Indigenous health in Australia—moves in the right direction

Abstract

On July 23, the Australian Government announced the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, its new 10 year plan addressing health inequalities between Indigenous and non-Indigenous Australians. This plan follows on from a Health Performance Framework report published earlier this year, which outlined the health disparities faced by Indigenous Australians in Queensland and news that many Australian states, including Queensland, had reduced funding to Aboriginal community-health programmes. The plan sets out several principles that serve to structure the strategies put forward: notably, health equality and a human rights approach, together with Aboriginal and Torres Strait Islander community control and engagement, partnership, and accountability. A key feature of the plan that informs all these principles is addressing racism that has for many years hampered the access by Indigenous Australians to health care and to public health services. Overall, the plan seeks to make health equality a reality by 2031 by tackling the gap in life expectancy between Indigenous and non-Indigenous Australians, the gap in the mortality rate of children younger than 5 years, the gap in educational access and attainment, and the gap in employment outcomes. The plan recognises that the Australian health system is not accessed equally according to need. Indigenous Australians access health services at 1·1-times the rate of non-Indigenous Australians and yet their need of health services is estimated to be 2–3-times greater due to poorer health status. Indigenous people also receive fewer procedures and prescriptions than do non-Indigenous people with the same health conditions. This health disadvantage is the consequence of both the failure of mainstream services and the inability of Indigenous people to access these services. Beyond specific health outcomes, the plan also recognises that Indigenous Australians have a more holistic view of health—more than just the wellbeing of the individual the health of Indigenous Australians refers to the social, emotional, and cultural wellbeing of the whole community within which each individual can thrive. Culture strongly affects how Indigenous Australians interact with health services, be it when and why they seek out services, how likely they are to accept or adhere to treatment, and how likely prevention and health promotion strategies are to succeed. It is awareness and sensitivity to these issues that underpins the plan. In addition to direct health care, the plan also includes a strategy for the advancement of evidence-based practice to guide the care of Indigenous communities. More data on Indigenous people need to be collected and the availability, quality, and analysis of these data need to be improved at all levels: national, state, territory, and local. Underidentification of Indigenous people has hampered the monitoring of health outcomes. But beyond the pursuit of data, the plan states, research and evaluation activities should be done in a way that respects and values Indigenous people. The research process should be an equal partnership recognising that the input of communities is equally important to the output from researchers. In 2006 and 2009, two Series of reports on the health of Indigenous peoples were published in The Lancet. The conclusion of the 2009 Series was that not enough time had passed since the previous Series to see real results in terms of health indicators. We will seek to reassess progress, in The Lancet, in an upcoming report card on Indigenous health in Australia. But, disappointingly, the judgement might be that this too has come too soon to see measurable results, since the health plan states that implementation of its recommendations will be developed by the Australian Government in the coming 12 months and reviewed and reimplemented at least every 3 years. It is very welcome that the Australian Government has developed such an ambitious, comprehensive, and long-term plan for addressing the health inequalities faced by Indigenous Australians. However, it begs the question of how Australia, or any so-called developed nation, could have tolerated such health disparities for so long and why the plan still seems to lack a sense of urgency. It has long been time for all Australians to be truly treated as equals. The Minister for Indigenous Health, Warren Snowdon, concludes his foreword to the plan by stating that the government is “committed to fearless accountability”. However, it is not just the national government that must be held accountable but all the states and territories of Australia. The success of this plan rests on them all.