Indigenous inequalities are very evident in health. Unfortunately, Indigenous Australians suffer from much worse health problems than the non-Indigenous Australian population. Here are a few key figures to demonstrate the stark inequalities. In 2017, Indigenous children experienced 1.7 times higher levels of malnutrition than non-Indigenous children. Additionally, three in 10 indigenous people who needed to go to a health provider did not go. Indigenous people’s barriers to healthcare frequently include high costs, unavailability of services, the distance from healthcare services and long waiting times.
Another inequality is that 45% of Indigenous people, aged 15 years or over, said they experienced disability, compared to just 18.5% in the non-Indigenous population. Between 2014-2016, Indigenous children aged 0-4 were more than twice as likely to die as non-Indigenous children. In the Northern Territory, Indigenous infant mortality was four times higher than the national rate. Lastly, Indigenous people had to wait 50 days on average for elective surgery compared to 40 days for non-Indigenous people. All this evidence highlights the stark Indigenous inequalities in health, demonstrating the gap that exists in access to key services and educational tools.
Original Closing the Gap Framework
In 2008, the Australian government made a promise to address Indigenous inequalities in a strategy called Closing the Gap. “The Gap” refers to the vast health and life-expectancy inequalities that exist between Indigenous and non-Indigenous Australians. The framework involved seven targets aimed at reducing socio-economic Indigenous inequalities, including many health targets. However, when the government began evaluating the success of the framework, it became clear that there is still a long way to go.
Five of the seven targets remain unmet, with very little evidence of progress in those target areas. The two targets that the Australian government has met were early education and Year 12 completion rates, but the other targets including child mortality, school attendance, literacy and numeracy and employment and life expectancy, have shown little or no improvements. A lot of the discussions around the failure of the framework have surrounded the issue of the lack of Indigenous voices. The Australian government established the framework with no engagement of the local Indigenous people it was seeking to help. It ignored their individual experiences and their local solutions, and instead came up with a one size fits all solution that failed to understand the Indigenous community.
2020 Programme Refresh
Because of the failure of the original Closing the Gap framework to address Indigenous inequalities in health, in July 2020, the government met and agreed upon a new approach. The government believed a refresh and shift in the Closing the Gap framework was necessary. This refresh involved a partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak organizations. This represents a huge advancement and the first time that an agreement with an aim to improve the lives of Aboriginal and Torres Strait Islander people has actually involved Indigenous people in its localized solutions.
This newly designed framework will embed the cultural determinants and social determinants of health to provide a single, overarching policy framework for Indigenous health. The vision is that Aboriginal and Torres Strait Islander peoples will be able to enjoy long, healthy lives that are centered in culture, with access to services that are prevention-focused, responsive, culturally safe and free of racism and inequity. The framework ensures that Indigenous people are at the center of creating solutions that work for them in their cultures. Alongside this nationwide government framework, other progress is occurring including the implementation of more healthcare services with healthcare officials that actually represent the population. In fact, healthcare services are involving more Indigenous workers and the government is implementing Indigenous-specific healthcare facilities to better cater to Indigenous people’s specific needs.
Evidence is beginning to mount showing the positive effects of reducing Indigenous inequalities in health. For example, from 2013 to 2019, the number of Indigenous medical practitioners employed across Australia increased from 234 to 488. Additionally, Indigenous-specific primary healthcare organizations provided 3.7 million episodes of care in 2018-19. Though progress has been slow so far, there are some promising statistics and a renewed government focus that will hopefully start to reduce Indigenous inequalities in health.
– Lizzie Alexander