Concluding comments

Please select category from the dropdown list below.

Overview of the health of Indigenous people in Western Australia 2011    Introduction    Population structure    Births and pregnancy outcome    Mortality    Hospitalisation    Selected health conditions       Cardiovascular health       Cancer       Diabetes       Social and emotional wellbeing (including mental health)       Kidney health (renal disease)       Injury       Respiratory disease       Communicable diseases          Sexually transmitted infections          Hepatitis          HIV/AIDS          Other communicable diseases       Eye health       Ear health       Oral health    Health risk factors    Concluding comments

It is clear from this overview of current health status that Indigenous people remain the least healthy sub-population in WA [1]. Being a ‘snapshot’ of the most recent indicators of health status – with little attention to trends – the overview, however, doesn’t reflect, the evidence that the health status of Indigenous people in WA continues to improve slowly.

For a start, there have been significant reductions in recorded mortality in recent years in a number of jurisdictions, including WA. Age-standardised death rates for Indigenous people living in WA, SA and the NT declined by around 13% over the period 1991-2006 [2]. The declines in death rates were less for Indigenous people than for non-Indigenous people. This trend is particularly evident over the period 2005-2009, with Indigenous:non-Indigenous death rate ratios in WA increasing for both males and females with ratios highest in the middle adult years (nearly eight times higher) [3].

The most recent estimates of life expectancy at birth for Indigenous people in WA – 65.0 years for males and 70.4 years for females in 2005-2007 – are higher than previous estimates, but, as the ABS warns, the apparent improvements are likely to be due largely to revised statistical methods [3].

Indigenous infant mortality rates for WA, SA and the NT declined significantly over the 16-year period 1991-2006 [2]. The Indigenous rate declined by 47% over that period, slightly more than the 34% decline of the rate for non-Indigenous people. The Indigenous:non-Indigenous rate ratio declined from 4.3 to 3.2 [2], with more recent estimates for the period 2007-2009 in WA reporting an Indigenous:non-Indigenous rate ratio of 2.6 [3].

The declines in infant mortality rates have occurred despite the lack of real changes in the birthweights of babies born to Indigenous mothers – the mean weights of babies born to Indigenous mothers are still around 240 grams less than the weights of those born to non-Indigenous mothers in WA [4]. Importantly, the proportions of low birthweight (less than 2,500 grams) babies born to Indigenous mothers increased by 16% over the 15-year period and are still around twice those of babies born to other mothers [5].

In terms of specific health conditions in WA, substantial improvements have occurred in the overall impact of many infectious diseases (including improvements due to immunisation programs):

• substantial declines in death rates from invasive pneumococcal pneumonia (mostly due to the introduction of vaccination programs) [6][7][8][9]
• reductions in the incidence and severity of trachoma (though inflammatory trachoma remains endemic in some remote communities of central and northern Australia) [10][11]
• a substantial reduction in the prevalence of hepatitis B virus infection (since the introduction of vaccination programs) [12][13]
• a marked reductions in mortality from gastroenteritis over recent decades with 69 deaths of Indigenous children (53 were infants) in the period 1970-1979, nine Indigenous deaths (six infants) in the period 1980-1989, and no deaths reported in the period 1990-2000 [14], and
• a reduction in the number of new cases of tuberculosis, from 18 in 1999-2003 to 11 in 2003-2007 [15][16][17][18][19].

There is no doubt other evidence of improvement in some measures of health status, and of deterioration in others, but clearly, the gap between the health status of Indigenous people and that of other Australians is still very, very wide.

The vast gap between the health of Indigenous and other Australians was highlighted in the Social Justice Report 2005, which called on Australian governments to commit to achieving Indigenous health equality within 25 years [20].

Following the release of the report, 40 of Australia’s leading Indigenous and non-Indigenous health peak bodies and human rights organisations joined forces to launch a campaign to ‘close the gap’ on health inequality [21]. In December 2006, the coalition published an open letter to the Prime Minister, the State Premiers and Territory Chief Ministers, parliamentarians and the Australian public calling for an end to Indigenous health inequality. The ‘close the gap’ campaign was launched in April 2007.

Importantly, Australian governments, through the Council of Australian Governments (COAG) committed in December 2007 to ‘closing the gaps’ in disadvantage between Indigenous and other Australians [22].

The Indigenous Health Summit, held in March 2008, concluded with the Prime Minister issuing, on behalf of the Australian Government and the Indigenous peoples of Australia, a statement of intent ‘to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030’ [23].

In March 2008, the Prime Minister also announced establishment of the National Indigenous Health Equality Council, which ‘advises the [Australian Government’s] Minister for Health and Ageing, the Hon Nicola Roxon MP, on the achievement of equitable and sustainable health outcomes for Aboriginal and Torres Strait Islander peoples’ [24].

Each State and Territory was tasked with developing implementation plans detailing their respective ‘Closing the gap’ initiatives which for WA, committed the State government to a process that involves genuine engagement and partnership with the Western Australian Aboriginal community [1][25].

Reflecting the increased attention directed to Indigenous reform, it is now a standing item on all COAG meetings. As a part of its deliberations about ‘closing the gap’, COAG has agreed on a number of specific targets for reducing Indigenous disadvantage in the areas of education, early childhood development, health and employment [1][26]. Particular targets are to:

• close the life expectancy gap within a generation
• halve the gap in mortality rates for Indigenous children under five within a decade, and
• halve the gap in reading, writing and numeracy achievements for children within a decade.

In addressing these targets, COAG has committed $4.6 billion over four years across early childhood development, health, housing, economic participation and remote service delivery, and has also achieved a number of supportive commitments by the corporate and community sectors [26]. Agreement has been reached also on the establishment of a new national Indigenous representative body.

This is the first time that such a high level of commitments has been made by the Australian, State and Territory governments and others, raising the possibility of substantial reductions in the health and other disadvantages experienced by Indigenous people.

As encouraging as these commitments are, achievement of substantial improvements in the health and wellbeing of Indigenous people will depend largely on the effective implementation of comprehensive strategies and policies that address the complexity of the factors underlying the disadvantages experienced by Indigenous people.

Importantly, effective, integrated comprehensive strategies and policies will need to be sustained for a long time, as improvements to the extent set in the various targets will not occur in the short-term. The timeframes for the ‘closing the gap’ targets suggest there is some awareness by governments of the enormity of the challenge, but the real test will be to sustain the commitments through changing political and economic cycles.

References

1. Western Australian Department of Health (2011) Our footprints : a traveller's guide to the COAG implementation process in Western Australia. Perth: Government of Western Australia
2. Australian Institute of Health and Welfare (2008) Aboriginal and Torres Strait Islander health performance framework, 2008 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
3. Australian Bureau of Statistics (2010) Deaths, Australia, 2009. Canberra: Australian Bureau of Statistics
4. Laws PJ, Li Z, Sullivan EA (2010) Australia's mothers and babies 2008. Canberra: Australian Institute of Health and Welfare
5. Laws P, Sullivan EA (2009) Australia's mothers and babies 2007. Sydney: AIHW National Perinatal Statistics Unit
6. Roche PW, Krause V, Cook H, Barralet J, Coleman D, Sweeny A, Fielding J, Giele C, Gilmour R, Holland R, Kampen R, Brown M, Gilbert L, Hogg G, Murphy D (2008) Invasive pneumococcal disease in Australia, 2006. Communicable Diseases Intelligence; 32(1): 18-30
7. Williams SR, Mernagh PJ, Lee MHT, Tan JT (2011) Changing epidemiology of invasive pneumococcal disease in Australian children after introduction of a 7-valent pneumococcal conjugate vaccine. Medical Journal of Australia; 194(3): 116-120
8. Roche PW, Krause VL, Bartlett M, Coleman D, Cook H, Davis C, Fielding JE, Holland R, Giele C, Gilmour R, Kampen R, Brown M, Gilbert L, Hogg G, Murphy D (2006) Invasive pneumococcal disease in Australia, 2004. Communicable Diseases Intelligence; 30(1): 80-92
9. Mak DB (2004) Invasive pneumococcal disease in the Kimberley, 1995-2001. Australian Journal of Rural Health; 12(6): 237-240
10. Taylor HR, National Indigenous Eye Health Survey Team (2009) National Indigenous eye health survey: minum barreng (tracking eyes): full report. Melbourne: Indigenous Eye Health Unit, The University of Melbourne
11. Adams K, Burgess J, Dharmage S (2010) Trachoma surveillance report 2009. Melbourne: National Trachoma Surveillance and Reporting Unit
12. Gonorrhoea (2006) Family Planning Association of WA
13. Menzies R, Turnour C, Chiu C, McIntyre P (2008) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Canberra: Department of Health and Ageing
14. Gracey M, Cullinane J (2003) Gastroenteritis and environmental health among Aboriginal infants and children in Western Australia. Journal of Paediatrics and Child Health; 39(6): 427-431
15. Barry C, Konstantinos A, National Tuberculosis Advisory Committee (2009) Tuberculosis notifications in Australia, 2007. Communicable Diseases Intelligence; 33(3): 1-12
16. Li J, Roche P, Spencer J, National Tuberculosis Advisory Committee (2004) Tuberculosis notifications in Australia, 2003. Communicable Diseases Intelligence; 28(4): 464-473
17. Roche P, National Tuberculosis Advisory Committee (2006) Tuberculosis notifications in Australia, 2004. Communicable Diseases Intelligence; 30(1): 93-101
18. Roche P, Bastian I, Krause V (2007) Tuberculosis notifications in Australia, 2005. Communicable Diseases Intelligence; 31(1): 71-80
19. Roche PW, Krause V, Konstantinos A, Bastian I, Antic R, Brown L, Christensen A, Gebbie S, Hurwitz M, Misrachi A, Waring J (2008) Tuberculosis notifications in Australia, 2006. Communicable Diseases Intelligence; 32(1): 1-11
20. Aboriginal and Torres Strait Islander Social Justice Commissioner (2005) Social justice report 2005. Sydney: Human Rights & Equal Opportunity Commission
21. Calma T (2009) Close the gap campaign for Aboriginal and Torres Strait Islander health equality by 2030: a community guide. Canberra: Australian Human Rights Commission
22. Council of Australian Governments (2009) National Indigenous reform agreement (closing the gap). Canberra: Council of Australian Governments
23. Australian Government (2008) Statement of intent. Paper presented at the Indigenous Health Equality Summit: Close the Gap. 20 March 2008, Canberra
24. Anderson I (2009) Close the Gap: National Indigenous Health Equality Council. Medical Journal of Australia; 190(10): 546
25. Western Australian Department of Indigenous Affairs (2010) Closing the gap in Indigenous life outcomes, Western Australia. Perth, WA: Department of Indigenous Affairs, Western Australia
26. Department of Families Housing Community Services and Indigenous Affairs (2009) Closing the gap on Indigenous disadvantage: the challenge for Australia. Canberra: Commonwealth of Australia