Since the start of the Close the Gap Campaign and the public movement it inspired, people have been demanding and voicing their concern towards equalising life outcomes for all Australians.
- Aboriginal and Torres Strait Islander people born in 2015-17 have a life expectancy estimated to be 8.6 years lower than that of non-Indigenous people
- First Nations People are 5 times more likely to suffer from diabetes and 4 times more likely for chronic kidney disease compared to non-Indigenous Australians
- Two-thirds of First Nations People have one chronic disease, and one-third suffer from 3 or more chronic diseases
- 80 per cent of the mortality gap between First Nations and non-Indigenous Australians aged 35-74 years is due to chronic diseases
The differences in health outcomes are causally linked to the social determinants of health, health risk factors and access to appropriate health services. The social determinants of health are estimated to be responsible for more than one-third of the health gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. First Nations peoples on average have lower levels of education, employment, income, and poorer quality of housing. These factors, known as the social determinants of health, impact on an individual’s health status, and are inextricably connected. If First Nations adults had the same household income, employment rate, working hours, and smoking rates as non-Indigenous Australians, the health gap would be reduced by more than a third.
National Agreement in 2020
In July 2020, a new National Agreement was reached after evidence from the previous 12 years of the Government’s first iteration of the Closing the Gap Strategy not having achieved what had been hoped for.Upon reviewing the failures of the previous Agreement, Prime Minister Morrison stated ‘that without true partnership with Aboriginal and Torres Strait Islander people, we will hamper our own progress’.The Coalition of Aboriginal and Torres Strait Islander Peak Organisations, and all Australian governments (the Federal, State, Territory and Australian Local Government Association) committed to 16 targets under the National Agreement to Close the Gap, including the following.
Target 1: Close the gap in life expectancy within a generation by 2031
Target 10: By 2031, reduce the rate of Aborignal and Torres Strait Islander adults held in incarceration by at least 15 per cent
Target 14: Signficant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero
The foundation of these 16 targets are the four priority reform areas:
- shared decision making,
- building the community controlled sector,
- improving mainstream institutions, and
- Aboriginal and Torres Strait Islander led data.
Pat Turner AM, CEO of NACCHO, stated ‘the four priority reform areas, including for the first time a commitment to fighting structural racism, are game changers that the government is committing to’.
Disability continues to be overlooked generally with none of the 16 targets in the new National Agreement addressing the disability experience of First Nations Peoples.
First Peoples Disability Network has commented on this oversight and questioned the policys’ aspiration to be ‘evidence based’ due to the lack of engagement with evidence showing the acute disadvantage of Aboriginal and Torres Strait Islander peoples with disability. Damian Griffis, CEO of First Nations Disability Network stated that disability is still not well understood, and there needs to be stand alone targets for disability, implementing disability within cross cutting targets such as education is not enough.
‘Disability is not just a health issue, it exists under all target areas; families, children and youth, justice, health, economic development, culture and language, education, healing and eliminating racism and systemic discrimination.’ – First Nations Disability Network Australia CEO Damian Griffis.
The 2020 Covid-19 pandemic has heightened the need for protection of First Nations Peoples living with a disability, as they were already amongst the most vulnerable in the community. This has been recently highlighted in the Report from the 2020 Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.
Australian governments must continue to work with First Peoples Disability Network as the peak organisation advocating for First Nations Peoples with a disability in order to address the disproportionate rate to which disability burdens this vulnerable community group.
Aboriginal Community Controlled Health Organisations
Increased support for Aboriginal Community Controlled Health Organisation services (ACCHO) are one of the strengths of the 2020 National Agreement, under priority reform area 2: building the community controlled sector. ACCHOs are organisations owned, initiated and established by and in local Aboriginal communities. They deliver holistic and culturally appropriate health services and are a crucial component in closing the gap of inequalities faced by First Nations people. The ACCHOs focus on prevention, early intervention, and comprehensive care, which reduces access barriers and racism, therefore improving health outcomes. Additionally, ACCHOs train the medical workforce, employ First Nations peoples and deliver best practice care. This priority reform area will hopefully help overcome the entrenched and generational inequalities faced by First Nations people.
Racism in the Health System
For the first time, the Agreement acknowledges and sets reform around fighting structural racism. Racism towards Aboriginal and Torres Strait Islander peoples is a reality, exacerbated through a history of abuse, dispossession and intergenerational trauma from colonisation. Between 2014-15, 33 per cent of Aboriginal and Torres Strait Islander people over the age of 15 had reported experiencing unfair treatment during the past 12 months. Within the health system, experiences of racism are associated with poorer-self reported health status, lower perceived quality of care, underutilisation of service, delays in seeking care, failure to follow recommendations, distrust, interruptions in care, and avoidance. Racism within the health system is not only experienced by users of the system, but also practitioners operating within the system.
First Nations Advocacy in Australia
A pivotal moment in First Nations advocacy for rights in Australia was in 2005, with the then Aboriginal and Torres Strait Islander Social Justice Commissioner, Professor Tom Calma calling on governments, through his Social justice report, to urgently close the gap in life expectancy and health status for Aboriginal and Torres Strait Islander peoples within 25 years. This sparked the development of the Close the Gap campaign in 2007, the establishment of the National Indigenous Health Equality Council in 2008, and the Council of Australian Governments (COAG) approving the National Indigenous Reform Agreement, with six Closing the Gap targets (the Closing the Gap Strategy).
With the first iteration of Closing the Gap Strategy failing to make necessary inroads into the health disparities, a new framework was developed during 2018 to 2020. The new National Agreement is community-leadership with First Nations people at the centre, all supporting a strengths-based approach. Despite the limited progress made by governments, the Close the Gap campaign has continued to hold governments accountable to their obligations and promises to close the gap.
Overcoming the entrenched and generational inequalities faced by Aboriginal and Torres Strait Islander peoples is a national priority. It is an issue which every person, organisation and business within Australia can assist in overcoming.
With the introduction of the new National Agreement on Closing the Gap and its 16 socio-economic targets, it is hoped that long-lasting change and parity in life outcomes for First Nations Peoples will be finally achieved.