NACCHO political alert : Health Minister Dutton signals major overhaul of health :Full transcript 7:30 report

Question Time in the House of Representatives

“Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent.

If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today.”

Minister for Health Peter Dutton  Speaking on ABC 7:30 report , read full transcript below


According to reports in the Guardian the federal health minister, Peter Dutton, has signalled dramatic changes to Medicare to address “staggering” increases in health spending, confirming the Abbott government would consider a new fee for visits to the doctor.

Laying the groundwork for politically sensitive reforms, Dutton said he wanted to “start a national conversation about modernising and strengthening Medicare”. He said the health system was “riddled with inefficiency and waste” and warned that doing nothing to address the long-term budget burden was not an option.

In a speech in Brisbane on Wednesday, the minister flagged a greater role for the private sector and private insurers in primary care as the government wanted to “grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs”.

But Labor seized on his comments of evidence that the government planned “to destroy universal healthcare in Australia” by making people pay more to access services.

The shadow health minister, Catherine King, said Dutton’s claims about rising health costs were “hysterical” as Australia spent 9.1% of its gross domestic product on health compared with 17% by the United States.

Dutton followed up his speech with an interview on the ABC’s 7.30 program in which he said the country should debate how governments and consumers paid for health services. He said the discussion should include payment models for people who had “a means to contribute to their own healthcare”.

A discussion about who pays for our health system and how is what Federal Health Minister Peter Dutton has flagged, suggesting those with a mean to contribute may have to pay more.


SARAH FERGUSON, PRESENTER: Federal Health Minister Peter Dutton today called for a fearless, far-reaching debate about Australia’s health system, saying that current spending is unsustainable. He’s now flagging major changes to health services, with Australians who can afford it paying more for healthcare and medicines.

The minister has revealed he’s looking at a potential Medicare co-payment, which some argue could mean the end of universal healthcare. It comes after a controversial week in the Health portfolio, with junior Health Minister Fiona Nash accused of doing the bidding of the junk food industry, pulling down a healthy consumers’ website years in preparation. Peter Dutton joined me earlier from Brisbane.

Peter Dutton, thank you very much for joining us.

PETER DUTTON, HEALTH MINISTER: Pleasure. Thank you, Sarah.

SARAH FERGUSON: You said in your speech today that in the past 10 years the cost of Medicare has increased by 120 per cent, the Pharmaceutical Benefits Scheme by 90 per cent, hospital care by 80 per cent. You say that’s not sustainable and something must be done. What exactly is it that you are planning to do?

PETER DUTTON: Well the first thing that we have to do is have a conversation with the Australian people to say that we want to strengthen and modernise Medicare. It’s a system that, obviously, all Australians, including myself, hold near and dear. But it’s a system that was set up in the 1980s and we have to accept the changing and ageing demographic of our society, we have one of the highest obesity rates in the world, we have cancers that if early detection takes place, we can help those people if we have better connections between people and their GPs – all of those things are great, but they have to be paid for. So we have to look at where it is we’re spending money at the moment, whether or not that’s the most efficient way to spend the money so that we can strengthen and sustain our system into the future.

SARAH FERGUSON: Now, does that include increasing the costs of healthcare for those who can afford to pay more?

PETER DUTTON: Well I think it does and at the moment government pays about 70 per cent of that which we spend on health each year, and I know these figures sort of gloss – are glossed over or go over people’s heads, but $140 billion at the moment we’re spending each year on health that we raise about $10 billion a year out of the Medicare levy. There is enormous amounts of money to be spent. There are lots of technologies coming through, and as a First World country, we want to adopt those early and we have to have a conversation about how we pay for those and those that have a capacity to pay in many cases are already paying within the system, but we have to have a discussion about how it is that payment model works going forward.

SARAH FERGUSON: Individuals are already contributing about 18 per cent of the cost of their own health care. Are you saying those payments are going to have to go up?

PETER DUTTON: Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent. If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today. We have to look at the next 10 years where we we’re going to have millions of people who will go onto the age group of over 65. I want to make sure that we can provide for those and we do have to have a national discussion about who pays for what and how the Government pays going forward and how consumers pay for those health services.

SARAH FERGUSON: Specifically, for example, are you in favour of introducing a Medicare copayment. A figure of $6 a visit has been touted already?

PETER DUTTON: Well there are suggestions that have been made both in favour and against this particular proposal, but it’s one aspect that the Government will need to consider. The Commission of Audit obviously …

SARAH FERGUSON: And what’s your own view – what’s your own view on that? Excuse me.

PETER DUTTON: Well my own view is that people at the moment pay a co-contribution through when they buy their medicines, regardless of their income. People pay as little as $6 for a $17,000 prescription, a single prescription. People pay a copayment at the moment for their private health insurance. 11 million Australians have private health insurance. Many Australians already pay a copayment when they go to see the doctor. Now, the issue is how you guarantee access, particularly for those who are without means, and how you don’t deter people from going to see a doctor if there is some sort of a payment mechanism in place.

SARAH FERGUSON: You also raise the issue today of the ageing population. Is your government going to be forced to make older people who have more resources pay more for their healthcare?

PETER DUTTON: Well, I don’t want to single anybody out, but what I would say is that as a general principle, in a society where we have an ageing of our population, regardless of people’s age, if they have a means to contribute to their own health care, we should be embarking on a discussion about how that payment model will work.

SARAH FERGUSON: And is that going to require a new form of means testing to make that possible?

PETER DUTTON: Well, not necessarily, and again, this is the recommendations that we’ll wait to see from the Commission of Audit. I want to make sure that, for argument’s sake, we have a discussion about you or me on reasonable incomes whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test, should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill. I think these are all reasonable discussions for our population to have.

SARAH FERGUSON: Now, you set out as the key rationale for your speech today the dramatically rising rates of obesity and diabetes in society, yet your own junior minister, Fiona Nash, shut down a website which was designed to help prevent those scourges. Was that a mistake?

PETER DUTTON: It wasn’t a mistake. The Government obviously has a number of people who were advising us in these particular areas. The issue that you speak of is a reasonable discussion to take place. But to put this issue into perspective, there was a system that was proposed in relation to a star rating that people could assess whether or not they purchased particular foods based on that system or that star rating system. The system hasn’t started, and as I understand the minister’s position, she said that the website shouldn’t proceed until there had been a rolling out of this system or a better understanding …

SARAH FERGUSON: But that wasn’t the view of those people who had been involved in putting that website together; they said it was ready to go.

PETER DUTTON: Well again, I mean, you’ve got Labor premiers sitting around the table in South Australia and Tasmania, two of the worst-performing health systems in the country. I don’t place much credibility in what might have been leaked by Labor ministers out of that meeting. I find Fiona Nash not only to be an effective minister, but a very decent person. I think she’s served her constituency well.

SARAH FERGUSON: That’s not actually the question here. Excuse me, minister, …

PETER DUTTON: Well it goes to credibility and the credibility that I place in this debate is with Senator Nash and I think she has done the right thing here. We’ll have a proper discussion about what we should do in terms of food labelling and the rest of it, but we aren’t going to be cajoled or bullied by people like SA or Tasmania or indeed the ACT, who have very poor performing health systems.

SARAH FERGUSON: Forgive me for interrupting. It doesn’t just go to the credibility of the minister. I’m asking you for your opinion. These are exactly the tools that public health experts say the public needs to fight diabetes and obesity. Do you still maintain that website should be taken down?

PETER DUTTON: If the system hasn’t started, I don’t see an argument for the website being up in place and that’s the decision rightly that the minister took.

SARAH FERGUSON: Did you know that her chief-of-staff was a lobbyist for the food and soft drink industry?

PETER DUTTON: Well, again, Sarah, these are matters that have been trawled over.

SARAH FERGUSON: What’s the answer to the question, if you would?

PETER DUTTON: Well I knew of course, as everybody else did, Mr Furnival’s history, but today is our opportunity to talk about ways in which we can strengthen Medicare going forward and that’s the speech I gave today and I think that’s the discussion the public wants to hear about, about how can we provide …

SARAH FERGUSON: Except that you’re – minister, if I may say, you’re the person that raised the issue of obesity and diabetes, that wasn’t me.


SARAH FERGUSON: You made that the centrepiece of your speech, the opening lines in fact.


SARAH FERGUSON: You’re saying you knew that Mr Furnival was a lobbyist for the food and drink industry. Doesn’t that mean there was a clear conflict of interest between his past and the actions of your minister?

PETER DUTTON: No, the appropriate, the appropriate – as I’m advised, the appropriate declarations were made and signed, and as I say, Mr Furnival now has moved on. Our discussion today was about the fact that we have one of the highest obesity rates in the world. About two in three Australians have – are either overweight or obese. We now have about 2,200 young children and youngsters who are identified as having Type 2 diabetes. That’s what I was speaking about today and frankly I think that’s a much more substantive discussion to have with the public and if we do that then we can talk about the ways that we can make our system sustainable going forwards.

SARAH FERGUSON: Thank you very much indeed for joining us, Mr Dutton.

PETER DUTTON: My pleasure. Thank you.

Please Take

NACCHO needs to improve how we  connect, inform and engage into the Ifuture.


NACCHO Aboriginal Health :Social media the new health danger in Aboriginal Communities


The use of social media in the region is also problematic because of the small population size of remote communities, and the complex family relationships that often break down into community division.

The exposure of the mental health epidemic afflicting children in the lands comes as community leaders call for more action to protect children. Some community members say the government must consider a strong response, such as community boarding houses, to keep children safe at night.

ABORIGINAL teenagers in remote communities of central Australia are using Facebook to regularly threaten suicide, prostitute themselves and talk about substance abuse.

Child welfare advocates have sent The Australian Facebook posts from children as young as 13 that lay bare the dysfunction of the region.


Bullying is also commonplace, with teenagers regularly threatening violent abuse on the site.

Picture Above: Nyuminya Ken, from Ernabella in the APY Lands of South Australia, has sent her daughter away to school in Victoria to escape cyber bullying. Picture: Stuart McEvoy Source: News Corp Australia

Story Sarah Martin Published THE AUSTRALIAN 20 FEB


The disturbing posts include a teenage girl expressing “real shame” at young girls in her community who “strip their self when they hanging out for dope”.

The Australian has seen at least a dozen posts of children from the Anangu Pitjantjatjara Yankunytjatjara lands threatening suicide, and posts of teenagers listing mobile phone numbers to procure sex.

Nyuminya Ken, a respected elder in the community of Ernabella, said there was widespread concern about the inappropriate use of Facebook.

One post has a young girl saying “all the man stop ringing to my phone, I’m little kids, not big woman … I don’t like big man”. In another post, a pregnant 18-year-old says she is addicted to sniffing laundry products, saying: “Damaging this kids brain. Cnt get rid of it. Gona sniff it all night till I get sick.” Another girl, understood to be just 14, threatens to hang herself when her family goes to sleep. “Feel lost right now hang myself,” the girl writes.

The use of social media in the region is also problematic because of the small population size of remote communities, and the complex family relationships that often break down into community division.

The exposure of the mental health epidemic afflicting children in the lands comes as community leaders call for more action to protect children. Some community members say the government must consider a strong response, such as community boarding houses, to keep children safe at night.

Child Protection Minister Jennifer Rankine said she had ordered Families SA to do an immediate check on each of the children, whose posts were brought to the department’s attention by The Australian.

“I have been advised that only one of the seven young people is known to Families SA,” Ms Rankine said. “An FSA officer has been instructed to check on this child’s welfare immediately.

“I have also instructed FSA to work with SA Police in an effort to … check on their welfare.”

A spokeswoman for the minister said police had checked on the children and they were “safe and happy”.

Mrs Ken said that she had spoken to the region’s women’s council and police about its use, and wanted more action to prevent it adding to the community’s ills.

“All the girls are doing Facebook, and we don’t want it on their phones,” she said.

She said she had asked for the police to come to the school to talk to students about the Facebook “problem.”

A Facebook spokeswoman said the safety of users was a priority. “Facebook takes threats of self-harm very seriously. We also work with suicide prevention agencies around the world to provide assistance for people in distress.”

As for the site being used for minors to procure sex, the spokeswoman said Facebook had a strict policy, involving law enforcement collaboration, against the sharing of pornographic content and any explicitly sexual content where a minor was involved.

If you are depressed or contemplating suicide, help is available at Lifeline on 131 114.

Please Take

NACCHO needs to improve how we  connect, inform and engage into the Ifuture.


NACCHO weekly health news wrap :Health Minister Peter Dutton backs less bureaucrats, more frontline GPs


LABOR’S “dud’’ Medicare Locals will be rebadged and redesigned after GPs complained that the $1.8 billion bureaucracy is failing to deliver real services to patients.

See previous NACCHO reports here

NACCHO Aboriginal healthly debate: Medicare Locals (MLs) their future is unclear ?

Also below Croakey Health WRAP

Senior government sources have revealed that a review into the system has confirmed some sites underperforming. Staff working at Medicare Locals also hate the name, complaining patients think they can claim Medicare refund there or actually see a doctor.


But the review has come with a hefty $550,000 price tag according to tender documents obtained by the Sunday Telegraph. Despite the contract running for just three months, it comes with a $550,000 contract for accounting services awarded to Deloitte.

Medicare Locals were established by the Rudd-Gillard government and were designed to better integrate GP and primate health care services. Unlike GP superclinics, they are not a shopfront with doctors.

Doctors have also labelled the program a dud, with the Australian Medical Association releasing a survey stating that 75 per cent of GPs believed the program had “not resulted in any improvement in access to, or deliver of primary healthcare, and should be scrapped.”

Health Minister Peter Dutton confirmed he would announce changes to Medicare locals when he had considered the findings of the review.

“Labor wasted billions in health and we have to get the system back on track so we can pay for cancer drugs, the ageing population and the massive onset of dementia and obesity,’’ he said.

But Labor health spokeswoman Catherine King said any moves to scrap Medicare locals, reduce funding or close some down would represent a broken election promise.

“Any cut to Medicare Locals would be a clear broken promise by the Prime Minister.

Medicare Locals are transforming the way primary care is delivered across Australia and making it easier for all Australians to get to doctors, psychologists, nurses and other allied health professionals,’’ she said.

During the election, the Prime Minister announced he would review Medicare locals if elected, admitting he cannot guarantee they will stay “exactly the same.”

“I don’t guarantee they’re all going to stay exactly the same. Our focus is on trying to move the money from the back office to frontline services,’’ he said.

“Now, can I say that absolutely no Medicare Local will close? I can’t say that.”

But a week later, during a leaders’ debate on August 27, Mr Abbott also pledged: “we are not shutting any Medicare Locals.”


By Melissa Davey

Welcome back to the fortnightly Health Wrap, and the first for 2014.  We hope your start to the year has been a healthy one. There have been some hot health topics in the headlines for the past couple of weeks, and they have particularly focussed on alcohol and cancer.

World Cancer Day reveals some sombre projections

A cancer tidal-wave is on the horizon, the BBC reports, leaving World Health Organisation (WHO) scientists warning that that much tougher restriction on alcohol and sugar intake is needed. The BBC also reports the World Cancer Fund as saying that the public still has a huge level of naivety about the importance of diet and alcohol intake in cancer prevention.

Alcohol is an attributable factor in nearly 2000 new cancer diagnoses a year in Scotland, with an increased risk of developing breast, head, neck, oesophagus, bowel and liver cancers, the Herald Scotland reports. The article says that even drinking alcohol within sensible limits may lead to an increase in cancer risk.

The success of the program has prompted some Australian health experts to call for cigarette-style warning labels to be placed on alcohol packaging warning of cancer and other risks, reports.

World Cancer Day on February 4 coincided with the release of the WHO’s World Cancer Report, which found cancer had surpassed heart disease as the biggest killer in Australia. In 2011 there were 7.87 million cancer deaths compared to 7.02 million from heart disease (stroke deaths were considered separately), the report found.

Also concerning was the release of Cancer Council NSW data  that revealed NSW men over 50 are three times as likely to die from melanoma as women the same age, partly because more than half of men in that age bracket are not aware of the high risk associated with skin cancer.

Meanwhile the New York Times asks if we are giving ourselves cancer, in this piece examining the link between radiation – particularly from CT scans– and the disease.

Finally, The European Cancer Patient’s Bill of Rights was unveiled this week to address the differences in care received by cancer patients across Europe. Some 1000 medical organisations and cancer groups from 17 European countries collaborated to produce the Bill.


A mixed response to alcohol law reforms

The NSW government has revealed its latest plan to curb alcohol-related violence which will see an eight-year minimum sentence for alcohol or drug-fuelled assaults that result in death, while bottle shops will close at 10pm across the state and licensed premises in the centre of Sydney won’t be allowed to let new patrons in after 1.30am. The laws have civil liberties groups up-in-arms, the ABC’s PM reports.

But NSW Opposition leader John Robertson believes the plans don’t go far enough, telling SBS that the announcement is rife with loopholes. “We have lock-outs with loopholes where small bars will be exempt from lock-outs,” Mr Robertson said to SBS. “Backpacker bars will be exempt from lock-outs and hotels with bars will also be exempt from lock-outs.”

The family of alcohol-related violence victim Thomas Kelly, the teenager who died in 2012 after being punched once in the head, spoke to the media following the reform announcements, describing them as “bittersweet” but “amazing”.

However, the SBS reports legal experts have raised concerns about plans that have been rushed through the State Parliament, fearing they will result in a large increase in the number of Indigenous people jailed. Fines for some drunken violence offences will result in people who are unable to pay being jailed, they report.

While the Australian Medical Association (AMA) welcomed the proposed measures, they also say measures should be tougher. The AMA called on the federal government to convene a national summit bringing together government, councils, police, health experts, teachers, victims and industry to come up with solutions to the alcohol misuse epidemic.

Finally, Croakey reports that The Alcohol and other Drugs Council of Australia – the national peak body for the alcohol and other drugs sector for nearly 50 years – has put in a heartfelt request to present to the Abbott Government’s National Commission of Audit on the impact of its unexpected defunding last November.


Vaccines, fluoride and vitamins – pushing for best practice

Prominent public health expert and anti-pseudoscience campaigner Dr Ken Harvey quit his job as an adjunct professor with Victoria’s La Trobe University after the University struck a $15 million, six-year deal with vitamins manufacturer Swisse.

The ABC reports the University described the memorandum of understanding with Swisse as an important step towards establishing a complementary medicine centre, which Dr Harvey described as a conflict of interest.

Dr Harvey’s move has been supported by Friends of Science and Medicine, an association that lobbies for evidence-based medicine, The Conversation reports. The organisation has called on La Trobe University to abandon the planned research into Swisse supplements.  In his resignation letter, Professor Harvey said he was concerned La Trobe University would be pressured to “produce results that will justify the company’s investment”.

GP and medical writer Dr Justin Coleman has also backed Dr Harvey’s  “brave stance”, writing:

“ I am a senior lecturer at two Australian universities and I would also be very troubled if one of them compromised its independence in this way.”

To vaccines, and The West Australian reports more WA doctors are refusing to endorse parents who object to their children being vaccinated, but who need a letter from their GP to get government benefit payments.

New Federal Human Services Department figures reveal an extra 479 WA children were added to the conscientious objectors’ database last year – a 13% increase on the previous year, the piece says.

Meanwhile, experts fear public confidence in vaccination programs could be undermined after dozens of young children were given a flu vaccine despite it being banned for under five-year-olds. The Therapeutic Goods Administration says across the country, 43 children under the age of five were injected with Fluvax last year, the ABC reports.

This excellent map from Mother Jones reveals the high cost of vaccine hysteria across the world, with measles and mumps making a comeback thanks to anti-vaxxers claiming an autism link – a link that has been utterly and thoroughly debunked thanks to evidence and science.

We’ll let Slate have the final say on anti-vaxx nonsense, in this piece which explores what creationists and anti-vaxxers have in common. “Ignorance is curable by education, but wilfully ignoring the facts can be contagious — and even fatal,” they write.


E-cigarettes – ban or regulate?

In a world where there are one billion smokers and smoking kills almost six million people a year, the regulation of e-cigarettes is a high-stakes debate, writes health journalist Andre Picard for the Globe and Mail.

While research on e-cigarettes and their potential harms and potential benefits is in its infancy, and data on long-term risks and benefits are lacking, he writes that with tobacco causing so many deaths around the world e-cigarettes may be a step in the right direction.

But as this piece for OPB says, a major barrier to policy making on e-cigarettes is the lack of scientific knowledge about the products. A report released this month by the US Surgeon General called for research and regulations on e-cigarettes, as well as other new nicotine-based products being introduced to the market, the piece says.

Meanwhile, tobacco giant Philip Morris has been taken-to-task by the ABC’s Fact Check Unit for saying “the data is clear” that plain packaging has not stopped people smoking. Public health experts and even Philip Morris competitor Imperial Tobacco say it’s too soon to draw conclusions about the long-term impact of plain packaging on smoking, the ABC reports.

Meanwhile,  Dr Melissa Stoneham reports for Croakey on research that investigated smoking cessation apps and whether they adhered to evidence-based practice. The researchers found that of the more than 400 apps available, most were missing basic evidence-based practices, such as referral to a Quit line or providing information on approved medications.


Experts are arguing for a cultural approach to health spending in light of high costs and poor outcomes, this piece for Al Jazeera says. According to the World Health Organization, Australia’s 670,000 Aboriginal and Torres Strait Islander people suffer from diseases found nowhere else in the developed world – such as trachoma, a form of preventable blindness.

Meanwhile the National Aboriginal Community Controlled Health Organisation (NACCHO) reports that during the past three years, Aboriginal and Torres Strait Islander suicides reached nearly 400.

Commenting on the crisis, NACCHO chair Justin Mohamed said: “Aboriginal and Torres Strait Islander people experience suicide at around twice the rate of the rest of the population. Aboriginal teenage men and women are up to 5.9 times more likely to take their own lives than non-Aboriginal people.”

Psychiatrist Professor Alan Rosen writes for Croakey that the impact of sustained heatwaves or drought on Aboriginal communities needs further investigation. He referred to this study; ‘The impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales’, published in the Australian Journal of Rural Health in 2011.

It found drought was affecting Aboriginal wellbeing by damaging traditional culture; skewing the population profile in smaller centres; exacerbating underlying grief and trauma; and undermining livelihoods and participation, amongst other things.


Australians nutritional guidelines need to be tougher

Australian researchers have found controls on food manufacturers are being weakly implemented, as foods continue to contain too many unhealthy ingredients like sugar and fat. Professor Bruce Neal, at The George Institute and The University of Sydney, led a team that evaluated the Federal Government’s Food and Health Dialogue, Health Canal reports. The evaluation was published in the Medical Journal of Australia.

As director of Health Strategies for the Cancer Council NSW, Kathy Chapman, writes in a piece published by Croakey and originally appearing in The Conversation; “most people doing their grocery shopping are blissfully unaware of the industry lobbying and backroom politics that determines what information appears on food labels”.

But attempts to treat obesity are being hampered by flaws in clinical guidelines as well, with the head of clinical obesity research at the Baker IDI Heart and Diabetes Institute, John Dixon, saying Australian obesity guidelines contain inadequate advice on monitoring nutritional deficiencies after bariatric surgery.

National Health and Medical Research Council guidelines released in June last year contained the “potentially dangerous” implication that nutritional problems should only be assessed after symptoms developed, including muscle wastage and bone pain, Professor Dixon tells Fairfax.

However, Australia must be getting at least something right in the war on obesity. New Zealand Prime Minister John Key has announced that Australia‘s obesity prevention program will be adopted there , International Business Times reports. New Zealand Health Minister Tony Ryall visited Victoria and said the children who were part of the obesity prevention program had become more active and lost weight.

Meanwhile, academics and policy experts specialising in medicine and nutrition in the UK have formed a campaign group, Action on Sugar, to convince manufacturers to gradually lower the amount of sugar added to foods – so slowly that it isn’t missed by consumers.

But this piece in New Scientist says using initiatives that have successfully reduced the amount of salt in manufactured foods may not work when it comes to sugar.


Health sector reforms and health policy

In this piece for Croakey, Australian Healthcare and Hospitals Association CEO Alison Verhoeven reports on a round-table meeting held in Canberra to celebrate Medicare’s 30th birthday. She asks whether consumer expectations for access to free public hospital services and bulk-billed consultations with doctors are realistic in a time when healthcare costs are increasing.  Some thoughtful wishes for a 30th birthday makeover for Medicare were also shared in this Croakey piece.

Sydney Morning Herald Economics Editor Ross Gittins writes that while therising cost of healthcare is the greatest reason for increasing in budget deficits, it is rarely made clear that this assumes a limit on the growth in healthcare taxation.

And Drs Gemma Carey from the Centre of Excellence in Intervention and Prevention Science and Pauline McLoughlin from the LightHouse Foundation examine the Victorian Government’s recently launched  ‘Roadmap for Community and Human Services Reform’, lead by Dr Peter Shergold. Their article for Croakey covers some of the challenges for reformers hoping to tackle ‘top-down’ relationships, service silos, overly complex funding arrangements and legacies of mistrust.

The policy head of Research Assets at the Sax Institute*, Bob Wells, says health policy analysts have spent the first weeks of the year vigorously debating ways to rein in Australia’s rising health budget and to make the system more efficient. His  piece for The Conversation examines a couple of the proposals on the table.

Meanwhile Professor Peter Brooks argues in a piece for Croakey that reform of the fee-for-service payment system must be considered as part of a broader discussion about the future sustainability of the health system.

Also for Croakey, a health policy analyst writing anonymously  examines what might be expected from the National Commission of Audit when it comes to health policy. Looking back might help us look to the future, the writer says, speculating about what the Commission might recommend and implement including removing regulatory duplication, and pricing blood products.


Healthy bloggers

The health blog featured in this Health Wrap comes from NPR. Their comprehensive public health blog includes news about health from around the globe including the latest on prevention, disease outbreaks and the world’s response to health crises.


Other Croakey reading you may have missed this fortnight:


Last year, Health Minister Peter Dutton appointed Professor John Horvath, a former Commonwealth chief medical officer to head the review.

The terms of reference include an investigation into whether the program is actually delivering clinical services and whether it has increased the co-ordination of after hours care.

Nearly half of all GPs surveyed by the AMA last year found the bureaucracy employing 3,000 people was “duplicating existing GP services.

“The starting point for the Review is to change the name — ‘Medicare Locals’ means nothing to the people who need access to quality primary health care services in their communities,’’ Australian Medical Association President Steve Hambleton said in a statement.

“It sounds like another layer of bureaucracy. The name should project an active role in looking after people’s health.”


NACCHO CTG and Aboriginal incarceration rates : Abbott must Close The Gap on black justice


If Abbott were to seriously take on the incarceration issue, he would have to openly and actively confront the issue of ongoing systemic discrimination against Indigenous Australians, and acknowledge its historical causes, including colonialism and racism.

That would mean talking to the nation plainly about deaths in custody and acknowledging the fact that a black man can still face violent treatment and be left to die in “protective custody” without police facing serious punishment.” Max Chalmers

According to the latest national figures, indigenous young people – who  comprise just 5 per cent of the population – were detained at a staggering 31  times the rate of non-indigenous young people on an average night in June 2012.  Most were yet to be sentenced (see report below)

School attendance is a far less controversial topic than Indigenous incarceration rates.

No wonder Tony Abbott made it the centrepiece of his ‘Close the Gap’ speech.

In the lead-up to the 2013 election, Tony Abbott took a brief moment out from his relentless denigration of the government to broach a policy area that usually doesn’t make the debate.

Cautiously, he vowed to be a prime minister for Australia’s first peoples.

“It is my hope that I could be, not just a prime minister, but a prime minister for Aboriginal Affairs,” he said

In an address to Federal Parliament yesterday, Abbott took a tentative step towards positioning Indigenous Affairs alongside the government’s holy trinity of policy talking points.

His government is “no less serious [about Indigenous Affairs] than it is about stopping the boats, fixing the budget, and building the roads of the 21st century.”

Putting Indigenous Affairs on the national agenda is a move that should draw praise. But the way Abbott has chosen to frame the issue raises questions about how serious his government really will be in its efforts to help overcome the outrageous disadvantage Indigenous Australians continue to experience.

Indigenous groups were quick to point out one particularly glaring omission from Abbott’s remarks.

“Today, Australia’s national shame is the mass imprisonment of Aboriginal people, particularly young people. Australia’s Aboriginal children are detained at the world’s highest rates,” Phil Naden, the NSW and ACT Aboriginal Legal Service CEO noted in a press release.

“More than half of the young people in detention today (over 52 per cent) are Aboriginal, and most are unsentenced.”

Indigenous incarceration indeed remains a national shame. The Australian Bureau of Statistics paints a bleak picture, with rates of incarceration continuing to rise markedly between 2002 and 2012. West Australia is beyond crisis point, with the rate of incarceration for Indigenous Australians 20 times higher than non-Indigenous.

Source: ABS.

Source: ABS.

Despite the 1991 Royal Commission, deaths in custody have increased, along with the surging incarceration rate. There is little reason to think that the next generation of Indigenous Australians will fare much better.

Instead of raising the issue of justice, Abbott framed his address around education. Truancy rates must be reduced, he said, and the time for excuses was over.

“Generally speaking, the more remote the school, the more excuses are made for poor attendance,” he observed, before pledging to end the gap between Indigenous and non-Indigenous school attendance within five years. No reference was made to a similar standard with which to target improvements in justice outcomes.

“We were very surprised to hear there was no bipartisan commitment today towards incorporating justice targets into the Government’s Closing the Gap strategy,” Naden said on Wednesday.

Improving rates of Indigenous school attendance is an easy sell to white Australia. Everybody can get on board with sending kids to school; there is an implicit blame placed on Indigenous communities for failing to enforce school attendance, or teach their children adequate patterns of civil behaviour.

“One of the worst forms of neglect is failing to give children the education they need for a decent life,” Abbott said, following the statement up with a list of state and federal government programs designed to lower truancy rates.

But like his entire address, the line was left open, raising the question of who exactly is responsible for that neglect? This is the Liberal Party’s characteristic approach: the individual is to blame for their personal failings and societal causes don’t rate a mention.

If Abbott were to seriously take on the incarceration issue, he would have to openly and actively confront the issue of ongoing systemic discrimination against Indigenous Australians, and acknowledge its historical causes, including colonialism and racism.

That would mean talking to the nation plainly about deaths in custody and acknowledging the fact that a black man can still face violent treatment and be left to die in “protective custody” without police facing serious punishment.

It would mean taking on the state and territory governments – especially the Liberal ones – whose tough on crime policies disproportionately affect their Indigenous constituents.

It would mean investigating and policing routine police brutality, such as the recent taser attack by police on an Indigenous woman in Queensland, in which she lost an eye.

And it would mean facing off against a host of other powerful actors, like the Australian Hotels Association, who have succeeded in reversing the NT government’s efforts to limit liquor supply.

Abbott’s record on the issue is not strong so far. One of the Coalition’s nastiest election eve announcements was the decision to slash $42 million from Aboriginal legal aid, a figure that was significantly reduced after the election but will do much damage.

If he decides to pivot on the issue, and to devote the state’s energy and resources to lowering the almost unbelievable rates of incarceration, he will find a host of allies who are ready to take up the challenge. There is a growing awareness that by focusing state resources on policing and prisons we do nothing to attend to the causes of incarnation.

The justice reinvestment movement is starting to make this case publicly. There are also scores of Indigenous communities finding local solutions to the localised and diverse causes of incarceration.

There is some evidence to suggest the government will start to take an interest in such programs. Warren Mundine, the head of Abbott’s Indigenous Advisory Council today announced a program to help provide jobs training for Indigenous teenagers in WA.

Abbott has frequently used his time in outback Indigenous communities as evidence that he can succeed where so many previous PMs have either failed, or failed to even try. But if he is serious about using his position to help reverse the shameful disparity in living standards between Indigenous and non-Indigenous Australians, he must make justice a top priority


Biana Hall SMH

Thx Tracker

Imagine if more than half the young people detained in Australia today were  from Sydney. Imagine if they were white. Newspaper letter writers would whip  themselves into a frenzy, GetUp! would run a national campaign and tens of  thousands would take to the streets to march for the freedom of Australia’s  children.

Instead, 53 per cent of young people in detention are indigenous. And instead  of a national outcry, Australia is gripped by a national silence.

According to the latest national figures, indigenous young people – who  comprise just 5 per cent of the population – were detained at a staggering 31  times the rate of non-indigenous young people on an average night in June 2012.  Most were yet to be sentenced.

Last week, Prime Minister Tony Abbott delivered a heartfelt speech on the  government’s progress on the Closing the Gap goals to improve indigenous  people’s health and life expectancy.

The news wasn’t good. Abbott said there had been ”almost no progress” in closing the decade-wide gap between the life expectancies of indigenous people and non-indigenous people. There had been ”very little improvement” towards halving the gap in reading, writing and numeracy, and indigenous employment ”has, if anything, slipped backwards”.

”We are not on track to achieve the more important and meaningful targets,”  Abbott  said.

Declaring that Australia’s challenge was to ”break the tyranny of low  expectations”,  Abbott announced that from next year, indigenous  school-attendance data would be included in the government’s Closing the Gap  measures.

He set an ambitious target to lift the attendance rates of all schools to  more than 90 per cent within five years (in very remote communities, just 31 per  cent of children are meeting the minimum attendance standards).

It’s a very welcome start, but some observers were dismayed at what he didn’t  say: that cutting the incarceration rate of indigenous people should be at the  forefront of attempts to close the gap.

The NSW and ACT Aboriginal Legal Service has long called for justice targets  to become part of the Closing the Gap goals.

Chief executive Phil Naden described the ”mass incarceration” of indigenous  people as Australia’s ”national shame”.

“Disadvantage robs Aboriginal people of a long, healthy life, and the  incarceration of Aboriginal people affects all targets.”

In 2011, a parliamentary inquiry recommended that justice targets become part  of the overall Closing the Gap strategy. Contact with the justice system, it  said, ”represents a symptom of the broader social and economic disadvantage  faced by many indigenous people in Australia”.

”We have reached the point of intergenerational family dysfunction in many  indigenous communities, with problems of domestic violence, alcohol and drug  abuse, inadequate housing, poor health and school attendance, and a lack of job  skills and employment opportunities impacting on the next generation of  indigenous Australians.”

So how, we should be asking, can we pretend the national shame of mass  Aboriginal incarceration isn’t symptomatic of other problems?

For a moment, it looked like the federal government might act. Before  last  year’s election, Labor said it would include justice targets in the Close the  Gap measures. In August, the Coalition’s indigenous affairs spokesman Nigel  Scullion raised expectations when he told The Australian: ”We will be  looking carefully at that and doing research to see how you implement another  gap measure around this justice issue.”

But on Wednesday, the Prime Minister – who in December oversaw $13.4 million  in cuts to indigenous legal aid funding over four years – made no mention of  justice. Abbott said: ”I am confident of this: amidst all the mistakes,  disappointment and uncertain starts, the one failure that has mostly been  avoided is lack of goodwill.”

What we have so often lacked is political will

Read more:

NACCHO CTG member response :NT only jurisdiction on track to close the gap by 2031: Congress Alice Springs

Donna Ah chee

Closing the Gap is working but requires long term commitment and investment

“The NT is the only jurisdiction currently on track to close the gap by 2031.

This achievement is in large part, the result of governments working in genuine partnership with Aboriginal community-controlled health services and investing new funds where they are most needed.

This is strong evidence that the significant investment in the NT, especially the investment in Aboriginal primary health care, is working”,

 Ms Donna Ah Chee (pictured above left )the CEO of Congress, NACCHO board member and former CEO of NACCHO

The Central Australian Aboriginal Congress Aboriginal Corporation welcomed the latest Closing the Gap report card, calling for an emphasis on continued commitment and long-term investment by the Council of Australian Governments to meet meaningful targets in Aboriginal disadvantage.

“Overall there has only been a small improvement across the nation in closing the life expectancy gap for Aboriginal people. However, looking at averages across the nation does not tell the story of significant improvement in Aboriginal life expectancy rates in the Northern Territory. The NT is the only jurisdiction currently on track to close the gap by 2031. This achievement is in large part, the result of governments working in genuine partnership with Aboriginal community-controlled health services and investing new funds where they are most needed. This is strong evidence that the significant investment in the NT, especially the investment in Aboriginal primary health care, is working”, said Ms Donna Ah Chee the CEO of Congress.

“The fact that the nation is on track to achieve its goal to halve the gap in year 12 educational attainment by 2020 is important. Achieving better educational outcomes is largely a precursor to stable, meaningful employment at a reasonable income level. However, the improvement in education is not uniform and a lot more needs to be done in remote communities across the NT.

“Although the addition of a new target on closing the gap in school attendance rates may be useful, Congress is disappointed that the new target was not more directly focused on closing the gap in actual Educational outcomes. Attendance at school is important but it it’s only a means to a successful outcome which is completing year 12 studies and being fully literate and numerate. If children have entered school without the developmental capacity to learn and do well then attendance alone will not be sufficient to address the gap in educational and employment outcomes.

“Congress suggested that the new target could have been to close the gap in the Australian Early Development Index scores of children aged five years, as this is the key to closing the gap in both school attendance and successful educational outcomes. We need a “bottom up” strategy to addressing school attendance which ensures our kids enter school capable and ready so that school is where they want to be not where they have to be.

“Congress also welcomed the improvement in Aboriginal child mortality rates.

“It is a concern that there has been no progress on some targets, especially the employment target, but there is a wide ranging review currently underway on this issue which will hopefully lead to some useful new approaches. In the meantime, it is vital that all Australian governments, through COAG, recommit to the long term cooperation and  investment that is clearly working though the Closing the Gap National Partnership Agreements”, said Ms Ah Chee.

For more information, contact Emily MacKenzie, Communications Officer, on 8953 7814 or by email at

NACCHO member news: Apunipima Cape York Health Council welcomes the Close the Gap Report and continued investment into Aboriginal health services.

IMG_6848 Low res

Dr Mark Wenitong , Apunipima Cape York Health Council and NACCHO advisor getting “checked out” by daughter Naomi Wenitong

Has been urging Health action to Close the Gap

Today’s release of the Progress and Priorities Report by the Close the Gap Committee shows the investment in Aboriginal Community Controlled Health Organisations is contributing to closing the health gap between Indigenous and non-Indigenous Australians.


Chair of Apunipima Cape York Health Council Thomas Hudson said, “We welcome the Close the Gap Report and its recommendations for the continued investment into Aboriginal health services.

“The report shows slow but real progress towards achieving the Close the Gap targets and we are proud that by delivering community controlled primary health care services in Cape York and are contributing to those targets through an increase in GP Management Plans, chronic disease programs, educational and prevention programs, Maternal and Child Health services, Men’s Health services, adult health checks, immunisation rates and episodes of care.

“Evidence shows that better health outcomes and significant health gains can be achieved by Aboriginal communities having control of their own health. While there is still a lot of work to do in order to reach the Close the Gap targets, Aboriginal Community Controlled Health Organisations (ACCHO) are front and centre in the fight for health equality. Community owned and community driven health services provide culturally appropriate, responsive care underpinned by self – determination and ground – up solutions.

“Apunipima is committed to strengthening culturally appropriate, family centred, community controlled primary health care across Cape York. We have a family and community centred approach to primary health care and are proud of the fact that over 50 percent of our workforce identify as Aboriginal or Torres Strait Islander. We believe that employment is integral to the health of individuals, families and communities.

We know that education is the road to employment and that healthy kids have better educational outcomes. By focusing on the health of mums, bubs, toddlers we support school readiness and in turn, school attendance.

Thanks to Close the Gap the infant mortality rate is falling – let’s give that child the best start in life so they can have a healthy, productive future.

“Apunipima supports the key recommendations of the Close the Gap Report and we call on the new government to build on the success of the Close the Gap campaign which is seeing slow but steady gains in a range of health indicators.

NACCHO Press Release CTG report: Investment in Aboriginal community controlled health key to closing the gap


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,”

Close the Gap Progress and Priorities report released  by the Close the Gap Campaign

DOWNLOAD THE PRIME MINISTER 2014 Closing the Gap Report here

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.”


Have you registered your CLOSE THE GAP event

NACCHO @Indigenous political alert :Q and A with Warren Mundine: on the importance of role models and education


Each week, a new guest hosts the @IndigenousX Twitter account to discuss topics of interest as Aboriginal and/or Torres Strait Islander people

The Guardian in partnership with IndigenousX, invites its weekly host to tell us about who they are, what issues they’re passionate about, and what they have in store for us during their upcoming week

This weeks host is Warren Mundine and we understand he will be visiting Western Desert communities this week and reporting online



If you are not on TWITTER leave your question (140 characters) in the COMMENTS below and NACCHO media will pass it on  Email mailto:


Warren Mundine tell us about yourself.

I was born in Grafton in Northern NSW and moved to Auburn in Western Sydney when I was seven years old. I’m from the Bundjalung, Gumbaynggir and Yuin people. My father’s family come from Baryulgil about 80 km north of Grafton, on the Clarence River. He grew up there and moved when he married my mother.

I was one of 11 children and I slept in a single bed with three of my brothers until I was about 12 – which was fine except that my youngest brother wet the bed.
My first name “Nyunggai” means “sun”. It was the skin name that my father gave to me as a child. Recently I changed my name by deed poll to Nyunggai Warren Mundine and so now I use it officially.
My parents worked and sent us to Catholic schools. God, work and school were very important in our family. Even so, as a teenager I started to drift and my reading and writing didn’t progress past primary level. I caused my parents a lot of trouble getting into fights, consuming alcohol and drugs, etc. At one point I was arrested and detained as a juvenile. My parents, a priest and a local white couple stood up for me in court and I was given another chance. They kept an eye on me, I got a labouring job and finished school at TAFE.
I stayed in labouring and trade jobs for about 10 years. My first office job was as a clerk at the Tax Office. I lived in Armidale and Dubbo when my kids were young and got elected to Dubbo Council where I was deputy mayor.

That’s how I got involved in the Labor party, and eventually I was elected its national president. I spent about nine years as CEO of NTSCorp, working with NSW Aboriginal communities on their native title, and I was CEO of GenerationOne in 2013.

I now run my own business and have been appointed to advise the prime minister on Indigenous issues as chair of the Indigenous Advisory Council.
I’m married to Elizabeth and between us we have 10 children (most are grown up). It’s a lot of fun. And of course, I am a mad lover of football.

What do you plan to talk about on @IndigenousX this week?

This week I wrote a blog post which I called The First Tree. It’s about how we address seemingly insurmountable problems.  People laugh at on me on Twitter for having simple suggestions – like getting kids to school – and focusing on practical things.

But I don’t think theorising and admiring a problem from every angle achieves much. Sometimes simple things are what leads to the biggest changes, most quickly.
So I will be focussing on the “bread and butter” issues for closing the gap – jobs, education, school attendance, health, welfare  – and I want to prompt some discussion on our traditional nations and cultures and what they have to offer us. As always I want to prompt conversations which make people think, and where readers are prepared to challenge their own thinking.

What issue(s) affecting Indigenous peoples do you think is most pressing?

If you read my articles, speeches and blogs you will get a good idea of where I think the priorities are. School attendance, welfare to work and incarceration, particularly juvenile detention, are big ones.
And for communities – social stability, economic and commercial development, land ownership.
The high suicide rates amongst Indigenous people is a devastating problem. I’ve been reading and talking to people over the last few months in particular so as to understand it better. It’s not a topic that is easy to discuss on a medium like Twitter, however.

Who are your role models and why?

My father, Roy Mundine, and mother Dolly Mundine (née Donovan) were big role models in my life. Apart from them, my greatest role model was Lionel Rose, world champion boxer. He was a 19 year old Aboriginal boy from Jackson Flats, and he won the world title. He showed me that the world can be your oyster if you are willing to focus and work hard.
Also Charles Perkins and John Moriarty who both overcame adversity, went to university when it wasn’t easy for Aboriginal people to do that – both played football, and John was selected for the national team.

What are your hopes for the future?

This year my hope is that all Indigenous kids are going to school every school day, and that state and territory governments bring in mandatory diversionary programs for juvenile offenders into jobs and education.
I’ve outlined my long term hopes in a number of my articles and speeches, particularly the Garma Speech and my recent Australia Day address.
In the end, my hope is that Indigenous people can be full participants in Australian life and all it has to offer as well as being part of strong and thriving traditional nations where they can take care of their culture, language, traditional lands and build an economic future.

NACCHO Aboriginal health political alert:’PM for Indigenous affairs’ has his task cut out on that front

sunset 2

EARLY life experiences become hard-wired into the body, with lifelong effects on health and wellbeing.”

A very important statement – but not news. Research demonstrating the complex interplay of “givens” (genetics) and early-life “contingent factors” (the environment of pregnancy and early childhood) in determining lifelong risk of ill-health dates back to the middle of the last century.

From diabetes to depression, the intra-uterine and early childhood environments critically influence the quality and length of our lives.

FROM THE AUSTRALIAN Ernest Hunter is a medical practitioner in north Queensland.

Photo courtesy Apunipima Cape York Health Council Photovoice project. Photographer Grace Morris’.

The quote opens the Australian Medical Association’s Aboriginal and Torres Strait Islander Health Report Card 2012-2013, with Steve Hambleton, president of the AMA, commenting in the introduction on “gaps in preventive child health care, the promotion of early childhood development, and the alleviation of key risks for adverse developmental outcomes, especially in remote communities”.

Download report card here

In fact, it can reasonably be argued that developmental adversity is the main contributor to the continuing poor health status of indigenous Australians. That’s the bad news; to the extent that those effects “become hard-wired into the body”, it may not be possible to rectify – at times even to modify – the harms done.

In my role as a psychiatrist and public health physician in Cape York, most of my work is about mitigating the downstream consequences, be it psychosis, depression, interpersonal violence, self-harm, alcohol abuse or chronic disease. There is no shortage of work for clinicians.

While indigenous developmental vulnerability and its effects should be cause for alarm, it is not a reason for fatalism. Indeed, the good news is that the scope for intervention and prevention is enormous and, broadly, we know what needs to be achieved: equity in pregnancy and early childhood health and social outcomes.

Unfortunately, we do not know how to get there – although, clearly, it’s not through business as usual. Even if it is achievable it will take generations for the full effects of healthy pregnancies and early childhoods to be reflected in a reduction in the burden of chronic disease from midlife on, particularly in remote Aboriginal communities.

Imagine if somehow the pregnancies of young indigenous women, right now, were no more likely than non-indigenous pregnancies to be exposed to smoking, alcohol consumption, other drug use, the effects of violence, high levels of maternal stress hormones and inadequate nutrition; if the babies were born to women at no greater risk of prematurity and labour complications, who have had access to the same quality of antenatal and birthing services. Don’t stop – imagine if those babies, now as healthy as their peers across Australia – could spend their infancies in safe, nurturing and stimulating environments in which they were nourished and cherished by their parents, no more likely to be exposed to abuse, neglect or removal from their families; if they did not live in overcrowded houses and were protected from the waves of chaos and stress that wash through homes in remote communities. Imagine.

Even if this miracle did occur, service demands will remain unchanged for a long time as the developmental adversity experienced by older relatives works its effects through the population. Indeed the consequences are evident already among their older siblings, let alone those suffering chronic diseases in middle age.

Educational disadvantage has received a lot of media attention, as has fetal alcohol exposure, both of which predispose affected children to a range of additional risks that will follow them through their lives. Lives that in many cases will be much shorter: the Commission for Children and Young People and the Child Guardian annual report on the deaths of children in Queensland records that between 2004-05 and 2012-13 the suicide rate of indigenous children aged 10 to 17 was more than 5.5 times higher than that of their non-indigenous peers.

The Australian public was given cause for some optimism with the announcement by Tony Abbott prior to the federal election that he intended to be the “prime minister for indigenous affairs” and that he would be “hands on”. Since becoming PM he has appointed, with fanfare, an Indigenous Advisory Council, which first met in December under the leadership of Warren Mundine. Unsurprisingly, this move has been divisive in the wider indigenous population (indeed there is a petition initiated by writer Ken Canning for it to be replaced by an elected body).

Abbott has many other pressing demands; he has alluded also to the sobriquet of “the infrastructure PM” and he could be a contender for the title of “tow/push the boats back PM” too – and much more. But his statements about indigenous affairs were clearly broadcast, and the implication was that he would brook no obstruction to pursuing it as a national – and personal – priority.

So it is surprising to hear rumours, just months after his seemingly heartfelt assurance, that he has reconsidered (or been forced to reconsider) his and the Coalition’s political investment.

While the Indigenous Advisory Council is now at the table and constitutional reform placed back on it, the setting is, so far, pretty humble. The main course may be a way off but the entrees are hardly satisfying.

Following on the heels of the announcement of funding cuts for legal services, Mundine has anticipated that Aboriginal and Torres Strait Islander Australians may have to share the pain of national economic recovery.

In Queensland, of course, they are already sharing it. Among the outcomes of the cuts and divestments since the change of the Queensland government has been a reduction in human resources and institutional capacity in population health and social programs which will have the greatest consequences for those most disadvantaged, the residents of remote Queensland Aboriginal communities.

As they have less visibility and voice, and as the effects will be delayed, it’s a safe political strategy. And, of course, it can always be passed off as a commonwealth responsibility.

Who should pay – commonwealth or state – has been argued ad nauseam. That has been and remains a major obstacle to effective action. But, in terms of responsibility, Abbott made a commitment – to the nation – that he would personally take on the challenge of making a difference for indigenous Australians.

I want to believe that it was sincere and that he understood, in making it, that it will require broad support and long-term effort. Whether he is sufficiently inclusive or overly reliant on particular individuals will be debated and will play out. But if he really is the “PM for indigenous affairs” then he needs to lead and be seen to do so – “hands on”. And he needs to be in there for the long haul.

These two issues, developmental determinants and opportunities, and assertive political leadership, are linked. Sufficient and sustained investment in the former is the surest means to effect significant gains in indigenous health (though perhaps not the most politically visible in the short term) and is dependent on the latter.

In election mode Abbott also frequently commented that “we say what we mean and we do what we say”. Now it’s time for doing.

Ernest Hunter is a medical practitioner in north Queensland.

NACCHO Aboriginal Health: Estimated 400 suicides in our communities in last three years

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“Aboriginal and Torres Strait Islander people experience suicide at around twice the rate of the rest of the population. Aboriginal teenage men and women are up to 5.9 times more likely to take their own lives than non-Aboriginal people.

This is a crisis affecting our young people. It’s critical real action is taken to urgently  address the issue and it’was heartening to see the previous Federal Government taking steps to do that.

For any strategy to be effective, local, community-led healthcare needs to be at its core.

But so far we have not heard from this Government on the future of The Aboriginal and Torres Strait Islander Mental Health and Suicide Prevention Advisory Group and the $17.8 million over four years in funding to reduce the incidence of suicidal and self-harming behaviour among Indigenous people.”

Justin Mohamed Chair NACCHO commenting on the crisis 

During the last three years of Aboriginal and Torres Strait Islander suicides are at nearly 400, no less than 380.

Research by Gerry Georgatos

Last year, I aggregated Australian Bureau of Statistics (ABS) hospital collated data on reported suicides of Aboriginal and Torres Strait Islander peoples – 996 suicides from 2001 to 2010. That is 1 in 24 of all deaths of Aboriginal and Torres Strait Islander people – by suicide.

READ previous NACCHO articles on suicide prevention here

NACCHO community support : Raising funds for Elders report into Preventing Self-harm & Indigenous suicide.

Update we reached out goal of $9,500

There is no ABS data available at time to determine whether the crisis has abated or got worse, but I have been record keeping reported suicides – whether through the media, community organisations or via other sources – for my own academic research on premature and unnatural deaths. I have found that from the beginning of 2011 to end 2013 there have been nearly 400 suicides – child, youth and adult – of Aboriginal and Torres Strait Islander peoples.

My own research estimates that the 996 suicides recorded between 2001 to 2010 are an under reporting of the actual numbers, and instead of 1 in 24 deaths by suicide, I have estimated that the rate of suicide was between 1 in 12 to 1 in 16. The 2001 to 2010 suicides average to 99.96 suicides per year. In reflection it was 99 custodial deaths alone over a ten year period in the 1980s that led to the Royal Commission into Aboriginal Deaths in Custody. How many suicides will it take before this nation’s most horrific tragedy is met head on with a Royal Commission?

My research compilations during the last three years of Aboriginal and Torres Strait Islander suicides are at nearly 400, no less than 380. Where there had been an average 99 deaths by suicide from 2001 to 2010, according to my research the annual average for 2011 to 2013 has tragically increased to approximately 130 suicides per annum.

Last year, on October 23, the Chair of the Prime Minister’s Indigenous Advisory Council (IAC), Warren Mundine read my journalism and some of the research published predominately in The National Indigenous Times and by The National Indigenous Radio Service and in The Stringer and Mr Mundine responded with a never-before-seen commitment by a high profile Government official to urgently do something about the out-of-control crisis

He added the crisis to the IAC’s mandate – and he time-limited it to six months so that the crisis would not languish. But three months have passed and we have not heard anything from the Council despite several requests to them for information on any potential progress.

At the time, Mr Mundine expressed his shock at the extent of the crisis.

“The figures sit before your eyes and the scale of it you sort of go ‘oh my god, what the hell is going on?’ I admit that I was probably one of the problems, because we seem to handle mental illness and suicide and shunt it away, we never dealt with it as a society, but we have to deal with it, confront it, because we are losing too many of our people, too many of our young ones… It is about us understanding this and challenging ourselves, and as I said I am just as bad as anyone else out there who put this away and did not want to deal with mental health and the suicide rates, so we have to get over that,” said Mr Mundine.

“We are looking at putting (the suicide crisis) on the table for our first meeting, and looking at over the next three and six months at what’s the advice we will be looking at giving to the Government and the Prime Minister to deal with this issue.”

“My personal opinion, and there is no science in this, this is just my observation, is our self-esteem and culture, I think, plays a major part in these areas.”

“It is a problem and I congratulate The National Indigenous Times for putting it on the front page. We need to really start focusing on this a lot better and I’m not talking about the people who are in there already doing it because they’re the champions. I’m talking about myself and the rest of Australia, we need to get our act together.”

Since October 23 there have been two score suicides.

Dumbartung Aboriginal Corporation CEO Robert Eggington said that in the last two weeks another spate of suicides has blighted both the south west and the north west of Western Australia.

“There have been suicides among our youth in recent weeks, another tragic spate. We met with the Premier last year and we are waiting for his promises to be kept to fund safe spaces and strategies for us to coordinate the helping of our people, but to date we have been kept waiting,” said Mr Eggington.

Chair of the Narrunga People, Tauto Sansbury said that he has been trying to arrange a meeting with Mr Mundine but despite three months of effort this has not occurred – Mr Mundine had promised to organise a meeting with Mr Sansbury following articles about the high rate of suicides among South Australia’s Aboriginal people.

“We have become used to broken promises by our State Government for a 24/7 crisis centre for our people and we hoped that Warren (Mundine) would represent the needs of our people, stand up for our most vulnerable, the at-risk, but to date he is yet to meet us let alone represent us,” said Mr Sansbury.

“Our young people and adults continue to fall victim to suicide.”

To the Northern Territory, where Aboriginal child suicides have increased by 500 per cent since the launching of the infamous “Intervention”, Arrente man and Bond University criminology student, Dennis Braun has reported the dark plight of one of the Territory’s communities – 33 deaths in five months. The community’s Elders have requested that the community is not publicly identified.

“The majority of the deceased were under 44 years of age. The youngest was a 13 year old who committed suicide a couple of days just before Christmas.”

“There should be an inquiry, but there is not despite 33 deaths. If this happened in an urban community like Sydney there’d be an outcry even after three or four deaths, with (residents and the wider community) wanting to know why it is happening and where to go for help.”

This publication has prioritised the suicide crisis for quite some time, sustaining the coverage, and the stories of loss, the grieving families, and we have effectively campaigned to Government to rise to the occasion. We do not apologise for this. On October 23, Mr Mundine and the Indigenous Advisory made a commitment that they must keep.


Warren Mundine including the suicide crisis to the IAC mandate

Government to address Aboriginal suicides

30 suicides in the last three months as we wait for promises to be kept

996 Aboriginal deaths by suicide – another shameful Australian record

Australia’s Aboriginal children – the world’s highest suicide rate

Whose child will be the next to die?

Suicide gap widening, says researcher