We must keep striving to close the gap in Indigenous health

"Just in the last week, three of my closest friends and a relative have been diagnosed with cancer. This is not an uncommon story, to be – as a community – constantly in grief, loss and trauma."

These words, from Janine Mohamed, chief executive of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, will be familiar to our communities across Australia.

As will her realisation, during primary school, that the Australia she experienced was very different to that experienced by other Australians. There often was not enough food in the house, and her constant trips to the doctor, accompanying her mother with schizophrenia, meant she missed a lot of school.

When the Prime Minister delivers the annual address on progress on closing the gap on Indigenous disadvantage in Parliament on Wednesday, we will be  reminded that these experiences are woven into the lives of Aboriginal and Torres Strait Islander people – but they need not be.

Seven years ago, we celebrated the coming together of politicians from all sides of politics to commit to closing the health inequality gap between Indigenous and non-Indigenous Australiansby 2030.

The Australian community also galvanised around the alarming statistics that babies born to Indigenous mothers were twice as likely to die as their non-Indigenous counterparts, that Aboriginal and Torres Strait Islander people died an average of 10 years earlier and suffered greater rates of heart disease, diabetes, kidney disease and mental health issues.

There was an overwhelming sense of the unfairness of this - Australia is a wealthy country; equal access to healthcare is a basic human right, and we should all expect it.

Since then, more than 200,000 Australians have pledged their support to ending this national disgrace, and the Prime Minister reports every year at this time on progress against a number of targets.

So, how are we doing? In our own report, we note that the target to halve mortality for under-fives by 2018 is on track to be met. Smoking rates are slowly going down, which then improves the likelihood of related diseases – lung cancer, heart disease – also lessening.

But closing the life expectancy target remains a harder job. Of course it is; it's taken centuries to get us to this point, we cannot expect any quick fixes.

In other countries we can see that a sustained, co-ordinated effort yields results. For example, a four-year rise in Maori life expectancy was achieved between 2000-02 and 2010-12 after two decades of sustained national effort. There was no chopping and changing of government policy.  Governments stayed the course and continued to invest in health.

Here, we know what can make a real difference.  We've got new data showing high levels of Indigenous people with undetected treatable and preventable chronic conditions – such as kidney disease and diabetes – that have a significant impact on life expectancy. Armed with this data we believe the nation now has an ability to make relatively large health and life expectancy gains.

To do this, there needs to be a much greater focus on access to appropriate primary healthcare services to detect and treat these conditions. Evidence shows Aboriginal community controlled health services controlled by the Aboriginal community are outperforming others in the detection and treatment of health issues.

This is because they know that everything is connected. In health services controlled by the Aboriginal community, doctors, nurses and Aboriginal and Torres Strait Islander health workers treat each person in a holistic, culturally appropriate way. They spend longer with their patients, know their history and know how to deal with the complex issues they face daily – homelessness, food shortages and mental health issues.

For example, a program developed in 2009 by the Apunipima Cape York Health Council provides "baby baskets", with practical gifts for mum and baby, health education material and food vouchers to buy fruit and vegetables in the first trimester and after birth.

Health workers engage with mothers, partners and families about issues affecting their growing baby – such as the importance of making healthy choices around smoking, alcohol and diet. At a relatively small cost, the program has resulted in a higher proportion of women making antenatal visits, being less likely to be iron deficient and more likely to be making healthy food choices and quit smoking.

The federal government needs to continue to invest in these Aboriginal medical services as a matter of priority. Given the health sector is the largest employer of Indigenous people, this also aligns with one of the stated Indigenous affairs priorities of the Australian government – of getting adults to work.

As set out in the government's Indigenous Advancement Strategy last year, the other two top priorities are getting children to school and building safer Indigenous communities.

But it's harder for children to go to school or for safer communities to be built if people don't enjoy good health.

The federal government must stay the course – it must continue to lead on closing the gap in Indigenous health, make no more cuts to Indigenous health funding, retain and increase funding to the successful Tackling Indigenous Smoking program, and connect the Closing the Gap health strategy to other Indigenous priorities, given the issues are interconnected.

With sustained commitment, we can be the generation that closes the gap.



This opinion piece, written by Mick Gooda, the Aboriginal and Torres Strait Islander Social Justice Commissioner, and Kirstie Parker, the co-chair of the National Congress of Australia's First Peoples,  first appeared on smh.com.au on 11 February 2015.