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Preference: Indigenous Health

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Rural health – the continuing challenge

Rural health is frequently inferior to city health. This old generalisation covers much contradictory detail, and exceptions abound: according to the Australian Institute of Health and Welfare, the life expectancy of non-Indigenous women in 2002-04 was much the same – 84 – whether they lived in big cities or very remote areas.  For men, the difference is a matter of six months or so. And it is not a rigid generalisation: increasingly sophisticated broadband-enabled communications and ever-more efficient transport have reduced the gap between city and country. 

Nevertheless, the numbers and the facts suggest that the accumulation of wealth, talent and many other features of contemporary city life confer a small advantage in life expectancy and wellbeing on city-dwellers. This disparity challenges those who hold the value that one of our social duties is to ensure, as far as possible, equality of opportunity to health and health care to all Australians. What should we do?

Two pathways to action present themselves for our consideration.

The first, and the one most easily grasped by the medical profession, concerns access to medical care in the rural setting. Massive technologically-based services can only be provided in large cities, and lesser technology-dependent services need at least strong regional bases.

We are getting better at finding ways to make these technologies available in relation to services such as radiotherapy, relieving the pressure on country women to favour radical breast surgery because they cannot afford the time and separation for chemo and radiotherapy.

But as we concentrate on providing rapid care for people with acute coronary syndrome and stroke (an increasing possibility in cities), the challenge of providing similar care in remote parts of the country may be beyond us at present.

The attitude of some to this problem – that those who live in remote parts of the country do so entirely by choice – is similar to saying that drowning people should be left, as they chose to swim or go boating.

But with telehealth, and many large city medical services increasingly interested in providing networked services to places that lack them, the problem is being partially addressed.

The search for equality of access may well require affirmative funding, and this has been recognised to some extent in fee structures and remuneration.

Equality does not mean paying the same for the care of people in different places: we need to accept that services provided beyond cities will cost more, and ensure that we finance them accordingly.

There are also concerns, raised most recently by Max Kamien, Emeritus Professor of General Practice at the University of Western Australia in Medical Observer, that the relaxation of hiring rules in many rural areas will “open the floodgates” to corporate practices.

While on the surface of it, a boost to the number of doctors working in rural areas would be welcome, this is not the case if they are being employed on short-term contracts to simply churn through large numbers of patients, and leave more challenging and time-consuming cases to existing practices. The focus needs to be on quality of care, not just quantity.

The extent to which the learned colleges have recognised the need for greater action on behalf of their rural members has been variable.

A framework for rural health developed by representatives of all Australian states, territories and the Commonwealth in 2011, recognised the need to be sensitive to the special needs of older people, babies and children, Aboriginal and Torres Strait Islander people, people with chronic disease, refugees and people from culturally and linguistically diverse backgrounds.

The second approach to rural health disparities takes us well beyond the surgery.

Even with networked services, e-health, and affirmative funding, we are faced with residual differences in health status that are attributable to the social and economic context of rural and remote life.

Medicine cannot, for example, diminish the vast distances many country people have to drive, every kilometre increasing their risk of a serious accident. At best, it can be sensitive to distance when arranging care of patients with continuing problems.

Medicine cannot do much to promote high-quality educational opportunity, although the development of regional universities and technical education capacity has been impressive in the past three decades.

Rural clinical schools have done a remarkable job in acquainting future medical practitioners and other health professionals with the challenges and opportunities of rural practice, and the long-term effects of this intervention will be seen in the next 20 years.

Medicine, though, has no influence over agricultural and extractive industry policies, all of which have great significance for employment and economic sustainability in rural communities.

These environmental factors – the social determinants of health – set the health agenda.

Some fall within the sphere of influence of public health, but many are well beyond even its wide reach.

Their importance was reviewed in a paper by Jane Dixon, from the ANU, and Nicky Welch, from Waikato University, in The Australian Journal of Rural Health in 2000. ‘What is it about rural places or the rural experience that contributes to different health outcomes?’ they ask.

The broad-spectrum advocacy of the Rural Doctors Association of Australia and the Rural Health Alliance contribute to the wider political and policy agenda that may help us to answer this question and to make serious progress.

It is vital for medicine to respond to the needs of rural communities as they are, not as they might be in a reimagined ideal world.

My sense is that we are making steady progress.  The indicators that we have favour an optimistic view.

An up-close view of Indigenous health – good and bad

Professor Owler meets with staff at a remore community health service in the Northern Territory

By AMA President Professor Brian Owler

No running water, overcrowded and non-functional houses, lack of affordable healthy food, no essential services and crippling rates of diabetes, kidney disease and communicable infections – these are just some of the issues that people living in remote Northern Territory communities such as Utopia, Ampilatwatja and Kintore endure every day. On a recent visit to these three communities, I gained a deeper understanding of local health issues and the challenges that doctors and nurses face in delivering health services in remote areas.

In meeting with local Aboriginal leaders and health and medical staff, I found that each community has their own unique challenges; but the overall messages that I heard were strikingly similar. Funding for local health services is inadequate, it is difficult to attract skilled health and medical professionals to work in remote areas, it is logistically challenging to provide health care in remote communities (particularly when patients need to be transported for specialist care), and the level of chronic diseases in these communities are alarming.

Take diabetes, for example. In Kintore, 130 of the community’s approximately 450 residents have non-gestational diabetes – almost a third of its entire population – and in every three houses, one person is on dialysis due to the onset of kidney disease. What is even more concerning is the young age that Aboriginal people are being diagnosed with diabetes. In Utopia, a seven year-old girl was recently diagnosed with type 2 diabetes, and in Ampilatwatja, a 13 year-old girl was diagnosed with the same condition. Among the broader Australian population, or perhaps anywhere in the world, it is unheard of for child so young to be diagnosed with type 2 diabetes, yet it is clearly visible in remote Aboriginal communities.

The lack of water and affordable healthy food in remote communities is strongly linked to the epidemic levels of diabetes among Aboriginal people in these areas. Sugary drinks are more readily available than diet soft drinks, and in some communities they are more accessible than running water. It is unfathomable that in Australia, communities are going without water – a basic human right and a necessity for good health and wellbeing. This is an issue that demands immediate attention and action by all levels of government – without it, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

One important lesson that I did learn while visiting these communities is that it is not all doom and gloom when it comes to Indigenous health. Yes, Aboriginal people in remote areas face great adversity, but they are patient, resilient, strong-willed and are determined to take control of their own health – there are some real positives happening.

At the Purple House, an Aboriginal-controlled dialysis service based in Alice Springs, I was told an inspiring story of Aboriginal people taking action to generate funds for more dialysis sites. Kidney disease is rife across central Australia, with many Aboriginal people developing this condition as a result of poorly controlled diabetes.

The need for dialysis in remote Aboriginal communities is extremely high and for many, treatment means leaving family and country to be treated in Alice Springs. To allow people to be treated on country and near family, Aboriginal artists from across the western desert region grouped together and painted artworks that were auctioned to raise funds. The auction raised more than $1 million, and Purple House was able to expand their dialysis services. They now operate across nine remote communities in the Northern Territory and Western Australia. Purple House also provides a mobile dialysis service via their ‘Purple Truck’, which travels to remote Aboriginal communities.

It is very rare that good news stories such as this are widely publicised, which is disappointing. We need to shed more positive light on Indigenous health, and Indigenous affairs more broadly in Australia.

The POCHE Centre for Indigenous Health and Wellbeing in Alice Springs is also making a positive contribution to the health of Aboriginal people. At the POCHE Centre, I learnt about the research currently being undertaken by PhD candidate Maree Meredith, a young Aboriginal woman from Queensland. Her research project aims to determine the role that art centres play in contributing to positive health outcomes for Aboriginal people across the Anangu Pitjantjatjara Yankunytjatjara (APY) lands. To ensure that this research was in line with cultural protocols and to ensure that appropriate data was collected, Ms Meredith worked with Anangu people to design and deliver a survey in the local language.

For many years, anecdotal evidence has suggested art centres make a significant contribution towards health and wellbeing, but there has been no empirical data. This study aims to provide reliable evidence that art centres improve the health and wellbeing of Aboriginal people in remote communities. This is also a clear example of building the capacity of local Aboriginal people to participate in the local workforce.

Aboriginal people know what they want – they know the best way to improve their health and wellbeing, and this must be acknowledged and supported if we are to truly close the gap.

While in Kintore, I spoke with Aboriginal leaders who mentioned that the local people prefer a traditional social and emotional wellbeing framework to be implemented in their community, rather than a Western one.

The community developed a proposal for Government funding for this initiative, but unfortunately it was not accepted.

Connection to culture is important to the health and wellbeing of Indigenous people, and is known to produce positive health and life outcomes, such as reduced incarceration rates.

Aboriginal people needed to be provided with a reason to stay in the communities where they are connected to their land, culture and families. Recent comments made by certain members of Parliament about subsidising the ‘lifestyle choices’ of Aboriginal people in remote areas are extremely concerning.

Within each of these communities, I was disheartened to see a world-class health system fail the Aboriginal people in remote communities. But, I was truly impressed by the resilience and determination of the local Aboriginal people and the passion, commitment and dedication of doctors, nurses and other health staff who work tirelessly such challenging environments.

I am extremely grateful to Warren Snowden, Member for Lingiari, for making visits to these communities possible, and for accompanying me throughout the trip. I am hopeful that we will see further progress made in improving health and life outcomes for Indigenous people across Australia.

 

 

 

 

                       

United effort needed to close health gap

Genuine collaboration across the political divide is needed if good intentions about close the gap on Indigenous health is to result in tangible improvements, AMA President Professor Brian Owler has said.

Professor Owler said that although there had been welcome progress on some measures of Indigenous wellbeing, a multipronged approach involving all levels of government and their agencies was vital if significant and enduring advances were to be achieved.

“As a nation, we have changed the way we talk about Aboriginal and Torres Strait Islander health and, as a nation, we can now take the next step to close the health and life expectancy gap,” the AMA President said in a statement to mark National Close the Gap Day.

“A genuine partnership between governments, across the political spectrum, would be a catalyst to achieving significant and much-needed health and lifestyle improvements for all Indigenous Australians.”

Government figures show smoking rates among Indigenous people are coming down, and the nation is on track to halve the mortality rate for Aboriginal and Torres Strait Islander children by 2018.

But Professor Owler said they continued to suffer from a high incidence of treatable and preventable conditions including type 2 diabetes, rheumatic heart disease, kidney disease and scabies.

Furthermore, Indigenous people were much more likely to have undiagnosed and untreated chronic conditions, and to suffer several problems simultaneously.

Combined, these factors have meant that Indigenous people are, on average, dying 10 years earlier than other Australians.

The Federal Government led by Tony Abbott turned the policy focus on to school attendance and employment, but Professor Owler said good health was fundamental to improvement in other areas and should be a priority.

“We have seen encouraging improvements in some areas of Aboriginal and Torres Strait Islander health and wellbeing over recent years, but we need to see consistency of positive outcomes across the country and across the major health indicators,” he said. “Much more needs to be done to close health inequality gap between Indigenous and non- Indigenous people [and] health should be a foundation that underpins improvements in other measures.”

The AMA has been a long-standing supporter of the Close the Gap campaign, and Professor Owler said National Close the Gap Day was an important reminder for all Australians to act to improve Indigenous health equality.

“It is inexcusable that Australia, one of the world’s wealthiest nations, can allow three per cent of its citizens to have poorer health and die younger than the rest of the population,” he said. “Closing the gap is everybody’s business.”

Adrian Rollins

AMA in the News

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Focus on health wins, Northern Territory News, 20 February 2015

AMA President Professor Brian Owler visited health facilities in Alice Springs, as well as the Indigenous communities of Utopia, Ampilatwatja, and Kintore. Professor Owler said Indigenous health gains might be slow, but it is important successes are not lost in a sea of depressing statistics.

Angry medicos urge action over plight of detainees, Sydney Morning Herald, 22 February 2016

AMA President Professor Brian Owler has savaged the Department of Immigration and Border Protection for what he says has been its intimidation of doctors who speak out about the plight of asylum seekers.

Row stymies e-health rollout, AFR Weekend, 27 February 2016

Pharmacists and doctors are feuding over the Federal Government’s struggling electronic My Health Record system. AMA President Professor Brian Owler said the organisation backed e-health records as a way of controlling health costs, but the Government had failed to ask medical specialists what they needed to make My Health Record work.

Hangover cure no miracle as clinic closes, Sun Herald, 28 February 2016

NSW health authorities have launched an investigation into a national chain of hydration clinics after a Sydney woman was hospitalised following an intravenous vitamin infusion sold as a miracle hangover cure. AMA Vice President Dr Stephen Parnis has accused those behind the IV infusion trend of bringing the medical profession into disrepute.

Patients to feel pain as cuts bite, Adelaide Advertiser, 11 March 2016

Across Australia, public hospitals will lose more than a $1 billion in federal funding next year. AMA President Professor Brian Owler said as hospital capacity shrinks, doctors won’t be able to get their patients into hospital or keep them there to receive the critical care they require.

AMA warns of hospital funding crisis as cuts bite, Sydney Morning Herald, 11 March 2016

Hospitals are limiting surgery hours and forcing patients to wait longer for elective procedures as an economic disaster looms. AMA president Brian Owler said patients with life-threatening conditions such as cancer would wait longer for surgery, while emergency departments would struggle to treat half their sickest patients within 30 minutes.

Porn turning kids into predators, The Australian, 29 February 2016

Online pornography is turning children into copycat sexual predators, doctors and child abuse experts warned. AMA Vice President Dr Stephen Parnis said the internet was exposing children to sexually explicit content that taught sex was about use and abuse.

Radio

Professor Brian Owler, Radio National, 22 February 2016

AMA President Professor Brian Owler discussed calling for the immediate removal of infants and children from immigration detention centres, and for all asylum seekers to have access to quality health care.

Dr Stephen Parnis, 2HD Newcastle, 22 February 2016

AMA Vice President Dr Stephen Parnis discussed Turnbull Government plans for asylum seeker Baby Asha and her family to be returned to Nauru once medical and legal process are complete. Dr Parnis said doctors were in an untenable situation in treating patients with serious physical and mental health issues, particularly the children, who were under threat of return to conditions that will only exacerbate their health problems.

Dr Stephen Parnis, 5AA Adelaide, 28 February 2016

AMA Vice President Dr Stephen Parnis talked about hangover clinics. He said clinics which claim to cure hangovers through intravenous infusions have no benefit and could put lives at risk.

Professor Brian Owler, 2UE Sydney, 11 March 2015

AMA President Professor Brian Owler talked about public hospital funding. Professor Owler said Australia has one of the best health care systems in the world, but it relies on having adequate funding. 

Television

Professor Brian Owler, ABC Melbourne, 21 February 2016

Federal Immigration Minister, Peter Dutton, says that asylum seeker baby Asha and her family will moved to community detention, and not immediately sent to Nauru. The AMA reiterated its call for all children to be immediately released from detention

Dr Stephen Parnis, ABC Melbourne, 2 February 2016

A new report warns that Australia isn’t properly prepared for health problems triggered by an increase in heat waves over the next 40 years. AMA Vice President Dr Stephen Parnis said hundreds of people could die every year if nothing is done to tackle climate change.

Dr Stephen Parnis, Channel 10, 8 March 2015

An official submission to the Government proposes increasing the tax on alcohol. AMA Vice President Dr Stephen Parnis is supportive of increasing the price.

Professor Brian Owler, Prime 7, 10 March 2016

AMA President Professor Brian Owler warns regional communities they will be worst hit when the Federal Government’s hospital cuts take effect from next year. AMA urges the Government to prioritise health when it lays down the budget in May.

Professor Brian Owler, Sky News, 10 March 2016

AMA President Professor Brian Owler talks about the No Jab, No Pay laws coming into force on March 18, when parents who don’t ensure their child’s immunisation is up-to-date stand to lose childcare benefits.

 

 

[Editorial] Indigenous health in the Latin American golden decade

In 2006, a Lancet Series on Indigenous health highlighted alarming inequalities in health outcomes for Indigenous people in Latin America. Indigenous morbidity and mortality was higher, and indigeneity was identified as a proxy indicator of poverty, against which health disparities could be measured. Now, a decade later, the World Bank reports that although more than 70 million people have been lifted out of poverty in this so-called golden decade, Indigenous people have been left behind.

Flu season preparations begin

Free influenza vaccines are scheduled to be available from early April as the Federal Health Department ramps up preparations for the 2016 flu season.

The Commonwealth’s Chief Medical Officer, Professor Chris Baggoley, has written to GPs and health services nationwide advising of plans to supply two age-specific quadrivalent influenza vaccines which will be available free of charge to eligible patients under the National Immunisation Program.

The advanced warning follows criticisms of delays in supplying flu vaccines last year.

The National Immunisation Program usually commences in March, but was held back until late April last year as manufacturers scrambled to produce sufficient stocks of the vaccines.

At the time, the Health Department blamed the delay on the decision to include vaccines for two new flu strains.

Last year was also the first time that single-dose quadrivalent vaccines were approved for use by the Therapeutic Goods Administration.

Professor Baggoley said this year the intention was to have the vaccines available from early April, “subject to…supply”.

The two vaccines being supplied under the National Immunisation Program are Sanofi’s FluQuadri Junior, for children younger than three years of age, and GlaxoSmithKline’s Fluarix Tetra, for people aged three years and older.

Under the Program, the vaccines will be available free of charge for pregnant women; Indigenous children aged between six months and five years; Aboriginal and Torres Strait Islander people aged 15 years and older; people aged 65 years and older; and those six months or older with a predisposition to severe influenza.

Professor Baggoley said both the quadrivalent vaccines and trivalent vaccines will also be available for purchase on the private market.

The Australian Technical Advisory Group on Immunisation has urged the use of quadrivalent vaccines, but has advised that trivalent vaccines are an acceptable alternative, particularly where quadrivalents are not available.

Professor Baggoley will provide an update on the National Immunisation Program in mid-March as well as resources including promotional posters. Fact sheets for both providers and consumers will be available for download from the Immunise Australia website (http://www.immunise.health.gov.au/) around the same time.

Adrian Rollins

Latest news:

Patchy vaccination coverage leaves some at risk

Vaccination rates in some areas are so low that they are vulnerable to the spread of potentially dangerous diseases such as measles and whopping cough.

A report detailing child vaccination rates nationwide has found that although almost 91 per cent of children were fully vaccinated in 2014-15, in more than 100 postcodes less than 85 per cent were fully immunised, including just 73.3 per cent in the Brunswick Heads area on the New South Wales north coast.

The National Health Performance Authority report indicates that the country has a considerable way to go to achieve the target set by the Commonwealth, State and Territory chief health and medical officers for 95 per cent of all children to be fully vaccinated, though there were some encouraging signs of progress.

The NHPA found immunisation rates among one-year-old Indigenous children increased significantly in 14 per cent of geographical areas, and there was a big 8 percentage point jump in the rate outback South Australia.

The report also revealed improvements in Surfer’s Paradise, and the eastern suburbs of Sydney.

The findings were released against the backdrop of concerted efforts nationwide to boost immunisation rates, most notably through the Federal Government’s No Jab, No Pay laws, which deny family tax supplements and childcare benefits and rebates to parents who refuse to have their children vaccinated.

There have been anecdotal reports of surge in vaccinations before the commencement of the school year as the new rules loomed, but public health expert Julie Leask warned the causes of low vaccination rates were complex, and it was too early to assess the effectiveness of the No Jab, No Pay laws.

In her Human Factors blog (https://julieleask.wordpress.com/), Ms Leask, a social scientist at Sydney University’s School of Public Health, said a significant percentage of the 84,571 children reported as not fully vaccinated were in fact up-to-date but there were errors in recording their status on the Australian Childhood Immunisation Register.

In other instances, parents were unaware of vaccination requirements, or encountered problems in arranging for the immunisation of their children.

Ms Leask said that without further research, it was impossible to know how many children were being denied immunisation because their parents objected to it.

She said there were encouraging accounts of some parents who were previously objectors arranging for their children to be vaccinated – including some who were “angry and resentful, feeling coerced into making the decision because they cannot afford to miss the payments”.

But Ms Leask aired concerns about the implementation of the No Jab, No Pay laws.

She said Primary Health Networks and providers including GPs, nurses and Aboriginal health workers were being forced to work “very hard to implement a complex policy in a very short timeframe,” with often inadequate resources.

Providers were in many cases being overwhelmed by demand and had not been provided with additional assistance, and were being denied access to the ACIR and so could not update patient details.

The importance of high rates of vaccination have been underlined by warnings that the world remains “significantly off-track” targets to eliminate measles, and that communities with immunisation rates below 90 per cent were at risk of fast-spreading outbreaks.

The Gavi Vaccine Alliance said that although the number of deaths from malaria worldwide had fallen substantially in the past decade, the disease still claimed 114,900 lives in 2014 – most of them children younger than five years.

Gavi said it had developed a new approach to support periodic, data-driven measles and rubella campaigns in addition to action to tackle outbreaks.

“Measles is a key indicator of the strength of a country’s immunisation systems and, all too often, it ends up being the canary in the coalmine,” Gavi Chief Executive Dr Seth Berkley said. “Where we see measles outbreaks, we can be almost certain that coverage of other vaccines is also low.”

Adrian Rollins

AMA in the News – 23 February 2016

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

AMA attacks health insurers’ clawback, Adelaide Advertiser, 5 February 2015
Private health insurance customers could finally see a slowdown in the rate of premium rises, amid criticism of insurers for scaling back members’ entitlements. AMA President Professor Brian Owler accused some insurers of scaling back members’ coverage.

Sticking up for all children, Northern Territory News, 8 February 2016
The AMA wants all children who fall behind on their vaccination program to be allowed to catch up for free, calling for further Federal Government funding to boost immunisation rates. AMA President Professor Brian Owler said Government claims that health spending was unsustainable were not backed by evidence.

Medicare plan risks privacy, Adelaide Advertiser, 12 February 2016
A private company would know whether a patient had an abortion, herpes or was getting mental health treatment if the Government proceeds with a plan to privatise Medicare and medicine payments. The AMA is calling on the Government to change the system so a patient’s Medicare rebate could be assigned directly to the doctor.

Anti-vax nuts crack at last, The Sunday Telegraph, 14 Februay 2016
Almost 260 extra children are being immunised every week as even the most hardened anti-vaccine fanatics change their view. AMA President Professor Brian Owler said people are starting to realise the anti-vaccination lobby does not hold weight, and some of the policies are starting to take effect.

Indigenous health vital, The Herald Sun, 18 February 2016
AMA President Professor Brian Owler, in Alice Springs visiting health groups and clinics, said the Closing the Gap report, released last week, indicated that health had fallen off the radar.

Bulk-billing on the rise despite mooted cuts, The Australian, 19 February 2016
Bulk billing rates have continued to rise despite health groups warning patients will be left out-of-pocket because of a Federal Government freeze on Medicare rebates. AMA President Professor Brian Owler said the plan to remove the bulk billing incentive from pathology services was a sign the co-payment had risen from the grave.

Radio

Professor Brian Owler, 666 ABC Canberra, 8 February 2015
AMA President Professor Brian Owler discussed the AMA’s Pre-Budget Submission. Professor Owler criticised the Federal Government for telling basic ‘untruths’ about health spending.

Dr Brian Morton, 2GB Sydney, 9 February 2016
AMA Chair of General Practice Dr Brian Morton discussed homeopathy. Dr Morton said he was concerned that people who chose homoeopathy might put their health at risk. 

Professor Brian Owler, ABC News Radio, 11 February 2015
AMA President Professor Brian Owler talked about health spending and the MBS Review. 

Professor Brian Owler, ABC South East NSW, 15 February 2016
AMA President Professor Brian Owler discussed hydrocephalus. Professor Owler said shunt registry for hydrocephalus could be used as a quality assurance tool in order to decrease blockages and infections which affect morbidity and increase costs to the health system. 

Television

Professor Brian Owler, ABC News 24, 28 December 2015
Landmark legislation will be introduced into Parliament to legalise medicinal cannabis. AMA President Professor Brian Owler said medicinal cannabis should be regulated in the same way as other narcotics.

Professor Brian Owler, CNN, 16 February 2016
AMA President Professor Brian Owler slammed Government policy on asylum seekers. Professor Owler said doctors who work with asylum seeker children face an incredible ethical dilemma, because they cannot allow children to be discharged into an unsafe environment.

Professor Brian Owler, SBS Sydney, 17 February 2016
Prime Minister Malcolm Turnbull said there would be no change to Australia’s border protection policies despite an offer from New Zealand Prime Minister John Key to take in children headed for offshore detention. AMA President Professor Brian Owler said this was a complex issue, but the issue facing the AMA is to ensure the health care of asylum seekers and getting children out of detention.

Cut jail time to build on Indigenous health gains

Soaring Indigenous imprisonment rates and a stubbornly wide life expectancy gap underline calls for the Federal Government to fully fund the National Aboriginal and Torres Strait Islander Health Plan.

AMA President Professor Brian Owler said the latest update on Indigenous health and welfare from the Close the Gap Steering Committee was “a mixed bag”, showing improvement on measures such as child mortality and year 12 attainment, but weak gains in others.

The report found the target to halve the gap in child mortality by 2018 was on track, supported by a lift in immunisation rates that has seen more Indigenous children vaccinated by age five compared with their non-Indigenous counterparts, and Indigenous mortality rates, particularly from heart disease and stroke, are declining.

But the gap in life expectancy is not narrowing fast enough to close by the Council of Australian Government’s 2031 target.

The Close the Gap report shows that between 2005 and 2012, the life expectancy of Indigenous men increased by 1.6 years to 69.1 years, and for Indigenous women 0.6 of a year to 73.7 years (the life expectancy of non-Indigenous men in 2012 was 79.7 year and women, 83.1 years).

But the report’s authors cautioned that the improvements were within the margin of error “and could, in fact, be non-existent”.

Indigenous life expectancy is improving at an annual rate of 0.32 years for men and 0.12 years for women, but the Steering Committee said this would have to increase to between 0.6 and 0.8 years annually to reach the 2030 target.

Driving much of the improvement has been a 40 per cent fall in deaths from heart attacks and strokes, and fatal respiratory illnesses have declined by 27 per cent.

Despite this, heart attacks a strokes remain a major killer, accounting for a quarter of all Indigenous deaths between 2008 and 2012, while suicide was the leading cause of death due to external causes.

“It is disappointing that the target to close the gap in life expectancy by 2031 is not on track,” Professor Owler said. “This is a clear signal that we have to put politics aside and work together to reach this important milestone. Above all, we need consistent funding and support from all governments.”

In his report on Closing the Gap, Prime Minister Malcolm Turnbull agreed that a more concerted effort was needed.

“As a nation, we are a work in progress, and closing the substantial gaps in outcomes between Aboriginal and Torres Strait Islander people and other Australians is one of our most important tasks,” Mr Turnbull said. “There has been encouraging progress…but it is undeniable that progress…has been variable.”

Professor Owler said that to make improved gains, the Federal Government should reverse Budget cuts to programs like the Indigenous Advancement Strategy and the Indigenous Australian Health Program, and commit to genuine engagement with Aboriginal community controlled health services.

Nonetheless, a rapid narrowing of the health gap for infants and young children gives hope that eventually it will narrow for adults as well.

Though the infant mortality rate for Indigenous infants is 1.7 times that of other Australians, it declined 64 per cent between 1998 and 2012, making the gap 83 per cent narrower.

Close the Gap Campaign Co-Chair Dr Jackie Huggins said the long term impact of such improvements were yet to be seen and would take time to measure. The report advised no measurable improvements should be expected before 2018.

Furthermore, Dr Huggins said, “this should not be cause for complacency, because the overall health of Aboriginal and Torres Strait Islander peoples still lags behind the rest of the nation”.

The Campaign backed the AMA in calling for governments to reduce Indigenous incarceration rates.

It warned the nation was on track to have a record 10,000 Indigenous people behind bars this year, which is described as “a grim milestone”.

An AMA report highlighted that imprisonment exacerbated serious health problems and Indigenous incarceration rates needed to be reduced if the country was to close the health gap.

Adrian Rollins