The Australian Government is committed to closing the gap in life expectancy between Indigenous and non-Indigenous Australians. Achieving health equality is a core priority for the Government. The Government recognises that good health is a key enabler in supporting children to go to school, enabling adults to lead productive working lives, and building strong and resilient communities.
Closing the Gap – Prime Minister’s Report 2016 shows some positive trends in the health outcomes of Aboriginal and Torres Strait Islander people. Whilst there has been improvements in child mortality and life expectancy, there is much more to be done. Notable improvements in cardiovascular and respiratory disease outcomes, as well as reductions in smoking rates, will drive further improvements over time.
There remains significant work to be done in this area as Indigenous Australians continue to experience poorer health outcomes at higher rates and younger ages than non-Indigenous Australians.
Funding for Indigenous health
From 2016-17 to 2019-20 the Government will invest $3.4 billion through the Indigenous Australians’ Health Program (IAHP), an increase of over
$630 million when compared with the previous four years.
In 2015, the Government announced $85 million over three years from July 2016 to improve access to culturally sensitive, integrated mental health services for Aboriginal and Torres Strait Islander people, commissioned at the local level by Primary Health Networks (PHNs), with the close involvement of Aboriginal Community Controlled Health Services.
On 6 December 2015, the Government announced $241 million over four years from July 2016 for local alcohol and drug treatment services in response to the National Ice Taskforce’s Final Report. This will include a specific investment in local Aboriginal and Torres Strait Islander services given the impact of ice in many Indigenous communities.
The Government is expanding activity in the key priority areas of child and maternal health, and chronic disease prevention and management, building on proven strategies to close the gap and achieve health equality between Indigenous and non-Indigenous Australians.
Improving health outcomes for mothers and babies
The Government is committed to improving health outcomes for children and families and to halving the gap in child mortality for children aged less than five years.
There is strong evidence that long-term gains in the health status of Aboriginal and Torres Strait Islander people will come from investing in the early years of life and in supporting children and their families at this point in the life cycle. Programs that improve child health and wellbeing, commencing at preconception and continuing for the first five years of life, contribute to improved health, education and employment outcomes across the lifespan1 .
The 2014-15 Budget measure provided funding of $94 million for the Better Start to Life approach with the aim of increasing access to Aboriginal and Torres Strait Islander antenatal and postnatal care. Beginning in July 2015 under the IAHP, the Better Start to Life approach has involved the phased expansion of two established maternal, child and family health activities: the Australian Nurse–Family Partnership Program and New Directions: Mothers and Babies Services.
- New Directions: Mothers and Babies Services delivers child and family health services in a primary health care setting to improve the health of Indigenous Australians by improving access to: antenatal and postnatal care; standard information about baby care; practical advice and assistance with breastfeeding, nutrition and parenting; monitoring of developmental milestones, immunisation status and infections; and child health checks and referrals for Indigenous children before starting school.
- the Australian Nurse–Family Partnership Program is an evidence-based nurse-led home visiting program that supports women pregnant with an Aboriginal and Torres Strait Islander child from around 16 weeks gestation to 2 years of age. The program provides comprehensive support for antenatal and postnatal care, child health and development and parental life-course support to assist parents to develop a vision for their future and fulfill that vision by planning future pregnancies, completing their education and finding work.
The Government is also working to strengthen the links between child and family health services for Aboriginal and Torres Strait Islander families and other early childhood services that support families with high needs.
The Department of Health is working with the Department of Education and Training to deliver more integrated early childhood services in up to 16 sites across Australia in response to recommendation 1 of the Forrest Review, Creating Parity
Access to primary health care services
Government expenditure on Indigenous health has supported improved access to primary health care services for Aboriginal and Torres Strait Islander people.
It is estimated that Aboriginal and Torres Strait Islander people received 8.7 million Medicare-rebated services in 2015-16, of which 4.2 million were for GP services. The rate of GP Medicare services claimed by Aboriginal and Torres Strait Islander people has almost doubled over the ten-year period to 2015-16. The total number of health services provided would be higher as these figures do not include services that cannot be claimed from Medicare.
Medicare health assessments for Aboriginal and Torres Strait Islander people quadrupled between July 2009 and June 2016, increasing from approximately 45,000 in 2009-10 to over 195,000 in 2015-16.
There has also been a steady increase in the take-up of the Medicare chronic disease management items. In 2015-16, there were around 168,000 Medicare chronic disease plan items claimed for Aboriginal and Torres Strait Islander people. This is more than double the number claimed five years earlier in 2011.
By June 2016, approximately 407,900 Aboriginal and Torres Strait Islander people benefited from the Closing the Gap PBS Co-Payment measure and 17.8 million prescriptions were dispensed.
Tackling Indigenous smoking
The Tackling Indigenous Smoking program funds 37 regional grants to deliver best practice tobacco control approaches. The program supports locally-designed population health activities to: increase knowledge on the impacts of smoking; promote the benefits of not smoking; improve access to support; and build capacity of individuals and organisations to target and reduce Indigenous smoking in their communities. National supports include funding to enhance Quitline services for Aboriginal and Torres Strait Islander callers, training in brief interventions and a National Best Practice Unit.
The program also funds seven innovation grants, targeting critical smoking behaviours within Aboriginal and Torres Strait Islander communities, particularly pregnant women and young people in remote communities. These grants deliver intensive smoking prevention and cessation activities, coupled with research and evaluation.
National Tobacco Campaign
In 2015-16, the Government also invested $10 million for an Indigenous-specific National Tobacco Campaign. Resources for the campaign are available on the Quitnow website
Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013–2023)
The Implementation Plan was launched in October 2015 and outlines the actions to be taken by the Australian Government, the Aboriginal community controlled health sector and other key stakeholders to give effect to the vision, principles, priorities and strategies of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023
. The Implementation Plan has multi-partisan support as a key component towards Closing the Gap. It is comprised of seven domains: health systems effectiveness; maternal health and parenting; childhood health and development; adolescent and youth health; healthy adults; healthy ageing; and the social and cultural determinants of health.
To monitor progress, the Implementation Plan introduces 20 new goals that deal broadly with improving the health of pregnant women, reducing smoking, tackling diabetes, providing more health checks and achieving better immunisation rates.
The Implementation Plan is iterative and being progressed in two stages. The first stage (2015-2018) is to strengthen the health system to:
- respond flexibly to identified needs and service gaps;
- support Aboriginal and Torres Strait Islander people to make healthy choices; and
- provide culturally safe access to quality early intervention and treatment services.
The second stage of the Implementation Plan will include:
- development of Domain 7 - Social and Cultural Determinants of Health;
- increased engagement and involvement with other Australian Government agencies, state, territory and local governments, the Aboriginal community controlled health sector, the non-government sector and the corporate/private sector;
- new challenges and priorities;
- emerging evidence and opportunities; and
- strategic responses on mental health, social and emotional wellbeing, suicide prevention and alcohol and other drug use.
The Implementation Plan Advisory Group (IPAG) has been established to provide advice to the Australian Government Departments of Health and the Prime Minister and Cabinet as they monitor and review the Implementation Plan. In addition to officials from these departments and the Australian Institute of Health and Welfare, IPAG has representation from the National Health Leadership Forum and the National Aboriginal Community Controlled Health Organisation. Indigenous experts on early childhood, primary and acute care are also represented.
IPAG met in September and December 2016 to provide advice in relation to the Implementation Plan. IPAG has identified systemic racism and the social and cultural determinants of health as key issues to be addressed.
The Department of Health has established a cross-portfolio working group to develop a whole-of-government blueprint to address the Social and Cultural Determinants of Health in the 2018 iteration of the Implementation Plan.
Karoly, L, Kilburn, R Cannon, J (2005) Early Childhood Interventions : Proven Results, Future Promise