Total government expenditure on Indigenous health has risen significantly since the commencement of the National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes in 2009-10 and now represents about 5.1 per cent of total government health expenditure. Of this, the Commonwealth provides about one-third or around $1.6 billion.
However while there is a significant effort underway to close the gap in Indigenous disadvantage and life expectancy, in most areas this effort has yet to show real returns on the investments. The disadvantages that have built up over more than 200 years will not disappear overnight, and sustained and concerted efforts are needed to redress them. Chronic diseases, which account for a major part of the life expectancy gap, take time to develop, and equally, it will take time to halt their progress and even longer to prevent their advent in the first place. Programs will need to be sustained over decades if they are to have an impact on improving health outcomes.
On this basis, it is worrying to see that continued funding for the NPA on Closing the Gap in Indigenous Health Outcomes, as announced in April, will be less over each of the next three years than in 2012-13. At the same time, the Budget Papers show that expenses in the Aboriginal and Torres Strait Islander health sub-function will decline by 2.7 per cent in real terms over the forward estimates. This comes as states such as Queensland and New South Wales have made damaging cuts to health services and Closing the Gap programs.
Education is a significant determinant of health status so it is also concerning to see a reduced level of funding provided for Indigenous education over the next six years, especially when efforts to close the gap in education for indigenous students have stalled. These cuts in health and educations commitments cannot be justified by saying that Indigenous Australians can access mainstream programs. In many cases these are absent, inappropriate, or perceived as culturally insensitive, despite recent efforts to improve these deficits.
While data limitations continue to hamper our ability to measure progress in improving Indigenous health and the performance of the health system, the timeliness of reports is also a problem. For example, the most recent progress report on the initiatives in the Indigenous Chronic Disease Package, which represents the Commonwealth’s contribution to the NPA on Closing the Gap in Indigenous Health Outcomes, is from October 2011 and presents data from the 2010-11 financial year. Such time lags limit the ability of those overseeing the programs to be responsive to problems, demands and resource needs and ensure the best value for the resources invested.
There is also a problem with transparency and the public reporting of expenditures. It is increasingly difficult to track Commonwealth expenditures in this area, and almost impossible to account for State and Territory commitments.
There are several critical developments in 2013 that together will likely determine whether the goal of Indigenous health equality is achieved by 2030. These include the scheduled completion and implementation of a National Aboriginal and Torres Strait Islander Health Plan, the renewal - with adequate funding from all governments - of the NPA on Closing the Gap in Indigenous Health Outcomes, and the federal election that is scheduled for 14 September 2013.
My analysis of the Indigenous provisions in the Australian Government’s 2013-14 and the implementation and impact of the Commonwealth’s Indigenous Chronic Disease Package is available at http://ses.library.usyd.edu.au/handle/2123/9115
Dr Lesley Russell is a Senior Research Fellow at the Australian Primary Health Care Research Institute at the Australian National University and a Research Associate at the Menzies Centre for Health Policy at the University of Sydney.