The Building Blocks — Action to Close the Gap (Continued)
Closing the Gap: Health
Investment in Indigenous health has increased significantly particularly for primary health care services, building the health workforce, targeting specific health problems and addressing health risk factors among Indigenous people.
Two of the Closing the Gap targets relate to health:
- closing the life expectancy gap within a generation
- halving the gap in mortality rates for Indigenous children under five within a decade.
Through the Indigenous Chronic Disease Package, the Australian Government is contributing $805.5 million to the $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, agreed in November 2008.
Aboriginal and Torres Strait Islander people experience a burden of disease two and a half times that of other Australians, with 70 per cent of the health gap due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease. The National Partnership is focusing on early identification and better management of chronic disease and reduction of chronic disease risk factors.
The Indigenous Chronic Disease Package involves:
- significant new funding for preventive health
- support and funding for more coordinated and patient-focused primary health care in both Indigenous community-controlled health services and general practice
- increased access to affordable medicines and specialist and allied health care
- building the numbers and skills of the Indigenous health workforce.
The Commonwealth's Implementation Plan was endorsed by the Australian Health Ministers' Conference in September 2009. Delivery commenced in 2010.
From May 2010, accredited general practices and Indigenous health services can receive incentives to identify, treat and manage Indigenous people with a chronic disease. In 2010‑11, the Australian Government will expand the availability of free or low cost medicines for Indigenous patients with a chronic disease or chronic disease risk factors. Access to essential medical specialist care and allied health professional will also be increased.
The National Partnership includes a commitment to recruitment and/or training of more than 160 Aboriginal and Torres Strait Islander outreach workers as well as additional health professionals, nurses, and Indigenous health project officers within Australian Divisions of General Practice (GP) and Indigenous health organisations.
The first intake of 83 outreach workers are being recruited from local communities to help link community members with health services. In 2010‑11 a further 40 outreach worker positions will be established. This year, 38 GP registrar training posts are also being provided in Indigenous health services. Fifty professional development nursing scholarships will be provided to nurses currently working in an Indigenous health service and 50 nurse clinical placements for undergraduate nurses working in Indigenous health. Recruitment of 94 Indigenous project officers in the Divisions of General Practice and National Aboriginal Community Controlled Health Organisation state affiliates is also underway.
The Indigenous Chronic Disease Package includes specific measures to tackle chronic disease risk factors, including poor nutrition and lack of exercise, through the commencement of Healthy Lifestyle Workers, Healthy Lifestyle sessions and activities, and local community social marketing campaigns.
There is a strong emphasis in the Package on tackling smoking. It is estimated that smoking accounts for 12 per cent of the total disease burden and one fifth of the deaths among Indigenous Australians. Mr Tom Calma, former Aboriginal and Torres Strait Islander Social Justice Commissioner, has been appointed the National Coordinator for Tackling Indigenous Smoking. The recruitment of a network of regional and local tobacco action workers is proceeding. A social marketing campaign to reduce smoking is being developed for delivery in local communities. Team based service delivery by Healthy Lifestyle Workers and tobacco action workers will begin from 2010‑11, together with enhanced Quitline services.
A complementary Indigenous Tobacco Control Initiative, with funding of $14.5 million over four years from 2008‑09, is researching effective anti‑tobacco strategies in Indigenous communities, trialing and evaluating innovative community projects and offering smoking cessation training to staff working in Indigenous health. There are currently six sites trialing innovative methodologies, with 14 further projects across urban, regional and remote areas commencing this year. Findings will contribute to a comprehensive national approach to tackling smoking through the National Partnership Agreement.
Eating good fresh food is another path to good health. Indigenous people, particularly those living in remote communities, often struggle to get good food. The Australian Government has been working intensively with remote stores in the Northern Territory since 2007 to tackle problems arising from the poor quality and limited range of food available in many stores. This has involved the assessment, licensing and monitoring of more than 90 operators and working with managers and store committees to strengthen the day to day running of stores. Funding of $18.3 million over three years was provided in the 2009‑10 Budget to continue this work.
In 2010 there are 88 Australian Government licensed stores in the Northern Territory, 21 operated through the government funded Outback Stores and five through the Arnhem Land Progress Association. Nine stores have received infrastructure upgrades to improve operational efficiency and nutritional outcomes. Training is provided to operators to improve retail practices and nutrition awareness. In addition, the Office of the Registrar of Indigenous Corporations delivered five Building Stronger Stores workshops in the Northern Territory in 2009, with 98 attendees.
The coming year will see the roll out of 10 community projects in the Northern Territory integrating governance and retail practice training for store committees.
At its July 2009 meeting COAG gave in principle agreement to extend the stores regulation work nationwide. Following this decision, on 7 December 2009, COAG agreed to a National Strategy for Food Security in Remote Indigenous Communities, outlining five strategic actions. These actions are:
- national standards for stores and take-aways in remote communities in the areas of retail management, financial management, governance, infrastructure, food and nutrition policy and promotion and food preparation and safety
- a quality improvement scheme to support implementation of the standards
- improved governance and accountability of remote community stores through increased incorporation under the Corporations (Aboriginal and Torres Strait Islander) Act 2006
- a National Healthy Eating Plan for remote Indigenous communities
- a national workforce plan to improve food security in remote Indigenous communities.
The Strategy will be piloted in around 15 remote Indigenous communities across Australia during 2010‑11.
The Australian Government has committed $58.3 million over four years from 2009‑10 to improved ear and eye health services for Indigenous people to reduce avoidable hearing and vision loss and help children to succeed at school.
A National Framework for the Delivery of Trachoma Control Programs has been finalised and trachoma control activities will be expanded in South Australia, Western Australia and the Northern Territory. This will enable more than 120 Aboriginal communities to be screened at least once a year. The need for trachoma control programs in other jurisdictions is currently being investigated. New monitoring arrangements will track progress in the elimination of endemic trachoma.
In the next six months several initiatives will be underway targeting better access to treatment of trachoma and elimination of the disease. These initiatives include new eye health services delivered through the expanded Visiting Optometrists Scheme in up to 115 Indigenous communities. Work will continue through the Central Australian and Barkly Integrated Eye Health Strategy including funding for additional eye surgical procedures. In September-October 2009, 52 procedures were completed and a second intensive surgery week was held in April 201. Additional eye and ear surgical procedures will be conducted in the coming years.
From May this year, approximately 200 sets of medical hearing equipment will be placed in priority Indigenous health services, with appropriate training for hearing health workers. A communication campaign to raise awareness of hearing health begins in the second half of 2010.
This Government made an election commitment to reduce rheumatic heart fever among Indigenous children, funded at $11.2 million over four years from 2008‑09. Almost unknown in the wider community, rheumatic heart fever is a contributor to later chronic heart disease. The Menzies School of Health Research in Darwin has established a national coordination unit known as RHD Australia, which is helping to manage funded activities, implement a communication plan, develop education and training materials, and develop a data set. Agreements are in place with the Northern Territory, Western Australian and Queensland Governments to establish and expand registers and control programs.
Under the Closing the Gap in the Northern Territory National Partnership Agreement the Australian Government is continuing to enhance health and related services, including alcohol treatment and rehabilitation.
The Expanding Health Service Delivery Initiative provides up to $182.1 million over four years from 2008‑09 for increased primary health care in remote locations in the Northern Territory, planning for regional support for remote area services, staff housing and clinic refurbishment. Since October 2008 this initiative has provided more than 390 health professionals who have been assigned to short term placements through the Remote Area Health Corps.
Follow-up treatment arising from the child health checks conducted in 2007‑08 is proceeding with funding of up to $35.8 million over five years from 2007‑08. In 2010‑11 an estimated 200 children will receive an ear, nose and throat treatment and follow up services, and more than 3,700 dental services will be provided to children living in prescribed communities.
The Northern Territory Mobile Outreach Service Plus expands existing sexual assault counselling services begun in 2007‑08, and now provides a response to any form of child abuse related trauma for Indigenous children, families and communities in all remote regions across the Northern Territory. Since April 2008 a total of 294 visits to 82 communities and town camps in the Northern Territory have been delivered. The expanded service began in November 2009 and is expected to be at full capacity by October 2010. Total funding of $18.5 million is being provided over five years from 2007‑08 for the Northern Territory Mobile Outreach Service Plus and related services.
What Health Reform will do for Indigenous Australians
The Government's health and hospitals reform package will deliver important changes across primary care, hospitals and aged care that will benefit Indigenous people and communities. The reforms will deliver services that are better integrated, better coordinated, and more responsive to the needs of patients.
Under the National Health and Hospital Network, the Commonwealth will have full funding and policy responsibility for all GP and related services. Funding and policy responsibility for services currently funded and managed by state and territory governments, such as community health clinics with allied health services such as dieticians and psychologists, will be brought together with Commonwealth-funded services such as GPs and Aboriginal Community Controlled Health Services to improve the quality of care for patients. This will enable health services to be better integrated and tailored to local needs.
The Government will invest $449.2 million over four years from 2010‑11 to transform the way Australians with long term illness are treated. This will begin with improving health outcomes for the nearly one million Australians living with diabetes.
From 2012 they will be able to choose to sign up with a GP practice or medical service of their choice. This practice will:
- become responsible for managing their care, including by developing a personalised care plan
- help organise access to the additional services they need, such as care from a dietician or podiatrist, as set out in their personalised care plan
- be paid, in part, on the basis of their performance in keeping their patients healthy and out of hospital.
This will also benefit Indigenous Australians who experience diabetes at higher rates compared to non Indigenous Australians.
Primary health care services, including Aboriginal Community Controlled Health Services, will be able to access funding under two new measures which improve access to after hours care and improve primary care infrastructure. Many people, particularly those living in rural and remote areas, who do not readily have access to after hours GP services or are not aware they exist, will gain access to high quality, affordable, and integrated after hours primary care services.
The Government will invest $355.2 million over three years in this year's Budget to fund around 23 new GP Super Clinics and help around 425 General Practices, primary care and community health services and Aboriginal Medical Services. This will improve the quality and accessibility of these services.
To reduce smoking rates, the Government has implemented a 25 per cent increase in tobacco excise from 30 April 2010, above normal CPI adjustments, with the proceeds to be spent on health and hospitals. The Government will also legislate to mandate plain packaging for tobacco products from 1 July 2012 and boost its investments in anti‑smoking advertising campaigns which will further bolster the effort to reduce smoking and the resulting disease burden among Indigenous people.
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