Close the Gap - Part 2 Outcomes from the National
Indigenous Health Equality
Close the Gap National Indigenous Health Equality
Summit Targets Outline Summary
The Council of Australian Governments has agreed to a partnership between all levels of government to work with Indigenous Australian communities to achieve the target of closing the gap on Indigenous disadvantage. COAG committed to:
- closing the life expectancy gap within a generation;
- halving the mortality gap for children under five within a decade; and
- halving the gap in reading, writing and numeracy within a decade.
The aim of these targets is to achieve the three COAG goals, and particularly the two health goals.
Hence they address:
- the main components of excess child mortality – low birth weight, respiratory and other infections, and injuries;
- the main components of life expectancy gap – chronic disease (cardiovascular disease (CVD), renal, diabetes), injuries and respiratory infections account for 75% of the gap. CVD is the largest component and a major driver of the life expectancy gap (~1/3); and
- mental health and social and emotional well being, which are central to the achievement of better health.
The achievement of the COAG goals requires a far more effective approach to Aboriginal and Torres Strait Islander health and in particular, those factors which are major contributors to current gaps in child mortality and the life expectancy gap.
The Campaign partners are therefore presenting an integrated set of Close the Gap targets. These targets are designed to support the commitment in the Statement of Intent, signed in Parliament House Canberra on March 20, 2008:
“To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities in health services, in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030”
While it is essential to ensure that there are effective programs, ‘cherry picking’ specific targets will not achieve the COAG goals. Effective delivery of health services for any individual topic requires an adequate infrastructure for general health service delivery.
The primary health care model used all around the world is that services are delivered by generalist health workers and medical practitioners, backed up by specific staff and resources. However, having a sufficient supply of generalist health workers and medical practitioners is a prerequisite for the specific programs.
Campaign partners places far more reliance on programs to achieve the goals of equal access for equal need and equal health outcomes. It is of limited value to say a particular condition or factor is important unless it is clear what the health target is, how it is to be achieved, indicative expenditure required (both recurrent and capital), program, workforce and infrastructure requirements to provide the necessary services and the monitoring, evaluation and management processes required. The integrated sets of targets are designed to deal with these requirements, and mark a turning point for Aboriginal and Torres Strait Islander services. In particular as agreed by COAG, a par tnership approach is proposed, involving Aboriginal people and their representative bodies, health agencies,
government agencies and the wider community.
These targets should be seen as the first step in a continuing process, where their refinement and implementation can be conducted through a genuine partnership between government and Aboriginal and Torres Strait Islander and other organisations.
The details of the structure and processes of this partnership will have to be determined and are essential to the achievement of the COAG goals. A fresh Government approach to partnership and to its management, monitoring, evaluation and review processes is essential for the achievement of the COAG goals – a little bit more of the same will not close the gap.
The main elements of the targets are set out below, preceded by relevant extracts from the Statement of Intent in text boxes.
1. Partnership Targets
This is a statement of intent – between the Government of Australia and the Aboriginal and Torres Strait Islander Peoples of Australia, supported by non-Indigenous Australians and Aboriginal and Torres Strait Islander and non-Indigenous health organizations – to work
together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030.
We recognise that specific measures are needed to improve Aboriginal and Torres Strait Islander peoples’ access to health services. Crucial to ensuring equal access to health services is ensuring that Aboriginal and Torres Strait Islander peoples are actively involved in the design, delivery, and control of these services.
We commit: To ensuring the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs.
(a) Frameworks for participation:
The establishment of national framework agreements to secure the appropriate engagement of Aboriginal and Torres Strait Islander peoples and their representative bodies in the design and delivery of accessible, culturally appropriate and quality health services.
2. Health Status Targets
We share a determination to close the fundamental divide between the health outcomes and life expectancy of the Aboriginal and Torres Strait Islander peoples of Australia and
(a) Maternal and Child Health
Reduce low birth weight, control infections particularly gastroenteritis and respiratory infections, maternal education, dedicated services for mothers and babies.
(b) Chronic disease:
- Secondary prevention of chronic disease – risk identification and management including health checks.
- Acute care – reduce time to admission and implementation of care guidelines for CVD, diabetes, chronic kidney disease (CKD).
- Tertiary prevention – services for cardiac rehabilitation, CKD, stroke.
(c) Mental health and emotional and social well-being:
- Reduce the impact of loss, grief and trauma.
- Reduce the disparity in suicide rates and mental health disorders including depression, and psychosis.
- Improve mental health outcomes and reduce adverse events for Indigenous patients including Indigenous people with chronic disease, substance abuse or in custody.
3. Primary Health Care and other Health Services Targets
We are committed to working towards ensuring Aboriginal and Torres Strait Islander peoples have access to health services that are equal in standard to those enjoyed by other Australians, and enjoy living conditions that support their social, emotional and cultural well-being.
We recognise that specific measures are needed to improve Aboriginal and Torres Strait Islander peoples’ access to health services.
We commit: To ensuring primary health care services for Aboriginal and Torres Strait Islander peoples which are capable of bridging the gap in health standards by 2018
To supporting and developing Aboriginal and Torres Strait Islander community-controlled health services in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal and Torres Strait Islander health and wellbeing.
To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples.
To respect and promote the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable, and of good quality.
(a) A Capacity Building Plan
For culturally appropriate Aboriginal and Torres Strait Islander primary health care services
(governance, capital works and recurrent support) to provide comprehensive care to an accredited standard to meet the level of need.
(b) Mainstream health services
Improve access to MBS/ PBS, AHCA, GP Divisions, specialist outreach.
(c) Specific Programs:
- Mothers and children – national coverage of Maternal and Child Health services (see Health targets), Rheumatic Fever/ Rheumatic Heart Disease (see Health targets), home visits, nutrition,
- Chronic disease – implement National Chronic Disease Strategy and National Service Improvement Framework, screening,
- Prevention – smoking, alcohol and substance misuse, physical activity and nutrition
- Mental and social-emotional well-being – mental health, men’s health including suicide prevention.
- Other – men’s health, oral, environmental, vaccine preventable, communicable disease.
4. Infrastructure Targets
We commit: To ensuring primary health infrastructure for Aboriginal and Torres Strait Islander peoples which is capable of bridging the gap in health standards by 2018. To measure, monitor, and report on our joint efforts, in accordance with benchmarks and targets, to ensure that we are progressively realising our shared ambitions.
National Training Plan for Aboriginal and Torres Strait Islander doctors, nurses, allied health workers, dentist, AHWs; recruitment and retention, training programs for non-Indigenous health workforce; National Network of Health Centres of Excellence for services, teaching and research.
(b) Capital works and equipment
(c) Engagement of Aboriginal and Torres Strait Islander communities
(d) Housing - Home maintenance, housing design.
(f) Health information and data.
5. Social Determinants Targets
(A separate process is required for the development of targets for these topics of fundamental
We are committed to ensuring that Aboriginal and Torres Strait Islander peoples have equal
life chances to all other Australians.
We commit: To working collectively to systematically address the social determinants that
impact on achieving health equality for Aboriginal and Torres Strait Islander peoples.
(b) Community safety.
(d) Community development.
(f) Criminal justice system review and reform.
The details of each of these targets, together with timelines and indicative resource requirements, are outlined in the tables that follow.