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THE commitment in 2007 to closing the gap between the health status and life expectancy of Aboriginal and Torres Strait Islander people and non-Aboriginal Australians has been heralded as a defining point in Australia’s history.
Despite widespread support for the sentiment behind the call to “close the gap”, one could argue there has been little enduring, system-wide change since the signing of the agreement. Aboriginal and Torres Strait Islander people continue to experience significant disparities in life expectancy arising from a complex interconnection of social determinants, barriers to accessing health care and inequities in receiving evidence-based care.
Enduring initiatives to close the gap need to be comprehensive and strategically targeted in nature, and systematic in their implementation.
We have recently developed and disseminated a practical, system-wide approach purposefully focused on the prevention and management across the continuum of care for a disease that carries the greatest mortality and morbidity burden — cardiovascular disease.
Focusing on cardiovascular disease has enabled us to gain the knowledge and evidence needed to develop tangible actions in an area that is recognised as a priority by the Aboriginal and Torres Strait Islander community.
The mission, in response to the identified need by the Cardiac Society of Australia and New Zealand in 2009, was to document the gap in mortality and define equity in service delivery by developing a set of essential, minimum service standards.
This process started in 2011 with a group of experts in cardiovascular health and Aboriginal and Torres Strait Islander service provision. Following an evidence review, a set of evidence-based standards has been developed overlayed with an understanding of the needs of Aboriginal and Torres Strait Islander people.
From this, the Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander people — ESSENCE — were born.
They include overarching cardiovascular standards as well as standards for coronary heart disease, stroke, heart failure, hypertension and rheumatic heart disease.
The creation, publication and promotion of ESSENCE are the first steps in a nationwide translation of the evidence into policy-relevant action. The standards can be used to drive improvements in care, planning, prevention and monitoring of the cardiovascular health of Aboriginal and Torres Strait Islander people by identifying areas that strategically contribute to closing the gap.
Clinicians have two important roles in regard to ESSENCE.
The first is to proactively apply the standards in everyday practice, whatever your position or role within the system — prevention, primary care, acute care or rehabilitation. Some of the standards can be implemented immediately through individual or small team practice change and little, if any, systems change.
The second is to drive the adaption of existing systems or the development of new systems to support the implementation of the standards to enable appropriate evidence-based cardiovascular care for all Aboriginal and Torres Strait Islander clients at all times.
At a national, state and community level there are efforts to enable the standards to underpin system reform, particularly by working with existing national reforms aimed at influencing policy and practice.
The next stage is developing measurement indicators to support the implementation of the standards across the system, and a further project aimed at primary care via the proposed primary health networks.
Developing systems to measure progress, implementing evidence-based practical and resource actions, and evaluating health system performance will be required to ensure that the gap is actually closing.
Professor Alex Brown and Professor Garry Jennings developed ESSENCE with a national steering committee of experts in Aboriginal and Torres Strait Islander cardiovascular care. Professor Brown is program leader of Aboriginal research at the South Australian Health and Medical Research Institute, Adelaide, and Professor Jennings is director and chief executive officer of the Baker IDI Heart and Diabetes Institute.
The authors acknowledge the assistance of Rebekah O’Shea, Kathy Mott, Katharine McBride, Tony Lawson and Wendy Keech.
A useful document, that applies generally, but for Aborigional people, it seems a top down, medical rather than a social approach, looking at their miserable situations in remote Australia. It can clearly apply in rural/urban areas.
Three years ago, I spent 10 days in a remote community of 300 residents, on “the intervention”. Not one male had a job, CDEP had been cancelled, so the men sat around and smoked/drank/gambled in the daytime. Fresh fruit/vegetables were a frightful price, trucked from Darwin, and their homes were unrepaired, filthy, with broken sewerage/ roaming dogs,an irregular electricity supply too.
Few seemed interested in taking drugs, and even less in regular exercise. Obesity rampant.
The single nurse was preoccupied with the 80 children, health screening, and bureaucracy, with almost no time for health education.
To my mind, and talking with the locals, secure land rights, jobs, and social harmony will lead to them contemplating useful, fulfilling lives, and help to reduce smoking, drinking, improve diet and the CV risk factors that this plan advocates.
A robust document which could be more generally applicable. Hypertension is included as one of the 7 Tables in the ESSENCE document describing Essential Services Standards. Given that diabetes is substantially increased in the indigenous population and a strong contributor to cardiovascular disease (albeit with a different, more chronic, time-line compared with other modifiable risk factors such as hypertension and dyslipidaemia), I wonder why it did not merit its own tabulated set of standards in the document. It could be inferred that hypertension is of greater importance than diabetes in management of indigenous patients.