Australia's Closing the Gap Policy: Progress and Barriers

Introduction

In 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 intended to ensure that all relevant stakeholders would cooperate to achieve equality in life expectancy and health status between indigenous and non-indigenous Australians by 2030 (Human Rights and Equal Opportunity Commission, 2008).

For quite a long time, it has been known that indigenous people in Australia face a significant health disadvantage. Many organizations and activists have over the years been trying to bridge the gap in health status between indigenous and non-indigenous Australians, and the signing of the agreement marked a major milestone that served two purposes: it raised public awareness of the issue and it helped lay down a plan for achieving parity in health status (Pholi, Black, & Richards, 2009).

The plan for achieving health parity was named Closing the Gap, and it is largely a continuation of a community-based campaign that had been initiated approximately a year before the agreement was signed. Many indigenous community organizations, health service providers, and policy documents are now focused on closing the gap. Policymakers and journalists reporting on indigenous health matters are also directing attention toward the gap in health parity and the issues surrounding it. Perhaps the most influential stakeholder in the campaign is the Commonwealth Government of Australia.

The government is working to improve health outcomes for indigenous people living in both urban and rural areas. Some of the ways it is doing this include improving the provision of health services and boosting food security, especially among indigenous communities in remote areas. Ensuring that indigenous people have access to healthy, acceptable, and affordable food is one of the essential requirements for better health (Department of the Prime Minister and the Cabinet, 2008). This paper examines the Closing the Gap policy and the progress made so far.

Objectives of the Closing the Gap Policy

The overarching goal of the policy is to create parity in the health status of indigenous and non-indigenous Australians. The policy is organized around several specific targets, described below.

Closing the Life Expectancy Gap Within a Generation

One of the measures most 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 mortality levels. By definition, life expectancy refers to how long an average individual drawn from a population is likely to live, based on present death rates for their gender (Biddle & Taylor, 2012). It is usually expressed as the number of years one is expected to live from birth.

The life expectancy for Aboriginal and Torres Strait Islander men born between 2015 and 2017 is 71.6 years, compared to 80.2 years for non-indigenous Australians — a gap of 8.6 years. Similarly, there is a large gap in life expectancy between indigenous and non-indigenous females. Indigenous females born between 2015 and 2017 are expected to live approximately 75.6 years, while non-indigenous females are expected to live up to 83.4 years — a gap of 7.8 years.

This is not to say that no progress has been made. The life expectancy of both indigenous males and females has increased over the years. Between 2005–2007 and 2015–2017, life expectancy for indigenous females increased by 2.7 years and for indigenous males by 4.4 years. Nevertheless, indigenous men and women do not, on average, live as long as their non-indigenous counterparts, due to persistent health disparities. Even in correctional facilities, the number of indigenous deaths tends to be higher than that of non-indigenous deaths — a pattern also linked to the disproportionately large number of indigenous people in the Australian prison system (Weatherburn, Fitzgerald, & Hua, 2003).

Between 2005–2007 and 2015–2017, the gap in life expectancy between indigenous and non-indigenous males narrowed by 2.9 years, and between indigenous and non-indigenous females by 1.9 years (AIHW, 2019). These reductions indicate that some progress has been achieved in closing the gap.

Halving the Mortality Gap for Indigenous Children Under Five Within a Decade

Mortality data is also an important measure of a population's health, providing crucial information that can be used in policymaking and program review. This data includes death patterns — information about the major causes of death for certain populations over time. Evaluating death patterns can help explain changes and differences in health status and inform future policy. Aboriginal and Torres Strait Islander populations have higher death rates than non-indigenous populations across all major causes of death and all age groups.

In the years between 2004 and 2008, the death rate for Aboriginal Australian males was nearly double that of non-indigenous Australian males, and the death rate for Aboriginal Australian females was twice that of non-indigenous females. The life expectancy for indigenous males between 2005 and 2007 was 67.2 years — 11.5 years less than for non-indigenous males — while for indigenous females it was 72.9 years, which was 9.7 years less than for non-indigenous females (AIHW, 2011).

Between 1998 and 2016, the mortality rate for indigenous Australians decreased by 14 percent. The mortality rate for non-indigenous Australians also declined over the same period, though to a lesser degree, which reduced the gap between the two populations by approximately 9 percent. Despite this promising trend, the indigenous mortality rate is not declining rapidly enough to meet the 2030 targets, particularly because mortality rates among non-indigenous Australians are also falling. More concerted effort is therefore required.

Building Safe and Strong Communities

Evidence indicates that indigenous Australians are more likely than non-indigenous Australians to experience child abuse and neglect, family violence, other forms of violent crime, and incarceration. Addressing community safety is therefore essential — without progress in this area, the other objectives of the Closing the Gap policy are unlikely to deliver meaningful benefits to Aboriginal and Torres Strait Islander peoples (Department of the Prime Minister and the Cabinet, 2008).

The key to improving community safety lies in addressing the entrenched disadvantage and underlying factors that drive violent and criminal behavior and contribute to the overrepresentation of indigenous people in child protection and justice systems. This can be achieved by reducing the number of family disputes that result in violence and the broken homes that can become precursors to criminal behavior and incarceration.

Critique of the Health Improvement Approach

Life expectancy is a valuable measure of a population's health status; however, it is very difficult to gather accurate data on it. The method used to estimate Aboriginal and Torres Strait Islander life expectancy was recently changed. The new approach accounts for changes in self-identification among indigenous populations between censuses, which means that current data cannot be directly compared to data collected before the Closing the Gap policy began. Furthermore, life expectancy figures are almost always re-estimated between censuses, adding another layer of complexity to longitudinal comparisons.

Despite these limitations, data gathered by Altman, Biddle, and Hunter provides useful insight into historical trends in life expectancy in the late twentieth century. Their data shows that male life expectancy in the indigenous population improved, but not at the same rate as for non-indigenous Australian males — particularly after 1991. Additionally, between 1978 and 1981, life expectancy for non-indigenous females improved while that for indigenous females actually declined (Altman, Biddle, & Hunter, 2009).

The persistent inequality in health status and life expectancy is deeply troubling and demands urgent action (Krieg, 2006). Although promising progress has been made, there is a need to reimagine policies and replan several approaches to ensure that the Closing the Gap strategy does not inadvertently erode indigenous cultures, languages, and connection to land — the very foundations of indigenous strength and resilience (Murphy, 2012).

Critique of the Building Safe and Strong Communities Objective

The approach to resolving community safety problems appears well considered in that it focuses on the root causes rather than merely the resulting effects. This includes working with domestic violence prevention and resolution services to reduce family violence and developing programs that build local capacity and support women in reducing and tackling abuse. However, like other areas of the policy, progress has been slow and costly, resulting in delays that Aboriginal people cannot afford. Furthermore, the task of resolving incarceration-related problems has been left primarily in the hands of correctional services (Krieg, 2006), rather than being addressed within communities where the determinants of incarceration and recidivism can more effectively be tackled.

Conclusion

To evaluate the progress made by the Closing the Gap program in improving indigenous health, a reliable measure is required. This paper has used life expectancy and health status as its primary measures. The available data and literature confirm that a significant gap remains — though there is evidence that the gap has been narrowing. Whether it will close fully remains uncertain, as the available strategies and resources have proved limited.

Some studies indicate that progress toward achieving health parity has significantly slowed, with insufficient funding and a lack of national leadership identified as key contributing factors. Nevertheless, there is reason for cautious optimism. By increasing funding to support indigenous health initiatives, building the capacity of indigenous health organizations, and encouraging indigenous leaders to participate meaningfully in decision-making, indigenous health outcomes can be significantly improved. With sustained commitment, the goal of health parity by 2030 remains achievable (Rosenstock, Mukandi, Zwi, & Hill, 2013).

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