Indigenous health of Australians closing the gap Prime Ministers report 2018

1. Introduction
Early 2008, representatives from indigenous health organizations, the Aboriginal and Torres Strait Islander Social Justice Commissioner, and the commonwealth government of Australia, signed an agreement that was meant to ensure that all the relevant stakeholders cooperate to ensure indigenous and non-indigenous Australians have equality in life expectancy and health status by 2030 (Human Rights and Equal Opportunity Commission 2008).
For quite a long time, it has been known that indigenous people in Australia have a disadvantage in terms of health. Many organizations and activists have over the years been trying to bridge the gap in health status between them and non-indigenous Australians and the signing of the agreement was a huge milestone that served two purposes. It raised public awareness on the matter and it helped to lay down plan for the achievement of parity in health status (Pholi, Black, & Richards, 2009).
The plan behind achieving health parity was christened “Closing the gap” and it is more of a continuation of a community-based campaign that was initiated about a year before the agreement was signed. Many indigenous community organizations, health services providers, and policy documents are now focused on closing the gap. Policymakers and even news reporters reporting on indigenous health matters are also focusing on the gap in health parity and the issues surrounding it. Perhaps the biggest player or stakeholder in the campaign to close the gap is the Commonwealth government of Australia.
The government is working to improve health outcomes for indigenous people living both in urban and rural areas. Some of the ways in which the government is working to improve the health of indigenous communities include improving the provision of health services and boosting food security especially among indigenous communities living in remote areas. Making sure indigenous people have access to healthy, acceptable, and affordable food is one of the requirements for better health (Department of Prime Miniter and the Cabinet, 2008). This report is an examination of the closing the gap policy and the progress so far.
1. Objective and critique of the closing the gap policy
1. Objectives
The goal of the policy is to create parity in the health status of indigenous and non-indigenous Australians.
0. Closing the life expectancy gap within a generation
One of the measures commonly used to assess a population’s health is life expectancy. Apart from being a measure of population health, life expectancy is also an indicator of a population’s mortality level. By definition, life expectancy is how long an average individual randomly drawn from a population is likely to live based on present death rates for his or her gender (Biddle & Taylor, 2012). It is usually expressed as how many years one can live from birth.
The life expectancy for Aboriginal and Torres Strait Islander men born between 2015 to 2017 is 71.6 years compared to 80.2 years for non-indigenous Australians. The gap between the two populations is 8.6 years. Similarly, there is also a large gap in the life expectancy between indigenous females and non-indigenous females. For while indigenous females born between 2015 and 2017 are expected to live for about 75.6 years, non-indigenous females are expected to live up to 83.4 years. The gap is 7.8 years. This is not to say that progress has not been made. For while the gap remains large, the life expectancy of indigenous males and females has increased over the years. Between 2005-2007 and 2015-2017, the life expectancy for indigenous females has increased by 2.7 years while for males has increased by 4.4 years. Nevertheless, the fact is that indigenous men and women do not averagely live longer because of health disparity. Even in correctional facilities, the number of indigenous deaths is usually higher than that of non-indigenous deaths. This has, however, also been linked to the disproportionately huge number of indigenous people in the Australian prison system (Weatherburn, Fitzgerald, & Hua, 2003). With that said, between 2005-2007 and 2015-2017, the gap in life expectancy between indigenous males and non-indigenous Australian males has reduced by 2.9 years, while that between indigenous females and non-indigenous females has also reduced by 1.9 years (AIHW, 2019). These reductions indicate that some progress has been achieved in trying to close the gap.
0. Halving the gap in mortality rates for Indigenous children under five within a decade;
The data about deaths is also an important measure of the health of a population. It provides crucial information that can be used in policymaking and review to better a population’s health. The data usually includes death patterns i.e. information about the major causes of death for certain populations over time. Evaluating death patterns can provide an explanation on the changes and differences in health status and can provide important information for policymaking. Aboriginal and Torres Strait Islander populations have higher death rates vis-à-vis non-indigenous populations. And this is for all the big causes of death and for all the age groups. In the years between 2004 and 2008, the death rate for aboriginal Australian males was nearly double that for non-indigenous Australian males. Similarly, the death rate for aboriginal Australian females was twice that for non-indigenous Australian females. The life expectancy for indigenous males between 2005 and 2007 was 67.2 years, while for females it was 72.9 years. The 67.2 years is 11.5 years less than the life expectancy for non-aboriginal males, while the 72.9 years is 9.7 years less than the life expectancy for non-aboriginal females (AIHW, 2011).
Between the year 1998 and the year 2016, the mortality rate for indigenous decreased by 14 percent. The mortality rate for non-indigenous Australians also went down over the same period but not as much. This reduced the difference in the mortality rate or the gap to 9 percent, which is promising but not very significant. Despite the promising progress made, the indigenous mortality rate is not reducing significantly enough over the years to meet the target of life expectancy by 2030 for mortality rates are also reducing for non-aboriginal Australians. So more needs to be done to close the gap.
1.0.2 Building safe and strong communities i.e. reducing family violence and causes of Indigenous incarceration.
A review shows that indigenous more likely to experience child abuse and neglect, family violence and other forms of violent crime and to be incarcerated than non-Indigenous Australians. Therefore, the closing the gap policy on safe and strong communities is must be met if the other items are to be of any value to the Torres strait islander people (Department of Prime Miniter and the Cabinet, 2008). The key to improving community safety for Aboriginal and Torres Strait Islander people lies in addressing the entrenched disadvantage and underlying factors that drive violent and criminal behavior and contribute to the overrepresentation of Indigenous people in the child protection and justice systems. This can be achieved by reducing the number of family issues and related disputes that result in violence, broken homes which can also be a precursor for crimes that can lead to incarceration.
1. Critique of the health improvement approach being undertaken.
Life expectancy is obviously a very good measure of the health status of a population. However, it is near impossible to get accurate data on it. Moreover, the method used to estimate Aboriginal and Torres Strait Islander life expectancy was recently changed. The new way of estimating takes into account the changes in self-identification amongst indigenous populations between censuses. So the data available right now cannot really be equivalent or compared to the data available before the commencement of the closing the gap policy. Moreover, it is also difficult to use life expectancy as a measure of indigenous health status because life expectancy is almost always re-estimated in between censuses. Nevertheless, data gathered by Altman, Biddle, and Hunter can help in understanding historical trends in life expectancy late in the 20th century. The data shows that male life expectancy in the indigenous population improved but not at an equal rate of improvement to that of non-indigenous Australian male population particularly after 1991. Also, between 1978 and 1981, life expectancy for non-indigenous females improved while that for indigenous females declined (Altman, Biddle, & Hunter, 2009).
The lack of equality in health status and life expectancy is definitely shameful and demands action (Krieg, 2006). And although promising progress has been made so far, there is a need to reimagine policies and re-plan several things to make sure that the new closing the gap policy is not robbing indigenous people of their cultures, their languages, and the lands, which are the very things that make them strong and resilient (Murphy, 2012).
1.2 Critique of Building safe and strong communities
The approach to resolving this particular sets of problems appear to be well thought out as they seem to focus on the root of the problem as opposed to the solving the resultant effects. This involves working with domestic violence prevention and resolution services to reduce family violence, developing programs that build local capacity and improve the lot of local women towards reducing and tackling abusing. However, like other areas, progress has been slow and expensive resulting in time delays that aboriginal people cannot afford. Also, the task of resolving incarceration problems has been left primarily in the hands of correctional services (Krieg, 2006) as opposed to in communities where determinants of incarceration and recidivism can be better addressed.
3. Contents and methods
This particular section is a description of the various methods applied for the implementation of this policy.
· Primary medical care investment and development that will cost about 3.6 billion dollars for four years.
· Collaborations with Aboriginal and Torres Strait Islander individuals via a NFA (Network Funding Agreement) established in discussion with the ACCH (Aboriginal Community Controlled Health) sector and assumes an outcome-oriented approach towards financing an indigenous sector support organization national network.
· Helping disabled indigenous Australians
· Emotional and social wellbeing
· Academic nutrition ventures at the Northern Territory (COAG)
4. Efficaciousness
The struggle of sticking to funding lines in order to evaluate policy efficacy has been observed. Jon Altman, a professor at the Center for Aboriginal Economic Policy Research, has noticed that in the ‘Black’ expenditure of the government, the Productivity Commission’s Indigenous Expenditure Report is not able to disclose just how much money was spent to close the gap- how much was used on provision of service and how much on management, how efficiently a particular service was provided, or the benefits Aboriginal Australians got from the policy (Gardiner-Garden, 2019).
5. How likely is it to succeed in its aims – particularly in a sustainable way?
The probability of the policy to succeed is low because of two reasons:
Country and City Indigenous Australians have needs that are different
Country and city indigenous Australians have needs that are different and this is not usually addressed at the policy level. Thus, reports show that the outcomes resulting from the efforts to bring health status parity are different for city and country indigenous populations. And with indigenous Australians living more in regional areas, the lack of emphasis on the need to improve health status will likely result in failure to bring any significant changes (Biddle, 2019).
Changing Goals
A recent review found that the Closing the Gap policy has recently changed its long term goal of attaining health status parity between non-indigenous and indigenous populations by 2030 and is instead focusing on goals that are short term and political. The review, which covered the last ten years was pretty damning on the issue and said that the policy/ strategy is now suffering from shortsightedness. The review was done by a nonprofit by the name Close the Gap Campaign and the conclusion of it was that bureaucratic and political changes have all but stopped the gradual progress that the country hoped to achieve for its indigenous populations. According to the nongovernmental organization, only one goal may be achieved by the end of the program. The review pointed a finger at the Commonwealth government for cutting more than half a billion dollars from the budget of the National Indigenous Affairs Agency in 2014 saying that the action effectively ended a 25-year program in its fifth year. The program now seemingly exists more in name than by actual progress being done to help indigenous people live healthier and better lives.
6. What are the barriers to success?
· Difficulties in evaluating how effective interventions are towards improving indigenous health.
· Difficulties in accessing care because of prohibitive financial costs including the cost of medication and the cost of consultation.
· Insufficient funding for indigenous health.
· Lack of sensitivity and cultural awareness among mainstream care providers leading to indigenous people feeling left out or unwanted.
· Lack of willingness to self-identify among some indigenous populations.
· Lack of confidence among care providers to ask patients to identify themselves.
7. How might it be improved?
· Improvement in support for indigenous health by the national leadership and the federal government as a whole. This improvement could result in more funding to enable the Indigenous Affairs agency to meet at least its health targets for closing the gap.
· Ensuring the existing targets are followed and that they are not compromised by anything.
· Capacity building in regional areas to ensure that health targets are met in such areas (Wahlquist, 2018).
· More engagement with Aboriginal and Torres Strait Islander people at the grassroots level to find out how their health cane be improved.
· Encouraging indigenous people to get into public service in numbers to help make policies that will improve their lives.
8. Conclusion
To evaluate the progress made by the Closing the Gap program especially with regards to the progress made in improving indigenous health, there is a need to use a measure. The measure used here was life expectancy and health status and the data and literature available show that there is a gap that needs to be closed. The size of the gap has been reducing according to some researchers. However, whether the gap is truly closing or not remains to be determined as the available strategies are limited. Some studies have shown that progress towards achieving health parity has significantly slowed down and noted lack of sufficient funding and lack of national leadership on the matter as some of the reasons why. However, there is hope. By increasing funding to improve indigenous health, building the capacity of indigenous health organizations, and encouraging indigenous leaders to participate in decision-making, indigenous health can be significantly improved and the goal of health parity can be achieved by 2030 (Rosenstock, Mukandi, Zwi, & Hill, 2013).
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