Concluding comments
Indigenous people remain the least healthy sub-population in Australia,
and there is evidence that the disparity between Indigenous and
non-Indigenous health, at least measured by mortality, has widened
in recent years [1]. The lack of real improvement
in Indigenous mortality in Australia contrasts markedly with the
situation among Indigenous people in New Zealand, Canada and the
United States. The success achieved in those countries ‘generates
considerable confidence that effective action in Australia will
produce substantial changes in Indigenous health’ [1].
Achievement of these changes will require progress in five areas:
infrastructure (including physical environmental and socioeconomic
aspects); Indigenous self-determination of health services; access
to a network of community-controlled primary healthcare services;
an adequate level of resources; and a skilled workforce.
Substantial progress has been made in the past decade in some aspects
of Indigenous health, and there have been improvements in some indicators
of Indigenous health status [2]. As well, all Australian
governments have made a commitment through the Council of Australian
Governments to address the enormous disadvantages experienced by
Indigenous people [3].
Within the health sector, the substantial increase in resources
provided by the Commonwealth since 1995–96 has enabled consolidation
and expansion of the Australia-wide network of Aboriginal community-controlled
health services and of Indigenous-controlled substance-misuse services,
and development of the role of NACCHO (National Aboriginal Community
Controlled Health Organisation) in national advocacy and in support
of Indigenous-controlled services [2].
The increased funding that has enabled the growth and development
of NACCHO, its affiliates, and community-controlled health and substance-misuse
services has been important, but a comprehensive review undertaken
by the Commonwealth Grants Commission (CGC) in 2000 concluded that
‘the poorer health status of Indigenous people, and their
greater reliance on the public health [care] system, would justify
at least a doubling of the average per capita expenditure on non-Indigenous
people’ [4]. The CGC conclusion about the
inadequacy of spending on Indigenous health services was matched
by similar conclusions about expenditure on a number of health-related
areas, such as education, training, employment, housing, and infrastructure
[4]. In view of the importance to health of these
‘up-stream’ factors, the achievement of major gains
in Indigenous health will require a much greater commitment by governments
in many areas.
The commitments expressed by Australian governments through COAG
to addressing the enormous disadvantages experienced by Indigenous
people are encouraging. However, unless these commitments are supported
by the allocation of resources to at least the levels suggested
by the CGC in the areas of health, education, training, employment,
housing and infrastructure, it is likely that Indigenous people
will remain the least healthy Australian sub-population for many
years into the future.
References
1 Ring IT, Firman D (1998) Reducing Indigenous
mortality in Australia: lessons from overseas. Medical Journal
of Australia;169:528-533
2 Thomson N (2003) Responding to our 'spectacular
failure'. In: Thomson N, ed. The health of Indigenous Australians.
South Melbourne: Oxford University Press:488-511
3 Council of Australian Governments (COAG)
(2004) Council of Australian Governments' Meeting, 25 June 2004.
Communique, Indigenous affairs. Retrieved 15 November 2004
from http://www.coag.gov.au/meetings/250604/index.htm#indigenous
4 Commonwealth Grants Commission (2001) Report
on Indigenous funding. Canberra: Commonwealth Grants Commission
The Australian Indigenous HealthInfoNet attempts to contribute to improvements in Indigenous health by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers and the general community. We welcome your comments and feedback about this overview. Australian Indigenous HealthInfoNet |
This web site contains PDF documents that require the most current version of Adobe Reader to view. To download click on the icon below.
