ABORIGINAL AND TORRES STRAIT ISLANDER

HEALTH

TheroleofRDAAinaddressingthehealthneedsofAboriginalandTorresStraitIslanderpeople.

INTRODUCTION

TheinequitiesthatexistwithrespecttoaccesstohealthservicesandinhealthoutcomesforAboriginalandTorresStraitIslanderpeoplearewidelyrecognisedandhavebeenaconcernofRDAA,itsStateandTerritorymemberorganisationsandtheirindividualmembersformanyyears.RuralDoctorsAssociations(RDAs)invariousStatesplayedapivotalroleinthedevelopmentofthefirstAboriginalhealthcurriculaandinlobbyingtoensuretheybecamepartofmainstreamsystems.Nationally,RDAAhasbeeninvolvedinpolicydevelopmentandsupportingthedeliveryofmedicalcaretoimprovethehealthstatusofFirstAustralians.

RDAAremainsconcernedthat,althoughtherehasbeensomeimprovementinmarkersofhealthandhealthrisk,including infantandchildmortalityratesandavoidablemortalityrelatedtocardiovascularandkidneydiseases1,FirstAustraliansstilldieatyoungeragesandathigherratesthanotherAustralians2,withchronicdiseasesbeingsignificantcontributorstothemortalitygap3.

Approximately65%ofAboriginalandTorresStraitIslanderpeopleliveoutsidemajorcities4andrelyonaccesstohealthservicesinrural,regionalandremotecommunities.EnsuringaccesstoruralandremotedoctorsandotherhealthprofessionalswhoaretrainedinculturalcompetenciesandsupportedtoprovideholistichealthcareisessentialtoachieveClosingtheGaptargets.

BACKGROUND

ItiswidelyrecognisedthatAboriginalandTorresStraitIslanderpeoplegenerallyhavesignificantlypoorerhealthoutcomesandmortalityratesthannon-IndigenousAustralians.FindingsfromtheNationalAboriginalandTorresStraitIslanderHealthMeasuresSurveyshowedthatAboriginalandTorresStraitIslanderpeopleare:

• morethanthreetimesaslikelytohavediabetes(rateratioof3.3)• twiceaslikelytohavesignsofchronickidneydisease(rateratioof2.1)• nearlytwiceaslikelytohavehightriglycerides(rateratio1.9)• morelikelytohavemorethanonechroniccondition,forexamplehavingbothdiabetesand

kidneydiseaseatthesametime(53.1%comparedwith32.5%).5

AboriginalandTorresStraitIslanderpeoplealsoexperiencehigherratesofmentalhealth-relatedproblems.ThesuiciderateforAboriginalandTorresStraitIslanderpeople(basedonage-standardisedrates)wasalmosttwicetheratefornon-IndigenousAustraliansin2008-2012overall.For15-19yearolds,theratewasfivetimesashighasthenon-Indigenousrate(334and7per100,000population).6

OverthelastdecadetheCommonwealthGovernmenthasendeavouredtoaddresstheseissuesthroughtheClosingtheGapinitiative.InDecember2007theCouncilofAustralianGovernments(COAG)agreedtargetstoclosethegapbetweenIndigenousandnon-IndigenousAustraliansincluding:

• toclosethegapinlifeexpectancywithinageneration(by2031),and• tohalvethegapinmortalityratesforIndigenouschildrenunderfiveby2018.7

Tothisendthe2008NationalPartnershipAgreementonClosingtheGapinIndigenousHealthOutcomesidentifiedfivepriorityareasforaction:

• tacklingsmoking• providingahealthytransitiontoadulthood• makingIndigenoushealtheveryone'sbusiness• deliveringeffectiveprimaryhealthcareservices,and• bettercoordinatingthepatientjourneythroughthehealthsystem.8

In2013,theNationalAboriginalandTorresStraitIslanderHealthPlan2013-20239,astrategicframeworkforactionwhichidentifiedunderlyingprinciplesandprioritiesforspecificactionsforthenextdecade,wasintroduced.AnImplementationPlanfortheNationalAboriginalandTorresStraitIslanderHealthPlan2013–202310waspublishedin2015,andinDecember2017areportonnationalconsultations11toinformthe2018iterationoftheImplementationPlanfortheNationalAboriginalandTorresStraitIslanderHealthPlan2013-2023wasreleased.

TheimportanceofmaintainingtheseeffortstoachieveClosingtheGaptargetsishighlightedbytheClosingtheGap:PrimeMinister’sReport2017whichindicatedthat,althoughtherewasanoveralldeclineinAboriginalandTorresStraitIslandermortalityratesbetween1998and2015,Australiawasnotontracktoclosethegapinlifeexpectancyby203112.TheClosingtheGap:PrimeMinister’sReport2018reiteratedthisoutlookandpointedoutthattherehasbeennoimprovementsincethe2006baseline13.Further,between2005-2007and2010-2012,therehasbeenonlyasmallreductioninthelifeexpectancygapforbothmalesandfemales14.

ThetargettohalvethemortalityratesforIndigenouschildrenby2018isnowontracktobemet.Whileoverthelongerterm(1998to2016)childmortalityrateshavedeclinedandthegaphasnarrowedtherehasbeenslowerprogresssincethe2008baseline15.

Thesereportsindicatethatsomeprogresshasbeenmadeinsomeareas,butin2018onlythreeofthesevenClosingtheGaptargetsthatspanhealth,educationandemploymentareontracktobemet16.Targetstodrivesustainedeffortareessentialbutcannotbeachievedwithoutappropriateresourcing.

Atthetimeofwriting,aClosingtheGapRefreshconsultationprocessisunderwaywithsubmissionsdueby31March2018.ThroughthisprocesstheClosingtheGapagendamaybeexpandedorcontracted17.COAGhasalso“committedtomoreaccuratelymeasureprogressandincreaseaccountabilitybysettingnationalaswellasstateandterritorytargets”18.

RDAA’SPOSITION

RDAArecognisesthatspecialeffortsarerequiredtoraisethehealthstatusofAboriginalandTorresStraitIslanderpeopletothatoftherestoftheAustraliancommunityandbelievesthatthesemustinclude:

• recognitionofthefundamentalimportanceofsocio-economic,environmentalandculturalfactors–includingconstitutionalrecognitionofAboriginalandTorresStraitIslanderpeople,intergenerationaltraumaandnegativehealtheffectsthatstemfromit,theimportanceofHomeland,infrastructure,education,transportandemployment–onhealthstatus.Thesemajordeterminantsofhealthandwell-beingmustbefactoredintoallstrategiestosupportAboriginalandTorresStraitIslanderpeopleandcommunities.Accesstobasiclivingrequirementsandconditionssuchascleancontinuouswatersupply,housing,functionalsewerage,areasonabledietandnutritionalrequirementsisessentialforhealth.RDAAthereforeemphasisestheneedtoprioritiseaddressingbroaderinfrastructureissuesaswellasprovidingformorespecifichealthservices

• involvement,partnershipandleadershipfromlocalAboriginalandTorresStraitIslanderpeopleindeterminingthetypeofhealthservicesbestsuitedtolocalneedsandresourcesindevelopinganddeliveringhealthpolicyandprograms

• supportforAboriginalCommunityControlledHealthServices

• aculturallyrespectful,consultativeapproachtopolicyandprogramdevelopmentonallAboriginalandTorresStraitIslanderhealthissues

Inaddition,RDAAbelievesthatthefollowingarenecessarytosupportqualityhealthcareforFirstAustralians:

• policyandprogramdevelopmentatalljurisdictionallevelswhichcontinuestoevolvetoachieveClosingtheGaptargets

• aprimaryhealthcareapproachandmulti-disciplinarystrategiesbasedonaholisticviewofthehealthoftheindividualandthecommunity

• appropriateincentivestostrengthentheroleandabilityofruralandremotegeneralpracticeinmaintainingandimprovingthehealthofAboriginalandTorresStraitIslanderpeople

• specialattentiondirectedto

o AboriginalandTorresStraitIslanderchildrentoaddresstheissuesthatimpactondevelopmentofchildrenandbreakthecyclesofpoorerhealthandwellbeing

o thepreventionofchronicdisease

• areviewandupdateofthe2004CDAMSIndigenousHealthCurriculumFramework19withafocusonprovidingpractical,bestpracticeapproachestoimprovetheconsistencyofcurriculumimplementation,andachieveminimumstandardsforeducationinAboriginalandTorresStraitIslanderhealth,culturalawarenessandrespect,culturalsafetyandcompetencies,andincross-culturalcommunicationthatarealignedwiththebroader2014

AboriginalandTorresStraitIslanderHealthCurriculumFramework20andtheAustralianMedicalCouncil’sStandardsforAssessmentandAccreditationofPrimaryMedicalPrograms21

• theprovisionofadvancedskillstraininginAboriginalandTorresStraitIslanderHealththatisalignedwithlocalneedswithintheNationalRuralGeneralistPathway

• employmentorientationprogramsthatincludesawarenesseducationandexposuretolocalcommunityculture

• specialmeasurestoattractandretainmedicalpractitionerstoAboriginalMedicalServiceswhichrecogniseclearroledelineation,comparableremuneration,appropriatemanagementandacceptableandsecurelivingandworkingconditionsasprerequisitesforastablemedicalworkforce

• ongoingaccesstointernalandexternalprofessionaldevelopmentopportunitiesforthoseinvolvedinthedeliveryofAboriginalandTorresStraitIslanderhealthservices

• specificmeasurestoincreasethenumberofAboriginalandTorresStraitIslanderpeopleattainingqualificationsinthehealthprofessionsandenteringtheruralhealthworkforce,includingprogramstoencourageAboriginalandTorresStraitIslanderpeopletoconsideracareerinruralmedicine,nursingandalliedhealth

• increasedsupportforAboriginalandTorresStraitIslanderpeopletoundertaketraininglocallyforhealthroles,includingAboriginalHealthWorkers,AssistantsinNursing(AINs)andalliedhealthassistants

RDAA,inlinewithitsReconciliationActionPlan,seekstoestablish,buildandmaintainpartnershipswithkeyAboriginalandTorresStraitIslanderorganisations,includingtheAustralianIndigenousDoctors’Association(AIDA)andtheNationalAboriginalCommunityControlledHealthOrganisation(NACCHO),toachieveidentifiedgoals.

RDAAwillworkto

• ensurethattheinterestsofruralmedicalpractitionersprovidingcareforAboriginalandTorresStraitIslanderpeoplearerecognisedandpromotedinrelevantforums,andsupportstrategiestobuildasustainablemedicalworkforcewhichisadequatelytrainedandresourcedtoprovidehealthcareforFirstAustralians,includingby

o providingaccesstoappropriateonlineculturalcompetenciestraining,withakeyfocusonAboriginalandTorresStraitIslanderpeople,forRDAmembersandtheirstaff

RDAAwillsupportotherstakeholdersintheirworktoimprovehealthoutcomesforallAboriginalandTorresStraitIslanderpeople.

ENDNOTES

1. Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW. p228.

2. In 2010-12, the estimated life expectancy at birth for Indigenous males was 69.1 years – 10.6 years lower than for non-Indigenous males (79.7 years) – and 73.7 years for Indigenous females – 9.5 years lower than for non-Indigenous females (83.1 years). In the 5-year period 2008-2012, 65% of deaths among Indigenous people occurred before the age of 65 compared with 19% of deaths among non-Indigenous people and the mortality rate for Indigenous people was 1.6 times that of non-Indigenous people.

Australian Institute of Health and Welfare 2015. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW. p110.

3. Ibid p115.

4. Drawn from Australian Bureau of Statistics 2016. Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016: Aboriginal and Torres Strait Islander Population 2016 Census Data Summary. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Aboriginal%20and%20Torres%20Strait%20Islander%20Population%20Data%20Summary~10. Viewed 10 February 2018.

5. Australian Bureau of Statistics 2014. Australian Aboriginal and Torres Strait Islander Health Measures Survey: Biomedical Results, 2012-13, ABS, September 2014. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.003. Viewed 10 February 2018.

6. Op cit AIHW 2015. p80.

7. Council of Australian Governments. Council of Australian Government’s Meeting: Communiqué. December 2007. https://www.coag.gov.au/meeting-outcomes/coag-meeting-communiqué-20-december-2007. Downloaded and viewed 10 February 2018.

8. Council of Australian Governments, 2008. National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes http://www.federalfinancialrelations.gov.au/content/npa/health/_archive/ctg-health-outcomes/national_partnership.pdf. Downloaded and viewed 10 February 2018.

9. Commonwealth of Australia 2013. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Available at http://www.health.gov.au/natsihp. Viewed 10 February 2018.

10. Commonwealth of Australia, Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-implementation-plan. Downloaded and viewed 10 February 2018.

11. Commonwealth of Australia, Department of Health, My Life My Lead - Opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: Report on the national consultations December 2017. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-ipag-consulation. Downloaded and viewed 10 February 2018.

12. Commonwealth of Australia, Department of the Prime Minister and Cabinet, Closing the Gap: Prime Minister’s Report 2017. https://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf Downloaded and viewed 08 February 2018. p81.

13. Commonwealth of Australia, Department of the Prime Minister and Cabinet, Closing the Gap: Prime Minister’s Report 2017. http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2018.pdf?a=1 Downloaded and viewed 19 February 2018. p104.

14. Loc cit.

15. Ibid p37.

16. Ibid p08.

17. Closing the Gap: The Next Phase Public Discussion Paper. p5. https://closingthegaprefresh.pmc.gov.au/sites/default/files/resources/ctg-next-phase-discussion-paper.pdf. Downloaded and viewed 17 January 2018.

18. Loc cit.

19 Committee of Deans of Australian Medical Schools, August 2004. CDAMS Indigenous Health Curriculum Framework. Available at http://www.medicaldeans.org.au/projects-activities/indigenous-health/cdams-indigenous-health-curriculum-framework/.

20. Commonwealth of Australia, 2014. Aboriginal and Torres Strait Islander Health Curriculum Framework. http://www.health.gov.au/internet/main/publishing.nsf/Content/aboriginal-torres-strait-islander-health-curriculum-framework.

21. Australian Medical Council. December 2012. Standards for Assessment and Accreditation of Primary Medical Programs. Available at http://www.amc.org.au/accreditation/primary-medical-education. Under review as at 07 February 2018.