Reducing the inequalities in indigenous health: a new way forward

The health of Aboriginal and Torres Strait Islander peoples continues to progress at a slow rate with only minor improvements in health status reported in recent years.1 Social inequalities have contributed to the poor health status of Indigenous Australians. Forced relocation, urban migration, poor education, lack of employment, low income, inadequate housing, lack of environmental infrastructure and a lack of appropriate health service provision are all important social determinants of ill health for Aboriginal and Torres Strait Islander peoples.2 The United Nations advocates for individuals on the right to the highest attainable standard of health. Over the past four decades the right to health has been recognized, but only now are we seeing the emphasis and emergence on a rights based approach to health service planning and delivery. The campaign for indigenous health equality in Australia, which has been developed under the leadership of the Human Rights and Equal Opportunity Commission (HREOC) and its Social Justice Report 2005, offers a new way forward in improving health outcomes for indigenous Australians.3 The national campaign on 'Close the Gap', which is focused on reducing the 17-year life-expectancy gap between indigenous and non-indigenous Australians set the foundation for the National Indigenous Health Equality Summit from 18–20 March 2008 in Canberra. The Summit was the culmination of the 2-year campaign for indigenous health equality, 'Close the Gap', undertaken by a coalition of more than 40 indigenous and non-indigenous organizations. HREOC's Aboriginal and Torres Strait Islander Social Justice Commissioner Tom Calma played an important role in planning and managing the Summit. The process was an excellent example of partnership, consultation and collaboration across several diverse groups, including national indigenous peak bodies, such as The National Aboriginal Community Controlled Health Organisation (NACCHO), Australian Indigenous Doctors Association (AIDA), Indigenous Dentists Association of Australia (IDAA), Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN), Australians for Native Title and Reconciliation (ANTaR), and non-indigenous organisations, including OXFAM Australia, The Royal Australasian College of Physicians (RACP), Australian Medical Association (AMA), and the Royal Australian College of General Practice (RACGP). The Summit addressed four key areas of policy which are as follows: Primary Health Care Policy Group targeted primary health care services and the related issue of health workforce planning and development Health Infrastructure Policy Group looked at health infrastructure, including health workforce, Equipment and capital, housing, water supply, nutrition and environmental health Social Determinants Policy Group overviewed employment, education, income and stressors The Health Status Targets Policy Group developed several specific health targets, which will be presented to government The Indigenous Health Equality Summit steering committee developed a Statement of Intent, which addresses 'Closing the Gap' and working 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. The statement of intent and signatures is set out below. This is a statement of intent – between the Government of Australia and the Aboriginal and Torres Strait Islander Peoples of Australia, supported by non-indigenous Australians and Aboriginal and Torres Strait Islander and non-indigenous health organizations – 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. We share a determination to close the fundamental divide between the health outcomes and life expectancy of the Aboriginal and Torres Strait Islander peoples of Australia and non-indigenous Australians. We are committed to ensuring that Aboriginal and Torres Strait Islander peoples have equal life chances as all other Australians. We are committed to working towards ensuring Aboriginal and Torres Strait Islander peoples have access to health services that are equal in standard to those enjoyed by other Australians, and enjoy living conditions that support their social, emotional and cultural wellbeing. We recognise that specific measures are needed to improve Aboriginal and Torres Strait Islander peoples' access to health services. Crucial to ensuring equal access to health services is ensuring that Aboriginal and Torres Strait Islander peoples are actively involved in the design, delivery, and control of these services. To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities in health services, in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians by 2030. To ensuring primary health care services and health infrastructure for Aboriginal and Torres Strait Islander peoples which are capable of bridging the gap in health standards by 2018. To ensuring the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs. To working collectively to systematically address the social determinants that impact on achieving health equality for Aboriginal and Torres Strait Islander peoples. To building on the evidence base and supporting what works in Aboriginal and Torres Strait Islander health, and relevant international experience. To supporting and developing Aboriginal and Torres Strait Islander community-controlled health services in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal and Torres Strait Islander health and wellbeing. To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples. To respecting and promoting the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable, and of good quality. To measuring, monitoring, and reporting on our joint efforts, in accordance with benchmarks and targets, to ensure that we are progressively realising our shared ambitions. Representative of the Australian Government National Aboriginal Community Controlled Health Organisation Congress of Aboriginal and Torres Strait Islander Nurses Australian Indigenous Doctors Association Indigenous Dentists Association of Australia Aboriginal and Torres Strait Islander Social Justice Commissioner, Human Rights and Equal Opportunity Commission RACP National Heart Foundation RACGP Divisions of general practice (GP) Reconciliation Australia AMA Get up The above Statement of Intent signed by government and indigenous health leaders captures the essence of the partnership, a true commitment to working together and is a respectful and real way to realize the goal of closing the gap in life expectation. Before signing the Statement of Intent in the great hall of Parliament House the Rudd government announced two significant new policy initiatives at the landmark National Indigenous Health Equality Summit. The first policy initiative will invest $14.5 million over 4 years to tackle the high rates of smoking in indigenous communities. Smoking is one of the preventable risk factors in chronic disease that could reduce significantly indigenous ill health if prevalence rates of smoking were reduced. The prevalence of smoking varies from community to community with estimates ranging from 50 to 80%. The smoking rate in the non-indigenous population is less than 20%, a major difference. In 2003 smoking caused 12% of the total burden of disease and one-fifth of all deaths among indigenous Australians.4 The second policy initiative will invest $19 million on a National Indigenous Health Workforce Training Plan. Support will be given to NACCHO, AIDA and CATSIN to expand their mentoring and networking programmes and to establish a National Health Worker Association. The Indigenous Medical Education Network will also be supported to expand indigenous health curricula into medical, allied health and nursing schools across Australia.5 The new Labor government has shown considerable commitment to improving indigenous health since taking office, first, with the apology to the stolen generation, which set the scene for moving on, and second, with the signing of the Statement of Intent, a human rights approach and blueprint for a new way forward in reducing the inequalities in indigenous health.