19 March is National Close the Gap Day, an annual event coordinated by Oxfam Australia to highlight the significant gap in health status between Indigenous and non-Indigenous Australians. For the origin of the day, the non-government campaign behind it and the Council of Australian Government (COAG)’s National Indigenous Reform Agreement (NIRA) and its ‘Closing the gap’ strategy see an earlier FlagPost.
Extent of the gap
According to the Australian Institute of Health and Welfare (AIHW), the health gap between Indigenous and non-Indigenous Australians ‘start(s) at birth and continue(s) throughout life’ and is best illustrated by differences in life expectancy. For women, Indigenous life expectancy at birth in 2010–2012 was 73.7 years, compared with 83.1 years for non-Indigenous females, a gap of 9.5 years. For men in that period, Indigenous life expectancy was estimated to be 69.1 years compared with 79.7 years for non-Indigenous males.
Closing the gap health targets
COAG’s NIRA included 6 closing the gap targets, two with direct health relevance. The Closing the Gap: Prime Minister’s Report, 2015 found ‘closing the life expectancy gap within a generation’ was not on track as ‘no significant change was detected between the 2006 baseline and 2013’ but ‘halving the gap in mortality rates for Indigenous children under five within a decade’ was on track as Indigenous child death rate declined by 31 per cent, outpacing the decline in non‑Indigenous child deaths between 1998 and 2013’. For more detail and explanation see the Productivity Commission’s Overcoming Indigenous Disadvantage: Key Indicators 2014 Report and Fact Sheet and the AIHW’s Australia’s Health 2014 chapter 7. They identify problems quantifying the relevant death rates and contributing factors. The regional dimension to the inequality is yet to be fully explored.
COAG’s NIRA included a range of National Partnerships. The National Partnership on Closing the Gap on Indigenous Health Outcomes expired in June 2013 and was not renewed, and two agencies billed in the 2013 Prime Minister’s report as helping to keep Governments accountable, the COAG Reform Council and the Coordinator General for Remote Indigenous Services, have been discontinued. The 2012 National Partnership on Stronger Futures in the Northern Territory (which has a health component) continues. The Government has introduced a new Indigenous health program architecture and explains it in its Portfolio Budget Statement 2014-15 Health Portfolio (Outcome 5.3) and Indigenous Health 2014-15 Budget—Questions and Answers.
The Productivity Commission’s Indigenous Expenditure Report 2012 detailed identifiable expenditure on services, including in area of health, for Indigenous Australians, but as Professor Altman observed in ‘Black government expenditure—it’s a white thing’, the report does not reveal what was spent on service provision and what on administration, how effectively a service was delivered or how much benefit Indigenous Australians garnered from expenditure.
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) is not mentioned in the latest Prime Minister’s Report, but in it the previous Government committed to principles of recognition, community control, partnership and accountability, and to encouraging governments to ‘work together across all building blocks […] take action across key social determinants […] and align program goals across sectors of government.’
What is needed?
What is needed to succeed in closing the health gap? Is it just patience? Is it greater attention to ‘What works’, a heading under which the Closing the gap clearinghouse presents many findings? Is it greater attention to education, employment and community safety, three of the present Government’s priorities—there being no doubt of the contribution played by these ‘social determinants’. Is it a greater commitment to Aboriginal controlled primary health care, as argued in the National Aboriginal Community Controlled Health Organisation’s 10 Point plan 2013-2030? Is it constitutional recognition and firming State/Commonwealth responsibilities as argued in the Lowitja Institute’s Building a Legal Framework for Aboriginal and Torres Strait Islander Health. Is it, as argued in the Close the Gap Steering Committee’s Progress and Priorities report 2015, all the above plus a continued commitment from the Commonwealth to lead and to the NATSIHP?
Is what’s needed something as small as renewed attention to nutrition, as argued for in Aboriginal health policy: is nutrition the ‘gap’ in 'Closing the Gap'? Or is the something much bigger? Desert Knowledge Australia’s Fixing the hole in Australia’s Heartland: How Government needs to work in remote Australia, found ‘no considered development framework and, despite many successive attempts, little coordination amongst the tiers of government, the various jurisdictions or the people and communities that make up remote Australia’, identified governance dysfunction as a prime cause of policy failure, called for ‘closing the gap between intentions and outcomes’, and argued for custom-built vision, policies and governance arrangements for remote Australia, followed by strategic long-term investment. Geoff Scott, CEO of the National Congress of Australia’s First Peoples, in ‘Don’t just do something’ identified budget cuts impacting directly on frontline service, ‘misaligned strategies or programs’, a lack of co-ordination between ministers and agencies, ‘an environment of sanctioned chaos’, a ‘focus on the negative in the indigenous environment’ that was not solving problems and tainting sentiment for Constitutional recognition, and a need for ‘a regional focus which is about sustainable fixes …’.
For further discussion and information see the Healthinfonet’s Closing-the-gap web-pages.