Does evidence influence policy? Resource allocation and the Indigenous Burden of Disease study.

Christopher M Doran,Peter Hill,Rod Ling,Andrew Searles

doi:10.1071/ah15105

Abstract

Objective The Indigenous Burden of Disease (IBoD) report is the most comprehensive assessment of Indigenous disease burden in Australia. The aim of the present study was to investigate the potential effect of the IBoD report on Australian Indigenous health policy, service expenditure and research funding. Findings have significance for understanding factors that may influence Indigenous health policy. Methods The potential effect of the IBoD report was considered by: (1) conducting a text search of pertinent documents published by the federal government, Council of Australian Governments and the National Health and Medical Research Council of Australia (NHMRC) and observing the quantity and quality of references to IBoD; (2) examining data on government Indigenous healthcare expenditure for trends consistent with the findings and policy implications of the IBoD report; and (3) examining NHMRC Indigenous grant allocation trends consistent with the findings and policy implications of the IBoD report. Results Of 110 government and NHMRC documents found, IBoD was cited in 27. Immediately after publication of the IBoD report, federal and state governments increased Indigenous health spending (relative to non-Indigenous), notably for community health and public health at the state level. Expenditure on Indigenous hospital separations for chronic diseases also increased. These changes are broadly consistent with the findings of the IBoD report on the significance of chronic disease and the need to address certain risk factors. However, there is no evidence that such changes had a causal connection with the IBoD study. After publication of the IBoD report, changes in NHMRC Indigenous research funding showed little consistency with the findings of the IBoD report. Conclusions The present study found only indirect and inconsistent correlational evidence of the potential influence of the IBoD report on Indigenous health expenditure and research funding. Further assessment of the potential influence of the IBoD report on Indigenous health policy will require more targeted research, including interviews with key informants involved in developing health policy. What is known about the topic? There are currently no publications that consider the potential effed of the IBoD study on Indigenous health expenditure and research funding. What does this paper add? This paper offers the first consideration of the potential effect of the IBoD report. It contains analyses of data from readily available sources, examining national expenditures on Indigenous health and NHMRC Indigenous research, before and after the publication of the IBoD report. What are the implications for practitioners? The paper is relevant to analysts interested in drivers of Indigenous health policy. Although it finds correlations between the release of the IBoD report and some subsequent health spending decisions, other factors should be investigated to better understand the complexity of processes that drive government efforts to improve Indigenous health.

Highlights

The years 2007 and 2008 were significant for Australian Indigenous health policy
The present study found only indirect and inconsistent correlational evidence of the potential influence of the Indigenous Burden of Disease (IBoD) report on Indigenous health expenditure and research funding
Further assessment of the potential influence of the IBoD report on Indigenous health policy will require more targeted research, including interviews with key informants involved in developing health policy

Summary

Introduction

Committed to eliminate differences in Indigenous and nonIndigenous life expectancy and infant mortality.[2] In 2008, the new federal government began its first parliament by making the Apology to Australia’s Indigenous Peoples.[3] The Prime Minister signed the Statement of Intent, committing to close the Indigenous and non-Indigenous health gap.[4] Later in 2008, COAG developed targets and timelines to achieve Indigenous health equality.[5] Coinciding with these events was the 2007 publication of the Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003 (hereafter referred to as the IBoD report).[6] This report identified the extent and causes of Indigenous health problems and quantified the contribution of key risk factors. It found 11 major significant risk factors behind the inequity in burden of disease: tobacco smoking, obesity, physical inactivity, high blood cholesterol, alcohol, high blood pressure, low fruit and vegetable intake, illicit drugs, intimate partner violence, child sexual abuse and unsafe sex

Methods

Results

Discussion

Conclusion