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The Indigenous Health Crisis: A Summary “If you were an Indigenous citizen of this country,
How big is the problem? The health of Indigenous Australians is the worst in the developed world, with life expectancies 20 years less than other Australians. Alarmingly, the crisis is getting worse rather than better. In similar countries, such as New Zealand, the US and Canada, the health of Indigenous peoples has been rapidly improved by determined government action over the last 25 years. Why not in Australia? Despite its severity, the Indigenous health crisis is both solveable and preventable. The Right to Health “The enjoyment of the highest attainable standard of health
is one of the fundamental rights of every human being without distinction
of race, religion, political belief, economic or social condition.” Health is a human right that is directly linked to other fundamental human rights: housing, education, employment, Indigenous rights to self-determination, enjoyment and protection of their cultures and relationships to land. This link between health and rights was acknowledged in the National Strategic Framework for Aboriginal and Torres Strait Islander Health, endorsed in July 2003 by all Australian governments, which has as its goal: “To ensure that Aboriginal and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice.” Why is Indigenous health so bad? The answer is a compound of social and economic disadvantage - poverty, poor nutrition, poor housing, low education levels and high unemployment – along with social marginalisation, prejudice and racism. [2] These negative social conditions and the poor health typically associated with them have been compounded by the long term failure of governments to fulfil their responsibilities to provide adequate services and infrastructure for Indigenous communities and to address the socio-economic disadvantage of Indigenous people. In tackling health and disadvantage, a significant difference between Australia and countries such as Canada, New Zealand and the US, is the existence of treaties which have resulted in more direct federal government responsibility. This has enabled better coordinated health services, and improved access to resources and infrastructure. [3] How do we address the problems? We already know where to start. Many inquiries and reports have produced the same recommendations. All that is wanting is the political will to implement these recommendations. A National Aboriginal Health Strategy (NAHS) was developed in 1989. The principal finding of the 1994 Review of the NAHS was that ‘the NAHS was never effectively implemented’ (See 'Key Recommendations' below). Responsibility lies primarily with Commonwealth, state and territory governments that have control over policy implementation, funding provision and Indigenous participation. [4] Initiatives such as the Commonwealth Government's Primary Health Care Access Program (PHCAP) are steps in the rights direction, however, available funding is way below what is required to meet current needs (see 'How much will it cost?' below). It’s time to act! The latest incarnation of the NAHS, the National Strategic Framework for Aboriginal and Torres Strait Islander Health - A Framework for Action by Governments, says that “whilst some significant successes have been realised, the ad hoc approaches of the past have resulted in many unsustainable programs, uncoordinated activity, gaps, duplication and inefficient use of resources.” It is not good enough to revise strategy every few years. It is well past time to act.
What works? The Indigenous health crisis can be solved and we already have a good understanding of what works. Indigenous Australians experience many barriers to accessing mainstream health services. Aboriginal community-controlled health services have therefore proved to be a critical element, having delivered 1.34 million episodes of primary health care in 2001-2. [5] Development and strengthening of the sector is needed to further improve outcomes. For example, the recent Coordinated Care Trial involving the pooling of Northern Territory and Commonwealth health funding to the Aboriginal-controlled Katherine West Health Board, has been a clear success. [6] The Board, which directly manages Indigenous health services for the entire region, has delivered significant improvements in health care. The Aboriginal-controlled Maari Ma Health Service in Broken Hill is another success story. With a health agreement with NSW and the Commonwealth and a partnership with the Royal Flying Doctor Service, Maari Ma provides health services for both Indigenous and non-Indigenous communities across the entire western NSW region. [7] Such new approaches complement existing Aboriginal controlled health services, such as the Nganampa Health Council, which has provided comprehensive primary health care services to the Anangu Pitjantjajara Lands for over 20 years. These success stories demonstrate the importance of Aboriginal control based on principles of self-determination and effective community governance. [8] They also demonstrate the importance of governments adopting a cooperative approach based on meaningful negotiation with and participation of Indigenous communities. Indigenous health services are not the whole of the solution. Effort is also required to ensure better, and more culturally-appropriate access to mainstream medical services. There are other essential elements to solving the health crisis. Foremost is adequate and sustained funding based on need. Indigenous health problems require more than band-aids. Inadequate, short-term funding cannot produce lasting improvements. A skilled and appropriate workforce is also essential. [9] Recent research for the AMA estimated that a 50% increase in doctors and allied health professionals working in Indigenous health is required. [10]
How much will it cost? Access Economics was commissioned by the AMA to estimate workforce and funding needs in Indigenous health. They estimated afunding shortfall of $452.5 million a year, including $400 million in primary health care services . [11] Australia spends over $60 billion annually on health. [12] The additional funding required to achieve equitable health outcomes for Indigenous people amounts to less than 1% of this total expenditure. Yet in the 2004/05 Federal Budget, only $10 million a year was provided in additional funding for primary health care - 40 times less than Access Economic' estimation of need! « Back
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