Aboriginal and Torres Strait Islander Health (7)

Aboriginal and Torres Strait Islander Health Expenditure

  • In 2013-2014, health expenditure for Aboriginal and Torres Strait Islander people was estimated at 8,5158,515 per person, compared to 6,1806,180 per non-Indigenous person. This was 38% more, according to the Australian Institute of Health and Welfare.
  • By 2015-2016, this had increased to 8,9498,949 per person for Aboriginal and Torres Strait Islander people, compared to 6,6576,657 per non-Indigenous person.
  • Over this time, there was an increase of 434434 for Aboriginal and Torres Strait Islander people, but an increase of 477477 for non-Indigenous people.
  • The burden of disease is 2.3 times greater for Aboriginal and Torres Strait Islander people than for the non-Indigenous population.
  • In 2013-2014, overall government spending was only 53% of the needs-based requirements for Aboriginal and Torres Strait Islander health.
  • In 2015-2016, the Commonwealth Government was spending 1.3 times the amount on Aboriginal and Torres Strait Islander people compared to the mainstream population.

Close the Gap

  • Close the Gap was a statement from Tom Kalner, the Social Justice Commissioner (now Chancellor of the University of Canberra).
  • In 2005, Kalner stated that it was unacceptable that Australia could not address the health crisis affecting 3% of the population.
  • Kalner called on the government to close the gap, which was picked up by Oxfam, who had a campaign with Kathy Freeman and Ian Thorpe.
  • In 2008, the government, under Prime Minister Kevin Rudd, introduced Closing the Gap, the government's national strategy to address health inequalities.
  • The Prime Minister releases reports explaining contributions to the Closing the Gap strategy and the outcomes.
  • Oxfam has released a counter-report on how they perceive the government is tracking in Closing the Gap.

Life Expectancy

  • Life expectancy for Indigenous people is a lot lower than for non-Indigenous people.
  • Life expectancy is increasing for everyone.
  • There is still a large gap between Indigenous and non-Indigenous life expectancy.
  • There has been an improvement in life expectancy for Aboriginal and Torres Strait Islander men and women, but the life expectancy gap is not closing and is getting wider.
  • The rate of life expectancy improvement in the non-Indigenous population is greater than the increase for the Aboriginal and Torres Strait Islander population.
  • The government is still looking at 1998 as its starting point, even though the strategy didn't start until 2008.
  • Between 1998 and 2008, life expectancy was already improving considerably.
  • From 2008 until now, the gains have slowed considerably.

Child Mortality Gap

  • If you can reduce child mortality, you also have a greater chance of improving overall life expectancy.
  • There is considerable change over time.
  • These aren't collected annually.
  • At one point, they were on track.
  • In the early 2000s to 2010, they were well on track to close the gap.
  • The target is to halve child life expectancy gap, not actually to close the gap.
  • By 2012, it looked like they might be on a trajectory to close that gap.
  • By 2018, they've completely shut off and are nowhere near affecting that change.

Critical Analysis of Data

  • Be critical about the data you get, the data you read, and the sources that it comes from.
  • The Australian Bureau of Statistics, the Australian Institute of Health and Welfare, are to be trusted, good sources with unbiased opinions.
  • Data can be used to represent anything.
  • Everybody has an agenda.
  • You can use information to tell a story any way you like.
  • When the government is reporting, they're recognizing a failure, but there's still a story behind that.
  • There's still information that they're keeping or a story that they're not telling just by sticking a graph up and saying, This is where we're at.
  • Always be critical about what you see.

Closing the Gap Targets

  • There was two targets that were actually achieved within the expected timeframes. early education and Year 12 or equivalent.
  • While Aboriginal and Torres Strait Islander people are less likely to get a HSCTR OP, a year 12 attainment through high school, they're actually more likely to get a TAFE qualification.
  • Under the previous targets, that wasn't actually a factor.
  • Child mortality wasn't met, life expectancy is still not met, and employment was still not met.
  • There was a massive flaw in this idea of setting these targets, and that was that Aboriginal and Torres Strait Islander people weren't consulted.
  • The government agreed to close the gap, and then they set about determining what are the social determinants that we need to actually improve life expectancy.

Social Determinants and Racism

  • If you can get a good education, you can get a good job. If you can get a good job, then you put yourself in a better socioeconomic position. If you're in a better socioeconomic position, then you're more likely to have healthy life outcomes.
  • If you can't access food, or you can't access school, or you can't access these other services, then how do you get a better education? How do you get a better job?
  • Is this addressing the racism issues that we see in our health and education and employment systems
  • There's been any number of reports of people putting forward two exactly the same job applications under different names and invariably the person with the white sounding name or the European sounding name is more likely to get an interview than the person with an ethnic sounding name.
  • We can't escape the fact that there is racism within our systems.

Language and Education

  • We live in a colonized society where English is the predominant language, but if you go into the Northern parts of Australia, up into the Northern parts of Queensland, particularly the Northern parts of the Northern Territory and Western Australia, you can meet communities where English might be a second, third, even fourth language.
  • Part of the issue being that the government made it illegal for schools in the Northern Territory to teach dual language.
  • So if you've got a five year old coming to you who speaks English as a second or third language, and the only thing they're allowed to teach at school is English, what's the likelihood that that child's going to be easily engaged in that education system?

Enrollment vs. Attendance

  • You can enroll in a class, but never turn up.
  • Being enrolled attached to child payments.
  • If you're on government benefits, your child has to be enrolled in an early child education program for you to continue to receive your benefits.
  • If you don't have a car and you can't drop your kid at school, or if you're sick and you can't get out of bed, I've got four year olds, I can tell you they don't get themselves out of bed, get themselves dressed and get themselves off to school.
  • I'm sure there's more than one person in the 70 students enrolled currently into the Zoom that could put their hand up and say they wagged at least one day of school. So even sending your child to school doesn't guarantee their attendance.

Government Policy Impact on Life Expectancy

  • It's quite possible that we just plateaued.
  • We're not increasing the amount of funding that we're putting towards the systems that support Aboriginal and Torres Strait Islander people.
  • We know that Aboriginal and Torres Strait Islander people are more likely to attend Aboriginal and Torres Strait Islander community controlled health organizations.
  • Some of the barriers are privacy.

Access and Systemic Disadvantage

  • These are not Aboriginal and Torres Strait Islander issues. These are not issues of Aboriginality. These are social issues that affect anybody in a low socioeconomic position.
  • We have more Aboriginal and Torres Strait Islander people who are low socioeconomic and disadvantaged and unable to achieve these things than non Indigenous. And that's one of the reasons we have this massive disparity.
  • They do disproportionately impact Aboriginal and Torres Strait Islander people. If any of you recall Naomi Watts from two years ago now, think she was, two, three years ago, she was pregnant.
  • She went to the local hospital, I think it was anywhere between eight and fifteen times. I can't exactly recall. Because she was having headaches and nausea.
  • The doctors told her to take a Panadol and go home and she died. And the coroner's report found that there was racism involved in that, that had she been a non Aboriginal Torres Strait Islander person, it's more likely that she would have been admitted to hospital and they would have discovered what her issue was instead of sending her home and assuming that she had a substance issue or a drinking issue or was seeking medication.

Coalition of the Peaks

  • Last year the government announced a partnership with the Coalition of the Peaks. The Coalition of the Peaks is, I think there's up to 50 organizations now.
  • NACCHO, is a peak body.
  • All of those peak bodies came together under NACCHO to form the Coalition of Peaks.
  • In 2017, when Closing the Gap strategy was coming to an end, the government held a series of consultations across the country.
  • From those consultations, the peak bodies pushed back and said, isn't good enough. This is not a consultation. What you need is genuine partnership. We deserve a position at the table. We deserve our voice to be heard. And we know our people better than you do.
  • We've gone from eight targets to 16.

New Targets

  • The majority of them mentioned children and nothing else about the other people within the community?
  • More targets now, aren't there? More targets involving children as opposed to just early education and child mortality.
  • All very, very positive.
  • Instead of closing the gap and changing mortality and what we call a deficit discourse, where all we do is focus on the deficit.

Holistic Approach

  • The concept of health to Aboriginal and Torres Strait Islander people is holistic. It's a life death life cycle.
  • You cannot just take one single element and change that and have a profound influence on absolutely everything else.
  • It's not a Western system where you say, My arm is broken. We'll cut it off and the rest of you will be fine. It doesn't work that way.

Greening Australia Policy

  • Greening Australia was a policy that was put in place back in the kind of early 1800s, sorry, the late 1800s, so 1788ish, 1800s when Europeans came to Australia.
  • They didn't understand our landscape.
  • They tried to make Australia as European as possible.
  • Aboriginal and Torres Strait Islander people only hunted and gathered.
  • Europeans came and they tried to green what was called the greening policy.
  • Planted European foods. I mean, have cotton and wheat and corn and all sorts of European foods here that were not here three hundred years ago.
  • Clear paddocks and cleared areas and brought in cattle and sheep, which we now know do horrific damage to our landscape.

National Nutrition Strategy

  • No national target.
  • Back before 2010, there was a national a Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan, NACS and SAP for short.
  • When it finished, it wasn't renewed and there was no additional national strategy.

Food Security Definition (United Nations World Food Summit):

  • Defined what food security would look like.
  • In 2010, the General Assembly made access to clean drinking water a human right.
  • Not only now is it a requirement, you know, to be healthy, but it should be a human right. People should have access to clean drinking water.

Australian Food Security

  • Defined by Australia as existing whenever the availability of nutritionally adequate and safe food or the ability to acquire acceptable food in society Sorry, in a socially acceptable way is limited or uncertain.
  • Traditional versus contemporary.
  • What's a socially acceptable method?

World Health Organization: key issues around achieving food security

  • Access, availability and use

Availability

  • Can I walk into any Woolworths store and buy food that I recognize and that I want when I want it?

Accessibility

  • If I can't go and hunt down a kangaroo.
  • Built environment.

Quality

  • Storage and it's transport.

Affordability

Food Literacy

  • Do you have the knowledge?
  • Health hardware is just a fancy word for cooking equipment and fridges.

Food Security

  • Back in 2013, '3 point '7 percent of non Aboriginal and Torres Strait Islander people in the population were living in a household that ran out of food, literally did not have food, and couldn't afford to buy more, or they went without when they ran out.
  • For Aboriginal and Torres Strait Islander people, this was 227% respectively.

Food Sovereignty

  • Food sovereignty asserts the right of people to nourishing and culturally appropriate food produced in an ethical and ecologically sound way, and their own right to collectively determine their own food and agricultural systems.