“ The life expectancy gap has in fact started to widen again and the Indigenous child mortality rate is now more than double that of other children.
This is a national shame and demands an urgent tripartite health partnership. This must be high on the agenda at tomorrow’s COAG meeting.”
In a departure from the campaign’s usual report, this year’s review focusses on the decade since the 2008 signing of the Close the Gap Statement of Intent.”
Close the Gap Campaign Co-Chair and Aboriginal and Torres Strait Islander Social Justice Commissioner, June Oscar AO, said the Close the Gap strategy began in 2008 with great promise but has failed to deliver.
Read CTG call for urgent action to address national shame press release Part 2
Download the 40 Page review HERE
“ The Close the Gap refresh being considered by the COAG provides an opportunity to reflect upon and reform current policy settings and institutionalised thinking,
The Close the Gap targets should remain, as should the National Indigenous Reform Agreement framework and associated National Partnership Agreements. They serve to focus the nation and increase our collective accountability.
What we need however is radically different action to achieve the targets
This starts with Aboriginal and Torres Strait Islander peoples, their community controlled health organisations and peak representatives having a genuine say over their own health and wellbeing and health policies.
“Increased funding is needed for ACCHOs to expand in regions where there are low access to health services and high levels of disease, and in areas of mental health, disability services and aged care.
ACCHOs have consistently demonstrated that they achieve better results for Aboriginal and Torres Strait Islander peoples, at better value for money.
NACCHO Chairperson, Mr John Singer.
Download NACCHO Press Release
Download NACCHO Press Background Paper
Part 1 NACCHO Press Release : Increased support to Aboriginal Community Controlled Health Organisations needed to Close the Gap in life expectancy gap
The National Aboriginal Community Controlled Health Organisation (NACCHO) calls for urgent and radically different action to Close the Gap.
“The Council of Australian Governments’ (COAG) commitment to Close the Gap in 2007 was welcome.
It was a positive step towards mobilising government resources and effort to address the under investment in Aboriginal and Torres Strait Islander peoples’ health”, said NACCHO Chairperson, Mr John Singer.
“But ten years on the gap in life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians is widening, not closing.
Jurisdictions currently spend $2 per Aboriginal and Torres Strait Islander for every $1 for the rest of the population whereas the Commonwealth in the past has spent only $1.21 per Aboriginal and Torres Strait Island person for every $1 spent on the rest of the population. NACCHO calls for the Commonwealth to increase funding to Close the Gap”, said John Singer.
NACCHO is a proud member of the Close the Gap Campaign and stands by its report released today: ‘A ten-year review: the Closing the Gap Strategy and Recommendations for Reset’.
The review found that the Close the Gap strategy has never been fully implemented. Underfunding in Aboriginal and Torres Strait Islander health services and infrastructure has persisted – funding is not always based on need, has been cut and in some cases redirected through mainstream providers.
The role of Aboriginal Community Controlled Health Organisations (ACCHOs) in delivering more successful care for Aboriginal and Torres Strait Islander peoples than the mainstream service providers is not properly recognised.
A health equality plan was not in place until the release of the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan 2015, and this is unfunded.
And despite the initial investment in remote housing, there has not been a sufficient and properly resourced plan to adequately address the social determinants of health.
The framework underpinning the Close the Gap strategy – a national approach and leadership, increased accountability, clear roles and responsibilities and increased funding through National Partnership Agreements – has unraveled and in some cases been abandoned altogether.
A comprehensive and funded Indigenous health workforce is required to improve the responsiveness of health services to Aboriginal and Torres Strait islander peoples and increase cultural safety.
A boost in disease specific initiatives is urgently needed in areas where Aboriginal and Torres Strait Islander peoples have a high burden of disease or are particularly vulnerable, like ear health and renal disease, delivered through ACCHOs.”
“There also needs to be a way in which NACCHO and other Indigenous health leaders can come together with COAG to agree a ‘refreshed approach’ to Close the Gap”, said Mr Singer.
NACCHO has proposed to Government a way forward to Close the Gap in life expectancy and is looking forward to working with the Australian Government on the further development of its proposals.
The only way to close the gap is with the full participation of Aboriginal and Torres Strait Islander peoples. Until Aboriginal and Torres Strait Islander peoples are fully engaged and have control over their health and wellbeing any ‘refresh’ will be marginal at best, and certainly won’t close the gap
Part 2 CALL FOR URGENT JOINT ACTION TO ADDRESS NATIONAL SHAME
Australian governments must join forces with Aboriginal and Torres Strait Islander organisations to address the national shame of a widening life expectancy gap for our nation’s First Peoples.
“It’s time for each State and Territory government to affirm or reaffirm their commitments made via the Close the Gap Statement of Intent.
“Until now, the scrutiny has rightly been on the Federal Government regarding the need for it to lead the strategy and to coordinate and resource the effort.
But it’s now time for state and territory governments to step up.
“We want to see Premiers, Chief Ministers, Health and Indigenous Affairs Ministers in every jurisdiction providing regular and public accountability on their efforts to address the inequality gaps in their State or Territory.
“No more finger pointing between governments. A reset Closing the Gap Strategy should clearly articulate targets for both levels of government and be underpinned by a new set of agreements that include Aboriginal and Torres Strait Islander peoples, their leaders and organisations.”
Last year, the Prime Minister reported that six out of the seven targets were ‘not on track’. Since then, the Federal Government has announced that the COAG agreed
Closing the Gap Strategy would go through a ‘refresh’ process.
Close the Gap Co-Chair and Co-Chair of the National Congress of Australia’s First Peoples Rod Little, said the refresh process is the last chance to get government policy right to achieve the goal of health equality by 2030.
“The Close the Gap Campaign is led by more than 40 Aboriginal and Torres Strait Islander and non-Indigenous health and human rights bodies,” Mr Little said.
“No other group can boast this level of leadership, experience and expertise. We stand ready to work together with Federal, State and Territory governments. We have the solutions.
“You must get the engagement on this right. No half measures. No preconceived policies that are imposed, rather than respectfully discussed and collectively decided.”
The Close the Gap Campaign Co-Chairs have warned that, without a recommitment, the closing the gap targets will measure nothing but the collective failure of Australian governments to work together and to stay the course.
“While the approach has all but fallen apart, we know that with the right settings and right approach, including Aboriginal and Torres Strait Islander Peoples leading the resetting of the strategy, we can start to meet the challenge of health inequality, and live up to the ideals that all Australians have a fundamental right to health,” the Co-Chairs said.
Part 3 :This review’s major findings are:
1.First, the Close the Gap Statement of Intent (and close the gap approach) has to date only been partially and incoherently implemented via the Closing the Gap Strategy:
An effective health equality plan was not in place until the release of the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan in 2015 – which has never been funded. The complementary National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 needs an implementation plan and funding as appropriate. There is still yet to be a national plan to address housing and health infrastructure, and social determinants were not connected to health planning until recently and still lack sufficient resources.
The Closing the Gap Strategy focus on child and maternal health and addressing chronic disease and risk factors – such as smoking through the Tackling Indigenous Smoking Program – are welcomed and should be sustained.
However, there was no complementary systematic focus on building primary health service capacity according to need, particularly through the Aboriginal Community Controlled Health Services and truly shifting Aboriginal and Torres Strait Islander health to a preventive footing rather than responding ‘after the event’ to health crisis.
2.Second, the Closing the Gap Strategy – a 25-year program – was effectively abandoned after five-years and so cannot be said to have been anything but partially implemented in itself.
This is because the ‘architecture’ to support the Closing the Gap Strategy (national approach, national leadership, funding agreements) had unraveled by 2014-2015.
3.Third, a refreshed Closing the Gap Strategy requires a reset which re-builds the requisite ‘architecture’ (national approach, national leadership, outcome-orientated funding agreements).
National priorities like addressing Aboriginal and Torres Strait Islander health inequality have not gone away, are getting worse, and more than ever require a national response.
Without a recommitment to such ‘architecture’, the nation is now in a situation where the closing the gap targets will measure nothing but the collective failure of Australian governments to work together and to stay the course.
4.Fourth, a refreshed Closing the Gap Strategy must be founded on implementing the existing Close the Gap Statement of Intent commitments.
In the past ten years, Australian governments have behaved as if the Close the Gap Statement of Intent was of little relevance to the Closing the Gap Strategy when in fact it should have fundamentally informed it.
It is time to align the two. A refreshed Closing the Gap Strategy must focus on delivering equality of opportunity in relation to health goods and services, especially primary health care, according to need and in relation to health infrastructure (an adequate and capable health workforce, housing, food, water).
This should be in addition to the focus on maternal and infant health, chronic disease and other health needs. The social determinants of health inequality (income, education, racism) also must be addressed at a fundamental level.
5.Fifth, there is a ‘funding myth’ about Aboriginal and Torres Strait Islander health – indeed in many Indigenous Affairs areas – that must be confronted as it impedes progress.
That is the idea of dedicated health expenditure being a waste of taxpayer funds.
Yet, if Australian governments are serious about achieving Aboriginal and Torres Strait Islander health equality within a generation, a refreshed Closing the Gap Strategy must include commitments to realistic and equitable levels of investment (indexed according to need).
Higher spending on Aboriginal and Torres Strait Islander health should hardly be a surprise.
Spending on the elderly, for example, is higher than on the young because everyone understands the elderly have greater health needs.
Likewise, the Aboriginal and Torres Strait Islander population have, on average, 2.3 times the disease burden of non-Indigenous people.[i] Yet on a per person basis, Australian government health expenditure was $1.38 per Aboriginal and Torres Strait Islander person for every $1.00 spent per non-Indigenous person in 2013-14.[ii]
So, for the duration of the Closing the Gap Strategy Australian government expenditure was not commensurate with these substantially greater and more complex health needs.
This remains the case. Because non-Indigenous Australians rely significantly on private health insurance and private health providers to meet much of their health needs, in addition to government support, the overall situation for Aboriginal and Torres Strait Islander health can be characterised as ‘systemic’ or ‘market failure’.
Private sources will not make up the shortfall. Australian government ‘market intervention’ – increased expenditure directed as indicated in the recommendations below – is required to address this.
The Close the Gap Campaign believes no Australian government can preside over widening mortality and life expectancy gaps and, yet, maintain targets to close these gaps without additional funding. Indeed, the Campaign believes the position of Australian governments is absolutely untenable in that regard.
In considering these findings, the Close the Gap Campaign are clear that the Close the Gap Statement of Intent remains a current, powerful and coherent guide to achieving Aboriginal and Torres Strait Islander health equality, and to the refreshment of the Closing the Gap Strategy in 2018.
Accordingly, this review recommends that:
Recommendation 1: the ‘refreshed’ Closing the Gap Strategy is co-designed with Aboriginal and Torres Strait Islander health leaders and includes community consultations.
This requires a tripartite negotiation process with Aboriginal and Torres Strait Islander health leaders, and the Federal and State and Territory governments. Time must be allowed for this process.
Further, Australian governments must be accountable to Aboriginal and Torres Strait Islander people for its effective implementation.
Recommendation 2: to underpin the Closing the Gap Strategy refresh, Australian governments reinvigorate the ‘architecture’ required for a national approach to addressing Aboriginal and Torres Strait Islander health equality.
This architecture includes: a national agreement, Federal leadership, and national funding agreements that require the development of jurisdictional implementation plans and clear accountability for implementation.
This includes by reporting against national and state/territory targets.
Recommendation 3: the Closing the Gap Strategy elements such as maternal and infant health programs and the focus on chronic disease (including the Tackling Indigenous Smoking program) are maintained and expanded in a refreshed Closing the Gap Strategy.
Along with Recommendation 2, a priority focus of the ‘refreshed’ Closing the Gap Strategy is on delivering equality of opportunity in relation to health goods and services and in relation to health infrastructure (housing, food, water).
The social determinants of health inequality (income, education, racism) must also be addressed at a far more fundamental level than before. This includes through the following recommendations:
Recommendation 4: the current Closing the Gap Strategy health targets are maintained, but complemented by targets or reporting on the inputs to those health targets.
These input targets or measures should be agreed by Aboriginal and Torres Strait Islander health leaders and Australian governments as a part of the Closing the Gap Strategy refresh process and include:
- Expenditure, including aggregate amounts and in relation to specific underlying factors as below;
- Primary health care services, with preference given to Aboriginal Community Controlled Health Services, and a guarantee across all health services of culturally safe care;
- The identified elements that address institutional racism in the health system;
- Health workforce, particularly the numbers of Aboriginal and Torres Strait Islander people trained and employed at all levels, including senior levels, of the health workforce; and
- Health enabling infrastructure, particularly housing.
Recommendation 5: the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan is costed and fully funded by the Federal government, and future iterations are more directly linked to the commitments of the Close the Gap Statement of Intent; and, an implementation plan for the complementary National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 is developed, costed and implemented by the end of 2018 in partnership with Aboriginal and Torres Strait Islander health leaders and communities
This will include:
- A five-year national plan to identify and fill health service gaps funded from the 2018-2019 Federal budget onwards and with a service provider preference for Aboriginal Community Controlled Health Services (ACCHSs). This includes provision for the greater development of ACCHS’s satellite and outreach services.
- Aboriginal and Torres Strait Islander health leadership, Federal, State and Territory agreements clarifying roles, responsibilities and funding commitments at the jurisdictional level.
- Aboriginal and Torres Strait Islander health leadership, Primary Health Network and Federal agreements clarifying roles, responsibilities and funding commitments at the regional level.
Recommendation 6: an overarching health infrastructure and housing plan to secure Aboriginal and Torres Strait Islander Peoples equality in these areas, to support the attainment of life expectancy and health equality by 2030, is developed, costed and implemented by the end of 2018.
[i] Australian Institute of Health and Welfare 2016. Healthy Futures—Aboriginal Community Controlled Health Services: Report Card 2016. Cat. no. IHW 171. Canberra: AIHW, p. 40.
[ii] Australian Health Ministers’ Advisory Council, 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra, p. 192.