Dr James Haughton, Social Policy
Key issues
It has been a decade since they were announced, and most of the Closing the Gap targets have not been met.
What happened, and what are the prospects for the refreshed targets?
The origins of Closing the Gap
In the Social
Justice Report 2005, Aboriginal and Torres Strait Islander Social Justice
Commissioner Tom
Calma urged Australian governments to commit to achieving equality of
health status and life expectancy between Aboriginal and Torres Strait Islander
and non-Indigenous people within 25 years. At the time, the life expectancy gap
was thought to be 17 years; better
data has since shown it was approximately 11 years. Health and Aboriginal
and Torres Strait Islander non-government organisations responded with a Close
the Gap campaign, including the annual National Close the Gap Day.
Prime Minister Kevin Rudd and Opposition Leader Brendan Nelson committed to the goal in 2008. The Council of
Australian Governments (COAG) then committed to six (later seven) Closing the
Gap targets in the National Indigenous Reform Agreement, four of which were
to be met by 2018. The Prime Minister reports annually to Parliament on progress towards
the targets. The Human Rights Commission also issues its own
annual Close
the Gap reports.
Outcomes of Closing the Gap
Only two of
the seven Closing the Gap targets were on track to be met in the 2019
report to Parliament. These two targets are:
- to have 95 per cent of Aboriginal
and Torres Strait Islander four-year-olds enrolled in early childhood education
by 2025 and
- to halve the Year 12 attainment gap by
2020.
Four targets due to expire
in 2018 were not on track, and were unlikely to be met (final data for 2018 is
not yet available); and the 2031 life expectancy target was not on track. The targets
and their status are:
- halve the gap in child mortality rates by
2018—there has been a modest improvement of 10 per cent in child
mortality, but non-Indigenous rates have improved by 35 per cent,
leading to a slightly wider gap
- close the gap in school attendance by 2018—attendance
has worsened slightly
- close the gap in life expectancy by 2031—there
has been a slight improvement of 2.5 years for men and 1.9 years for women, but
this is too slow to meet the target
- halve the gap in reading and numeracy by
2018—there have been gains in reading and numeracy, particularly at younger
ages, but not enough to meet the target and
- halve the gap in employment by 2018—the gap
has widened by 1.5 percentage points, partly driven by the abolition of the former Community
Development Employment Projects program and the mining boom wind down).
Why were the targets not
met?
Lack of partnership with
Indigenous people
As Prime Minister Scott Morrison
suggested in his 2019 Closing the Gap speech, the original Closing the Gap targets and policies
were devised without significant partnership from Aboriginal and Torres Strait Islander peoples
and with limited input from state and territory governments. The available evidence is that policies designed and delivered by, or in cooperation with,
Aboriginal and Torres Strait Islander stakeholders achieve better results. Many
issues of most concern to Aboriginal and Torres Strait Islander communities and
which contribute to disadvantage (such as high rates of incarceration and child
removal) are primarily state responsibilities, so were not included in the
original Closing the Gap framework. Lack of Aboriginal and Torres Strait
Islander voices may have contributed to a ‘deficit approach’ that focused on ‘gaps’, instead of on targets and programs that leveraged strengths—like culture and
connection to country.
Lack of evaluation and monitoring
Reviews by the Productivity Commission, the Australian National Audit Office (ANAO) and non-government bodies have shown that as few as eight per cent of Indigenous
programs have been evaluated for effectiveness or on cost-benefit grounds. A Productivity Commission roundtable concluded:
The lack of assessment
or evaluation has not only resulted in significant gaps in the Australian
evidence base, but has also contributed to ‘a litany of poor policies being
recycled’.
In 2014 the Coalition Government abolished or
defunded several governance, monitoring and evaluation agencies including the
COAG Working Group on Indigenous Reform, the Closing the Gap
Clearinghouse, the Australian National Preventative Health Agency and the Coordinator-General
for Remote Indigenous Services. As a result, according
to the ANAO, the Closing the Gap strategy was not effectively monitored or
evaluated after 2014.
Unrealistic expectations or timescales
From the beginning of the Closing the Gap period, demographers
warned that the necessary improvements in Aboriginal and Torres Strait
Islander health and socio-economic outcomes represented a major break from the existing
trends of slow improvement. They would therefore require fundamental
changes in policy and/or funding levels if they were to be realised.
Furthermore, policymakers may not have considered
that health
and wellbeing policies usually take several years to produce effects
visible in health statistics; for example, a sustained anti-smoking campaign starting
today will only show measurable population health outcomes after several years.
Results over multi-year timescales can be difficult to reconcile with political
and election cycles.
Inadequate and skewed investment
The Close
the Gap Campaign Steering Committee, an umbrella group of Aboriginal and
Torres Strait Islander peak bodies, has argued that the lack of partnership
with Aboriginal and Torres Strait Islander peoples combined with a lack of
knowledge of what works has led to poor investment and persisting gaps:
... expenditure on Aboriginal and Torres Strait
Islander people is heavily skewed toward the costs of reacting to the outcomes
of disadvantage rather than investments to reduce or overcome disadvantage.
Furthermore, the 2017
Indigenous Expenditure Report states that to ‘know the direct impact of
expenditure on the outcomes requires a cost benefit analysis’. The Close the
Gap Campaign agrees and believes that far greater effort should be spent on
working with First Peoples on the approaches that can be shown to work,
especially those that address the root causes of poor health, and direct
investment to them.
Meeting the Closing the Gap targets implied a
significant increase in the rate of improvement in Aboriginal and Torres Strait
Islander health and socio-economic indicators, not just matching but exceeding
the ongoing improvements in non-Indigenous health and socio-economic outcomes. This
would imply a commensurate increase in funding for Indigenous-specific
programs.
However, available evidence from the Parliamentary
Library and the Indigenous
Expenditure Reports indicates that spending on Indigenous-specific programs
has been approximately constant in real terms since 2003, apart from a one-off
increase during the Northern Territory Emergency Response. Indigenous-specific
spending has declined as a percentage of Commonwealth spending or of GDP, and on
a per-capita basis, owing to the increasing Aboriginal and Torres Strait
Islander population. From 2008–09 to 2015–16, Commonwealth Indigenous-specific
per capita funding declined from $7,216 to $6,987. The Labor Governments’
Closing the Gap programs were largely paid for by redirecting funding.
In the absence of significant funding increases,
better targeting of existing funding might have produced better results.
However, as the Closing the Gap Campaign stated,
spending on Aboriginal and Torres Strait Islander peoples is skewed towards
reacting to disadvantage rather than investing in overcoming it. Examples of
skewed expenditure include:
- governments spend $3.9 billion
annually (2016 figure) on incarcerating Aboriginal and Torres Strait Islander
people, with overall economic costs of $7.9 billion, and
- In 2013–14, Aboriginal and Torres Strait Islander rates
of potentially preventable hospitalisations were three times higher than
non-Indigenous rates, and expenditure on secondary and tertiary care (chiefly
hospitals) was 42 per cent higher per capita, at $4539 vs $3200 for
non-Indigenous Australians, yet the rate
of avoidable deaths was 328 per cent higher, suggesting insufficient
expenditure in primary and preventative care.
This situation of under-or poorly-directed funding may
have been exacerbated by the incoming Coalition Government’s
decisions in 2014 to let the National Partnership Agreements on Closing
the Gap in Indigenous Health Outcomes ($1.58 billion) and on Indigenous
Early Childhood Development ($564 million) lapse (including the associated
anti-smoking programs); and to cancel
$369.7 million in spending on the National
Partnership Agreement on Preventative Health. The National
Strategic Framework on Aboriginal and Torres Strait Islander Peoples’ Mental
Health and Social and Emotional Wellbeing also lapsed under the Labor Government
in 2009. These lapses meant both a loss of funding and a loss of overall
strategic direction.
Steps towards future change
A longer-term view
Despite not meeting many
of the Closing the Gap targets, it is important to recognise that there have
been drastic improvements in Aboriginal and Torres Strait Islander health and socio-economic status since the Commonwealth first became involved in Indigenous
Affairs in 1967. Subsequent years saw the dismantling of policies such as segregated
hospitals and race-based child removals (‘the Stolen Generations’) and the
funding of Aboriginal and Torres Strait Islander community controlled health,
legal and other services, leading to significant improvements. For example, Aboriginal
infant mortality in the Northern Territory declined by 97 per cent. The health
improvements have mainly come from addressing communicable diseases (before 1967, Aboriginal children were not included
in government vaccination programs); nutrition; and maternal and infant care.
Policymakers should
therefore consider that, although there are still unique, medically treatable problems
such as trachoma,
many of the ‘low-hanging fruit’ of Aboriginal and Torres Strait Islander health
have already been addressed, leaving more intractable factors that require
greater, targeted and sustained investment.
More than half of the
remaining health gap is now driven by social and behavioural factors that produce chronic disease—factors which in turn are driven by social, economic and cultural disadvantages in areas such as education, employment and housing. Closing
the remaining gaps, therefore, requires addressing many different aspects of
Aboriginal and Torres Strait Islander disadvantage in combination; and, in the
health sector, prioritising preventative, public and primary health care
programs that can address the social and behavioural factors.
Current policy framework
The Coalition Government
devised a new Closing the Gap target framework in collaboration with the National Coalition of Aboriginal and Torres
Strait Islander Peak Organisations and relevant state and
territory ministers. The new framework includes targets for Aboriginal and
Torres Strait Islander land and culture; child protection; and incarceration.
Major parties have
committed to an increased voice for Aboriginal and Torres Strait Islander
peoples in decision making, with the Coalition focussed upon local and regional decisions and the ALP on a constitutionally entrenched Voice to
Parliament.
In 2017, following
critical reports from the ANAO, former Minister for Indigenous Affairs Nigel
Scullion committed to spending $10 million a year on evaluating
Indigenous programs. The Government
legislated for a new Indigenous Evaluation Commissioner at the Productivity
Commission, who is devising an Indigenous Evaluation Strategy. The experience of the last decade has also provided
a greater evidence base on the key drivers of disadvantage, particularly
social and behavioural drivers.
The Coalition Government
has also recommenced the National Strategic Framework for Aboriginal and Torres
Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing—which is guiding investments in youth suicide prevention—and made new commitments to ongoing investment in preventative health and Aboriginal and Torres Strait Islander health.
These policies may address many of the key problems of the Closing the Gap period, if the knowledge gained from Aboriginal and Torres Strait Islander voices and better evidence is matched with appropriately funded and targeted programs.
Further reading
Australian Institute of Health and Welfare (AIHW), Closing the Gap targets: 2017 analysis of progress and key drivers of change, AIHW, Canberra, April 2018.
C Holland for the Close the Gap Steering Committee, Close the Gap 2018 – A ten year review, Close the Gap Steering Committee for Indigenous Health Equity, February 2018.
J Haughton,
‘Indigenous affairs overview’,
Budget Review 2019–20, Parliamentary Library, Canberra, April 2019.
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