001-02, the ratio of health spending as a proportion of GDP and taxation revenue has risen, particularly following the global financial crisis,’ said AIHW CEO David Kalisch.
Over the decade to 2011-12, the Australian Government ratio of health expenditure to taxation revenue rose by 4.0 percentage points to 26.4%, while the state and territory governments’ ratio rose by 8.1 percentage points to 24.5%.
‘Our analysis of health inflation suggests that in recent years annual price rises in the broader economy have generally been greater than price rises in the health sector’, Mr Kalisch said.
The estimated recurrent expenditure on health per person in 2011-12 was $5,881, a rise from $5,681 per person in 2010-11 and $4,062 in 2001-02 (after adjusting for inflation).
Public hospital spending was the biggest component of health expenditure in 2011-12, accounting for $42.0 billion, or 31.8% of recurrent expenditure. The largest component of the overall rise in health spending was also spending on public hospital services (up by $2.1 billion), making up almost a third of the growth in recurrent health expenditure.
The Australian Government’s share of public hospital funding was 38.2% in 2011-12, down from 39.6% in 2010-11. The state and territory governments’ share of public hospital expenditure was 53.3% in 2011-12, up from 52.0% in 2010-11.
The AIHW is a major national agency set up by the Australian Government to provide reliable, regular and relevant information and statistics on Australia’s health and welfare.
NACCHO JOB Opportunities:
Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.
Deputy NACCHO chair Matthew Cooke, Chair Justin Mohamed and board member John Singer launching Blueprint
Photo Wayne Quilliam
NACCHO has long recognised the importance of an Aboriginal male health policy and program to close the gap by 2030 on the alarming Aboriginal male mortality rates across Australia.
Aboriginal males have arguably the worst health outcomes of any population group in Australia.
To address the real social and emotional needs of males in our communities, NACCHO proposes a positive approach to Aboriginal male health and wellbeing
NACCHO, its affiliates and members are committed to building upon past innovations and we require targeted actions and investments to implement a wide range of Aboriginal male health and wellbeing programs and strategies.
We call on State, Territory and Federal governments to commit to a specific, substantial and sustainable funding allocation for the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030
This blueprint sets out how the Aboriginal Community Controlled Health Services sector will continue to improve our rates of access to health and wellbeing services by Aboriginal males through working closely within our communities, strengthening cultural safety and further building upon our current Aboriginal male health workforce and leadership.
We celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children
The NACCHO 10-Point Blue print Plan is based on a robust body of work that includes the Close theGap Statement of Intent and the Close the Gap targets, the National Framework for the Improvement of Aboriginal and Torres Strait Islander Male Health (2002),NACCHO’s position paper on Aboriginal male health (2010) the 2013 National Aboriginal and Torres Strait Islander Health Plan (NATSIHP), and the NACCHO Healthy futures 10 point plan 2013-2030
These solutions have been developed in response to the deep-rooted social, political and economic conditions that effect Aboriginal males and the need to be addressed alongside the delivery of essential health care.
Our plan is based on evidence, targeted to need and capable of addressing the existing inequalities in Aboriginal male health services, with the aim of achieving equality of health status and life expectancy between Aboriginal males and non-Aboriginal males by 2030.
This blueprint celebrates our success so far and proposes the strategies that governments, NACCHO affiliates and member services must in partnership commit to and invest in to ensure major health gains are maintained into the future
NACCHO, our affiliates and members remain focused on creating a healthy future for generational change and the NACCHO Aboriginal Male Health 10 point Blueprint 2013-2030 will enable comprehensive and long-term action to achieve real outcomes.
To close the gap in life expectancy between Aboriginal males and non-Aboriginal within a generation we need achieve these 10 key goals
1. To call on government at all levels to invest a specific, substantial and sustainable funding allocation for the, NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030 a comprehensive, long-term Aboriginal male Health plan of action that is based on evidence, targeted to need, and capable of addressing the existing inequities in Aboriginal male health
2. To assist delivering community-controlled ,comprehensive primary male health care, services that are culturally appropriate accessible, affordable, good quality, innovative to bridge the gap in health standards and to respect and promote the rights of Aboriginal males, in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal male health and well-being
3. To ensure Aboriginal males have equal access to health services that are equal in standard to those enjoyed by other Australians, and ensure primary health care services and health infrastructure for Aboriginal males are capable of bridging the gap in health standards by 2030.
4. To prioritise specific funding to address mental health, social and emotional well-being and suicide prevention for Aboriginal males.
5. To ensure that we address Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education.
6.To improve access to and the responsiveness of mainstream health services and programs to Aboriginal and Torres Strait Islander people’s health services are provided commensurate Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues
7.To provide an adequate workforce to meet Aboriginal male health needs by increasing the recruitment, retention, effectiveness and training of male health practitioners working within Aboriginal settings and by building the capacity of the Aboriginal and Torres Strait Islander health workforce.
8 To identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Services (ACCHSs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses. Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.
9. To build on the evidence base of what works in Aboriginal health, supporting it with research and data on relevant local and international experience and to ensure that the quality of data quality in all jurisdictions meets AIHW standards.
10. To measure, monitor, and report on our joint efforts in accordance with benchmarks and targets – to ensure that we are progressively reaching our shared aims.
About NACCHO and Aboriginal Male health:
NACCHO is the national authority in comprehensive primary Aboriginal healthcare .
The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national peak Aboriginal health body representing 150 Aboriginal Community Controlled Health Services (ACCHS).
This is achieved by working with our Affiliates, the State and Territory peak Aboriginal Community Controlled Health bodies, to address shared concerns on a nationally agreed agenda for Aboriginal and Torres Strait Islander health and social justice equality.
NACCHO and the Aboriginal community controlled comprehensive primary health care services, which are NACCHO members are enduring examples of community initiated and controlled responses to community issues.
NACCHO’s Strategic Directions focus on three central areas that are consistent with its constitutional objectives.
Strategic Direction 1: Shape the national reform of Aboriginal health.
Strategic Direction 2: Promote and support high performance and best practice models of culturally appropriate and comprehensive primary health care.
Strategic Direction 3: Promote research that will build evidence-informed best practice in Aboriginal health policy and service delivery.
The NACCHO HEALTHY FUTURES 10-point plan 2013-2030 provides our sector, stakeholders, partners and governments with a clear set of priorities and strategies that will result in improvements in Aboriginal health outcomes and is the foundation for this NACCHO Aboriginal Male Health 10 point Blueprint plan 2013-2030
NOTE : Throughout this document the word Male is used instead of Men. At the inaugural Aboriginal and Torres Strait Islander Male Health Gathering-Alice Springs 1999, all delegates present agreed that the word Male would be used instead of the word Men. With the intention being to encompass the Male existence from it’s beginnings in the womb until death.
Throughout this document the word Aboriginal is used instead of Aboriginal and Torres Strait Islander. This is in line with the National Aboriginal Community Controlled Health Organisation (NACCHO) being representative of Aboriginal People. This does not intend to exclude nor be disrespectful to our Brothers from the Torres Strait Islands.
Shane Duffy, the Chairperson of the National Aboriginal & Torres Strait Islander Legal Services (NATSILS) delivered a joint statement on behalf NATSILS and the Indigenous Peoples Organisation Network of Australia (IPO) in response to a Study on access to justice in the promotion and protection of the rights of Indigenous Peoples at the Expert Mechanism on the Rights of Indigenous Peoples (EMRIP) at the Sixth Session meeting in Geneva from 8-12 July 2013.
Mr Duffy said studies such as these provide a critical point of reference and authoritative guidance for States (National Governments) in their efforts to provide for and implement their obligations concerning the rights of Indigenous Peoples.
However, while Mr Duffy agrees that the experience of Indigenous Peoples within the criminal justice system the world over requires urgent action, he said care needs to be taken not to confine States understanding their responsibilities by limiting the expression or scope of these rights to one element or area of concern.
He further added; Access to justice for Indigenous Peoples must be about how we can use both Indigenous and Western systems of justice to ensure the greatest possible quality of life for all Indigenous Peoples’, which is highlighted at Article 5 of the Declaration on the Rights of Indigenous Peoples that affirms Indigenous Peoples right to maintain and strengthen our political, legal, economic, social and cultural institutions while retaining our right to also participate fully in the political, economic, social and cultural life of the State.
Mr Duffy’s statement called on the Human Rights Council (HRC) to encourage States to implement the United Nations Declaration on the Rights of Indigenous Peoples as the foundational document for the development of all policies concerning Indigenous Peoples, including issues related to access to justice, and that the HRC request the EMRIP extend the Study on access to justice in the promotion an protection of the rights of Indigenous Peoples to include a practical analysis of Articles 1 (4) and 2 (2) of the Convention on the Elimination of All Forms of Racial Discrimination and General Comment XXIII by the CERD as it relates to special measures and the requirement to obtain free, prior and informed consent.
Mr Duffy further added ‘it is important that States utilise informed standardised data collections that ensures a more strategic approach that provides appropriate needs based financial resources to Indigenous organisations to build their capacity to respond appropriately to Indigenous justice needs.
Mr Duffy said, ‘In Australia, the statistics provide a damning picture, with Aboriginal and Torres Strait Islander adults incarcerated at 15 times the rate of non-Indigenous adults; imprisonment rate for our women has grown by 58.6% between the years 2000 to 2010; Our children are 24 times more likely to be in youth detention than non-Indigenous young people. In 2011-12, our children were subjected to child protection substantiations at a rate of 41.9 per 1000, nearly eight times that of non-Indigenous children. They are also ten times more likely to be in out-of-home care (comprising 31% of all children in care), despite making up only 4.2% of the population of all children and young people. In addition to the rising rates, our children are increasingly being placed with non-Indigenous foster carers.
We have therefore called on the Australian government to take into consideration the significant issues highlighted in the full intervention to work collaboratively with us to facilitate the restoration and strengthening of local governance and decision-making structures to improve Aboriginal and Torres Strait Islander people’s access to justice’.
For a full copy of Mr Duffy’s Intervention and/or interview enquiries please contact Amala Groom
Phone: +61 425 820 658 Email
Article by: Ruth Armstrong, Senior Deputy Editor – Medical Journal of Australia, Sydney, NSW.
This issue of the MJA, timed to coincide with NAIDOC Week, is devoted to exploring the health status of Australia’s Aboriginal and Torres Strait Islander peoples — particularly our children and young people. Children aged 0–14 years make up 35% of the Australian Indigenous population, write Eades and Stanley.
Data on their health and development are patchy but indicate a growing divide between Indigenous and other Australian children for several risk factors and conditions. Azzopardi and colleagues add a systematic review of the evidence for young people aged 10–24 years into the mix, finding gaps in the observational research for urban settings, mental health and injury, and confirming the well known dearth of interventional studies.
Two studies in this issue add to the scant evidence available by testing simple interventions that might lead to improvements, such as providing subsidised fruit and vegetable boxes to disadvantaged families in regional towns (Black and colleagues) and swimming pools in remote communities (Stephen and colleagues).
Turning our thoughts to the health needs of Indigenous children is always important but is particularly timely now. A federal election, with all its potential for policy upheaval, is just 2 months away. In the first article in our pre-election series, Arabena recognises an urgent need for better data to evaluate existing and future policies, and envisages a plan for health that takes Aboriginal and Torres Strait Islanders’ perspectives, wishes and culture into account, and brings an end to aspects of the health system that contribute to inequality, such as racism.
Independently of the election, the Australian Government is developing a new National Aboriginal and Torres Strait Islander Health Plan for the next decade. Kimpton, president of the Australian Indigenous Doctors’ Association, says the plan will have the best chance of success if it has at its heart some important principles: nurturing of the Indigenous health workforce; genuine, strong partnerships with Indigenous organisations; fostering culture as integral to health and wellbeing; and promoting Indigenous leadership, while involving the whole health system.
The solutions to many health problems for Indigenous children lie outside the health system, but making our health services accessible, culturally safe and appropriate places will lead to better outcomes for the families who inevitably need them. “Cultural competence” can be a daunting term for doctors. Thackrah and Thompson encourage us to look at our own culture of medicine and the practical realities of patients’ lives when trying to put this difficult concept into practice.
Amid all this thinking and soul searching, there are good examples of what works — innovative health promotion and education programs combining the nurturing effects of “country” with exchanges of new knowledge (Webb and colleagues), and thriving health services where Indigenous families can truly have their health needs met and that also serve as centres of outreach bringing sorely needed medical expertise to remote communities (McGilvray).
As Milroy reminds us in her response to a study that found many Aboriginal children had been exposed to traumatic, potentially health damaging experiences (Askew and colleagues), Indigenous children need access to the best possible health services right now and for years to come.
History tells us that policies fail, and services falter, when they are not developed in consultation with those for whom they are designed. On this point, Eades and Stanley concur: “… we believe that Australian services have failed to close the gap in child health because they have been developed without involving or engaging First Nations people”. At this important time in Australian history, we have yet another chance to get it right. Be it by public policy or individual action, we need to do all we can to make our health services places of healing for Aboriginal and Torres Strait Islander children and their families.
The Aboriginal Medical Service Professional Development scholarships opened on 4 March 2013 and will close 19 April 2013.
The scholarships are an Australian Government initiative; distributed under the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS), to facilitate continuing professional development (CPD) and to encourage the pursuit of a health career in both rural and metropolitan areas.
The professional development scholarship is aimed to support nurses and midwives working in an Aboriginal Medical Service.
The scholarships are available for either CPD or postgraduate study and successful applicants may receive up to $15,000 for activities undertaken in the period 1 January 2013 to 31 December 2013.
The Australian College of Nursing’s (ACN) Chief Executive Officer, Adjunct Professor Debra Thoms is committed to continuing to support the Department of Health and Ageing’s Scholarship Scheme for nurses and midwives and to promote educational opportunities to nurses across Australia.
“It is encouraging to see the Government’s support of Australian nurse’s careers and ongoing development. These scholarships help to promote nursing as a career within Australia and particularly in Indigenous communities. Scholarships provide nurses with the security they need to further their careers,” Professor Thoms said.
NAHSSS scholarships are open to Australian citizens whose registration with the Nursing and Midwifery Board of Australia is current as an enrolled nurse, a registered nurse or registered midwife. Applicants must be working in a clinical setting.