Dr James Haughton
This brief covers Indigenous health, wellbeing including
housing, and culture including land.
Closing the Gap
The 2017 Closing the Gap report indicated all Closing
the Gap targets, except one (year 12 attainment rates), are not being met.
For the second time (the first was in 2013), child mortality is below target,
driven by high rates of Indigenous infant and child death in Remote and Very
Remote Australia, particularly in the Northern Territory.
The 2017 Closing the Gap report was accompanied by commitments to stay
the course and work with Indigenous people, particularly on the high rates of
incarceration (covered in the Budget Review brief ‘Indigenous
Affairs: Government Priority Areas’) and suicide.
Suicide is the fifth-highest killer of Aboriginal and Torres Strait Islander
people (especially youth) and the subject of a major government-backed
evaluation which made findings echoing the Prime Minister’s commitment: to do
things with Indigenous people, not to them.
As several Indigenous and stakeholder groups have noted, there
is very little in the Budget that addresses these issues.
While the Budget includes several suicide prevention measures under the heading
‘Prioritising Mental Health’ (see the brief ‘Mental Health’), almost none of
these appear to respond to the recommendations of the Aboriginal and Torres
Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) report. Type 2
diabetes is the second-highest killer of Indigenous people, but the only diabetes-related
measures announced are for type 1, from which Indigenous Australians rarely
suffer. Smoking is one of the
leading causes of death (via respiratory disease and cancer) and infant
mortality in Indigenous Australia, but funding for Indigenous anti-smoking
campaigns has not been fully restored to its pre-2014 level—$130 million was
cut in the 2014–15 Budget, and the re-released funding is $116.8 million.
Furthermore, progress on Indigenous health and employment in
remote areas, particularly in the Northern Territory, may be affected by the
expiry in the 2017–18 financial year of the Rudd Government’s National
Partnership Agreement on Remote Indigenous Housing (NPARIH) and the house
rebuilding and refurbishment component of the National Partnership Agreement on
Northern Territory Remote Aboriginal Investment (formerly Stronger Futures in
the Northern Territory). Together, these two agreements will spend $436 million
in 2017–18, dropping to $3.5 million (to fund interpreter services) in 2018–19.
In order to fund the Community Development Programme, the 2015–16 Budget’s
forward estimates had already cut $95 million from NPARIH’s 2017–18 budget and
182 houses from its construction target. At this point there is no
indication whether these National Partnerships will be renewed, despite the Government’s
other commitments to housing affordability. A spokesperson for the
Minister for Indigenous Affairs, Senator Nigel Scullion, has said that
negotiations regarding the National Partnerships are ongoing.
The National Partnerships have contributed to a significant drop in
overcrowding in remote Indigenous communities, and consistently exceeded their
Indigenous employment targets. Without a comparable
building program in place, the rapid growth of the Indigenous population is
likely to drive overcrowding back up, with resulting impacts upon health, unemployment
(from the loss of building jobs) and other areas.
Although there are no big-ticket items in the 2017–18 Budget
addressing major drivers of Indigenous health and wellbeing, there are a number
of smaller announcements which address specific issues.
Some $15 million of the $100 million redirected from the
former Green Army Program to the ‘National Landcare Programme – continuation’
measure will be directed to supporting new Indigenous Protected Areas.
As many Green Army projects were already on Indigenous land and/or employed
Indigenous people, it is not clear whether this represents a change in funding
to the Indigenous sector. This is relevant to
Indigenous health because access to cultural lands and protecting the
environment on Aboriginal lands is normally considered a health and wellbeing
The ‘Guaranteeing Medicare – development of the Health Care
Homes trial’ measure—which involves and has previously been supported by
Aboriginal Community Controlled Health Organisations (ACCHOs)—is being delayed two
years on clinician-led advice.
The ‘Improving Access to Medicines – Maintaining Remote Area
Aboriginal Health Services pharmaceutical dispensing’ measure will receive $0.4
million over five years to maintain current levels of remuneration for
pharmacists in remote Indigenous communities. In recent years the
number of pharmacists making use of this service has declined slightly.
The ‘National Partnership Agreement on Rheumatic Fever
Strategy – continuation and expansion’ measure allocates an additional $7.6 million
to continue and expand the Agreement. Indigenous Australia has
some of the world’s highest rates of rheumatic fever, which is caused by a streptococcal
bacterial infection. The principal risk factor is overcrowding and the poor
sanitary conditions that result. Rheumatic fever causes
rheumatic heart disease, which can be fatal; an Indigenous person in the
Northern Territory is 55 times more likely to die of rheumatic heart disease
than a non-Indigenous person.
The ‘National Partnership Agreement on improving trachoma control
services for Indigenous Australians’ measure is due to receive an additional
$20.7 million over the forward estimates to continue trachoma control up to
2021, by which point the elimination of the disease is projected.
Overcrowding is also a trachoma risk factor.
The Government has funded the ‘Retta Dixon Home – compensation’
measure, but the amount of the settlement has not been released.
After a landmark class action, the Commonwealth settled out of court with 71
Aboriginal claimants who were physically and sexually abused at the Retta Dixon
home in Darwin, at a time when the Northern Territory was being administered
directly by the Commonwealth. Provision is also being
made for a Commonwealth redress scheme for survivors of institutional sexual
abuse. While the Budget does not indicate a total over the forward estimates
due to legal sensitivity, $4.8 million has been allocated in 2017–18 from Indigenous
Advancement Strategy (IAS) program outcome 3 (‘safety and wellbeing’), perhaps
indicating that the Commonwealth expects further Indigenous claimants.
It is not clear whether this $4.8 million expense will impact other Indigenous
safety and wellbeing programs.
Footprints in Time, the national longitudinal study
of Indigenous Children, will continue as part of a $40.9 million package
for longitudinal studies, providing insights into Indigenous children’s lives.
It appears that most of the measures discussed above will
not require new legislation separate from an appropriation Act. However, it is
expected that new legislation will be required to authorise the redress scheme
for survivors of institutional sexual abuse.
Non-Indigenous-specific measures which
may affect Indigenous health and wellbeing
There are a number of non-Indigenous-specific measures which
have the potential to improve Indigenous health and wellbeing. The extent to
which there is any improvement would depend on whether funding is apportioned according
to the relative prevalence of the condition in the Indigenous and
non-Indigenous populations, and whether programs were implemented in culturally
safe ways that make them accessible to Indigenous people. It is not possible to
say how much of the budget allocation (if any) from these or other measures
will be spent on Indigenous people, but the following measures may have some
impact if targeted appropriately:
- ‘Greater Choice for At Home Palliative Care’—an unwillingness to
die away from family and traditional lands/country has played a significant
role in the past in Indigenous people not seeking palliative care.
- ‘Healthy Heart Initiative – targeted activities’—ischaemic heart
diseases are the number-one killer of Indigenous Australians.
- ‘Improved Access to Health Care for Australian Participants of
British Nuclear Tests and Veterans of the British Commonwealth Occupation Force’—this
will provide Veterans’ Affairs Gold Card health care to army veterans and Indigenous
people affected by British nuclear testing at Maralinga, Emu Field and the
Montebello Islands. This has been welcomed by remaining survivors, although
they have noted that as it has been decades since compensation was recommended
by the 1985 McClelland Royal Commission, many potential claimants have since
- ‘Prioritising Mental Health – improving telehealth for
psychological services in regional, rural and remote Australia’—the ATSISPEP
report notes that many ACCHOs were unable to provide psychological services,
and this measure may have some potential to overcome that.
The suicide prevention support and research programs may have some potential to
reduce Indigenous suicide if this is prioritised by the recipients.
- ‘Housing social impact investments’—this trial measure targets people
supported by specialist homelessness services, those exiting out-of-home care,
and those exiting juvenile detention. These are all groups
with extremely high Indigenous representation.
Department of the Prime Minister and Cabinet (PM&C), Closing
the Gap: Prime Minister’s Report 2017, Commonwealth of Australia,
Ibid., pp. 24–25; Australian Bureau of Statistics (ABS), Deaths
Australia 2015, cat. no. 3302.0, ABS, Canberra, 2016, Table 7.
‘Prime Minister’s introduction’, pp. 4–5 in Closing the Gap: Prime
Minister’s Report 2017, op. cit.
of Death Australia 2014, cat. no. 3303.0, ABS, Canberra, 2016; P
Dudgeon, J Milroy, T Calma et al., Solutions
that work: what the evidence and our people tell us—Aboriginal and Torres
Strait Islander Suicide Prevention Evaluation Project Report (‘ATSISPEP
report’), University of Western Australia, November 2016.
N Thorpe, ‘BUDGET
2017: Indigenous bodies say government is out of touch’, National
Indigenous Television (NITV), 10 May 2017; Close the Gap campaign, AHRC:
Government urged to commit to Close the Gap priorities, media release,
7 May 2017; ANTaR, Budget
fails Aboriginal and Torres Strait Islander people, media release, 10
May 2017; Oxfam Australia, Budget
delivers only piecemeal measures for Australia’s First Peoples, media
release, 10 May 2017; Australian Indigenous Doctors Association, Does
the 2017 Budget show that the Government understands the frustrations of
Indigenous Australians?, media release, 10 May 2017; Reconciliation
cutting halted, but progress at risk, media release, 9 May 2017.
Causes of Death Australia 2014, op. cit.; PM&C, ‘Diabetes’,
in Aboriginal and Torres Strait Islander Health Performance Framework 2014
report, PM&C, 2014; the budget figures in this brief have been taken
from the following document unless otherwise sourced: Australian Government, Budget measures: budget
paper no. 2: 2017–18, pp. 110–111.
Closing the Gap: Prime Minister’s Report 2017, op. cit., p. 24;
K Carson, ‘Indigenous
smoking program cuts risk widening the gap’, The Conversation, 21 August
2014; Department of Health (DoH), ‘Tackling
Indigenous Smoking’, DoH website, 5 January 2017; W Snowdon, Funding
cuts a risk to the Tackling Smoking programme, media release, 30
Australian Government, Federal
financial relations: budget paper no. 3: 2017–18, pp. 44–45; M
de Brenni (Minister for Housing and Public Works (QLD)), Turnbull’s
Budget discriminates against remote Indigenous housing, media release,
10 May 2017.
Australian Government, Budget
measures: budget paper no. 2: 2015–16, p. 141. At this time the NPARIH
was renamed the National
Partnership on Remote Housing (NPRH)—see this PM&C webpage for revised
build targets, from which the figure of 182 houses is deduced. The actual
difference between the NPARIH and NPRH budgets is $101.7 million. The reason
for this discrepancy is unclear.
. A new
$1 billion National Housing Infrastructure Facility and a $375.3 million
National Housing and Homelessness Agreement are being established, but there is
as yet no indication whether these will include any Indigenous-specific or
Indigenous-directed components—Budget paper no. 2, op.
housing uncertainty’, RN Breakfast, transcript, Australian
Broadcasting Corporation, 16 May 2017.
Partnership Agreement on Remote Indigenous Housing, PM&C webpage.
and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to
2026, Cat. no. 3238.0, ABS, Canberra, 2014.
paper no. 2, op. cit., p. 97.
Dept of the Environment (DoE), Green
Army Indigenous projects factsheet, DoE, 2014.
For example, access to land is under culture and wellbeing in the
Productivity Commission’s (PC) Overcoming Indigenous Disadvantage reports. PC,
Indigenous Disadvantage’, PC website.
paper no. 2, op. cit., p. 108. See the Budget review
for additional information.
statistics on medicine 2015, DoH, 2016.
paper no. 2, op. cit., p. 118.
Heart Disease Australia (RHDA), ‘What is acute rheumatic
McDonald and T Calma, ‘Acute
rheumatic fever and social justice’, Medical Journal of Australia,
Federal financial relations: budget paper no. 3: 2017–18, op. cit.,
p. 25; Kirby Institute, Australian
trachoma surveillance report 2014, University of NSW, 2015.
paper no. 2, op. cit., p. 142.
Brennan and A Dias, ‘Abuse
survivors welcome compensation settlement over Retta Dixon home in Darwin’,
Australian Broadcasting Corporation (ABC), ABC News website, 30 March 2017.
paper no. 2, op. cit., p. 146; Australian Government, Portfolio
budget statements 2017–18: budget related paper no.1.14: Prime Minister and
Cabinet Portfolio, p. 24.
paper no. 2, op. cit., p. 144; for further information,
see the Footprints
in Time website.
paper no. 2, op. cit., p. 107; D Bell, M Lindeman and J Reid, ‘The
(mis)matching of resources and assessed need in remote Aboriginal community
aged care’, Australasian Journal on Ageing, 34(3), September 2015, pp.
paper no. 2, op. cit., p. 111; Causes of Death Australia
2014, op. cit.
paper no. 2, op. cit., p. 175; D Conifer, ‘Federal
budget 2017: Aboriginal people exposed to British nuclear testing to receive
improved health care’, ABC News website, 9 May 2017. See the Budget review
affairs’ for more details.
paper no. 2, op. cit., pp. 120–121; ATSISPEP
report, op. cit., p. 25. See also the Budget review
paper no. 2, op. cit., p. 156.
All online articles accessed May 2017.
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