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Executive summary

The commitment to close the Aboriginal and Torres Strait Islander health and life expectancy gap by 2030 was a watershed moment for the nation. Politicians, the Aboriginal and Torres Strait Islander and non-Indigenous health sector, and human rights organisations, made a public stand in committing to this agenda. And so did the Australian public. To date almost 200,000 Australians have signed the close the gap pledge[1] and approximately 140,000 Australians participated in last year’s National Close the Gap Day.[2] This is the generation that has taken on the responsibility to end Aboriginal and Torres Strait Islander health inequality.

Data released in 2013 demonstrates the stark reality of health inequality still faced by Aboriginal and Torres Strait Islander peoples. It reminds us why the national effort to close the gap is a multi-decade commitment that will span policy cycles, funding agreements and governments. It reminds us why it is fundamentally non-partisan in nature. At this juncture, with 16 years to go, the need to build on success, to continue key elements of the national effort, and to expand and strengthen it in key areas with bold policy initiatives, is critical.

We are beginning to see reductions in smoking rates and improvements in maternal and childhood health that can be expected to flow into increases in life expectancy. These positive outcomes provide evidence that the national effort to close the gap is working, and that generational change is possible. They provide encouragement that the gap will close by 2030 even though more time must be allowed for significant change to be seen.

The demonstrated impact of ‘closing the gap’-related investment in the Aboriginal Community Controlled Health Services (ACCHSs) provide further signs of positive change occurring. In this, a substantial foundation has been built that will help underpin the national effort to close the gap over the next two decades.

Staying on course with the national effort to close the gap requires acknowledgement that there are ‘green shoots’ evident, and foundation elements that are now in place, for which continuity is critical. It also requires a commitment to redouble our efforts. In particular:

  • the implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013-23 (Health Plan)[3] in partnership with Aboriginal and Torres Strait Islander peoples;
  • continuing to build partnerships with Aboriginal and Torres Strait Islander peoples for planning and service delivery; and
  • long-term funding for the national effort to close the gap, as currently delivered through national partnership agreements, and the quarantining of close the gap programs and related initiatives in ongoing reviews of the health system at state, territory and federal levels.

The Health Plan was launched in July 2013. It is a framework document that requires further elaboration and a formal implementation process to drive outcomes; and it needs measurable benchmarks and targets to ensure accountability. The importance of continuing planning to a significant level of detail over 2014 (including the identification of what needs to happen, by when, who is responsible, and how much it will cost) cannot be underestimated.

Further, the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy[4] was launched in June 2013. The implementation of this strategy, the renewal[5] of the Social and Emotional Wellbeing Framework,[6] and a new alcohol and other drug (AOD) strategy anticipated in 2014 provide significant opportunities to progress both Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing policy and planning alongside the implementation of the Health Plan.

Real and effective planning and service delivery partnerships with empowered Aboriginal and Torres Strait Islander communities through ACCHSs and their representatives will enable the best possible implementation processes for the above. Such partnerships not only empower communities to exercise responsibility for the health of their members, but also provide a risk-management framework to minimise waste. They help ensure resources go to services and programs that will have maximum impact in communities, the areas of health where they are needed most.

Investment in the national effort to close the gap must continue, and the cuts to health services that occurred in the past year should not be allowed to have a negative impact. The $1.57 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes[7] expired in June 2013, and the $564 million National Partnership Agreement on Indigenous Early Childhood Development will expire in June 2014.[8] The upkeep of these foundational, nationally coordinated agreements and the continuation of guaranteed funding over significant spans of time constitutes the third critical area of continuity. Such are the ‘fuel’ that will drive the national effort to close the gap over the next agreement cycle and beyond.

This year, 2014, also provides opportunities for the new Australian Government to build on the national effort to close the gap. These opportunities are discussed in part three of this report and summarised in the text box below.

Achieving Aboriginal and Torres Strait Islander health and life expectancy equality by 2030 is an ambitious yet achievable task. It is also an agreed national priority. With nearly 200,000 Australians supporting action to close the gap, it is clear that the Australian public demand that government, in partnership with Aboriginal and Torres Strait Islander peoples and their representatives, build on the close the gap platform to meet this challenge. They believe that we can and should be the generation to finally close the gap.

The Close the Gap Campaign Steering Committee (Campaign Steering Committee) calls on the new Australian Government to ensure policy continuity in critical areas of the national effort to close the gap, and to also take further steps in building on and strengthening the existing platform.

The Close the Gap Campaign Steering Committee calls:
  • For multiparty resolve and commitment to close the Aboriginal and Torres Strait Islander health and life expectancy equality gap by 2030 to continue, and for policy continuity during the term of the new Australian Government.
 
  • For the completion of the implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013-23 in genuine partnership with Aboriginal and Torres Strait Islander peoples and their representatives at the national level by:
    • Establishing a clear process that ensures a national implementation strategy is developed;
    • Finalising a national implementation strategy within 12 months. This strategy should include service models, address health infrastructure needs, contain strategies to ensure financing over long periods, and build the health workforce, as well as develop measurable benchmarks and targets to monitor progress; and
    • Moving to an implementation phase, by securing the necessary funding to fully implement the plan.
 
  • For the Australian Government to forge an agreement through the COAG process on a new National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and National Partnership Agreement on Indigenous Early Childhood Development.
 
  • For the Australian Government to strengthen the national effort to close the gap by:
    • Focusing on the expanding health services to meet need, particularly in the areas of mental health, maternal and child health and chronic disease. This should include a systematic inventory of service gaps, and planning to close these gaps on a region-by-region basis with a focus on health services in all areas of Australia. Further steps could also be taken to improve access to medicines. E-health systems should be utilised to enhance continuity of care.
    • Developing a dedicated Aboriginal and Torres Strait Islander mental health plan and otherwise implementing the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and completing and implementing the renewed Social and Emotional Wellbeing Framework and the planned AOD strategy.
    • Developing a whole-of-government mechanism across sectors and portfolios to drive an integrated response to health issues and their social and cultural determinants, including the impacts of intergenerational trauma.
    • Developing specific COAG Closing the Gap Targets in relation to incarceration rates and community safety in partnership with Aboriginal and Torres Strait Islander peoples and their representatives, as well as state and territory governments.
    • Developing formal mechanisms that ensure long-term funding commitments, including the national partnership agreements, are linked with progress in closing the health equality gap.
    • Developing a new administrative mechanism to determine the appropriate Aboriginal and Torres Strait Islander share of mainstream health programs on a basis that reflects both population size and an index of need. Utilising funds to produce the best return on investment.
    • Introducing and passing legislation to formalise a process for national monitoring and reporting on the national effort to close the gap in accordance with benchmarks and targets. This legislation should include a requirement for this process to be undertaken in partnership with Aboriginal and Torres Strait Islander peoples and their representatives. It should also have a sunset clause of 2031 – the year after the date by which all parties have committed to close the gap in health equality.
 

[1] More than 188,000 people have signed the pledge at time of writing. Oxfam Australia, Close the Gap, (undated web page). URL: https://www.oxfam.org.au/my/act/sign-the-close-the-gap-pledge/ (Accessed 14 January 2014).
[2] Correspondence, Oxfam Australia and the author, 2 December 2013 (on file).
[3] National Aboriginal and Torres Strait Islander Health Plan 2013-2023, Commonwealth of Australia, 2013. URL: https://www.health.gov.au/natsihp (Accessed 14 January 2014).
[4] National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, Commonwealth of Australia, 2013. URL: http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-natsisps-strat-toc (Accessed 14 January 2014).
[5] Development of a Renewed Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Framework - Discussion Paper, Commonwealth of Australia, 2013. URL: https://www.sprc.unsw.edu.au/about-us/doha-sewb-framework-consultation/discussion-paper/ (Accessed 14 January 2014).
[6] National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Well Being (2004 – 2009), Commonwealth of Australia, 2004. URL: http://www.health.gov.au/internet/publications/publishing.nsf/Content/indig-sew-frame04-toc (Accessed 14 January 2014).
[7] National Partnership Agreement on Closing the Gap on Indigenous Health Outcomes, Council of Australian Governments, 2008. URL: http://www.federalfinancialrelations.gov.au/content/npa/health_indigenous/ctg-health-outcomes/national_partnership.pdf (Accessed 14 January 2014).
[8] National Partnership Agreement on Indigenous Early Childhood Development, Council of Australian Governments, 2008. URL: http://www.federalfinancialrelations.gov.au/content/npa/health_indigenous/ctg-early-childhood/national_partnership_superseded.pdf (Accessed 14 January 2014).