Indigenous affairs: health, housing and other measures

Budget Review 2018–19 Index

James Haughton

Health

Two Closing the Gap targets relate directly to Indigenous health—the target to close the life expectancy gap by 2031 and the target to halve the child mortality gap by 2018.[1] Of these, the life expectancy target is not on track, while the child mortality target was on track in 2016. However, as the Prime Minister’s 2018 Closing the Gap report has noted, since the Closing the Gap goals were announced in 2008, progress has slowed, with a decline in Indigenous child mortality rates of 11.5 per cent’.[2]

Analyses of Indigenous budgets, such as the Productivity Commission’s Indigenous Expenditure Report, frequently distinguish between Indigenous specific programs and ‘mainstream’ programs that are also accessed by Indigenous people.[3] This corresponds to government accounting categories and also reflects the reality that, unless specific targeting and culturally appropriate and safe program delivery are incorporated, mainstream programs usually under-service Indigenous people.[4] The 2018–19 Budget includes both Indigenous-specific health measures and mainstream measures with Indigenous-targeted components.

Indigenous-specific measures

The Budget includes $3.9 billion for Department of Health Program 2.2, ‘Aboriginal and Torres Strait Islander Health’, over four years from 2018‑19, an increase of $200 million in total or about 4 per cent per year over current levels.[5] This includes:

  • a new funding model for Aboriginal Community Controlled Health Services (ACCHSs) devised in consultation with the sector, with no net funding change[6]
  • $105 million for better access to aged care for Aboriginal and Torres Strait Islander people, including support for remaining in remote communities.[7] See also the Parliamentary Library Budget Review article, ‘Aged care
  • $34.8 million over four years to support the delivery of dialysis by nurses, including Aboriginal and Torres Strait Islander health workers in remote areas, under a new Medicare Benefits Schedule item. This will mean that people needing dialysis will no longer have to move to urban centres such as Alice Springs or Darwin to receive treatment[8]
  • $4.8 million over three years to address crusted scabies in northern Australia, with the aim of eliminating it by 2022. Crusted scabies infection is associated with overcrowding and can cause rheumatic fever, rheumatic heart disease and renal disease, which are leading causes of death for Indigenous people and[9]
  • $3 million to increase the budget for Indigenous eye health to $34.3 million, and $30 million for Indigenous hearing health assessments.[10] This latter appears to be a reannouncement of the pre-budget commitment of $29.4 million to extend the Healthy Ears—Better Hearing, Better Listening Program.[11]

Non-Indigenous specific measures

Non-Indigenous specific measures with a noted Indigenous component or corresponding to areas of high Indigenous need include:

  • $23.2 million over four years for the Healthy Active Beginning Package, including a policy to reduce the traumatic injury rate among young Indigenous Australians who are 4.5 times more likely to sustain serious injury than non-Indigenous children[12]
  • $338.1 million for mental health, including suicide prevention, remote mental health care and youth mental health—see the Parliamentary Library Budget Review article, ‘Mental health’ 
  • $83.3 million for rural health, including investment in Aboriginal and Torres Strait Islander Health Professional Organisations of around $1.6 million a year.[13] See also the Parliamentary Library Budget Review article, ‘Rural health workforce’  and
  • $17.5 million over four years, provided from the Medical Research Future Fund (MRRF), for research into ‘Maternal health and the First 2000 days’ to address social determinants of health.[14] This seems to be modelled on the First 1000 Days Australia program for Aboriginal and Torres Strait Islander maternal and infant health promoted by Professor Kerry Arabena.[15]

Peak bodies in targeted areas, such as the National Aboriginal Community Controlled Health Organisations (NACCHO), the National Aboriginal and Torres Strait Islander Health Workers Association and Vision Australia, have generally welcomed the increased health spending.[16] However, several expressed concern that the Budget made little mention of the Closing the Gap framework or the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.[17]

Housing

The Budget includes $550 million over five years for housing in remote Aboriginal communities in the Northern Territory, which is to be matched by $550 million from the Northern Territory Government. Currently, the National Partnership on Remote Housing (NPRH) will expire on 30 June 2018 without any further Australian Government investment for remote Indigenous housing in other states. The Minister for Indigenous Affairs, Nigel Scullion, has been reported as saying that negotiations with the states over future funding for remote Indigenous housing are ongoing.[18]

Reducing overcrowding is necessary to improve Indigenous health, education and other outcomes in remote Australia.[19] The Department of the Prime Minister and Cabinet’s Remote Housing Review (the Review) found that 5,500 more houses will be needed in remote Indigenous communities by 2028 to address severe overcrowding and population growth: 2,750 properties are required in the Northern Territory (NT), 1,100 in Queensland, 1,350 in Western Australia and 300 in South Australia. To address moderate overcrowding, approximately double this number of houses will be needed.[20]

The Review also found that best practice besser block construction in the NT, which has been the preferred design since 2014, had capital costs of about $520,000 per house, plus ancillary program costs of 15 per cent.[21] On this basis, $550 million would build approximately 920 houses. The matching NT contribution would double this, to 1,840 houses by 2023. If this housing program, and Commonwealth support for it, were continued to 2028 (as the NT government has indicated), and costs remained constant, then 3,680 houses would be built, meeting the 2,750 house target and making substantial inroads into moderate overcrowding.

Other measures

There are several measures relating to infrastructure and economic growth in remote areas with many Indigenous communities, including:

  • the Budget provides funding for roads in remote areas serving Indigenous communities, including $180 million for the Central Arnhem Road Upgrade, $100 million for the Buntine Highway Upgrade, $160 million for the Outback Way through central Australia, and $1.5 billion for roads in ‘Northern Australia’. This is previously committed funding, and media reports indicate most funding will not be distributed until 2022–23.[22] Infrastructure Australia has previously recommended increased road funding to remote Indigenous communities.[23] Warren Snowdon, the Labor Member for Lingiari, criticised the announcement, stating that the cost of a full upgrade for the Central Arnhem Road would be between $500 million and $1 billion[24]
  • $28.3 million over four years for the Remote Airstrip Upgrade Programme, which provides vital airstrip maintenance and upgrades to many remote Indigenous communities and
  • in the Agriculture portfolio, investment in forestry on Indigenous land through the $20 million ‘National Forestry Industry Plan’ measure. Forestry projects have been of particular interest to Indigenous peoples of the Cape York Peninsula, including the Wik.[25]

According to the Minister for Indigenous Affairs Nigel Scullion’s budget media release, the Budget includes $2 million over three years for the Australian Institute of Aboriginal and Torres Strait Islander Affairs (AIATSIS) ‘for a program of preservation and celebration of Indigenous languages and culture’.[26] In the PM&C Portfolio Budget Statement, this is listed as funding to commemorate the 250th Anniversary of James Cook’s Voyage that will be drawn from the Contingency Reserve.[27] This appears to refer to the ‘cultural engagement and consultation with Indigenous communities, including specialised training for Indigenous cultural heritage professionals in regional areas’ mentioned in the Communication and the Arts budget measure ‘250th Anniversary of James Cook’s Voyage – commemoration’. Local traditional owners have been described as giving ‘cautious support’ to the measure.[28]



[1].          Department of the Prime Minister and Cabinet (PM&C), Closing the Gap: Prime Minister’s Report 2018, 2018, pp. 8–9.

[2].          Ibid, p. 38.

[3].          Productivity Commission, Indigenous expenditure report 2017, Productivity Commission, 2017.

[4].          Indigenous-specific health programs are usually budgeted under the Department of Health’s (DoH) Program 2.2, ‘Aboriginal and Torres Strait Islander Health’ in the DoH Portfolio Budget Statement. On mainstream underservicing, see: K Alford, ‘Indigenous health expenditure deficits obscured in Closing the Gap reports’, Medical Journal of Australia, 203 (10), 2015, p. 403.

[5].          Australian Government, Portfolio budget statements 2018–19: budget related paper no. 1.9: Health Portfolio, pp. 20, 63.

[6].          DoH, Indigenous health –Indigenous health services, Budget fact sheet, DoH, 8 May 2018.

[7].          DoH, Indigenous health –National Aboriginal and Torres Strait Islander Flexible Aged Care program, Budget fact sheet, DoH, 8 May 2018.

[8].          DoH, Indigenous health –investment in remote renal services and infrastructure, Budget fact sheet, DoH, 8 May 2018.

[9].          DoH, Indigenous health –crusted scabies, Budget fact sheet, DoH, 8 May 2018.

[10].       DoH, Indigenous health –hearing and eye health, Budget fact sheet, DoH, 8 May 2018.

[11].       K Wyatt (Minister for Indigenous Health), Listening to Indigenous needs: Healthy Ears Program extended, media release, 9 March 2018.

[12].       N Scullion (Minister for Indigenous Affairs), 2018-19 Budget to strengthen economic, employment and health opportunities for First Australians, media release, 9 May 2018.

[13].       DoH, Indigenous health –continuation and expansion of support for Aboriginal and Torres Strait Islander Health Professional Organisations, Budget fact sheet, DoH, 8 May 2018.

[14].       The budget measures and figures in this brief have been taken from the following document unless otherwise sourced: Australian Government, Budget measures: budget paper no. 2: 2018–19, p. 116.

[15].       First 1000 Days Australia website.

[16].       National Aboriginal Community Controlled Health Organisations (NACCHO), Government announces new funding model for ACCHS, media release, 9 May 2018; See NACCHO Aboriginal Health News Alert, Top 10 peak health organisation press release responses  for a compilation of Indigenous health peak body budget responses.

[17].       Ibid.

[18].       B Smee, ‘Indigenous leaders say remote housing in jeopardy after “devastating” budget cut’, The Guardian, 10 May 2018; R Hocking, ‘Community reactions mixed as budget detail revealed’, National Indigenous Television (NITV), 9 May 2018; National Congress of Australia’s First Peoples, First peoples sacrificed in the name of budget surplus, media release, 9 May 2018.

[19].       Department of the Prime Minister and Cabinet (PM&C), Remote Housing Review: a review of the National Partnership Agreement on Remote Indigenous Housing and the Remote Housing Strategy (2008–2018), PM&C, 2017, pp. 15–21.

[20].       Ibid., pp. 22–25.

[21].       Ibid., pp. 31–33.

[22].       ‘NT not happy about 5-year road cash delays’, SBS News, 9 May 2018.

[23].       Infrastructure Australia, Infrastructure priority list: Australian Infrastructure Plan: project and initiative summaries, March 2018.

[24].       W Snowdon (Member for Lingiari), Turnbull is for the top end of town. Not the top end, media release, 8 May 2018.

[25].       G Marley, ‘Tigercat takes on Far North Queensland’, Australian Forests and Timber, 1 December 2017.

[26].       N Scullion (Minister for Indigenous Affairs), 2018–19 Budget to strengthen economic, employment and health opportunities for First Australians, op. cit.

[27].       Australian Government, Portfolio budget statements 2018–19: budget related paper no. 1.14: Prime Minister and Cabinet Portfolio, p.89.

[28].       NITV), ‘New Captain Cook monument draws mixed response from Indigenous community’, 30 April 2018.

 

All online articles accessed May 2018 

For copyright reasons some linked items are only available to members of Parliament.


© Commonwealth of Australia

Creative commons logo

Creative Commons

With the exception of the Commonwealth Coat of Arms, and to the extent that copyright subsists in a third party, this publication, its logo and front page design are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia licence.

In essence, you are free to copy and communicate this work in its current form for all non-commercial purposes, as long as you attribute the work to the author and abide by the other licence terms. The work cannot be adapted or modified in any way. Content from this publication should be attributed in the following way: Author(s), Title of publication, Series Name and No, Publisher, Date.

To the extent that copyright subsists in third party quotes it remains with the original owner and permission may be required to reuse the material.

Inquiries regarding the licence and any use of the publication are welcome to webmanager@aph.gov.au.

This work has been prepared to support the work of the Australian Parliament using information available at the time of production. The views expressed do not reflect an official position of the Parliamentary Library, nor do they constitute professional legal opinion.

Any concerns or complaints should be directed to the Parliamentary Librarian. Parliamentary Library staff are available to discuss the contents of publications with Senators and Members and their staff. To access this service, clients may contact the author or the Library‘s Central Enquiry Point for referral.  

Top