BY MARGARET ALLUM
As a group, indigenous people are disadvantaged relative to other Australians with respect to a number of socio-economic factors, and these disadvantages place them at a greater risk of ill health and reduced well-being ... Indigenous Australians die at younger ages than do non-indigenous Australians, and this is true for almost every type of disease or condition for which information is available ... The health disadvantage of indigenous Australians begins early in life and continues throughout the life cycle. â The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, a 1999 report from the Australian Bureau of Statistics and the Australian Institute for Health and Welfare.
The evidence for these claims is more than abundant, having been the subject of numerous studies and reports, conducted especially in the last few decades. The latest of these, Health is Life, published in May, is the result of an inquiry into indigenous health by the House of Representatives Standing Committee on Family and Community Affairs.
The report received 98 submissions from February 1998 to December 1999, consulted 60 organisations and indigenous communities, and made 35 recommendations which ranged from the funding of health programs and indigenous community involvement in their implementation to the need for improved housing and infrastructure services. Areas of concern addressed by the recommendations also included cultural, educational and employment issues and the urgent need for training more indigenous health professionals.
Physical and mental health
Submissions to the inquiry documented the disgraceful ill health of the indigenous population in both rural and urban areas, including a life expectancy around 18 years less than for other Australians and no significant improvement in mortality rates over the last 15 years.Over the past two decades, the major causes of illness and early death have shifted from communicable diseases, which have decreased, to hypertension, ischaemic heart disease and the complications of diabetes.
Diabetes leading to kidney failure has skyrocketed in the indigenous population. Janine Spencer, from the Menzies School of Health Research in Darwin, reported two years ago that the rate of kidney failure in Aboriginal people was doubling every four years and in 1996 was 838 per million compared with 39 per million for non-Aboriginal people. Little has been done to address this renal disease epidemic since then.
Aboriginal people have even resorted to desperate measures to address the lack of health funding for this area of health. In 1998, the Jawoyn Association announced that, following negotiations with the Northern Territory government, it would drop a claim for land 20 kilometres south of Katherine in exchange for a renal dialysis facility to be established in the town.
Health is Life also detailed the shocking rate of infant mortality and child morbidity (illness) which, although declining, is still significantly higher than for the non-indigenous population. The report noted that morbidity for indigenous children arises mostly from entirely preventable infections.
Malnutrition continues to contribute to growth retardation and predispose children to infectious diseases, the report states. This further contributes to premature mortality, as there is evidence to suggest that low birth weight and growth retardation before birth predisposes to diabetes mellitus, hypertension and heart disease later in life.
Poor nutrition, according to the Australian Institute of Health and Welfare, is the main underlying contributor to most indigenous illnesses, with contributing factors including the cost of fresh food in remote areas (up to three times more than in city supermarkets) and the high proportion of poor indigenous people's income spent on alcohol, tobacco and gambling, a spending pattern also common to non-indigenous people experiencing poverty.
The report also cites indigenous mental health and emotional wellbeing as another major problem. The submission from the Royal Australian and New Zealand College of Psychiatrists stated that the problem was caused by the loss of loved ones, childhood trauma, alcohol and drug related misery, violence, ongoing racism, stereotyping and discrimination, and the accumulated loss of 211 years of cultural destruction and dispossession.
According to the report, the overall health outcomes for indigenous Australians in urban areas is as poor as that for indigenous Australians in rural and remote areas.
Recommendations
Health is Life's first recommendation was that the commonwealth accept that it has the major responsibility for the provision of primary health care to indigenous Australians, and commit adequate resources to the task. At present the bulk of government funding and health provision is from the states and territories.The report found that, with services and programs being delivered by commonwealth, state, territory and local government agencies, there is no clear delineation, or agreement, about which level of government is ultimately responsible for ensuring that there are continuing improvements in the health of Australia's indigenous population.
This has been an incentive for the parties, particularly the states, to indulge wherever possible in shifting the onus for payment to the other sector, the report continues. There appears to be little, if any, coordination between these diverse commonwealth/state health programs, other environmental programs or programs provided through other agencies, in areas such as education and employment.
The report also recommends that indigenous health initiatives be overseen by the minister of Aboriginal affairs, rather than continuing as part of the department of health's overall responsibility.
The chairperson of the National Aboriginal Community Controlled Health Organisation, Puggy Hunter, and the Australian Medical Association federal president, Dr Kerryn Phelps, both told the committee that while they welcomed the recommendations relating to increased commonwealth responsibility, they did not agree that the Aboriginal affairs minister should be in the overseeing role.
Hunter said any move to lessen the responsibility of the health minister in the Aboriginal health area was a step backwards.
Federal funding
According to a past report from the National Aboriginal Health Strategy Working Party, Aboriginal people often feel that the motivation for government action in Aboriginal health comes as a response to intermittent political pressure, rather than from a commitment to effective long-term solutions for future generations.Action, or more correctly inaction, from recent governments indicates that this outlook has not significantly changed. Despite the dramatic disparity between indigenous and non-indigenous health, government health funding for both groups is very similar.
The report found that it is not true that government spending on Aboriginal health is higher than for the general population, despite the perennial misconception in the area of indigenous health, that excessive amounts of money are wasted on indigenous health programs with little improvement in health status to show for the expenditure.
Health is Life quotes research which estimates that only 15% of indigenous Australians in urban areas and 38% in more remote areas have an effective Medicare number or card, due to non-enrolments, expired enrolments and administrative barriers including the ability to provide acceptable forms of identification as required by Medicare.
Commonwealth funding for indigenous health, from both direct grants and the medical benefits and pharmaceutical benefits schemes, is around $100 per person less than other Australians received from the two schemes. The total amount of recurrent expenditure for all services and from all sources of funds for and by indigenous Australians was only 8% higher than that for and by other Australians according to figures in 1998.
In a 1998 AMA-commissioned report, Professor John Deeble from the Australian National University found that an additional $245 million per year was required to meet the level of need.
Hunter and Phelps, in a joint press release, said that the federal government's approach to Aboriginal health was grossly inadequate. They called on all parties to commit themselves to the specific funding levels put forward by Deeble.
There appears to be a fundamental lack of urgency in the federal government's approach to Aboriginal health. It's a steady-as-she-goes approach, the two said. But steady-as-she-goes is not good enough when Aboriginal people are dying 15 to 20 years younger than the rest of the population.<>><>41559S>n<>255D>