” A December 2017 report from the Australian Institute of Health and Welfare (AIHW) shows that the mortality gaps between Indigenous and non-Indigenous Australians are widening, not narrowing.
Urgent action is needed to reverse these trends to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy within a generation (by 2031).
The following submission by the National Aboriginal Community Controlled Health Organisation (NACCHO) in relation to the Commonwealth Budget 2018 aims to reverse the widening mortality gaps.”
Download the full NACCHO submission HERE
NACCHO-Pre-budget-submisson-2018
Widening mortality gaps require urgent action
The life expectancy gap means that Indigenous Australians are not only dying younger than non-Indigenous Australians but also carry a higher burden of disease across their life span, impacting on education and employment opportunities as well as their social and emotional wellbeing.
Preventable admissions and deaths are three times as high in Indigenous people yet use of the main Commonwealth schemes, Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) are at best half the needs based requirements.
It is simply impossible to close the mortality gaps under these conditions. No government can have a goal to close life expectancy and child mortality gaps and yet concurrently preside over widening mortality gaps.
Going forward, a radical departure is needed from a business as usual approach.
Funding considerations, fiscal imbalance and underuse of MBS/PBS
The recent Productivity Commission Report found that per capita government spending on Indigenous services 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.
Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.
In terms of health expenditure, the Commonwealth spends $1.4 for every $1 spent on the rest of the population, notwithstanding that, on the most conservative assumptions, Indigenous people have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.
This represents a significant 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.
A pressing need is to address the shortfall in spending for out of hospital services, for which the Commonwealth is mainly responsible, and which is directly and indirectly responsible for excessive preventable admissions funded by the jurisdictions – and avoidable deaths.
The fiscal imbalance whereby underspending by the Commonwealth leads to large increases in preventable admissions (and deaths) borne by the jurisdictions needs to be rectified.
Ultimately, NACCHO seeks an evidenced based, incremental plan to address gaps, and increased resources and effort to address the Indigenous burden of disease and life expectancy.
The following list of budget proposals reflect the burden of disease, the underfunding throughout the system and the comprehensive effort needed to close the gap and ideally would be considered as a total package.
NACCHO recommends initiatives that impact on the greatest number of Indigenous people and burden of preventable disease and support the sustainability of the Aboriginal Community Controlled Health Organisation (ACCHO) sector – see proposals 1. a) to e) and 3. a) and b) as a priority.
NACCHO is committed to working with the Australian Government on the below proposals and other collaborative initiatives that will help Close the Gap.
National Aboriginal Community Controlled Health Organisation
NACCHO is the national peak body representing 144 ACCHOs across the country on Aboriginal health and wellbeing issues
. In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.
Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period.
Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.
The following proposals are informed by NACCHO’s work with Aboriginal health services, its members, the views of Indigenous leaders expressed through the Redfern Statement and the Close the Gap campaign and its engagement and relationship with other peak health organisations, like the Australian Medical Association (AMA).
Guiding principles
Specialised health services for Indigenous people are essential to closing the gap as it is impossible to apply the same approach that is used in health services for non-Indigenous patients.
Many Indigenous people are uncomfortable seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. Access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation.
Many Indigenous people live below the poverty line so that services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Indigenous patients due to significant cultural, geographical and language disparities: ACCHOs attempt to overcome such challenges.
An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management.
They form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.
Studies have shown that ACCHOs are 23% better at attracting and retaining Indigenous clients than mainstream providers and at identifying and managing risk of chronic disease.
Indigenous people are more likely to access care if it is through an ACCHO and patients are more likely to follow chronic disease plans, return for follow up appointments and share information about their health and the health of their family.
ACCHOs provide care in context, understanding the environment in which many Indigenous people live and offering true primary health care. More people are also using ACCHOs.
In the 24 months to June 2015, our services increased their primary health care services, with the total number of clients rising by 8%. ACCHOs are also more cost-effective providing greater health benefits per dollar spent; measured at a value of $1.19:$1.
The lifetime health impact of interventions delivered our services is 50% greater than if these same interventions were delivered by mainstream health services, primarily due to improved Indigenous access.
If the gap is to close, the growth and development of ACCHOs across Australia is critical and should be a central component to policy considerations.
Mainstream health services also have a significant role in closing the gap in Indigenous health, providing tertiary care, specialist services and primary care where ACCHOs do not exist.
The Indigenous Australians’ Health Programme accounts for about 13% of government expenditure on Indigenous health.
Given that other programs are responsible for 87% of expenditure on Indigenous health, it reasonable to expect that mainstream services should be held more accountable in closing the gap than they currently are.
Greater effort is required by the mainstream health sector to improve its accessibility and responsiveness to Indigenous people and their health needs, reduce the burden of disease and to better support ACCHOs with medical and technical expertise.
The health system’s response to closing the gap in life expectancy involves a combination of mainstream and Indigenous-specific primary care providers (delivered primarily through ACCHOs) and where both are operating at the highest level to optimise their engagement and involvement with Indigenous people to improve health outcomes.
ACCHO’s provide a benchmark for Indigenous health care practice to the mainstream services, and through NACCHO can provide valuable good practice learnings to drive improved practices.
NACCHO also acknowledges the social determinants of health, including housing, family support, community safety, access to good nutrition, and the key role they play in influencing the life and health outcomes of Indigenous Australians.
Elsewhere NACCHO has and will continue to call on the Australian and state and territory governments to do more in these areas as they are foundational to closing the gap in life expectancy.
Addressing the social determinants of health is also critical to reducing the number of Indigenous incarceration. Comprehensively responding to the Royal Commission into the Protection and Detention of Children in the Northern Territory must be a non-negotiable priority.
Proposals
The following policy proposals are divided into four areas below and summarised in the following table:
- Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
- Proposals that improve responsiveness of mainstream health services for Indigenous people
- Proposals that address specific preventable diseases
- Proposals that build in an Indigenous position into policy considerations that impact on health.
NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted
Continued HERE NACCHO-Pre-budget-submisison-2018