Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?
Ronald Donato A C and Leonie Segal BA School of Commerce and Centre for Regulation and Market Analysis, GPO Box 2471, Adelaide, SA 5001, Australia.
B Health Economics and Social Policy Group, School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Email: leonie.segal@unisa.edu.au
C Corresponding author. Email: ronald.donato@unisa.edu.au
Australian Health Review 37(2) 232-238 https://doi.org/10.1071/AH12186
Submitted: 7 June 2012 Accepted: 10 September 2012 Published: 1 February 2013
Journal Compilation © AHHA 2013
Abstract
This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare.
What is known about the topic? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people.
What does the paper add? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians.
What are the implications for practitioners? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia’s First Peoples provides the opportunity for policymakers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.
References
[1] Australian Institute of Health and Welfare. Australia’s Health 2010. Canberra: AIHW; 2010.[2] Australian Institute of Health and Welfare. Indigenous health: age at death. Canberra: AIHW; 2012.]. Available at http://aihw.gov.au/mortality-indigenous/#age [verified 1 April 2012]
[3] Vos T, Barket B, Stanely L, Lopez A. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane School of Population Health, University of Queensland; 2007.
[4] Australian Institute of Health and Welfare. Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians. Canberra: AIHW; 2011.
[5] World Health Organization. Closing the gap in a generation: health equity through actions on the social determinants of health. Geneva: WHO; 2008.
[6] Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust 2011; 194 512–3.
| 21644897PubMed |
[7] Griew R, Tilton E, Cox N, Thomas, D. The link between primary health care and health outcomes for Aboriginal and Torres Strait Islander Australians. Sydney: Robert Griew Consulting; 2008.
[8] Carson B, Dunbar T, Chenal R, Bailie R, editors. Social determinants of indigenous health. Sydney: Allen and Unwin; 2007.
[9] Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview 2011. Canberra: AIHW; 2011.
[10] Ring I. A ‘whole of government’ approach needed on Indigenous health. Aust N Z J Public Health 1998; 22 639–40.
| A ‘whole of government’ approach needed on Indigenous health.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M%2FmsFyjsA%3D%3D&md5=bc2bf025e46b5b0da9103386e9299912CAS | 9848954PubMed |
[11] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83 457–502.
| Contribution of primary care to health systems and health.Crossref | GoogleScholarGoogle Scholar | 16202000PubMed |
[12] Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. J Health Serv Res 2003; 38 831–65.
| The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998.Crossref | GoogleScholarGoogle Scholar |
[13] Hurley C, Baum F, Johns J, Labonte R. Comprehensive primary health care in Australia: findings from a narrative review of the literature. Australas Med J 2010; 1 147–52.
[14] Commonwealth of Australia. Building a 21st century primary health care system: Australia’s first national primary health care strategy. Canberra: Commonwealth of Australia; 2010.
[15] Wakerman J, Humphreys J, Wells R, Kuipers P, Entwistle P, Jones J. Primary health care delivery models in rural and remote Australia – a systematic review. BMC Health Serv Res 2008; 8 276
| Primary health care delivery models in rural and remote Australia – a systematic review.Crossref | GoogleScholarGoogle Scholar | 19114003PubMed |
[16] Sequist T, Cullen T, Acton K. Indian Health Service innovations have helped reduce health disparities affecting American Indian and Alaskan Native people. Health Aff 2011; 30 1965–73.
| Indian Health Service innovations have helped reduce health disparities affecting American Indian and Alaskan Native people.Crossref | GoogleScholarGoogle Scholar |
[17] Commonwealth of Australia. Closing the Gap: Prime Minister’s report 2011. Canberra: Commonwealth of Australia; 2011.
[18] Dwyer J, Silburn K, Wilson G. National Strategies for improving Indigenous health and health care. Aboriginal and Torres Strait Islander Primary Health Care Review: consultant report no.1. Canberra: Commonwealth of Australia; 2004.
[19] Australian Institute of Health and Welfare. Expenditure on health for Aboriginal and Torres Strait Islanders people for 2008–09. Canberra: AIHW; 2011.
[20] Australian Institute of Health and Welfare. Expenditure on health for Aboriginal and Torres Strait Islanders people for 2006–07. Canberra: AIHW; 2009.
[21] Eagar K, Gordon R. Access and equity – the funding required to close the gap in Aboriginal and Islander health in far north Queensland. Centre for Health Services Development, University of Wollongong; 2008.
[22] Segal L, Dalziel K, Donato R. Economics-informed policy can drive better health but there will be few gains without structural change. Dialogue 2011; 30 44–50.
[23] Powell-Davies G, Williams A, Larsen K, Perkins D, Roland M, Harris M. Coordinating primary health care an analysis of the outcomes of a systematic review. Med J Aust 2008; 188 S65–8.
| 18429740PubMed |
[24] Naccarella L, Southern D, Furler J, Scott A, Prosser L, Young D, et al Primary care funding and organisational policy options and implications: a narrative review of evidence from five comparator countries. Med J Aust 2008; 188 S73–6.
| 18429742PubMed |
[25] National Health and Hospitals Reform Commission. A healthier future for all Australians: final report 2009. Canberra: NHHRC; 2009.
[26] Commonwealth of Australia. The blame game: report on the inquiry into health funding. House of Representatives Standing Committee on Health and Ageing. Canberra: Commonwealth of Australia; 2006.
[27] Donato R, Segal L. The economics of primary health care reform in Australia - towards single fundholding through development of primary care organisations. Aust N Z J Public Health 2010; 34 613–9.
| The economics of primary health care reform in Australia - towards single fundholding through development of primary care organisations.Crossref | GoogleScholarGoogle Scholar | 21134065PubMed |
[28] Commonwealth of Australia. Closing the gap on Indigenous disadvantage: the challenge for Australia. Canberra: Commonwealth of Australia; 2009.
[29] Commonwealth of Australia. Closing the Gap: the Indigenous chronic disease package in 2009–2010. Canberra: Commonwealth of Australia; 2010.
[30] Council of Australian Governments. National Indigenous Reform Agreement (Closing the Gap). Canberra: COAG; 2009.
[31] Commonwealth of Australia. A national health and hospitals network for Australia’s future. Canberra: Commonwealth of Australia; 2010.
[32] Council of Australian Governments. National Health Reform Agreement. Canberra: COAG; 2011.
[33] Lavoie J, Forget E, Prakash T, Dahl M, Martens P, O’Neil J. Have improvements in on-reserve health services and initiatives promoting community control improved First Nation’s health in Manitoba? Soc Sci Med 2010; 71 717–24.
| Have improvements in on-reserve health services and initiatives promoting community control improved First Nation’s health in Manitoba?Crossref | GoogleScholarGoogle Scholar | 20554364PubMed |
[34] Chandler M, Lalonde C. Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcult Psychiatry 1998; 35 191–219.
| Cultural continuity as a hedge against suicide in Canada’s First Nations.Crossref | GoogleScholarGoogle Scholar |
[35] Bramley D, Hebert P, Tuzzio L, Chassin M. Disparities in Indigenous health: a cross-country comparison between New Zealand and the United States. Am J Public Health 2005; 95 844–50.
| 15855464PubMed |
[36] Cornell S, Kalt J. American Indian self-determination: the political economy of a policy that works. Harvard Kennedy School, RWP10–043. Cambridge, MA: Harvard Kennedy School; 2010. Available at http://dash.harvard.edu/handle/1/4553307 [verified 5 March 2012].
[37] Burns J, Thomson N, Brooks J, Burrow S, Kirov E, McGougan B, Valenti A. Describing an iceberg from a glimpse of its tip: a summary of the literature on achievements in Aboriginal and Torres Strait Islander health. Perth (Australia): Australian Indigenous Health info Net; 2002.
[38] Black A. Evidence of effective interventions to improve the social and environment factors impacting on health. Office for Aboriginal and Torres Strait Islander Health. Canberra: Commonwealth of Australia; 2007.
[39] Productivity Commission. Overcoming Indigenous disadvantage: key indicators 2009. Canberra: Productivity Commission; 2011.
[40] Australian Institute of Health and Welfare; Australian Institute of Family Studies. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence. Canberra: AIHW and Melbourne: AIFS; 2011.
[41] Baeza J, Lewis J. Indigenous health organizations in Australia connections and capacity. Int J Health Serv 2010; 40 719–42.
| Indigenous health organizations in Australia connections and capacity.Crossref | GoogleScholarGoogle Scholar | 21058540PubMed |
[42] Bartlett B, Boffa J. The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy. Aust J Primary Health 2005; 11 53–61.
| The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy.Crossref | GoogleScholarGoogle Scholar |
[43] Dwyer J, Lavoie J, O’Donnell K, Marlina U, Sullivan P. Contracting for Indigenous health care: towards mutual accountability. Aust J Publ Admin 2011; 70 34–46.
| Contracting for Indigenous health care: towards mutual accountability.Crossref | GoogleScholarGoogle Scholar |
[44] Martini A, Marlina U, Dwyer J, Lavoie J, O’Donnell K, Sullivan P. Aboriginal community controlled health service funding: report to the sector 2011. Melbourne (AUST); The Lowitja Institute; 2011.
[45] Segal L, Donato R, Richardson J, Peacock S. Strengths and limitations of competitive versus non-competitive models of integrated capitated fundholding. J Health Serv Res Policy 2002; 7 56–64.
| Strengths and limitations of competitive versus non-competitive models of integrated capitated fundholding.Crossref | GoogleScholarGoogle Scholar |
[46] Steering Committee for Indigenous Health Equality. Shadow report: on Australian Government’s progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians. Close the Gap Steering Committee for Indigenous Health Equality; 2011. Available at http://resources.oxfam.org.au/pages/view.php?ref=593 [verified 1 February 2012]
[47] Lyon K. They said it couldn’t be done: contracting for Veteran’s hospital care in Australia. In: Bloom A, editor. Health reform in Australia and New Zealand. South Melbourne: Oxford University Press; 2000.
