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
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