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Australian Indigenous HealthBulletin
 

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It is clear from this Overview of current health status that Indigenous people remain the least healthy sub-population in WA. 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. Between 1991 and 2010, there was a 35% reduction in the death rates for Indigenous people in WA (there was a 31% reduction for other Western Australians) [1]. Much of the decline appears to have been in the first half of the 20-year period, however, since there has been no significant change in the total mortality rate for Indigenous people between 2001 and 2010.

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 [2].

Indigenous infant mortality rates for WA declined significantly over the 20-year period 1991-2010 [1]. The Indigenous rate declined by 62% over that period, slightly more than the 46% decline of the rate for other people in WA. The gap between Indigenous and other Australians closed significantly (67%).

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 were still 214 grams less than the weights of those born to non-Indigenous mothers in WA in 2010 [3]. Babies born to Indigenous women in WA in were more than twice more likely to be of LBW than were those born to all women in WA. There was no significant change to the proportions of LBW babies born to Indigenous mothers during the period 2001 to 2009 in WA [1].

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):

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 [14].

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 [15]. 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 [16].

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’ ([17] p.1).

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’ ([18] p.546).

Each state and territory was tasked with developing implementation plans detailing their respective Closing the gap initiatives which for WA committed them to a process that involves genuine engagement and partnership with the Western Australian Aboriginal community [19][20].

Reflecting the increased attention directed to Indigenous reform, it is 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 [19][21]. Particular targets are to:

In addressing these targets, COAG committed $4.6 billion in 2008 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 [21]. Of these funds, $1.57 billion was allocated to the National partnership agreement on closing the gap in Indigenous health outcomes to ‘reduce the biggest risk factors, such as smoking, to improve chronic disease management and follow-up, and to expand the capacity of the health workforce to tackle chronic disease in the Indigenous population’ ([21], p.20). Agreement was also reached on the establishment of a new national Indigenous representative body, which led to the formation of the National Congress of Australia’s First Peoples in 2010.

In April 2013, the Australian Government announced $777 million to fund its share of a renewed National partnership agreement on closing the gap in Indigenous health outcomes for a further three years to 30 June 2016 [22]. The state and territory governments were asked to continue their investment to renew the National partnership agreement. In June 2013, the WA State government announced new funding of $31 million to continue services to improve the health and wellbeing of Aboriginal West Australians [23].

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. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012 report: Western Australia. Canberra: Australian Institute of Health and Welfare
  2. Australian Bureau of Statistics (2010) Deaths, Australia, 2009. Canberra: Australian Bureau of Statistics
  3. Li Z, Zeki R, Hilder L, Sullivan EA (2012) Australia's mothers and babies 2010. Canberra: Australian Institute of Health and Welfare
  4. Barry C, Krause VL, Cook HM, Menzies RI (2012) Invasive pneumococcal disease in Australia 2007 and 2008. Communicable Diseases Intelligence; 36(2): E151-E165
  5. Jacups SP, Cheng A (2011) The epidemiology of community acquired bacteremic pneumonia, due to streptococcus pneumoniae, in the top end of the Northern Territory, Australia - over 22 years. Vaccine; 29(33): 5386-5392
  6. Massey PD, Kerry T, Osbourn M, Taylor K, Durrheim DN (2011) Invasive pneumococcal disease in New South Wales, Australia: reporting Aboriginal and Torres Strait Islander status improves epidemiology: surveillance report. Western Pacific Surveillance and Response; 2(3): 1-4
  7. Mak DB (2004) Invasive pneumococcal disease in the Kimberley, 1995-2001. Australian Journal of Rural Health; 12(6): 237-240
  8. Hanna JN, Humphreys JL, Murphy DM (2006) Invasive pneumococcal disease in Indigenous people in north Queensland, 1999-2004. Medical Journal of Australia; 184(3): 118-121
  9. Get up & grow: healthy eating and physical activity for early childhood: children need a challenge: adventurous outdoor play is part of their learning and development (2009) Department of Health and Ageing
  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. The Kirby Institute (2013) Australian trachoma surveillance report 2012. Sydney: The Kirby Institute, University of New South Wales
  12. Adams K, Burgess J, Dharmage S (2010) Trachoma surveillance report 2009. Melbourne: National Trachoma Surveillance and Reporting Unit
  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. Aboriginal and Torres Strait Islander Social Justice Commissioner (2005) Social justice report 2005. Sydney: Human Rights & Equal Opportunity Commission
  15. 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
  16. Council of Australian Governments (2009) National Indigenous reform agreement (closing the gap). Canberra: Council of Australian Governments
  17. Australian Government (2008) Statement of intent. Paper presented at the Indigenous Health Equality Summit: Close the Gap. 20 March 2008, Canberra
  18. Anderson I (2009) Close the Gap: National Indigenous Health Equality Council. Medical Journal of Australia; 190(10): 546
  19. 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
  20. Western Australian Department of Indigenous Affairs (2010) Closing the gap in Indigenous life outcomes, Western Australia. Perth, WA: Department of Indigenous Affairs, Western Australia
  21. Department of Families Housing Community Services and Indigenous Affairs (2009) Closing the gap on Indigenous disadvantage: the challenge for Australia. Canberra: Commonwealth of Australia
  22. Australian Government (2013) $777 million for renewed effort to close the gap in Indigenous health. Retrieved 18 April 2013 from http://www.indigenous.gov.au/777-million-for-renewed-effort-to-close-the-gap-in-indigenous-health/
  23. Government of Western Australia (2013) Closing the Gap funding continues. Retrieved 19 June 2013 from http://www.mediastatements.wa.gov.au/Pages/StatementDetails.aspx?listName=StatementsBarnett&StatId=7496
 

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