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MEDICAL leaders have called on the major political parties to maintain the momentum in closing the gap in health outcomes between Aboriginal and Torres Strait Islander people and the general community in the approach to the 2013 federal election.
AMA president Dr Steve Hambleton said whichever party was elected to government, it was crucial that the work to close the gap continued.
“We need to keep the pedal pushed to the metal. With some early, promising signs of success being delivered, now is not the time to take the foot off the accelerator”, he said.
The current federal government had agreed to re-commit to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and had pledged continuation of funding of $777 million over 3 years for the services started under the package. The government had also called on all states to commit to the agreement, Dr Hambleton said. (1)
In this week’s MJA, Professor Kerry Arabena, director and chair of Indigenous health at the University of Melbourne’s Onemda VicHealth Koori Health Unit, said systematic, long-term action was needed to continue to “realise true health equality”. (2)
Professor Arabena also called for improved data collection to help to measure the impact of programs and to guide future plans, applauding recent efforts to develop a National Aboriginal and Torres Strait Islander Health Plan. (3)
Dr Tammy Kimpton, president of the Australian Indigenous Doctors’ Association, told MJA InSight both sides of politics had acknowledged that achieving health care equality for the Aboriginal and Torres Strait Islander communities would be a long-term goal — with a target of 2030 for health care parity.
“If we want to close the gap in life expectancy in Australia, we really need a clear, well-resourced plan with specific measurable outcomes developed in partnership with Indigenous health leaders”, said Dr Kimpton, adding that she was hopeful that this could be achieved with development of the new national health plan.
Dr Kimpton said increasing the number of Aboriginal and Torres Strait Islander professionals across all spectrums of health care was also key. She said that the past 15 years had seen sharp increases in the number of Aboriginal and Torres Strait Islander medical students, but greater support was needed to ensure these students also graduated.
Dr Hambleton agreed that a long-term plan was essential and said that drafting of the National Aboriginal and Torres Strait Islander health plan could provide the necessary guidance.
However, he said in addition to long-term goals, the plan should include short-term, measurable targets, to ensure governments over the next 20 years contributed to the delivery of the final outcome.
“It needs to have identifiable targets and goals in the short term with ways to measure [those goals], so we don’t get the idea that it’s a 20-year problem and we will worry about it [later],” he said, adding that, with focused goals, closing the gap within a generation was “entirely feasible”.
In the MJA, Professor Arabena wrote that to continue to improve Indigenous health outcomes it was also important to tackle some of the “less palatable” aspects of the health system, such as racism.
“Embodied in dubious practices, disparities in access and subtle variations in effort within health and other institutions and programs, racism has had and continues to have a real and damaging impact on the health of Aboriginal and Torres Strait Islander people”, she wrote.
Dr Kimpton agreed, saying covert racism was still “alive and well” in health care institutions and training institutions.
“For education and training institutions this is sometimes things like not offering health careers to Aboriginal and Torres Strait Islander students as an option because [of an assumption] they probably won’t be able to achieve the standard required for entry.”
Dr Kimpton said having open discussions about racism in health care were an important first step to addressing the issue.
1. COAG: National partnership agreement on closing the gap in Indigenous health outcomes
2. MJA 2013; 199: 22
3. Australian Government: National Aboriginal and Torres Strait Islander health plan
Chris Strakosch makes an interesting point. Is the corollary that identifying as Aboriginal reduces patient access to mainstream services ? Are there any studies comparing the health of people of Aboriginal ancestry who do not identify to health services as Aboriginal with those who do, in urban, rural and remote communities?
In my experience , “limitless” health dollars which are supposed to be spent on Aboriginal patients are consumed by bureaucrats, federal, state and Medicare Local. Endless goodwill , while found at each level of health care, is not universal.
If the gap is not closing, perhaps one aspect of “mainstream” private practice could be applied to Aboriginal health funding-that of fee for service, so that funding is delivered only at the point of service delivery to the patient. for medical and all other health services.
The good health enjoyed by non indigenous Australians is part of the fabric of an advanced Western society and cannot be dissected out as a separate phenomenon. Equality in health as with equality in education and everything else will only come when Aborigines join mainstream Australia. Aborigines can still maintain a special identity but will otherwise never achieve the desired goals even with limitless resources and endless goodwill.