“ Today marks a significant step forward in our historic partnership between governments and the Coalition of Aboriginal and Torres Strait Islander Peaks with the agreement that we will work towards a new National Agreement on Closing the Gap to guide efforts over the next ten years.
The conversation on Closing the Gap is changing because Aboriginal and Torres Strait Islander peoples are now at the negotiating table with governments.
The proposed priority reforms are based on what Aboriginal and Torres Strait Islander peoples have been saying for a long time is needed to close the gap and we now have a formal structure in place to put those solutions to governments.
If we are to close the gap it will be Aboriginal and Torres Strait Islander community-controlled organisations leading the way on service delivery. We already know that community-controlled organisations achieve better results because we understand what works best for our peoples.
It is a critical step for the Joint Council to formally recognise that Aboriginal and Torres Strait Islander peoples must share in decision-making on policies that affect their lives.
The Coalition of Peaks are looking forward to engaging with communities around Australia to build support from Aboriginal and Torres Strait Islander peoples for the priority reforms and to ensure that their views on what is needed to make them a success is captured in the new National Agreement.”
Pat Turner, Lead Convener of the Coalition of Peaks, CEO of NACCHO and Co-Chair of the Joint Council speaking after a meeting of the Joint Council on Closing the Gap was held in Adelaide on Friday 23 August
The Joint Council agreed on a communiqué, which is attached.
Joint Council makes progress towards new National Agreement on Closing the Gap
A meeting of the Joint Council on Closing the Gap was held in Adelaide on Friday 23 August , between representatives of the Council of Australian Governments (COAG) and a Coalition of Aboriginal and Torres Strait Islander Peak Bodies (Coalition of Peaks).
In its second ever meeting, the Joint Council today agreed to work towards a new National Agreement Closing the Gap.
Importantly, it also agreed in principle to the following three priority reforms to underpin the new agreement and accelerate progress on Closing the Gap:
Developing and strengthening structures to ensure the full involvement of Aboriginal and Torres Strait Islander peoples in shared decision making at the national, state and local or regional level and embedding their ownership, responsibility and expertise to close the gap;
Building the formal Aboriginal and Torres Strait Islander community-controlled services sector to deliver closing the gap services and programs in agreed priority areas; and
Ensuring all mainstream government agencies and institutions undertake systemic and structural transformation to contribute to Closing the Gap.
The priority reforms will form the basis of engagements with Aboriginal and Torres Strait Islander representatives of communities and organisations across Australia and will focus on building support and what is needed to make them a success.
In another first, the engagements will be led by the Coalition of Peaks, with the support of Australian Governments.
A Welcome to Country for the second meeting of the Joint Council on #ClosingtheGap in Adelaide , co-chaired by the Minister Ken Wyatt and Pat Turner AM, Lead Convenor of the Coalition of Peaks.
Friday’s agreement follows the release in December last year of a set of draft targets by the Council of Australian Governments in a range of areas including health, education, economic development and justice.
They include a desire to have 95 per cent of Aboriginal and Torres Strait Islander four-year-olds enrolled in early childhood education by 2025, a bid to close the life expectancy gap between indigenous and non-indigenous Australians by 2031 and efforts to ensure 65 per cent of indigenous youth aged between 15 and 24 are in employment, education or training by 2028.
The targets also seek to cut the number of Aboriginal and Torres Strait Island young people in detention by up to 19 per cent and the adult incarceration by at least five per cent by 2028.
The refreshed closing the gap agenda will also commit to targets that all governments will be accountable to the community for achieving.
About the Joint Council
The Joint Council was established under the historic Partnership Agreement, announced in March. The agreement represents the first time Aboriginal and Torres Strait Islander Peak bodies will have an equal say in the design, refresh, implementation, monitoring and evaluation of the Closing the Gap framework.
The council is comprised of 12 representatives elected by the Coalition of Peaks, a Minister nominated by the Commonwealth and each state and territory governments and one representative from the Australian Government Association.
“ It’s the first time ever that COAG has Aboriginal people as equal partners at the table negotiating how we work over the next decade to Close the Gap for our people
We’re at a crossroads, and we’ve decided to take up our rightful role.
I want our people living in safe, secure housing. I want them to have access to community-controlled health services no matter where they live. I want our people to have the best access to all education services, and I want our people to generally have the same opportunities as other Australians,” Ms Turner said.
I want our people to have full-time jobs. We’ve got to scrap the negative issues that we have deal with every day. We have to take a strengths-based approach and we have to make sure that we are getting our people out of poverty.”
National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Pat Turner.
“If we’re stepping up to this level than we have to take on the responsibility and be prepared to work extensively to achieve the outcomes we’re all aspiring to, and if there are changes along the way, then so be it. The buck will stop with us.”
Aboriginal Medical Services Alliance Northern Territory chief executive, John Paterson, said the agreement also means Indigenous groups are just as accountable as governments.
“ Labor welcomes the Closing the Gap Partnership Agreement announced by the Coalition Government and the Coalition of Peaks, made up of some 40 Aboriginal and Torres Strait Islander national and state /territory peaks and other organisations across Australia.
A formal agreement with First Nations organisations and providers to work together to Close the Gap is long overdue.
This announcement comes after years of delay, dysfunction and poor communication due to the failure in leadership of this government. It has been two years since the government announced a ‘refresh’ of the Close the Gap”
For Labor Party response /support see Full Press Release attached
Representatives of around 40 Indigenous peak bodies, making up a ‘coalition of peaks’ will co-chair a new joint council alongside ministers. Picture Brisbane Yesterday
The Council of Australian Governments has unveiled an historic partnership with Aboriginal and Torres Strait Islander organisations, as they look to refresh the Closing the Gap strategy and turn around a decade of disappointing results.
Aboriginal and Torres Strait Islander groups have sat down with state, territory and Commonwealth ministers, for the first time, to work on Closing the Gap.
Under a ten-year agreement, Indigenous peak bodies will share ownership and accountability to deliver real, substantive change for Indigenous Australians.
The partnership marks an historic turning point for the Closing the Gap strategy, which for the past eleven years has seen dismal results in delivering better outcomes for Indigenous Australians.
Last year, just two of the seven targets were on track to being met.
Representatives of around 40 Indigenous peak bodies, making up a ‘coalition of peaks’ will co-chair a new joint council alongside ministers.
Ms Turner and Indigenous Affairs Minister Nigel Scullion co-convened the first meeting in Brisbane on Wednesday.
The Morrison government is committing $4.6million over three years to fund the coalition’s secretariat work, and additional funding is expected in next Tuesday’s budget for the Closing the Gap refresh framework.
But Ms Turner warns the new coalition is not a substitute for an ‘Indigenous voice to the parliament.’
“Our focus is on the Close the Gap. We in no way are the ‘voice’ – that is a process that still has to be settled by the incoming government at the federal level,” she said.
The framework will undergo Indigenous-led evaluations every three years.
Details of new targets are expected to be revealed in mid-2019 but Indigenous groups have already flagged key areas of concern.
“We’ve got too many people in juvenile justice, we’ve got too many children being removed from their families, we’ve got so much family violence, drug and alcohol abuse.
And all those issues, this Closing the Gap can do something about,” said Victorian Aboriginal Community Controlled Health Organisation chief executive, Muriel Bamblett.
Ms Bamblett told NITV she hopes the new agreement will bring about real outcomes for Aboriginal and Torres Strait Islander people on the ground.
“We’re tired of going to the table and saying this is wrong … We know we’ve got the answers.”
” The Federal, State and Territory Health Ministers met in Alice Springs yesterday (2 August ) at the COAG Health Council to discuss a range of national health issues.
The meeting was hosted by the Hon Natasha Fyles, the Northern Territory Minister for Health. The meeting was chaired by the Ms Meegan Fitzharris MLA, Australian Capital Territory Minister for Health and Wellbeing.
On Wednesday 1 August Health Ministers held a Roundtable with Indigenous leaders to listen to what is important to Indigenous people and to talk about how we can work together to improve health and healthcare for Aboriginal and Torres Strait Islander people to achieve equity in health outcomes.
A separate communique has been prepared for the Indigenous Roundtable.
Following the meeting the Australian Commission for Safety and Quality in Health Care launched the National Safety and Quality Health Service Standards – User Guide for Aboriginal and Torres Strait Islander Health.
See full COAG Health Miinisters Communique Part 1 Below or Download HERE
” On Wednesday 1 August, COAG Health Council (CHC) members met with Indigenous health leaders for an Aboriginal and Torres Strait Islander Health Roundtable.
All Ministers welcomed and valued this momentous opportunity to hear collectively from Indigenous health leaders.
The COAG Health Council welcomed Minister Ken Wyatt, the Federal Minister for Indigenous Health to the meeting and expressed its deepest thanks to those Indigenous Leaders from across Australia who participated.”
See full COAG Health Miinisters Indigenous Health Rundtable Communique Part 1 Below or Download HERE
” So there’s work that we’ve centred our attention on, working very closely with the community-controlled health sector across the nation, because these are two very significant illnesses that prevail within Aboriginal communities – avoidable blindness, avoidable deafness.
But we also want to look at some of those other underlying issues that impact on a child in their early years – crusted on scabies, we’ve just committed a substantial piece of work around to tackle that issue and look at solutions.
But the underlying social determinants are absolutely critical. But with the state and territory health ministers meeting here in Alice Springs, it means we will have a very serious discussion around the way in which the Commonwealth and state and territories work in partnership with Aboriginal people, not for us to deliver programs to them.
Because often change will only come when families have the ownership, when communities are those who determine the priorities that are needed, that then are given the level of support and resourcing that is important in the way that we’ve done with Purple House.
Ken Wyatt Greg Hunt Press Conference Alice Springs see Part 2 Below or Download Transcripts of both
The best health comes when Indigenous communities and Indigenous leaders are able to take control, and that’s what they want to do.
They are saying – particularly through the ACCHOs – that we are able to help our own people if you give us the support and the tools, and that’s why the workforce plan is fundamental, coupled with additional support for research by and into Indigenous health.”
Major items discussed by COAG Health Ministers today included:
1.National collaboration to improve health outcomes for Aboriginal and Torres Strait Islander Australians
Health Ministers held a strategic discussion on national collaboration to improve health outcomes for Aboriginal and Torres Strait Islander Australians. The wide-ranging discussion covered the impacts of potentially preventable rates of eye disease, ear disease, kidney disease, crusted scabies, Rheumatic Heart Disease, Human T-Lymphotropic Virus Type 1 (HTLV-1) and mental health in Aboriginal and Torres Strait Islander communities. Ministers identified opportunities for collaborative action to improve Aboriginal and Torres Strait Islander health outcomes that builds on the work already underway across Australia.
Ministers acknowledged the breadth and depth of Indigenous health knowledge, experience and leadership represented at the Roundtable, as well as the proven record of Aboriginal controlled health organisations in improving the health and wellbeing of indigenous Australians.
Indigenous leaders spoke of the importance of mutual trust and respect, the need to increase cultural capability and eliminate racism in all health settings and services, and the importance of cultural safety in improving the health and wellbeing of indigenous Australians.
Ministers welcomed this message and agreed that cultural safety in providing healthcare to indigenous Australians was essential.
Ministers agreed to progress cultural safety training within their own jurisdiction and committed to explore the requirement for cultural safety training in health professionals registration.
Ministers agreed to progress initiatives to implement a Safe Patient Journey through the health care system within their own jurisdiction and committed to explore the requirement for cultural safety training in health professionals and tasked the Australian Health Practitioner Regulation Agency to develop options for the next CHC meeting in consultation with national bodies and indigenous health workforce representatives.
Indigenous leaders clearly outlined the importance of a workforce plan to guide action and inspire Aboriginal and Torres Strait Islander people to a successful career in health.
Ministers agreed to develop a National Aboriginal and Torres Strait Islander Health Workforce Plan with a first draft to be considered at the CHC’s next meeting, to be followed by consultation.
Ministers agreed to work with Indigenous leaders to develop a National Aboriginal and Torres Strait Islander Health and Medical Workforce Plan.
Ministers acknowledged the many successes and achievements in Indigenous health outlined during the Roundtable and welcomed the expressions of hope for the future. Equally, Ministers acknowledged the challenges faced by indigenous people across urban, rural and remote communities.
Ministers acknowledged the experience of Indigenous people in health settings and noted the importance of a safe clinical and cultural health journey for Indigenous people.
Recognising the importance of Aboriginal and Torres Strait Islander health and medical research and researchers, Commonwealth, states and territory Health Ministers commit to working together to strengthen Indigenous led health and medical research. This should include an enhanced focus on specific Aboriginal and Torres Strait Islander health and medical research to improve outcomes for the community.
In recognition of the significant value of continuing to build mutual trust, respect and understanding, Ministers committed to an annual dialogue with Indigenous health leaders with the next Roundtable to occur in 12 months’ time. Further, Aboriginal and Torres Strait Islander Health has been established as a standing item on every COAG Health Council meeting.
Ministers further strengthened the accountability for Aboriginal and Torres Strait Islander health by agreeing to invite the Commonwealth Minister for Indigenous Health to every COAG Health Council meeting thus embedding consideration of these matters in all health discussions.
Ministers acknowledged the strong contribution by Aboriginal and Torres Strait Islander leaders in advancing improvements in Indigenous Health and the achievements of the Commonwealth, states and territories.
Ministers concluded a strategic discussion in the CHC meeting on Thursday 2 August by reaffirming their commitment to addressing gaps in Indigenous health outcomes.
The summary themes from the discussion are listed below:
Develop a National Indigenous Health and Medical Workforce Plan that provides a career path, national scope of practice and builds more balance of indigenous and non-indigenous people across all health professions, make health an aspirational career for Aboriginal people. This should include a specific focus on a national scope of practice for Aboriginal Health Workers and Practitioners.
Trust, hope, faith and strong relationships important to ensure services meet needs.
Need for deep listening at all levels.
Important to recognise and share the good things that are already happening and some of the recent positive announcements.
Tap into the centres of excellence that are already operating and build on success.
Aboriginal and Torres Strait Islander people are invested in success and seek same investment from non-indigenous partners.
Need to have different approaches for urban, regional and remote communities to reflect the diversity of local needs, resources and capability across all settings.
Primary health care services critical to wellbeing to prevent the need for subsequent acute services, tackling chronic disease essential.
Make sure cultural capability and cultural safety are within legislation and policy frameworks.
It is important that there is collaborative, needs based planning and implementation rather than vertical disconnected programs, and funding needs to be long term to support sustainability.
Need a range of measures: personal health interventions as well as community strategies such as supply reduction of hazards.
It is important that other determinants such as housing, electricity and water are addressed.
In recognition of the importance of connection to country, services should also be on country where safe and appropriate.
Aboriginal and Torres Strait community leadership is critical to success
2.Mandatory reporting requirements by treating practitioners
Health Ministers approved a targeted consultation process for amendments to mandatory reporting requirements by treating practitioners. The targeted consultation process will seek feedback on proposed legislation that strikes a balance between ensuring health practitioners can seek help when needed, while also protecting the public from harm. The consultation process will involve professional bodies representing each registered health profession, consumer groups, National Boards and professional indemnity insurers. The
results of the targeted consultation process will inform a Bill to be presented to the Queensland Parliament as soon as possible.
Western Australia is not included in this process as its current arrangements will continue.
3.Australian Health Practitioner Regulation Agency
Health Ministers welcomed advice that all 15 health practitioner National Boards, their Accreditation Councils and AHPRA have partnered with Aboriginal and Torres Strait Islander health sector leaders and organisations to sign a National Registration and Accreditation Scheme Statement of Intent to achieve equity in health outcomes.
This joint commitment aims to ensure a culturally safe health workforce, increasing participation of Aboriginal and Torres Strait Islander Peoples in the registered health professions along with greater access to culturally safe health services.
This work will reach over 700,000 registered health practitioners, over 150,000 registered students and the 740 plus programs of study accredited through the National Scheme. The launch was held on traditional lands of the Wurundjeri Peoples of the Kulin Nation in Melbourne, Victoria with a Welcome to Country and a traditional smoking ceremony.
4.Update on 2016-17 determination of national health reform funding
Health Ministers received an update from the Commonwealth Health Minister on the process and timing of the 2016-17 determination, and of the importance of rapidly setting the 2016-17 determination of the national health reform funding to provide certainty for hospital services into the future. Health Ministers also noted the work on improvements to the reconciliation process for inclusion in the next National Health Reform Agreement.
Ministers welcomed the appointment of Michael Lambert as the Administrator of the National Health Funding Pool.
5.Private patients in public hospitals.
Ministers agreed to commission an independent review of a range of factors regarding utilisation of private health insurance in public hospitals to report as soon as possible but no later than 31 December 2018.
6.Progress update on the National Health Reform Agreement
The Commonwealth Minister for Health provided an update on drafting of the National Health Reform Agreement. The Council noted the importance of a dispute resolution process.
7.National approach to hearing health
Minsters recognised that 3.6 million Australians currently experience hearing loss and that the prevalence of hearing loss is expected to more than double by 2060. Ministers discussed the economic, social and health impacts of hearing loss, particularly for the 90 per cent of
Aboriginal and Torres Strait Islander children in some remote communities who experience otitis media infections at any time. Ministers agreed to further consider a national approach to hearing health, following the Commonwealth’s response to the House of Representatives Inquiry Report ‘Still Waiting to be Heard’ expected later this year.
8.Public dental funding arrangements
Ministers noted that the current National Partnership Agreement on Public Dental Services for Adults will end on 30 June 2019, and that the State and Territory public provider access to the Child Dental Benefits Schedule will end on 31 December 2019.
Ministers agreed that securing sustainable and fair future funding arrangements is critical to providing timely access to public dental care. Ministers agreed to commence formal negotiations to achieve fair, long-term public dental funding arrangements, including extension of access to the Child Dental Benefits Schedule.
9.Mutual recognition of mental health orders
Ministers discussed the important issue of ensuring continuity of care for mental health consumers moving between jurisdictions with different legislation. Ministers agreed that work to ensure interoperability of mental health legislation between states and territories, as part of the 5th National Mental Health and Suicide Prevention Plan is prioritised.
10.Recognising Continuity of Care for Consumers of Mental Health Services
The Council discussed and agreed to South Australia’s proposal that the COAG Health Council monitor the ongoing transition to the NDIS of mental health clients and to identify any emerging services gaps that need to be addressed in order to ensure continuity of support.
Ministers agreed that the Australian Health Ministers’ Advisory Council work with the Disability Reform Council Senior Officials Working Group and provide advice at the next COAG Health Council on actions to resolve interface issues between health and disability services.
11.Obesity – limiting the impact of unhealthy food and drinks on children
The Queensland Minister led a discussion on a suite of actions to improve children’s diets and prevent child obesity with a focus on health care settings, schools, children’s sport and recreation, food promotion and food regulation.
The development of cross-sectoral initiatives with education and sport and recreation sectors was noted. Health departments were tasked with developing national minimum nutrition standards for food and drink supply in public health care facilities. The Queensland Minister presented a national interim guide for reducing children’s exposure to unhealthy food and drink marketing. This guide was endorsed by Ministers, noting that the guide is for voluntary use by governments.
Health Ministers noted the voluntary pledge made by the Australian Beverages Council Limited to reduce sugar across their portfolio of products by 20% on average by 2025.
12. Implementation of National Cancer Work Plan – Additional Optimal Cancer Care Pathway
Health Ministers endorsed the Optimal Cancer Care Pathway (OCP) for Aboriginal and Torres Strait Islander peoples, which is the first OCP under the National Cancer Work Plan that specifically addresses the needs of a cultural group. It is critical that cancer service systems are culturally responsive and competent to address the current and growing disparities in health outcomes for Aboriginal and Torres Strait Islander Australians relative to non-Indigenous Australians. This OCP is designed to provide culturally safe and responsive healthcare, including acknowledging how social determinants can impact health outcomes. This OCP is to be used in conjunction with the 15 tumour-specific OCPs.
The OCP for Aboriginal and Torres Strait Islander peoples was developed collaboratively by Cancer Australia in partnership with the Victorian Department of Health and Human Services and Cancer Council Victoria. Ministers also gratefully acknowledge Aboriginal leadership in development of this pathway with input from an Expert Working Group and from Cancer Australia’s Leadership Group on Aboriginal and Torres Strait Islander Cancer Control, as well as feedback from many Aboriginal Controlled Community Organisations and peak groups during the public consultation phase.
13. Public disclosure to support hospital and clinical comparisons
Ministers agreed to commit to create a data and reporting environment that increases patient choice through greater public disclosure of hospital and clinician performance and information.
Ministers noted it is the Australian Institute of Health and Welfare’s (AIHW) role to facilitate consistent and timely reporting of health and welfare statistics and performance information, including the publication of the MyHospitals and MyHealthy Communities websites following the cessation of the National Health Performance Authority.
All jurisdictions agreed to work with the Commonwealth’s Chief Medical Officer in his investigation of the issue around a number of women being diagnosed with cancer, which may be linked to breast implants. This includes the role all jurisdictions play in reporting information to track the use of implants.
14.National Action Plan for Endometriosis
Ministers noted that the National Action Plan for Endometriosis has been finalised and was launched on 26 July 2018. All states and territories will be working with the Commonwealth toward implementation of the plan.
15.National Women’s Health Strategy 2020-2030 and National Men’s Health Strategy 2020-2030
Ministers noted that the Commonwealth is developing a National Women’s Health Strategy 2020-2030 and a National Men’s Health Strategy 2020-2030. Both Strategies are expected to be finalised and launched in early 2019.
16. Ministerial Advisory Committee on Out-of-Pocket Costs
Ministers noted the work being undertaken by the Ministerial Advisory Committee on Out-of-Pocket Costs. It was agreed that the Commonwealth release a detailed report of the activity of the Ministerial Advisory Committee on Out-of-Pocket Costs including specific fee transparency options before the next COAG Health Council meeting so that decisive actions can be agreed.
17. Digital health
Jurisdictions reaffirmed their support of a national opt out approach to the My Health Record. Jurisdictions noted clinical advice about the benefits of My Health Record and expressed their strong support for My Health Record to support patient’s health.
Ministers acknowledged some concerns in the community and noted actions proposed to provide community confidence, including strengthening privacy and security provisions of My Health Record.
Part 2Press Conference Alice Springs
It’s a real honour to be here at Purple House with Ken Wyatt, Indigenous Health Minister, but of course the first Indigenous Minister in the history of the Commonwealth of Australia.
And then Sarah and her team, all of the members of Purple House. Purple House is about saving lives and protecting lives.
It’s about closing the gap so as in Indigenous Australians have a better shot at better kidney health. As the Chief Medical Officer was just explaining, dialysis means that the machines do the work of the kidneys where the kidneys have been damaged, and that means that people can help expel the toxins, can have a healthier life and deal with some of the challenges and they can be on dialysis and manage their lives for literally two decades or more in some cases, as Brendan was setting out.
Today, I am delighted to announce that the Australian Government will under the National Health and Medical Research Council. These projects will cover things such as lung function, reducing smoking during pregnancy, improving the health of blood and Ken will talk to you in particular about point-of-care testing in dialysis.
It’s about ensuring that whilst we clearly have not closed the gap yet, which is why we asked together – the Council of Australian Governments – to come to Alice Springs and to focus on Indigenous Australia. Whilst we haven’t closed that gap, we are making progress, important steps, but a whole lot more to go.
This funding builds on what we’ve done in supporting Purple House and builds on what we’ve done in supporting additional remote dialysis. I’ll ask Ken to talk about those, but today is a critically important day for investment in Indigenous health, research and training and improved outcomes. Each one of these projects, each one of these 28 projects has the potential to save lives and improve lives. Ken?
It’s great to be here. I was in Darwin and I heard an elder from Tiwi Island talk about living life and enjoying it fully, until he had to go to Darwin, and he said when he went to a Royal Darwin Hospital he thought he was going for a prescription and tablets that would allow him to go home.
He said he never realised he would be married to a machine and never return to country. And what’s great is Purple House now provides that opportunity for elders and senior people within the community and younger ones who experience renal failure to go back to the point of where they grew up. Point-of-care testing makes it easier now to identify where we have renal problems and start to address the needs of individuals.
The $23 million that the Australian Government, the Turnbull Government have provided to Purple House means that the purple bus will reach further out into remote and isolated communities, but more importantly an increase in the number of dialysis point of access that enables both the use of chairs and other support programs that are important.
Over a period of time we’ve seen senior Aboriginal people make a decision to disengage from dialysis in regional hospitals, go back to country and die on country. This now changes that. This gives an incredible opportunity for people to spend time with their family, for culture and law to be passed on through those who have that task.
But more importantly, to keep families together and I think that the combination of the work that the Turnbull Government, and in particular Minister Hunt in his strong commitment to looking at the research that is required to close those gaps, has made an incredible difference. And it’s great having you here as well because you have also been an advocate and I’d like to invite you to make a couple of comments as well.
Okay. We’re happy to take any questions.
Well, if I may kick it off. Minister Hunt, we’ve heard a lot of concerns about privacy issues regarding My Health. What benefits though are there in digitising health records?
Well, enormous benefits, and I have to say that the Northern Territory is one of the nation’s leaders on that front and I’ve been discussing this with the Northern Territory Minister, who’s been a great advocate and it crosses party lines.
But when you have a mobile population and they may not have their own records as most people don’t, they don’t carry their records with them, if they’re a mobile population, or if the medical community is moving, then what this does is it marries up your history and your chronic conditions and your medicines across the different points of care.
So this gives every Australian the capacity to have their health care system with them, if they want it. And in Indigenous Australia, and in particular in the Northern Territory, we see that this area is leading the nation in terms of engagement with the population on digital health. So for Indigenous Australia it’s going to be a real game-changer.
Are you confident, Minister, that the changes you’ve made address the privacy concerns?
Yes, these are changes which come directly from the advice, request and sensible proposals put forward by the AMA and the College of GPs and really we’re doing two things, one, we are lifting Labor’s 2012 legislation to the same level as the practise of the last six years, which is an ironclad legislative guarantee that no health records will be released without a court order.
Secondly, once somebody seeks to have their record deleted, it will now be cancelled and fully deleted forever from the record so. If you seek to have it cancelled, if you seek to opt-out after a record’s been created, it’s gone forever, rather than the 130 years which was put in under Labor’s legislation.
Labor says the opt-out period should be put on hold. Will you do that?
That’s not the advice of the medical authorities who are very clear that they want this done this year, so we’ve extended by a month and we’ve worked with the medical authorities. I understand that Labor at the moment is being, shall we say, a little bit curious because only a few weeks ago they were welcoming this as a long-overdue step and when the legislation went through, unanimously, through the Parliament they praised this as an important and vital step forward.
The Women’s Legal Service in Queensland says you haven’t done enough to address new concerns around My Health Record and that it may risk the safety of women fleeing abusing partners. Have you heard of those concerns and are you doing anything on that front?
Yes, I’ve asked the head of the Digital Health Agency to talk with them and meet with them as a matter of priority. The advice I have is that there are very, very strong protections, but we’re always working with different groups and these have been raised and so the head of the Digital Health Agency will meet with and talk with those groups and take their concerns very, very seriously.
Minister, what else is the federal government doing to help ensure that Indigenous people can live a healthy life in remote communities?
Well, there’s a comprehensive program and I’ll ask Ken to address this in more detail. But you have of course the health treatment, and these 28 new projects are each about improving health in different areas, whether, as I say, it’s in relation to smoking rates for pregnant women, point of care for dialysis, whether it’s improving outcomes in relation to lung function.
But we’re also working through the education system on activity, on diet, and then of course there’s economic development, because you cannot escape the social determinants of health, they are a reality. That’s why Indigenous Australia has worse outcomes, because there are challenges that are unique to that community and we have to have a comprehensive program.
Now, Ken has, as much as any person in Australian history, helped drive that forward and he’s being supported on the ground. I have to say, Jacinta was one of the motivating sources for the COAG meeting to be here in Alice Springs. Ken?
Some of the priorities that we’re working on are premised on rheumatic heart disease and the impact that that has from birth through to later adult life. The increasing number of people living with renal failure and certainly our research is showing that the onset might be as early as 19 years in males.
So there’s work that we’ve centred our attention on, working very closely with the community-controlled health sector across the nation, because these are two very significant illnesses that prevail within Aboriginal communities – avoidable blindness, avoidable deafness. But we also want to look at some of those other underlying issues that impact on a child in their early years – crusted on scabies, we’ve just committed a substantial piece of work around to tackle that issue and look at solutions.
But the underlying social determinants are absolutely critical. But with the state and territory health ministers meeting here in Alice Springs, it means we will have a very serious discussion around the way in which the Commonwealth and state and territories work in partnership with Aboriginal people, not for us to deliver programs to them. Because often change will only come when families have the ownership, when communities are those who determine the priorities that are needed, that then are given the level of support and resourcing that is important in the way that we’ve done with Purple House.
On the ground approaches work far better than if we try and tackle them from capital cities, and so this whole focus means that we bring health and health thinking and design and planning much closer. Our roundtable this afternoon with the Indigenous leaders is a reflection of us seeking their advice to look at what are the directions that we need to seriously consider, given the geographic diversity of our nation.
Minister Wyatt, do you think there’s been enough done to explain, I guess, My Health? I mean, you’re here at Purple House where many languages are spoken other than English. Are you confident that the message is getting out there to those regional communities where English is perhaps third or fourth languages?
Look, I think our Aboriginal health workers who are employed by many organisations, including state and territory health systems, provide that front line interaction. Because I once made a comment to a group of Aboriginal health workers in New South Wales that power doesn’t sit with the director or with the minister, the power of change and impact sits with the Aboriginal health workers who understand the families, understand the communities, that can speak language and understand the nuances of the relationships within a community. I think that’s where our best opportunity lies.
Minister Wyatt, I think everybody would agree the syphilis epidemic is very high, too high, in Indigenous populations. What’s your plan to bring down those numbers?
Well when that was first raised with us there were two steps we took. One is the Chief Medical Officer undertook a piece of work with the Australian Health Minsters’ Council because the predominance of that work in terms of surveillance, treatment, and the provision of treatment, really reside with state and territories. But also, Aboriginal community-controlled health organisations play a key role. James Ward has also developed community awareness materials that are pragmatic and practical and kids can relate to the messages in the materials that he has produced.
But also having the community-controlled health services now turn their attention to point of care testing, but more importantly around some of the messages of why it’s important to practice safe sex. The other avenue we use which is a great one is through some of the big sporting events – Adrian Carson in Brisbane will be holding a rugby knock out carnival in Townsville. Now, at that they’re anticipating somewhere between 10,000 and 16,000 people will turn up along with all of those playing, so it gives a great opportunity for the community-controlled health sector to get some of those messages into the community.
But our strategic approach is working with the jurisdictions and with the Aboriginal communities in making sure that we entrench a practice of identification of STIs, including HIV and blood-borne viruses where they may prevail, but then providing the level of treatment that is important in eradicating the challenge that we’ve had. We’ve seen this outbreak across the top end of Australia and certainly the level of commitment that we’ve had from states and territories has been tremendous.
Is that going to be a similar approach for HLTV-1 virus?
Yes, we’ve set aside through the AHMAC process $8 million, which will be part of a process of a round of discussions involving Aboriginal community-controlled health services, key researchers, but also the jurisdictions in identifying the priorities. We have to ascertain the extent of the spread of the virus and not only consider that, but consider research that’s been done overseas.
I’ve certainly read some of the research out of Japan in terms of transmission points, but we need to have a look at what is the challenge here in Australia. I know it was something that was identified in the Fitzroy Valley in the 80s and 90s and certainly I want to compliment my own department and Minister Hunt’s department on the work that they’ve been doing with our state and territory colleagues and the community-controlled health sector.
“Australia’s Health Ministers have gathered in Alice Spring to shine a spotlight on Indigenous health, almost 10 years after the Council of Australian Governments (COAG) approved Closing the Gap targets to achieve health equality for First Nations peoples.
While we can reflect on progress – our people, on average, are living longer with fewer dying from chronic conditions – it is equally important to focus on our failure to close the gap in life expectancy, which remains about 10 years.
For sustainable change, however, local family warriors must step up, be respected, acknowledged and encouraged.
The Hon Ken Wyatt Indigenous Health Minister see Part 1 Below
“ Investigation and investment where it is needed is critical to delivering better health outcomes for First Nations Peoples, to protect lives and save lives
Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.
Kidney disease disproportionately affects Indigenous Australians — research has shown that almost one in five (18 per cent) Aboriginal and Torres Strait Islander people aged over 18 had indicators of chronic kidney disease.
I am delighted that we can announce $327,192 for Monash University to develop a point-of-care test for the diagnosis and management of chronic kidney disease.
Social and emotional well-being was another critical matter for Aboriginal and Torres Strait Islander Australians, especially youth.
The Australian Institute of Health and Welfare has found that the single largest contributor to ill health amongst Aboriginal and Torres Strait Islander Australians is mental health and substance use disorders,” said Minister Hunt.
Five projects across five different states will examine social and emotional well-being issues affecting Aboriginal and Torres Strait Islander infants, children, adolescents and young adults.
They will undertake culturally-informed research looking at the influencing factors, mental health and life-coaching, and fostering wellness.”
Health Minister Greg Hunt see full Press release Part 2
Part 1 Continued from opening quote
For over 65,000 years, First Nations people thrived without a plethora of organisations. We were child, family and community-centred.
Responsibility and authority revolved around a woman, with her key roles as the mother and protector, and equally, around a man, the father and family shield.
This year, I am focusing on five areas – renal health, rheumatic heart disease (RHD), avoidable blindness, avoidable deafness and crusted scabies.
First Nations people experience 7.3 times the burden of chronic kidney disease than other Australians. In the Northern Territory, RHD is 37 times more prevalent and, overall, we endure three times the rate of vision impairment.
Our children suffer, on average, 32 months of hearing loss compared with three months for other Australian children, while remote northern communities have the world’s highest rates of crusted scabies.
We are losing too many lives and not realising the potential of too many more.
In many remote locations, doctors and health workers are joined by fly-in fly-out health practitioners, providing specialist services.
However, we must ensure a local army of individuals on the ground is empowered to monitor for signs of illness.
We need home-based heroes, family warriors, as they were in times past – and still are in functional families.
They need to understand that infections such as skin sores can be precursors to RHD, kidney failure and crusted scabies.
We are not going to fully transform the health of those who are struggling, until they understand with pride and responsibility, the culture that perpetuated healthy lives for thousands of years.
Our mothers and fathers, uncles, aunts and grandparents are the first protectors of our children.
Now extended to 136 communities, the Better Start to Life program is proving the power of engaging with and supporting young parents to understand their responsibilities.
The Turnbull government has invested significantly in these areas but the record $3.9 billion committed to Indigenous health over the next four years will only ever be part of the currency of change.
It’s now time to highlight the heroes within our families, to move from disempowerment to empowerment, away from a deficit model.
I encourage every mother, father, uncle, aunt and Elder to become a warrior for health, joining in and taking responsibility for their own health and the health of their families.
Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.
The Government has committed $23.2 million through the National Health and Medical Research Council (NHMRC) to 28 new projects, and has launched a NHMRC Road Map 3 to help chart the direction for Indigenous health and medical research investment over the next ten years.
New research investment will include targeted renal, cancer and social and emotional wellbeing projects aimed at improving Aboriginal and Torres Strait Islander health outcomes.
The five projects together form the first of a series of targeted calls for research by the NHMRC to address Indigenous health priorities. Other calls will include healthy ageing and nutrition.
Minister for Indigenous Health, Ken Wyatt AM, said the new research projects would help to strengthen work already underway to curb chronic disease.
“The renal point-of-care test will complement the Renal Health Road Map that is currently being compiled,” Minister Wyatt said.
“This exciting new research is focused on making a difference on the ground, from reducing smoking during pregnancy and boosting cancer care, to combating diabetic blindness and improving diets.”
“The five social and emotional wellbeing projects are especially welcome, as we continue working with local communities to reduce the rate of suicide.”
Other key research projects announced today include point-of-care testing for blood-borne diseases and sexually transmitted infections, reducing incarceration rates of young women, improving prisoner mental health, burns care, lung health, scabies testing and reducing unborn baby deaths.
The direction of future First Nations research will be informed by the NHMRC’s Road Map 3, which will include a yearly report card and a commitment to spend at least 5% of annual NHMRC funding on Aboriginal and Torres Strait Islander health and medical research.
“Most importantly, the NHMRC Road Map 3 was developed in consultation with communities, First Nations researchers and the broader health and medical research sector to address Indigenous health issues and encourage and strengthen the capacity of Indigenous researchers, now and into the future,” said Minister Wyatt.
The NHMRC has today also released the Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders as well as Keeping Research on Track II.
The Guidelines provide a set of principles to ensure that research is safe, respectful, responsible, high-quality and of benefit to Aboriginal and Torres Strait Islander people and communities.
” COAG Health Ministers will discuss Aboriginal and Torres Strait Island health at their meeting in Alice Springs this week.
There is much to discuss. Ten years on from the start of Closing the Gap, progress is mixed, limited and disappointing, and the life expectancy gap is widening.
This is hardly surprising.
The National Partnership Agreements on Indigenous health, which spelt out the roles, responsibilities and funding of the Commonwealth and state and territory jurisdictions, have not yet been replaced by bilateral agreements.
Formal regional structures and agreements to bring together Aboriginal community controlled health and mainstream services have yet to be formalised nationally. On the broader front, culture, racism and social, political and economic issues cry out for attention.
The way forward is within the reach of the COAG Health Council.
If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.”
Ian Ring AO Honorary Professorial Fellow Research and Innovation Division University of Wollongong
While money isn’t the only factor, money myths are playing an important role in the failure to close the gap.
A recent Productivity Commission report found that per capita government spending on Aboriginal and Torres Strait Islander people was twice as high as for the rest of the population.
The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.
But higher spending on Aboriginal and Torres Strait Islander people should hardly be a surprise.
We are not surprised, for example, to find that per capita health spending on the elderly is higher than on the healthier young because the elderly have higher levels of illness.
Nor is it a surprise that welfare spending is higher for Indigenous people who lag considerably in education, employment and income. There would be something very wrong with the system if it were otherwise.
The key question in understanding the relativities of expenditure on Aboriginal and Torres Strait Islander people is equity of total expenditure, both public and private, in relation to need, but the Productivity Commission’s brief is simply to report on public expenditure, and that can be misleading.
Massive market failure
For health services, while state and territory governments spend on average $2 per capita on Indigenous people for every $1 spent on the rest of the population, the Commonwealth spends $1.20 for every $1 spent on the rest of the population, notwithstanding that the burden of disease and illness for Indigenous Australians is 2.3 times the rate of the rest of the population. And total government expenditure on Aboriginal and Torres Strait Islander health is only about 60 per cent of the needs based requirements.
This is massive market failure.
The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.
Mortality for the Indigenous population has flatlined since 2008 and the inevitable result is that the life expectancy gap is widening rather than closing.
This is not surprising since the Federal Government’s own reports clearly show that preventable admissions for Indigenous people, funded by the states and territories, are three times as high as for the rest of the population (see graphs below, and sources at the bottom of the post) yet use of the Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS), funded by the Commonwealth, appears at best to be a half and a third respectively of the needs based requirements for Indigenous people.
It is simply impossible for the mortality gaps to close under these conditions.
It is not that the Commonwealth is deliberately underfunding health services for Aboriginal and Torres Strait Islander people. However there are decades of experience establishing beyond all doubt that demand driven services designed to meet the needs of the bulk of the population will not adequately meet the needs of a very small minority of the population with very special needs.
In recognition of that, for over 40 years, the Commonwealth has been funding Aboriginal Community Controlled Health Services (ACCHS), which evidence shows better meet those needs, but the coverage of those services is patchy and needs to be expanded.
It has been shown that the nonviolent death rate for at risk Aboriginal people can be halved in just over three years by systematic application of knowledge we already have. It really is within the grasp of the current government to turn things around and now is the time to do it.
Priorities to address
A key requirement is to address the shortfall in Commonwealth funding for out of hospital services, which is contributing to excessive preventable admissions funded by the states and territories, and to avoidable deaths.
A vital priority is seed funding for the provision of satellite and outreach ACCHSs that Indigenous people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.
Additional funding is also required for mental health and social and emotional wellbeing services which are neglected in the Closing the Gap initiative.
And much more attention needs to be paid to the quality of services, with much needed investment in the training of clinicians, managers and public servants for the difficult and complex roles they have to play.
The ‘Refresh’: resource-free targets
The danger is that action will be put on hold in the belief that somehow the Closing the Gap ‘Refresh’ is going to solve everything!
The fear is that we have entered the world of magical targets – the kind where you just say what you would like to happen and that’s it, it just magically comes to pass without actually specifying, let alone actually doing all the things that are required to achieve the targets. It’s a bit like painting pictures in the sky: let’s put an end to war and famine without any thought or action about what would need to be done for those desirable things to come to pass.
With the Refresh target setting process, there seems to be a lot of emphasis on data issues while more or less completely overlooking consideration of the investment or services required to achieve the targets.
In an orthodox sensible planning process, target setting is an important element. Targets need to be directly related to overarching goals, and need to relate directly to the services, actions and investments that will be made to achieve the targets.
Timeframes setting out what is to be achieved in say 1 year, 5 years, 10 years etc are crucial, and both process and outcome targets need to be set. In the absence of this kind of process a belief that the Refresh will somehow turn things around may well be illusory.
It is extraordinary that the only response to the finding on the life expectancy target – that it not only won’t be met but is going backwards – is an apparent intent to freeze Commonwealth funding for Indigenous health services!
There is little point in having mortality goals which are clearly in jeopardy – and when the causes are not hard to define and the remedies clear – if there is insufficient action taken to actually achieve them.
The funds required for satellite and outreach ACCHS services to fill the service gaps, together with the other priorities described above, spread over a carefully prepared five year plan, are likely to be modest and would make a real and substantial improvement to the health of Indigenous people.
There is no call for some kind of special deal, but simply the same level of expenditure from both Commonwealth and state and territory governments for Australia’s Indigenous peoples that anyone else in the population with equivalent need would receive.
The way forward is within the reach of the COAG Health Council.
If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.
The Federal and State and Territory Health Ministers recently met in Darwin at the COAG Health Council to discuss a range of national health issues. The meeting was chaired by Jack Snelling, Minister for Health, South Australia.
1.Reform of the Federation
Council discussed the progress of work on the Reform of the Federation and the outcome of the consideration of health issues at the Leaders’ Retreat in July. Noting that further work for COAG’s consideration later in the year will be led by Tasmania and Victoria, Ministers agreed to work co-operatively in considering options for improving the efficiency of the health system, particularly in the provision of care for people with chronic disease and extending Medicare benefit arrangements to hospitals based on efficient pricing. Council noted that future arrangements for health financing would be considered in the context of the Reform of the Federation.
2.Impact of discontinued National Partnership Agreements (NPAs) on states and territories
Ministers noted that between 2008–09 and 2013–14 the Commonwealth provided an average of $1.7 billion per year to States and Territories under a range of National Partnership Agreements which are now concluded.
The Council agreed that, in consultation with all jurisdictions, they would explore new models for sufficient health and hospital funding as part of the broader discussion around the reform of federation.
3.Changes to eHealth Records
Ministers discussed proposed changes by the Australian Government to eHealth legislation to support delivery of the My Health Record and the establishment of the eHealth Commission. The amendments are aimed at bringing forward the benefits of a connected national eHealth system, aimed at providing improved health outcomes for consumers through national sharing of information and a more efficient health system.
Included in the draft legislation will be the implementation of the opt-out trials, to be conducted in some states and territories where participants will automatically receive an eHealth record unless they choose to opt out if they do not wish to have one. Under present arrangements, people have to specifically enrol to receive an eHealth record. Ministers were invited to nominate potential trial sites.
4. ICE – An opportunity for national collaboration
Noting the scope of the National Ice Taskforce, Health Ministers discussed the impact of this drug on the community and health workers confronting the aggressive behaviours associated with Ice. Ministers discussed other issues of shared interest and identified opportunities for health departments to enhance the effectiveness of responses to the harms associated with ice use amongst individuals, families and communities.
It was agreed that the Australian Health Ministers’ Advisory Council (AHMAC) would progress where appropriate, joint work and sharing of resources such as clinical guidelines, tools, training and local strategies to strengthen current health responses.
5.Healthy, Safe and Thriving: National Strategic Framework for Child and Youth Health
Ministers endorsed the Healthy, Safe and Thriving: National Strategic Framework for Child and Youth Health (the Framework) and its two supporting reference documents. Building on the achievements in child and youth health over the past 20 years, the Framework identifies continuing and emerging health issues for children and young people from preconception to 24 years of age. The Framework articulates a shared national vision with five key strategic priorities to improve health and wellbeing outcomes for children and youth in Australia over the next ten years.
6.National Framework for Action on Dementia
Ministers endorsed the National Framework for Action on Dementia 2015-2019, which aims to guide the development and implementation of policies, plans and actions to reduce the risk of dementia and improve the outcomes for people with dementia and their carers. The Framework will support ongoing policy development and action for governments, peak bodies, service providers, and the broader community, to work together in order to make a positive difference in the lives of people with dementia, their carers and families.
7.National Oral Health Plan 2015–2024
Oral health is an important part of general health, affecting not only the individual, but also the broader health system and economy.
Ministers considered and endorsed the new National Oral Health Plan 2015-2024, which provides strategic direction and a framework for collaborative action over the next ten years. Translation of the plan into practice requires jurisdictions and sectors to work together, with the Oral Health Monitoring Group reporting on progress of the National Oral Health Plan every two years.
8.National Bowel Cancer Screening Program
Ministers discussed the Commonwealth Government’s commitment to full implementation of the National Bowel Cancer Screening Program for people age 50-74 by 2020.
Ministers discussed their ongoing commitment to the National Bowel Cancer Screening Program, the importance of continually improving the effectiveness of the Program; the Commonwealth’s new investments in the national Cancer Screening Register; the importance of improving Program participation; the role of endoscopy in early diagnosis and the clear benefits of early treatment to patients and the health system as whole.
9.The relationship between welfare reform and health outcomes
In discussing this issue the Council noted the concern that the Northern Territory (NT) has in relation to the direct health effects that passive welfare has on Territorians.
The Ministers agreed that the NT would endeavour to provide further evidence of any possible link between passive welfare and poor health outcome to a future meeting.
10.Inclusion of Paramedics in the National Registration and Accreditation Scheme
In the Australian Health Workforce Ministerial Council today Ministers discussed the potential registration of paramedics under a national scheme. This issue has been referred back to AHMAC for further work and advice back to Ministers.
The primary health care sector that delivers the best results for Aboriginal and Torres Strait Islander People is the least funded. Funding for ACCHSs is unrelated to population size or need, is not indexed for inflation or service demand and is not distributed equitably within and between the States and Territories.
NACCHO advocates for a change in the way healthcare funding is allocated, which re-distributes an appropriate share of mainstream health funds to ACCHSs, taking into consideration expected population growth, indexation and health need.”
Previous NACCHO Press Release : The peak Aboriginal health body today welcomed the announcement by the Federal Government of three-year funding agreements for Aboriginal Community Controlled Health OrganisationsVIEW HERE
Position paper on the Federal Budget 2015
Closing the gap in health equality between Aboriginal and Torres Strait Islander peoples and other Australians is an agreed national priority. On this year’s National Close the Gap Day there was a record 1,596 events held across the country. The nation wants continued focus and action in order to close the unacceptable health and life expectancy gap. This requires continued and long-term investment.
The Close the Gap Campaign’s Progress and priorities report (the Executive Summary is contained in appendix 1) demonstrates that there is a real opportunity to make relatively large health and life expectancy gains in relatively short periods of time with a targeted focus on greater access to primary health care services to detect, treat and manage chronic health conditions in Aboriginal and Torres Strait Islander communities. Evidence also suggests that health is critical to achieving better education and employment outcomes and creating safer communities for Aboriginal and Torres Strait Islander communities.
All political parties have committed to end the health equality gap by 2030, supported by almost 200,000 Australians who made the pledge. With 15 years to go, we need to build on success.
We need to continue the national effort as a priority and we need to expand and strengthen these efforts with bold policy initiatives supported by continued long-term investment in Aboriginal and Torres Strait Islander health.
The Close the Gap Campaign believes that the Federal Budget 2015-16 should quarantine the Close the Gap funding against any further reductions and contain the following:
Address the measures creating a potential negative impact on Closing the Gap from the Federal Budget 2014-15 including:
Restore the Close the Gap funding to previous levels
An estimated total of $270 million has been cut from what was previously committed for the next three years for Indigenous primary health care services and chronic disease self-management programmes. These cuts occur at a time when these services are starting to have an effect in helping close the health and life expectancy gap. Closing the Gap is a long-term objective and continuity of funding is vital for success, therefore funding needs to be restored to at least the previous level. The importance of smoking programmes and the effects of cuts are outlined below.
Tackling Indigenous Smoking programme
Restore cuts of up to $130 million over 5 years from the Tackling Indigenous Smoking programme. The ‘freeze’ on recruitment of staff to the Tackling Smoking and Healthy Lifestyle Teams, which are central to delivery of the programme, must be overturned. Following a review, the future shape of the programme is still to be announced.
There is a clear link between smoking and poor outcomes in birth weight, child mortality and life expectancy. The freeze on recruitment reduces the reach of the programme, undermines the momentum built to date, and erodes the programme’s goodwill developed with Aboriginal and Torres Strait Islander communities.
The reduction in Aboriginal and Torres Strait Islander smoking rates by 10 percent over the last decade, as well as the marked increase in the number of Aboriginal and Torres Strait Islander people not taking up smoking, demonstrates that efforts to cut smoking rates are working and that further gains are possible.
National Indigenous Drug and Alcohol Committee
Revisit the decision to discontinue the National Indigenous Drug and Alcohol Committee, as the cost of the Committee is minor compared to its major impact on and relevance to major issues of importance to the health of Aboriginal and Torres Strait Islander peoples.
The creation of the Indigenous Australians’ Health Programme
Current funding formulae for Aboriginal health are outdated, and result in maldistributed and inequitable services unrelated either to population size or service need and demand. Further, the failure of mainstream services to deliver effective services for Aboriginal and Torres Strait Islander people lies at the heart of continuing Indigenous disadvantage. The Campaign Steering Committee supports a new funding formula for Aboriginal and Torres Strait Islander health services that is developed with the full and effective participation of Aboriginal and Torres Strait Islander people and their representative organisations.
The formula must be indexed for population growth and inflation, be geographically equitable and focus on areas with poor health outcomes and inadequate health services. Further, the evidence that demonstrates that ACCHS have inherent advantages as the provider of choice in terms of both better access and higher quality of service should be utilised in developing this funding allocation. New administrative mechanisms are required to ensure that Aboriginal and Torres Strait Islander peoples receive a share of mainstream programmes that is equitable in terms of their population size and programme need. Shortfalls are best redressed by directing funds to services which provide the best return on investment in terms of access and service quality – and the evidence is that ACCHS services generally outperform mainstream services.
Mainstream measures likely to have a disproportionate impact on Aboriginal and Torres Strait Islander peoples
The Campaign continues to be concerned about ‘mainstream’ measures flagged in the Budget 2014-15 that, if passed into law, may have a disproportionate impact on Aboriginal and Torres Strait Islander health. These include:
Any reforms to the Medicare system should be designed to ensure they do not further entrench existing barriers to equitable health care access for Aboriginal and Torres Strait Islander peoples;
Cuts to preventative health programmes in the Budget 2014-15. Preventative health initiatives have significant impacts on Aboriginal and Torres Strait Islander peoples because of the negative effect this will have on addressing chronic disease; and
The reduction in the Commonwealth’s contribution for funding hospitals.
Implementation of the National Aboriginal and Torres Strait Islander Health Plan
The Australian Government is currently finalising the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (Health Plan).
The Campaign Steering Committee believes that the Implementation Plan requires the following essential elements:
Set targets to measure progress and outcomes. Target setting is critical to achieving the COAG goals of life expectancy equality and halving the child mortality gap;
Develop a model of comprehensive core services across a person’s whole of life including end of life care with a particular focus, but not limited to, maternal and child health, chronic disease, and mental health and social and emotional wellbeing; and which interfaces with other key service sectors including, but not limited to, drug and alcohol, aged care and disability services;
Develop workforce, infrastructure, information management and funding strategies based on the core services model;
A mapping of regions with relatively poor health outcomes and inadequate services. This will enable the identification of service gaps and the development of capacity building plans, especially for ACCHS, to address these gaps;
Identify and eradicate systemic racism within the health system and improve access to and outcomes across primary, secondary and tertiary health care;
Ensure that culture is reflected in practical ways throughout Implementation Plan actions as it is central to the health and wellbeing of Aboriginal and Torres Strait Islander people;
Include a comprehensive address of the social and cultural determinants of health; and
Ensure the development and implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Wellbeing 2014-2019 as a dedicated mental health plan for Aboriginal and Torres Strait Islander peoples, and in coordination with the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the National Aboriginal and Torres Strait Islander Drug Strategy.
Establish partnership arrangements between the Australian Government and state and territory governments and between ACCHS and mainstream services providers at the regional level for the delivery of appropriate health services.
The Implementation Plan is capable of driving progress towards the provision of the best possible outcomes from investment in health and related services. As such the Federal Budget should:
Ensure ongoing funding for an oversight committee whose function is to constantly monitor results in order to continuously improve the quality, effectiveness and efficiency of the health services in the plan and accountable to both COAG and the National Health Leadership Forum;
Fund the process required to develop the core services model and the associated workforce, infrastructure, information management and funding strategies based on the core services model; and
Ensure Aboriginal and Torres Strait Islander health funding is maintained at least at current levels until the core services, workforce and funding work is finalised, with provision of a more considered view of funding requirements and issues.
Building the capability of the ACCHS sector
The ACCHS sector provides inherent advantages for Closing the Gap. Firstly, its service model is the provision of comprehensive primary health care. This model of care is needed because of the higher levels of illness, earlier age of onset of illness, the much greater levels of comorbidity in Aboriginal and Torres Strait Islander people – and the need to address the fundamental determinants of health if the gap is to be closed.
As stated earlier, the ACCHS sector offers considerable advantage in terms of access to services and proven advantages in the detection and management of chronic disease. In addition, the ACCHS sector is a major employer of Aboriginal and Torres Strait Islander people at all levels of skill. In many Aboriginal and Torres Strait Islander communities, the ACCHS operates as the primary employer.
ACCHS services were established because of the inability of mainstream services to deliver for Aboriginal and Torres Strait Islander people and have a critical role to play in closing the Gap. However, a long term plan for building the capabilities of ACCHS services is overdue. Such a plan should target areas with relatively poor health outcomes and insufficient or inadequate services and take into account capital costs for infrastructure and workforce development needs.
Further ACCHS should be funded to establish mental health and social and emotional wellbeing teams that are linked to Aboriginal and Torres Strait Islander special mental health services. This will form a key component of the implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing as a dedicated mental health plan.
Funding national and jurisdictional Aboriginal and Torres Strait Islander health organisations
ACCHS representative bodies at the national and state level and national Aboriginal and Torres Strait Islander health workforce, research and healing and wellbeing organisations provide critical leadership in the health sector. These organisations are important change drivers for improving health outcomes and community empowerment. They also provide support and development for health professionals in front line services to improve access and health outcomes. Ongoing funding for these organisations is an essential component of the national effort to close the gap.
Agreements with the states and territories
The Campaign Steering Committee believes there is a need for immediate Australian Government leadership to ensure a consistent national approach in the implementation of the Closing the Gap Strategy.
In this regard the Australian Government must work with States and Territories to forge new stronger and nationally consistent agreements (whether struck nationally or bilaterally) to continue the Closing the Gap Strategy.
The Indigenous Advancement Strategy (IAS)
Reinstate the $534.4million over five years cut from the Indigenous Affairs budget through programme rationalisation. The Campaign Steering Committee supports the reduction of red tape and duplication. However, the lack of detail how these cuts will apply and their impact on services and health outcomes is an ongoing concern. The Campaign is concerned that these cuts will have a negative impact on outcomes across the social determinants including education and employment outcomes.
The Campaign notes that the recent round of IAS funding has resulted in widespread distress in Aboriginal and Torres Strait Islander-controlled organisations for a variety of reasons:
The IAS process marked a shift to a competitive tender process. Many organisations did not anticipate this and were not prepared for this change of direction. Many organisations did not have the capacity or the resources to put together the kind of application required by the tender process and felt that they lacked support during the process. In some cases at least, the organisations serving the greatest need may be in a relatively weak position in a competitive tendering process.
The impact of the competitive process is also uncertain, in particular, whether this process had a disproportionate negative impact on Aboriginal and Torres Strait Islander-controlled organisations. The publicly available list of organisations recommended for funding indicates that a large number of non-Indigenous organisations were successful.
Questions remain whether the competitive process adequately considered a detailed understanding of community need as a critical criteria including: prioritisation of Aboriginal and Torres Strait Islander-controlled organisations and cultural competence as part of the selection criteria.
Short term funding and ongoing uncertainty is negatively affecting recruitment and strategic planning.
That the funding round will potentially result in services gaps.
The Campaign Steering Committee therefore calls on the Government to work with Aboriginal and Torres Strait Islander people and their representative organisations to address the concerns detailed above.
The Campaign Steering Committee is very concerned as to the announcement of potential closure of remote area Aboriginal communities in Western Australia as a consequence of the Federal Government reducing funding for basic infrastructure. This has clearly alarmed Aboriginal and Torres Strait Islander people throughout Western Australia and the nation as a whole. This policy, and the insecurity around IAS funding, is undermining the trust of Aboriginal and Torres Strait Islander peoples and is therefore putting the Federal Government’s Indigenous Affairs policy agenda at risk.
Closing communities is at odds with the nation’s commitment to Closing the Gap as it is clear from research that health outcomes for those Aboriginal and Torres Strait Islander people-living on country are more positive than outcomes for those who live in towns/cities. The decision to transfer responsibility of remote areas to states without consultation with communities and particularly before the Federalism Review and its implications for Aboriginal and Torres Strait Islander affairs has been considered is premature and injurious for Aboriginal and Torres Strait Islander peoples.
We therefore recommend that no action be taken until:
The health and wellbeing impacts, as well as implications for other matters such as native title rights, of such closures are properly and independently assessed;
The Federalism Review process has been completed and therefore that;
The Federal Government works with the Western Australian government to ensure that current levels of support for remote area communities are maintained.
The Campaign Steering Committee is of the view that a proposal to move from five year census intervals to ten year census intervals will have deleterious effects on the availability of information for rural populations in general and Aboriginal and Torres Strait Islander people in particular. The proposed methods for provision of intercensal estimates through administrative datasets are likely to be unable to estimate the characteristics of scattered small populations. Further, administrative datasets for Aboriginal and Torres Strait Islander people are generally unreliable due to incomplete identification of Aboriginal and Torres Strait Islander people. This proposed change will have a major deleterious impact on the ability to monitor the effectiveness of the Implementation Plan for the Health, particularly since it is important in the early stage of implementation to have up-to-date information about which elements of the Health Plan are working satisfactorily, and which need further action.
The Campaign Steering Committee recommends that the impact of the proposal to move to a ten yearly census interval on the estimates for Aboriginal and Torres Strait Islander people be considered before any final decision is made on any change in the census frequency.
Review of contracting mechanisms
The Campaign Steering Committee believes that the Federal Government should move to a preferred provider contracting mechanism rather than competitive arrangements, both in general, and in relation to funding directed to Primary Health Networks. This should be guided by the evidence base that Aboriginal and Torres Strait Islander organisations provide the best value.
Current contracting processes have led to inefficient, inequitable and maldistributed health services. Evidence indicates that ACCHS outperform mainstream services in terms of identification of at risk patients and appropriate prevention and treatment. The Campaign Steering Committee recognises fiscal constraints of the budgetary environment and the important public policy principle that funds should be directed to services that will have the greatest impact in terms of access and quality (i.e. ACCHS). Administrative mechanisms for funding should support the achievement of best results and standard preferred provider mechanisms are appropriate for this purpose.
Further, bid driven processes perpetuate inequities and maldistribution when the focus needs to be on areas with relatively poor health and inadequate services. The Campaign Steering Committee believes that funding priority should be directed to services which can produce the best results (default being ACCHS unless convincing evidence that alternative arrangements can produce better results than through strengthening ACCHS).
National Disability Insurance Scheme
The National Disability Insurance Scheme properly and equitably supports Aboriginal and Torres Strait Islander people with long term mental health conditions that qualify as a disability for the purposes of the scheme.
National Aboriginal and Torres Strait Islander Suicide Prevention Strategy
The Australian Government has committed approximately $18million to the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy. This funding commitment should be maintained and quarantined from any future budget cuts.
Appendix 1: Executive Summary of the Close the Gap Campaign’s Progress and priorities report 2015
The Campaign Steering Committee welcomes the absolute gains in Aboriginal and Torres Strait Islander life expectancy from 2005-2007 to 2010-2012. Over that five-year period, life expectancy is estimated to have increased by 1.6 years for males and by 0.6 of a year for females. But a life expectancy gap of around ten years remains for Aboriginal and Torres Strait Islander people when compared with non-Indigenous people.
Both the modesty of the gains, and the magnitude of the remaining life expectancy gap remind us why the Council of Australian Governments’ (COAG) Closing the Gap Strategy and the target to close the life expectancy gap by 2030 was needed. It remains necessary today. But we must also keep in mind that closing the life expectancy gap requires time. The Closing the Gap Strategy was operationalised in July 2009 and the latest data we have is from 2012-2013. This is too short a time to adequately assess the progress of this Strategy in achieving outcomes.
Instead, the Campaign Steering Committee looks to reductions in smoking rates, improvements to maternal and child health outcomes and demonstrated inroads into the impact of chronic diseases as evidence that the Closing the Gap Strategy is working.
The findings of the National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS), the largest biomedical survey ever conducted among Aboriginal and Torres Strait Islander people, are critical. The survey identified high levels of Aboriginal and Torres Strait Islander people with undetected treatable and preventable chronic conditions that impact significantly on life expectancy. Armed with this data, the Campaign Steering Committee believes the nation now has an enhanced ability to make relatively large health and life expectancy gains in relatively short periods of time.
To do this, there needs to be a much greater focus on access to appropriate primary health care services to detect, treat and manage these conditions. And the evidence is that Aboriginal Community Controlled Health Services (ACCHS) provide the best returns on investment in terms of providing both access to health services and the quality of those services.
As such, this report affirms the need to keep on track with the Closing the Gap Strategy and, with patience, many indicators suggest improvements to life expectancy will be seen in time. Any reduction in effort or momentum will squander the investment we have made as a nation up until now.
The comparison between the life expectancy of Maori peoples and Aboriginal and Torres Strait Islander peoples is illustrative. In 2010-12 an increase of approximately four years has been reported for the Maori life expectancy over the previous decade. But this occurred after two decades of effort in New Zealand. This demonstrates that substantial change is possible but it takes sustained and continuous effort.
The Campaign Steering Committee emphasises the need to ensure that potential changes in Commonwealth-State relations do not have the unintended effect of undermining the Closing the Gap Strategy. While recognising that all jurisdictions have a responsibility to contribute, the Campaign Steering Committee firmly supports the Australian Government’s continuing leadership role in an overall national approach.
The Campaign Steering Committee recognises the value in the new Indigenous Affairs priorities of the Australian Government: education, employment and community safety. But there are concerns. In particular, a clearer connection between the Indigenous Advancement Strategy and the Closing the Gap Strategy will enhance both policies. Employment, education and community safety are drivers of improved health and wellbeing. However, good health is equally important to employment, education and community safety. Further, the health sector is the biggest employer of Aboriginal and Torres Strait Islander people and increased investment in health services will result in increased employment.
The Campaign Steering Committee is also concerned that hard won Aboriginal and Torres Strait Islander health gains could be negatively impacted by proposed measures contained in the 2014-15 Budget. Cuts to the Tackling Indigenous Smoking programme are of particular concern and could hinder the significant progress made in reducing Aboriginal and Torres Strait Islander smoking rates in recent years. Investment in early prevention activities saves on the provision of complex care into the future. These programmes also address and have started to make inroads into primary prevention, particularly in healthy eating, nutrition and physical activity.
The development of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (Health Plan) will be pivotal in our shared efforts to close the gap. It provides an opportunity to increase the quality and efficiency of services, address service gaps by building on the existing capacity of ACCHS, and to expand the Aboriginal and Torres Strait Islander health workforce.
The Campaign Steering Committee remains steadfast in its belief that the road to closing the health gap is embodied in the Close the Gap Statement of Intent signed by the Australian Government and most state and territory governments. The Close the Gap Statement of Intent commits parties to genuine partnerships with Aboriginal and Torres Strait Islander peoples, ensuring appropriate evidence based health services, strengthening the ACCHS sector, effective planning and the use of targets, and addressing the social determinants of health.
“Indigenous Australians should enjoy the same health, education and employment outcomes as other Australians. But, instead there remains a persistent and terrible gap between the two in major areas.
Closing the gap between Indigenous and non-Indigenous Australians is a priority for all Australian governments. But closing the gap is a long-term challenge—one which requires enduring vigilance and resources”
John Brumby Chair NACCHO reform Council Speaking at the NACCHO SUMMIT
I would like to begin by acknowledging the traditional owners and custodians of the land on which we meet today, the Wurundjeri people of the Kulin nation. I pay my respects to their Elders both past and present.
It is my pleasure to be with you today to report on national progress in indigenous health.
As you know, the COAG Reform Council was established by COAG in 2006 to report on Australia’s national reform progress.
Our job is to hold all nine Australian governments accountable for implementing national reforms that began rolling out in 2008.
Importantly, we publicly report our findings to the Australian people.
In 2008, COAG agreed to goals on healthcare, education, skills and workforce development, disability, housing and closing the gap on Indigenous disadvantage.
That was six years ago.
Today I will be launching a supplement that focuses on the health outcomes for Indigenous people. The supplement draws on the findings we have made in two reports that we provide to the Council of Australian Governments (COAG) each year – the National Healthcare Agreement and the National Indigenous Reform Agreement.
Indigenous Australians should enjoy the same health, education and employment outcomes as other Australians. But, instead there remains a persistent and terrible gap between the two in major areas.
Closing the gap between Indigenous and non-Indigenous Australians is a priority for all Australian governments. But closing the gap is a long-term challenge—one which requires enduring vigilance and resources.
The Genesis of Closing the Gap
The genesis of the closing the gap campaign was a report in 2005 by Dr Tom Calma, the then Aboriginal and Torres Strait Islander Social Justice Commissioner.
The report called on the governments of Australia to commit to achieving health equality for Indigenous people within a generation.
This report sparked the National Indigenous Health Equality Campaign in 2006 that culminated in a formal launch of the close the gap campaign in Sydney in April 2007, where NACCHO was a leading voice calling for action.
NACCHO’s very name—National Aboriginal Community Controlled Health Organisation—reflects the campaign for self-determination … the wish of Indigenous Australians to have their own representative bodies.
On 20 December 2007, the Council of Australian Governments answered the call of NACCHO, ANTAR, Oxfam Australia and many other organisations and pledged to close the life expectancy gap between Indigenous and other Australians within a generation.
In March 2008, the Indigenous Health Equality Summit released a statement of intent which committed the Australian government, among other things, to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.
NACCHO was a signatory to that statement. The parties also agreed to use benchmarks and targets to measure, monitor and report.
COAG & Closing the Gap
In November 2008, our nation’s leaders committed to closing the gap within a generation (25 years) in the National Indigenous Reform Agreement (NIRA).
Importantly, COAG agreed to be accountable for closing these gaps and appointed the COAG Reform Council to monitor progress.
As you well know, COAG has six targets as part of its objective of closing the gap.
To close the life expectancy gap within a generation, by 2031.
To halve the gap in mortality rates for Indigenous children under five within a decade, by 2018.
To provide access to early childhood education for all Indigenous four-year olds in remote communities within five years, by 2013.
To halve the gap in reading, writing and numeracy within a decade, by 2018.
To halve the gap in the rate of Year 12 or equivalent attainment, by 2020.
And, finally, to halve the gap in employment outcomes within a decade by 2018.
For the past five years, the COAG Reform Council has dissected the data, measured progress and independently reported on whether Australian governments are achieving these targets in both our NIRA report and our report under the National Healthcare Agreement.
Indigenous Supplement to Healthcare in Australia 2012–13
What we have found under the NIRA report, the National Healthcare agreement and the supplement I am releasing today is that the health of Indigenous Australians continues to be poorer than non-Indigenous Australians.
We found that Indigenous life expectancy at birth was 69.1 years for men and 73.7 years for women. This equates to a gap between Indigenous and non-Indigenous life expectancy of 10.6 years for men and 9.5 years for women.
Although the national gap in life expectancy did slightly narrow over the last five years, it is extremely unlikely that governments will be able meet the target to close the life expectancy gap within a generation (that is, by 2031).
The life expectancy gap and potentially avoidable death
Closing the gap on life expectancy is complex and requires action on a range of fronts.
We report on a range of indicators and targets about many things that may help to achieve improvements in Indigenous health. These include indicators relating to preventative health, primary care, hospitals and the medical workforce.
I would like to focus today on the results we have found in regards to death from potentially avoidable causes – either through prevention, or through early intervention via primary or community care.
In regards to deaths from potentially avoidable causes – we measure according to whether they could have been potentially prevented or potentially treated.
Deaths from potentially preventable causes are avoidable through primary healthcare (such as the care provided by a GP or community care), health promotion (such as by improving healthy habits and behaviours) and preventative health (such as vaccination against some diseases or help to quit smoking).
Deaths from potentially treatable causes are avoidable through appropriate therapeutic interventions, such as surgery or medication, before a condition worsens. This is often the case where diseases are prevented early, such as through screening programs.
What we found was that Indigenous people were three times as likely to die of an avoidable cause. This means that three-quarters of deaths of Indigenous people aged under 75 were avoidable either through early prevention or treatment.
By way of comparison, two-thirds of all Australians died from avoidable causes.
It is a tragedy to think of all of those taken before their time purely because they did not receive care early enough, or did not make the lifestyle changes to prevent disease.
Early intervention is vital
This finding underlines two things that NACCHO well knows if we are to close this terrible gap in life expectancy:
Good access to primary or community care is vital.
Prevention is better than cure.
There have been large increases in the rates of indigenous people having health checks claimable from Medicare over time, and this was true of all age groups.
The rate of child health checks has more than doubled, from 87.9 per 1000 in 2009-10 to 193.0 per 1000 in 2012-13. This is an average annual increase of 35.7 checks per 1000 children aged 0 to 14 years.
In the 15-54 years age group, the rate of health checks more than doubled from 74.5 per 1000 in 2009-10 to 196.0 per 1000 in 2012-13. This equated to an average annual increase of 40.3 checks per 1000 people.
In the 55 years or over age group, the rate of health checks more than doubled from 137.5 checks per 1000 people in 2009-10 to 304.6 per 1000 indigenous people in 2012-13. This equates to an annual average increase of 54.8 checks per 100 people from 2009-10 to 2012-13.
In child health we have also seen some pleasing improvement.
The rate of Indigenous child deaths decreased by 35% to 164.7 deaths per 100,000 Indigenous children compared to 77.2 per 100,000 for non-Indigenous children, and death rates are falling more quickly.
This means that the gap in the child death rate between Indigenous and non-Indigenous children decreased by 38% from 1998 to 2012, and we are on track to reach the current 2018 target.
This is a resounding achievement and is partly due to increases in immunisation rates and health checks:
In 2012, immunisation rates for Indigenous children aged 2 years and 5 years were the same as for all children. However, rates at 1 year still lag behind.
And, the rate of child (0–14 years) health checks doubled between 2009–10 and 2012–13
These results in access to immunisation and health checks are very positive and reflect the hard work and what can be achieved when governments and community stakeholders, such as NACCHO and others work together.
We should ensure that these gains are not undone.
As you know, the cost of healthcare is very topical at the moment. Australians are being asked to consider what they would pay for access to a primary care physician.
What we found in our results for this report was that one in eight (12%) indigenous people already delayed or did not go to a GP as a result of cost. More than two out of five (43.9%) Indigenous people delayed or did not see a dental professional due to cost. And one-third (34.6%) delayed or did not fill a prescription also due to cost.
When people start to avoid going to their primary or community care provider because of cost or other reasons, they often end up in hospital.
And, what we found was that rates of potentially preventable hospitalisations for Indigenous people were already three to four times higher than rates for other Australians.
These results provide context for governments when they are considering policies around access to primary care. Governments should be careful that they do not put up barriers to healthcare access for Indigenous people as it may undo the good work that has been done in this space over five years and end up creating a different burden on the hospital system.
Prevention is better than cure
The other component that we will need focus on to close the gap in life expectancy is prevention – particularly prevention of circulatory diseases, endocrine disorders (like diabetes) and some cancers.
The results we found this year show significantly more work needs to be done.
The heart attack rate for Indigenous people in 2011 was two and a half times higher than that of other people.
And Indigenous Australians are more than five times more likely to die of endocrine diseases (like diabetes), and one and a half times as likely to die from a circulatory disease or cancer.
One of the primary drivers in rates of heart attacks and endocrine disorders are rates of excess body weight.
Around 70% of adult Indigenous Australians have excess body weight, meaning that they are either overweight or obese. The rate of obesity by itself was 42%.
This compares poorly to the broader Australian population, where 63% of all adults had excess body weight and 27% were obese.
This high rate is extremely concerning. Particularly when you consider the increased risks it poses for chronic diseases and early death.
Finally, I would like to turn to lung cancer. In 2010, the rates of lung cancer for Indigenous Australians was nearly double the rate for non-Indigenous Australians.
What is most tragic about lung cancer is how preventable it is. Lung cancer is very strongly linked with whether or not a person smokes. We found that the Indigenous adult smoking rate is more than double the non-Indigenous rate (41.1% vs 16.0%).
So, that is a brief summary of the health report.
Without a doubt, the results are still not good enough to close the gap in many of the health outcomes for indigenous people.
We continue to have too many Indigenous people dying before their time, of preventable diseases and conditions.
However, there are green shoots; we have seen increases in access to primary care, and most pleasingly we are on track to close the gap in child deaths.
The social determinants of health
I think it is important to recognise that these health outcomes will also be critically determined by non-health factors, what’s referred to as the ‘social determinants of health.’ The recognition of these social determinants has, in the words of the National Rural Health Alliance, become a ‘rejuvenated agenda.’
Our working conditions — whether that be our incomes, job stability, or workplace safety — and factors like education and housing among many others, each make meaningful contributions to our health.
To draw on the words of Dr Margaret Chan, the Director General of the World Health Organisation:
‘…the social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one.’
So, I would also like to discuss some results from our latest National Indigenous Reform Agreement report with you – particularly the results from education and employment.
We launched our latest NIRA report on government’s achievement against these targets in May.
We found that in literacy, numeracy and year 12 education, outcomes for Indigenous Australians are catching up with those of non-Indigenous Australians.
Between 2008 and 2013, the gap in the proportion of Indigenous and non-Indigenous students who met the national minimum standard narrowed in reading in all years and in Years 3 and 5 in numeracy.
In reading, the gap reduced most, by over 10 percentage points in Years 3 and 5. There were smaller reductions in Years 7 and 9 (1 to 3 percentage points).
In numeracy, the gap narrowed by 2 to 3 percentage points in Years 3 and 5 but widened in Year 9 by 4 percentage points. The gap widened in Year 7 by less than 1%.
The gap in the proportion of Indigenous and non-Indigenous 20–24 year olds who attained Year 12 or equivalent decreased significantly—by 12.2 percentage points .
And, over the past four years, the proportion of Indigenous Australians with or working towards a post school qualification increased from 33.1% to 42.3 %.
More work needed on childhood education, school attendance and employment
While most of this is heartening, our report also found that better results are needed in early childhood education, school attendance and in employment to meet COAG targets.
Early childhood education is a critical time for development as a successful learner. In 2012, 88% of Indigenous children in remote communities were enrolled in a preschool program in the year before school compared to 70% in major cities.
Similarly, 77% of children in remote areas attended a preschool program compared to 67% in major cities.
Another area of real concern we highlight is the falling rate of school attendance by Indigenous students in most year levels.
It’s very disappointing that—over four years—falls in Indigenous students’ attendance have outstripped any improvements made.
The worst drops in attendance were in South Australia the ACT and the Northern Territory, where attendance fell as much as 14 percentage points.
Only New South Wales and Victoria saw attendance rates improve and the gap narrow overall but even so, improvements were small —1 percentage point for most year levels.
Regular school attendance is vital for developing core skills in literacy and numeracy, and for successfully completing secondary education.
A slump in school attendance rates in all jurisdictions in the later years of compulsory schooling is particularly concerning given its potential to impact long-term economic participation.
Which leads me to employment – Australia is not on track to halve the gap in employment outcomes by 2018.
Since 2008, the gap between Indigenous and non-Indigenous employment outcomes has widened over the past five years by almost seven percentage points.
To give you some examples, we found just over 60% of Indigenous Australians were participating in the labour force, compared to almost 80% of non-Indigenous Australians.
And the overall unemployment rate for Indigenous Australians was four times that of non-Indigenous Australians—almost 22% compared to 5%.
Lower Indigenous employment and workforce participation has an impact right across the reform agenda, and must be prioritised for attention by COAG.
We, at the council, are pleased to see some positive outcomes under the Indigenous Reform Agreement, but are wary that there is still hard work and monitoring to be done in key areas.
Performance reporting matters
As you may be aware, the COAG Reform Council is being wound up on June 30, so we will no longer be reporting on these outcomes in the future.
In response to the news of the COAG Reform Council being abolished, Mick Gooda said:
“If we don’t have decisions made on the basis of the best evidence that we have available to us, we might as well be just making up things on the back of beer coasters again.”
The reports we release on Indigenous outcomes have not only enabled governments to monitor their performance. They have also equipped the public, and organisations such as NACCHO and the other peak bodies that are here today, with the information they need to hold governments to account for promises they have made in regards to Indigenous Australians.
Our reporting has provided the impetus for more focused effort to improve Indigenous health, education and economic participation and has highlighted important progress – reassuring governments and the community that change is indeed possible.
And after five years of reporting on governments’ performance, our reports have shown that we are still only at the beginning of the change required over a generation to close the gap.
I’ve been fortunate in my public life to have served in both federal and state parliaments, in opposition and in government.
And after all these years, I can honestly say that accountability—keeping governments honest—and evidence-based reform are not simply important ingredients – they are absolutely essential to getting results and keeping governments on track.
Although we do not know for sure who will be reporting on the targets to close the gap in the future, it has been suggested that the Prime Minister’s department will report on achievement of targets.
I have a great deal of respect for the Department of Prime Minister & Cabinet and I’m sure there are people with the skills to do that in PM&C.
However, what the COAG Reform Council did that was particularly special was hold governments to account on the promises they have made, but did so independently of any one government.
We report independently on the progress of all nine of Australia’s governments—the Commonwealth, the States and the Territories—in closing the gap.
That independence ensured that our reporting was impartial and objective.
Who will do this in the future?
We need to consider how to increase the effectiveness of our independent public reporting on government progress, such as improving the quality of indicators, and accessing better data.
It is important in the future that someone, or some organisation, will be there to properly measure what governments are achieving with the billions of dollars in taxpayers’ money they are spending.
Crucially, it is important that any future design of performance reporting frameworks and targets must involve indigenous stakeholders as equal partners.
Consultation with governments is required under the IGA. It should extend to key Indigenous stakeholders such as the Closing the Gap coalition.
With a tri-lateral coalition of the Commonwealth, State governments, and Indigenous representatives – we truly have a real chance of closing the gap.
So, in my last week as chairman of the COAG Reform Council, allow me to pay tribute to the work of NACCHO and extend my best wishes for the future of Indigenous health reform.
Your voice matters and I know it will shape a better future for Indigenous Australians. Thank you.
The Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) Justin Mohamed (pictured above) said evidence continues to mount that investing in services run by Aboriginal people for Aboriginal people makes good economic sense.
“Every new Aboriginal Community Controlled Health Organisation (ACCHO) and every new patient attending an Aboriginal Community Controlled Health Organisation, is a step toward closing the appalling health gap between Aboriginal and non-Aboriginal Australians,”
A new report reveals that the expansion of Aboriginal Community Controlled Health Organisations is contributing to closing the shameful health gap, prompting the call for continued investment by all levels of government.
The annual Close the Gap Progress and Priorities report released today by the Close the Gap Campaign shows that investment through national partnership agreements has created 30 new Aboriginal Community Controlled Health Organisations since 2008-9 and delivered 400,000 episodes of care.
The Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) Justin Mohamed said evidence continues to mount that investing in services run by Aboriginal people for Aboriginal people makes good economic sense.
“Every new Aboriginal Community Controlled Health Organisation (ACCHO) and every new patient attending an Aboriginal Community Controlled Health Organisation, is a step toward closing the appalling health gap between Aboriginal and non-Aboriginal Australians,” Mr Mohamed said.
“We are seeing time and again that the biggest health gains are being made when Aboriginal people have control over their own health.
“And the flow on effects are significant. The ability of our services to provide a platform for the generation of jobs and education cannot be underestimated. ACCHOs train and employ more than an estimated 5000 people, many Aboriginal, so the economic benefits are felt throughout our communities and more broadly.”
Mr Mohamed urged all governments to recommit to a national agreement to provide funding certainty to programs and services that are working and also for the Federal Government to move to implement the most recent health plan.
“The programs targeting maternal and child health, largely delivered by ACCHOs, are having an impact.
“Other services and programs are also showing gains. Generational change comes slowly but the incremental gains being made reinforce the need to maintain focus and investment over the long term.
“A new national partnership agreement is now long overdue and all governments must come to the table and demonstrate their commitment to improving the health of Aboriginal people.
“NACCHO would also like to see the Federal Government commit to delivering on the National Aboriginal and Torres Strait Islander Health Plan. Too much was invested by Aboriginal people in its development to have it be just another report gathering dust on a Ministerial shelf.”
Close the Gap Campaign Press release: action on health will lead change
The Close the Gap Campaign has called on the Government to continue to prioritise and drive action to ensure this is the generation that ends Aboriginal and Torres Strait Islander health inequality.
“We expect the Government to wholeheartedly grasp the opportunity to lead on closing the gap in health equality between Aboriginal and Torres Strait Islander people and other Australians,” said Close the Gap Campaign co-chairs Mick Gooda and Kirstie Parker.
Today, the Close the Gap Campaign releases its progress and priorities report which coincides with the Prime Minister’s release of the Government’s own closing the gap report.
“We are just starting to see reductions in smoking rates and improvements in maternal and childhood health. We need to build on these successes,” said Mick Gooda, who is also the Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission.
“This is a national effort that can achieve generational change. It is critical that Close the Gap continues as a national priority. We need to stay on track.
“All political parties and almost 200,000 Australians have committed to end the health equality gap by 2030.
“The Prime Minister’s closing the gap report released today continues the bipartisan tradition of reporting publicly on progress to achieving health equality by 2030,” Mr Gooda said.
“We know that empowering Aboriginal and Torres Strait Islander health services has broader benefits. Health services are the single biggest employer of Aboriginal and Torres Strait Islander people,” Ms Parker, who is also the Co-Chair of the National Congress of Australia’s First Peoples, said.
“Community controlled health services create jobs as well as train people in real vocations.
“We call on the Government to renew the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (NPA) and forge ahead with implementing the Aboriginal and Torres Strait Islander Health Plan in partnership with our people.
“This is the support needed for Aboriginal and Torres Strait Islander people to continue to exercise responsibility for their health.
“We can make real inroads in the national effort to close the gap if we continue to place a high priority on it.”
Call for incoming government to commit to Close the Gap
A renewed COAG National Partnership Agreement on Closing the Gap and action on the National Aboriginal and Torres Strait Islander Health Plan should be key priorities for the next government, according to an incoming government brief prepared by the Close the Gap Steering Committee.
Picture above Tanya Plibersek and Peter Dutton National Press Club Health Debate
The briefing paper, to be released today, outlines the key steps needed in the next parliament to ensure progress on closing the life expectancy gap between Aboriginal and Torres Strait Islander and other Australians.
The paper says that within its first hundred days, a new government should:
Reaffirm the commitment for the Prime Minister to annually report at the beginning of Parliament on progress towards closing the gap;
Secure a new COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, with a minimum Commonwealth investment of $777 million over the next three years; and
Begin the implementation of the National Aboriginal and Torres Strait Islander Health Plan in partnership with Aboriginal and Torres Strait Islander people and their representatives.
Campaign spokesperson and Chair of National Aboriginal Community Controlled Health Organisation, Justin Mohamed said that closing the gap is literally a life or death issue for Aboriginal and Torres Strait Islander people.
TEAM NACCHO at the NATIONAL PRESS CLUB Health Debate
“We’re only at the beginning of the journey to close the gap in life expectancy by 2030. We can’t turn back now because closing the gap needs long-term commitment and policy continuity. Aboriginal and Torres Strait Islander health in our hands is having an impact and we must keep supporting our people to deliver their own health outcomes,” Mr Mohamed said.
AMA President, Dr Steve Hambleton said that both Kevin Rudd and Tony Abbott have been strong supporters of Close the Gap.
AMA President, Dr Steve Hambleton with Department of Health Secretary Jane Halton .NACCHO’S Lisa Briggs and Justin Mohamed
He said that Tony Abbott gave the campaign strong encouragement in its early days when he was Health Minister and Kevin Rudd committed to the targets and deadlines we proposed and secured the first National Partnership Agreement through COAG.
“It’s important that momentum towards closing the gap is maintained regardless of who wins the election. Closing the gap is a generational effort and we are beginning to see signs of progress,” Dr Hambleton said.
Lowitja Institute Chair, Pat Anderson said the Close the Gap Steering Committee welcomed the attention given to Aboriginal and Torres Strait Islander education and employment in the election campaign.
“Along with racism, education and employment are key social determinants of health. But action on these needs to proceed at the same time as action on health because kids can’t study and parents can’t hold down a job if they have poor health,” Ms Anderson said.
The Close the Gap Campaign was launched by Olympians Catherine Freeman and Ian Thorpe in April 2007. Since then almost 200,000 Australians have signed up to the campaign, which has also received multi party support by all Federal, State and Territory Governments.