The health status of Australia's Aboriginal and Torres Strait Islander people continues to improve slowly, however, in order to reach the closing the gap targets such as life expectancy the rate of improvement will need to accelerate . It is clear from this Overview that Indigenous people remain the least healthy sub-population in Australia. As a 'snapshot' of the most recent indicators of health status – with limited attention to trends – the Overview doesn't fully reflect the evidence for improvements in key closing the gap targets.
With respect to life expectancy, there have been no new data available recently, the next estimate for 2015-2017 is expected to be published in 2018 or 2019 . While there has been a decrease in overall death rates between 1998 and 2013 of 16%, this apparent good news is tempered by the fact that there has been no significant decrease between 2006 and 2013 . The most recent estimates, in 2010-12, of life expectancy at birth for Indigenous people, indicate a life expectancy of 69.1 years for males and 73.7 years for females. This represents an absolute gain from 2005-2007 to 2010-2012. While these absolute gains are ameliorated somewhat by the relative gains by non-Indigenous people the Closing the Gap Steering Committee welcomed the gains as an ‘on the ground’ improvement that has tangible meaning for Aboriginal and Torres Strait Islander families and communities (, p.7). More recently Holland alluded to difficulties in the estimates due to changes in the methodology for estimation . Nevertheless, the relative magnitude of the task is noted in the Prime Minister’s Closing the gap report where it was stated that life expectancy will have to improve by almost 21 years for males and 16 years for females in the 2006-2031 period (it is also expected that life expectancy for non-Indigenous people will increase) . Put another way, the life expectancy increases of 0.32 per year for males and 0.12 per years for females would need to increase to 0.6 to 0.80 per year to meet the 2030 targets .
There appears to have been sustainable improvements in the target to halving the gap in mortality rates for Aboriginal and Torres Strait Islander children by 2018 . As noted earlier in the Overview, from 1998 to 2012, the IMR for Aboriginal and Torres Strait Islander people has declined by 64%; there was also a significant closing of the gap in IMRs between Aboriginal and Torres Strait Islander and non-Indigenous infants during this time period (by 83%) . This has been described as very significant, indicating that the rate of improvement for Aboriginal and Torres Strait Islander infants was higher than the non-Indigenous population .
Looking forward, key stakeholders and representative bodies have emphasised the importance of the Closing the gap strategy as a bipartisan, intergenerational commitment of past and successive Australian Governments . Working towards constitutional recognition for Aboriginal and Torres Strait Islander people also remains a key bipartisan Australian government commitment . This has previously been linked to positive health outcomes .
There is a natural tendency for readers of this Overview to focus on the plethora of health impacts and challenges that face Aboriginal and Torres Strait Islander people. As noted in the introduction, the shift to a strengths based narrative is not intended to obscure or minimise the importance of these challenges but rather to balance them with reference to the increasing number of positive initiatives and programs making a material difference to Aboriginal and Torres Strait Islander health outcomes. Patterns of negative health impacts across almost all health indicators are complex and interrelated and it remains important not to minimise the challenges and harm faced by Aboriginal and Torres Strait Islander people. However, in addition to life expectancy and mortality, there are encouraging signs and clear evidence of many positive health practices that challenge the stereotypical and homogenising views of Aboriginal and Torres Strait Islander people and their health that are not well known or publicised. In this review we have highlighted many of them including:
A greater focus on the lessons learned from these strengths based indicators and practices, coupled with bipartisan and sector support for emerging collaboration and culturally respectful policy and program development will make a strong and enduring contribution to positive health outcomes for Aboriginal and Torres Strait Islander people in the years to come.