Country in Focus
Queensland Government cuts Aboriginal community care
www.thelancet.com/respiratory Vol 1 May 2013
cannabis use is still a crucial issue in Aboriginal communities. Also, worryingly, the AIHW report shows that chronic disease, together with high smoking rates and kidney failure, remain problems for Aboriginal and Torres Strait Islanders. In 2008, the Council of Australian Governments (COAG), which includes the Federal and State Governments, committed AU$1·6 billion over 4 years for key activities to tackle Aboriginal health problems, including “the rollout of smoking cessation and reduction programmes, and training of workers to support these programmes”. The announcement of funding to tackle these key issues was welcomed by the Aboriginal community 5 years ago. However, now the Federal Government, the Queensland Government, and other state governments are introducing a process whereby money is being diverted away from community health projects and towards hospital care and what are termed Medicare Locals (small primary care organisations). Many health campaigners are critical of Medicare Locals, regarding them as being underfunded and ineffective for groups such as rural communities in remote areas. Further, they say money has yet to distributed to Medicare Locals from the State and Federal Governments to help fund effective health services. However, according to a government statement, Medicare Locals are providing better “value for money and improved after-hours care…for all Australians”. Yet, Najman says, “The problem is that money is being diverted away from where it is needed for Aborigines, where it was previously being used effectively. Now the government says there is not enough money to pay community health workers. It’s crazy, when the government continues to say that Aboriginal healthcare is a priority.
There were health workers along the coast of Queensland who were paid to run smoking cessation programmes for Indigenous people but now most of them have lost their jobs”, he says. Najman explains that smoking rates (as well as alcohol-related violence and the transmission of sexual diseases) are not treatment-focused issues, and therefore treating patients in a hospital, or even a clinical setting, is not appropriate. Meanwhile, Aboriginal Social Justice Commissioner Mick Gooda has called on the Federal and State Governments to make a “solid commitment” to renew the AU$1·6 billion funding to close the gap. He wants the Government to continue to roll out funding for Aboriginal healthcare. “This COAG funding, from Federal, State, and Territory Governments, is making a real difference to people’s lives, and must continue”, Gooda says. But the Queensland Aboriginal and Islander Health Council estimates that over half of the Australian expenditure of the $1·6 billion package has been spent on mainstream services, such as hospital care rather than on specific Aboriginal-focused initiatives. “Closing the gap” is a movement started in 2006 that holds an annual awareness day on March 21. It is supported by the government, nongovernmental organisations (NGOs), and lobby groups to find effective ways to increase life expectancy and improve the quality of life of
Published Online April 16, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70067-5 For the Australian Institute of Health and Welfare report see http://www.aihw.gov.au/ publication-detail/ ?id=60129542817
Jason Malouin/Oxfam
Australian doctors and health campaigners have been left frustrated and baffled by the Queensland Government’s recent budget cuts, which have resulted in a substantial reduction in Aboriginal community health programmes. The cuts are part of a trend around the country to divert health funding towards hospital care rather than the community care that is vital for reaching outback communities. “It is so frustrating. Smoking is the major contributor to death and disease in Australian society, and especially for Aborigines. But community outreach programmes were finally reaching outback Aboriginal communities. Aboriginal people were getting healthcare and advice on how to stop smoking tobacco and cannabis, and how to eat better, and they were getting vaccinated. They were getting basic health advice and care that is so necessary for Aboriginal people”, says Jake Najman from the University of Queensland’s School of Population Health in Brisbane. Government statistics show that such outreach programmes were slowly becoming effective in recent years. Indeed, according to a report released this month by the Federal Government department, the Australian Institute of Health and Welfare (AIHW), the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland, “from 2001 to 2010, the rate (in Queensland) of avoidable deaths fell by 32% in the Indigenous population and the infant mortality rate decreased by 41%, with a 71% reduction in the disparity between the Indigenous and non-Indigenous populations”. However, the AIHW report also found that in 2009, 52% of the Indigenous and 16% of the nonIndigenous women in Queensland smoked during pregnancy. As such, despite some promising news for Aboriginal healthcare, tobacco and
193
Country in Focus
www.sxc.hu
For Oxfam’s Close the Gap Shadow Report 2013 see https://www.oxfam.org.au/ explore/indigenous-australia/ close-the-gap/
194
Aborigines. They aim to match the life expectancy of Indigenous to that of non-Indigenous Australians— Aboriginal and Torres Strait Islanders still have a life expectancy 10–17 years less than other Australians. But apart from re-introducing community care workers and a renewal of funding, just what do Aboriginal campaigners want the government and medical profession to do to improve the lives of the Indigenous people? The answer is incremental changes and the re-introduction of “hope”. Put simply, Aboriginal healthcare, explains Laurelle Keough (Oxfam, Melbourne, Australia), “is primarily about tackling social problems”. This includes improving poor housing, poverty, bad diet, the paucity of primary, secondary, and tertiary education, and the general lack of opportunity. Aboriginal people also need to feel like there is hope for their future, that there is a life for them after primary school. Oxfam is of the belief that all these issues were being tackled, albeit slowly, by government-funded initiatives, and that continuity of funding is essential to close the gap. Oxfam has released the Close the Gap Shadow Report 2013, where the authors argue for community, not hospital care, and where “every dollar that can be redirected into primary healthcare services, and particularly to Aboriginal Community Heath Care Services from the public hospital system, is money well spent. In a
sense it proactively contributes to better health outcomes rather than being reactive health spending that does not drive health improvements”. The report also refers to the benefits of small, incremental improvements to Aboriginal people’s lives that will help them live longer. Indeed, pro-Aboriginal campaigners have been advocating incremental changes to Aboriginal people’s lifestyles for decades. Stephen Duckett, Director of the Health Program at the public policy thinktank, the Grattan Institute in Melbourne, is one such advocate. He believes that there is no magic bullet to improving Aboriginal health, but that a combination of eating better, good health advice, and access to healthcare, support for women and counselling (such as to combat domestic violence), plus the provision of jobs and education, will improve their lifestyle and life expectancy. Political will and constant funding from the government is also necessary. Previously he has criticised the care model provided by doctors and the aid world. He has said that the “fly in, fly out” and silo-funded service provided by doctors and NGOs from the cities for Aborigines does not create a sustainable service, that it disempowers the local people, and prevents a local workforce from being trained. However, this approach is currently necessary, and Australian city-based and overseas doctors have been employed to fill medical vacancies, since so few Indigenous or non-Indigenous Australians ever apply for the positions due to the harsh conditions and remoteness. For decades, universities in Australia have introduced affirmative-action entrance programmes to attract Indigenous people into medicine and nursing, but the uptake is still low, largely as a result of poor secondary schooling in Indigenous communities. All these factors lead to a continuing challenge in improving the respiratory health of Aboriginal
and Torres Strait Islander people according to James Lamerton, Senior Policy Advisor in health Reform at the government- funded National Aboriginal Community Controlled Health Organisation in Canberra. “Over 50% of Aborigines over the age of 14 smokes, and as a result Aborigines suffer significantly from COPD and asthma”, he says. According to the AIHW, there are higher hospitalisation rates for COPD and asthma in much of the Northern Territory and the north-west corner of Western Australia than in the cities. The AIHW acknowledges that this prevalence is most likely due to a paucity of primary care that could prevent such admissions in better resourced areas. “Socioeconomic status was found to be a significant explanation for the variation in hospitalisations for both asthma and COPD across geographical areas of Australia”, says AIHW spokesperson Nigel Harding. It seems quite ironic that in the one instance the Federal and State Governments of Australia are withdrawing money from community outback projects but acknowledging at the same time that there is a lack of primary care in those areas. However, Lamerton is also concerned about Aboriginal people living in urban areas. He would like to see further research done on city-based communities. “It’s not just about helping remote communities. Urban communities can also slip through the cracks. They are an amorphous population that often do not show up in the census and in some ways, self-contained remote communities can be easier to help. If we don’t even have these people on the census, how can we even start to assess their health needs?” The AIHW is releasing a series of reports for most states as part of the Aboriginal and Torres Strait Islander Health Performance Framework 2012.
Georgina Kenyon www.thelancet.com/respiratory Vol 1 May 2013
Queensland Government cuts Aboriginal community care
www.thelancet.com/respiratory Vol 1 May 2013
cannabis use is still a crucial issue in Aboriginal communities. Also, worryingly, the AIHW report shows that chronic disease, together with high smoking rates and kidney failure, remain problems for Aboriginal and Torres Strait Islanders. In 2008, the Council of Australian Governments (COAG), which includes the Federal and State Governments, committed AU$1·6 billion over 4 years for key activities to tackle Aboriginal health problems, including “the rollout of smoking cessation and reduction programmes, and training of workers to support these programmes”. The announcement of funding to tackle these key issues was welcomed by the Aboriginal community 5 years ago. However, now the Federal Government, the Queensland Government, and other state governments are introducing a process whereby money is being diverted away from community health projects and towards hospital care and what are termed Medicare Locals (small primary care organisations). Many health campaigners are critical of Medicare Locals, regarding them as being underfunded and ineffective for groups such as rural communities in remote areas. Further, they say money has yet to distributed to Medicare Locals from the State and Federal Governments to help fund effective health services. However, according to a government statement, Medicare Locals are providing better “value for money and improved after-hours care…for all Australians”. Yet, Najman says, “The problem is that money is being diverted away from where it is needed for Aborigines, where it was previously being used effectively. Now the government says there is not enough money to pay community health workers. It’s crazy, when the government continues to say that Aboriginal healthcare is a priority.
There were health workers along the coast of Queensland who were paid to run smoking cessation programmes for Indigenous people but now most of them have lost their jobs”, he says. Najman explains that smoking rates (as well as alcohol-related violence and the transmission of sexual diseases) are not treatment-focused issues, and therefore treating patients in a hospital, or even a clinical setting, is not appropriate. Meanwhile, Aboriginal Social Justice Commissioner Mick Gooda has called on the Federal and State Governments to make a “solid commitment” to renew the AU$1·6 billion funding to close the gap. He wants the Government to continue to roll out funding for Aboriginal healthcare. “This COAG funding, from Federal, State, and Territory Governments, is making a real difference to people’s lives, and must continue”, Gooda says. But the Queensland Aboriginal and Islander Health Council estimates that over half of the Australian expenditure of the $1·6 billion package has been spent on mainstream services, such as hospital care rather than on specific Aboriginal-focused initiatives. “Closing the gap” is a movement started in 2006 that holds an annual awareness day on March 21. It is supported by the government, nongovernmental organisations (NGOs), and lobby groups to find effective ways to increase life expectancy and improve the quality of life of
Published Online April 16, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70067-5 For the Australian Institute of Health and Welfare report see http://www.aihw.gov.au/ publication-detail/ ?id=60129542817
Jason Malouin/Oxfam
Australian doctors and health campaigners have been left frustrated and baffled by the Queensland Government’s recent budget cuts, which have resulted in a substantial reduction in Aboriginal community health programmes. The cuts are part of a trend around the country to divert health funding towards hospital care rather than the community care that is vital for reaching outback communities. “It is so frustrating. Smoking is the major contributor to death and disease in Australian society, and especially for Aborigines. But community outreach programmes were finally reaching outback Aboriginal communities. Aboriginal people were getting healthcare and advice on how to stop smoking tobacco and cannabis, and how to eat better, and they were getting vaccinated. They were getting basic health advice and care that is so necessary for Aboriginal people”, says Jake Najman from the University of Queensland’s School of Population Health in Brisbane. Government statistics show that such outreach programmes were slowly becoming effective in recent years. Indeed, according to a report released this month by the Federal Government department, the Australian Institute of Health and Welfare (AIHW), the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland, “from 2001 to 2010, the rate (in Queensland) of avoidable deaths fell by 32% in the Indigenous population and the infant mortality rate decreased by 41%, with a 71% reduction in the disparity between the Indigenous and non-Indigenous populations”. However, the AIHW report also found that in 2009, 52% of the Indigenous and 16% of the nonIndigenous women in Queensland smoked during pregnancy. As such, despite some promising news for Aboriginal healthcare, tobacco and
193
Country in Focus
www.sxc.hu
For Oxfam’s Close the Gap Shadow Report 2013 see https://www.oxfam.org.au/ explore/indigenous-australia/ close-the-gap/
194
Aborigines. They aim to match the life expectancy of Indigenous to that of non-Indigenous Australians— Aboriginal and Torres Strait Islanders still have a life expectancy 10–17 years less than other Australians. But apart from re-introducing community care workers and a renewal of funding, just what do Aboriginal campaigners want the government and medical profession to do to improve the lives of the Indigenous people? The answer is incremental changes and the re-introduction of “hope”. Put simply, Aboriginal healthcare, explains Laurelle Keough (Oxfam, Melbourne, Australia), “is primarily about tackling social problems”. This includes improving poor housing, poverty, bad diet, the paucity of primary, secondary, and tertiary education, and the general lack of opportunity. Aboriginal people also need to feel like there is hope for their future, that there is a life for them after primary school. Oxfam is of the belief that all these issues were being tackled, albeit slowly, by government-funded initiatives, and that continuity of funding is essential to close the gap. Oxfam has released the Close the Gap Shadow Report 2013, where the authors argue for community, not hospital care, and where “every dollar that can be redirected into primary healthcare services, and particularly to Aboriginal Community Heath Care Services from the public hospital system, is money well spent. In a
sense it proactively contributes to better health outcomes rather than being reactive health spending that does not drive health improvements”. The report also refers to the benefits of small, incremental improvements to Aboriginal people’s lives that will help them live longer. Indeed, pro-Aboriginal campaigners have been advocating incremental changes to Aboriginal people’s lifestyles for decades. Stephen Duckett, Director of the Health Program at the public policy thinktank, the Grattan Institute in Melbourne, is one such advocate. He believes that there is no magic bullet to improving Aboriginal health, but that a combination of eating better, good health advice, and access to healthcare, support for women and counselling (such as to combat domestic violence), plus the provision of jobs and education, will improve their lifestyle and life expectancy. Political will and constant funding from the government is also necessary. Previously he has criticised the care model provided by doctors and the aid world. He has said that the “fly in, fly out” and silo-funded service provided by doctors and NGOs from the cities for Aborigines does not create a sustainable service, that it disempowers the local people, and prevents a local workforce from being trained. However, this approach is currently necessary, and Australian city-based and overseas doctors have been employed to fill medical vacancies, since so few Indigenous or non-Indigenous Australians ever apply for the positions due to the harsh conditions and remoteness. For decades, universities in Australia have introduced affirmative-action entrance programmes to attract Indigenous people into medicine and nursing, but the uptake is still low, largely as a result of poor secondary schooling in Indigenous communities. All these factors lead to a continuing challenge in improving the respiratory health of Aboriginal
and Torres Strait Islander people according to James Lamerton, Senior Policy Advisor in health Reform at the government- funded National Aboriginal Community Controlled Health Organisation in Canberra. “Over 50% of Aborigines over the age of 14 smokes, and as a result Aborigines suffer significantly from COPD and asthma”, he says. According to the AIHW, there are higher hospitalisation rates for COPD and asthma in much of the Northern Territory and the north-west corner of Western Australia than in the cities. The AIHW acknowledges that this prevalence is most likely due to a paucity of primary care that could prevent such admissions in better resourced areas. “Socioeconomic status was found to be a significant explanation for the variation in hospitalisations for both asthma and COPD across geographical areas of Australia”, says AIHW spokesperson Nigel Harding. It seems quite ironic that in the one instance the Federal and State Governments of Australia are withdrawing money from community outback projects but acknowledging at the same time that there is a lack of primary care in those areas. However, Lamerton is also concerned about Aboriginal people living in urban areas. He would like to see further research done on city-based communities. “It’s not just about helping remote communities. Urban communities can also slip through the cracks. They are an amorphous population that often do not show up in the census and in some ways, self-contained remote communities can be easier to help. If we don’t even have these people on the census, how can we even start to assess their health needs?” The AIHW is releasing a series of reports for most states as part of the Aboriginal and Torres Strait Islander Health Performance Framework 2012.
Georgina Kenyon www.thelancet.com/respiratory Vol 1 May 2013
