Indigenous affairs: health and wellbeing

Budget Review 2017–18 Index

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.[1] 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.[2] 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.[3] 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.[4]

As several Indigenous and stakeholder groups have noted, there is very little in the Budget that addresses these issues.[5] 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.[6] 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.[7]

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.[8] 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.[9] At this point there is no indication whether these National Partnerships will be renewed, despite the Government’s other commitments to housing affordability.[10] A spokesperson for the Minister for Indigenous Affairs, Senator Nigel Scullion, has said that negotiations regarding the National Partnerships are ongoing.[11] The National Partnerships have contributed to a significant drop in overcrowding in remote Indigenous communities, and consistently exceeded their Indigenous employment targets.[12] 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.[13]

Indigenous-specific measures

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.[14] 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.[15] 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 issue.[16]

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.[17]

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.[18] In recent years the number of pharmacists making use of this service has declined slightly.[19]

The ‘National Partnership Agreement on Rheumatic Fever Strategy – continuation and expansion’ measure allocates an additional $7.6 million to continue and expand the Agreement.[20] 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.[21] 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.[22]

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.[23] 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.[24] 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.[25] 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.[26] 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.[27]

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.[28]
  • ‘Healthy Heart Initiative – targeted activities’—ischaemic heart diseases are the number-one killer of Indigenous Australians.[29]
  • ‘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 died.[30]
  • ‘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.[31] 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.[32] These are all groups with extremely high Indigenous representation.

[1].          Department of the Prime Minister and Cabinet (PM&C), Closing the Gap: Prime Minister’s Report 2017, Commonwealth of Australia, Canberra, 2017.

[2].          Ibid., pp. 24–25; Australian Bureau of Statistics (ABS), Deaths Australia 2015, cat. no. 3302.0, ABS, Canberra, 2016, Table 7.

[3].          ‘Prime Minister’s introduction’, pp. 4–5 in Closing the Gap: Prime Minister’s Report 2017, op. cit.

[4].          ABS, Causes 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.

[5].          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 Australia, Cost cutting halted, but progress at risk, media release, 9 May 2017.

[6].          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.

[7].          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 March 2017.

[8].          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.

[9].          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.

[10].       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. cit., p. 155, 170.

[11].       ‘Indigenous housing uncertainty’, RN Breakfast, transcript, Australian Broadcasting Corporation, 16 May 2017.

[12].       PM&C, National Partnership Agreement on Remote Indigenous Housing, PM&C webpage.

[13].       ABS, Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026, Cat. no. 3238.0, ABS, Canberra, 2014.

[14].       Budget paper no. 2, op. cit., p. 97.

[15].       Dept of the Environment (DoE), Green Army Indigenous projects factsheet, DoE, 2014.

[16].       For example, access to land is under culture and wellbeing in the Productivity Commission’s (PC) Overcoming Indigenous Disadvantage reports. PC, ‘Overcoming Indigenous Disadvantage’, PC website.

[17].       Budget paper no. 2, op. cit., p. 108. See the Budget review brief ‘Medicare’ for additional information.

[18].       Ibid., p. 113.

[19].       DoH, Australian statistics on medicine 2015, DoH, 2016.

[20].       Budget paper no. 2, op. cit., p. 118.

[21].       Rheumatic Heart Disease Australia (RHDA), ‘What is acute rheumatic fever?’, RHDA website.

[22].       A Brown, M McDonald and T Calma, ‘Acute rheumatic fever and social justice’, Medical Journal of Australia, 186(11), 2007,
pp. 557–8.

[23].       Federal financial relations: budget paper no. 3: 2017–18, op. cit., p. 25; Kirby Institute, Australian trachoma surveillance report 2014, University of NSW, 2015.

[24].       Budget paper no. 2, op. cit., p. 142.

[25].       B 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.

[26].       Budget 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.

[27].       Budget paper no. 2, op. cit., p. 144; for further information, see the Footprints in Time website.

[28].       Budget 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. 171–176.

[29].       Budget paper no. 2, op. cit., p. 111; Causes of Death Australia 2014, op. cit.

[30].       Budget 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 brief ‘Veteran’s affairs’ for more details.

[31].       Budget paper no. 2, op. cit., pp. 120–121; ATSISPEP report, op. cit., p. 25. See also the Budget review brief ‘Mental health’.

[32].       Budget paper no. 2, op. cit., p. 156.


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