NatioNal aborigiNal aNd torres strait islaNder HealtH PlaN · HealtH PlaN Companion document on...

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NatioNal aborigiNal aNd torres strait islaNder HealtH PlaN Companion document on Commonwealth government strategies and reforms — July 2013

NAtioNAl AborigiNAl ANd torres strAit islANder HeAltH PlAN – ComPANioN doCumeNt oN CommoNweAltH goverNmeNt strAtegies ANd reforms

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Introduction 2Australia’sHealthSystem 2Expenditureon,andInvestmentin,AboriginalandTorresStraitIslanderHealth 4InvestmenttoClosetheGapinIndigenousDisadvantage 5InvestmentsintheSocialDeterminantsofHealth 7 EarlyChildhoodEducation,SchoolingandTertiaryEducation 7 EarlyYears 8 AboriginalandTorresStraitIslanderEducation 8 EducationReform 8 EducationPrograms 9 HigherEducationandVocationalEducationandTraining 10 Housing 11 EnvironmentalHealth 11 AccommodationandHousing 11 EconomicDevelopment,ParticipationandEmployment 13 EconomicDevelopment 13 EconomicParticipationandEmployment 13 SafeCommunities 16 Justice 16 LegalServices 17 CommunitySafety 17InvestmentstoImprovetheEnablerstoHealth 18 ACulturallyRespectfulandNon-DiscriminatoryHealthSystem 18 HealthSystemEffectivenessandClinicallyAppropriateCare 19 Evidence-BasedPractice 23 MentalHealthandSocialandEmotionalWellbeing 25 HumanandCommunityCapability 29InvestmentstoImproveOutcomesAcrosstheLifeCourse 31 BroaderHealthAcrosstheLifeCourse 31 MaternalHealthandParenting 34 ChildhoodHealthandDevelopment 35 AdolescentandYouthHealth 38 HealthyAdults 38 HealthyAgeing 40References 42

Contents

IntroduCtIon

Thisdocumenthighlightsexistingactivities,partnershipsandprogramsthatcontributetoclosingthegapinhealthoutcomesforAboriginalandTorresStraitIslanderpeople.Whilenotanexhaustivelistofactivitiesandprograms,thisdocumenthighlightsexamplesofinvestments,recognisingtheimpactofwiderpoliciesandprogramsandreformagendasacrossareassuchasmentalhealth,housingandhomelessness,educationandeconomicparticipation,andtheircontributiontoaddressingAboriginalandTorresStraitIslanderdisadvantageandachievingsustainablehealthgains.

AustrAlIA’s heAlth system

Australia’shealthsystemsupportsuniversalandaffordableaccesstohighqualitymedical,pharmaceuticalandhospitalservices,whilehelpingpeopletostayhealthythroughhealthpromotionanddiseasepreventionactivities.

TheMedicare Benefits Scheme(MBS)subsidisespaymentsforservicesprovidedbydoctorsincludingspecialists,optometrists,nursesandmidwives,andinsomecircumstancesotheralliedhealthprofessionalssuchasclinicalpsychologists.ThePharmaceutical Benefits Scheme(PBS)subsidisespaymentsforasignificantproportionofprescriptionmedicinespurchasedfrompharmacies.TheAustralianGovernmentandstateandterritorygovernments

alsojointlyfundpublichospitalservices.ThissystemaimstogiveallAustralians,regardlessofpersonalcircumstance,accesstoaffordableorno-costhealthcare,andissupportedbyadditionalinvestmentthrougharangeofhealthprograms,healthresearchactivityandpublichealthinitiatives.1

Primaryhealthcareisintendedtobethefirstlevelofcontactanindividualhaswiththehealthsystem.Primaryhealthcareprovidersplayakeyroleintheprevention,promotion,screening,detection,treatmentandmanagementofillnessanddiseaseandhelppreventmorecomplexandexpensiveservicedeliveryatthesecondaryandtertiarylevel.

TheimplementationofNational Health Reformactivitiesisstrengtheninglocaldecision-makingandcommunityinvolvementinhealthservicedelivery.Toachievegreaterlocalengagement,National Health Reform isdeliveringbetteraccesstoservices,improvedlocalaccountabilityandtransparencyandgreaterresponsivenesstolocalcommunities,through:

• theestablishmentof61MedicareLocals,whicharecoordinatingprimaryhealthcaredeliveryandaddressinglocalhealthcareneedsandservicegaps,bydrivingimprovementsinprimaryhealthcare(includingafterhoursprimarycare)andensuringthatservicesaretailoredtomeettheneedsoflocalcommunities;and

• 136LocalHospitalNetworks,fundednationallytolocalisethemanagementofpublichospitals.

UnderNational Health Reform,theAustralianGovernmentwillinvestatleast$16.4billioninadditionalefficientgrowthoffundingfrom2014-15to2019-20toensureallAustralianscanaccessthecaretheyneed,whereandwhentheyneedit.

Thefollowingagencieshavealsobeenestablishedtosupportimprovedperformanceacrossthehealthsystemthroughnationalperformancestandardsandpublicaccountability:

• theNationalHealthPerformanceAuthority(NHPA)isanindependentagencythatprovidesinformationontheperformanceofeveryLocalHospitalNetworkandthehospitalswithinit,everyprivatehospitalandallMedicareLocalsthroughtheirHospitalPerformanceReportsandHealthyCommunitiesReports.TheperformancemeasuresandstandardscontainedinthePerformance and Accountability Framework willallowtheNHPAtoidentifyhigh-performingLocalHospitalNetworks,MedicareLocalsandhospitalstoenablethesharingofinnovativeandeffectivepractices,whilealsoidentifyingthosethatareunder-performingtoenableeffectiveperformancemanagement.

• theIndependentHospitalPricingAuthority(IHPA)isanindependentagencythatdeterminestheNationalEfficientPriceofpublichospitalservicesunderanewmodelofhospitalfunding:activity-basedfunding.Thenewnationalsystemofactivity-basedfundingwillmakepublichospitalfundingmoretransparent,andhelptodriveefficiencyinthedeliveryofpublichospitalservices.Publichospitalswillbefundedaccordingtothenumberandkindofservicestheyprovide.ThispricingsystemtakesintoaccounttheIndigenousstatusofpatientsthroughadjustments.In2013-14,theseadjustmentsprovideanadditional4percentifthepatientisflaggedasAboriginaland/orTorresStraitIslanderandisanadmittedacute,emergencyornon-admittedpatient.Anadjustmentof17percentisprovidedforanAboriginaland/orTorresStraitIslanderadmittedsubacutepatient.Thisnewapproachwillprovideincentivesforhospitalstotreatpatientsmoreefficientlyandforhospitalsandgovernmentstoensurepatientsaretreatedinthemostappropriatesetting.Forserviceswhereactivity-basedfundingwouldnotbeappropriate,includingsmallcountryhospitals,fundingwillcontinuetobeprovidedthroughblockgrants.

expendIture on, And Investment In, AborIgInAl And torres strAIt IslAnder heAlth

Between2001-02and2010-11,therehasbeenanincreaseinAboriginalandTorresStraitIslanderhealthexpenditure,andthisexpenditurehasincreasedatafasterratethanforotherAustralians.Overthisperiod,perpersonhealthexpenditurebythestateandterritorygovernmentsforAboriginalandTorresStraitIslanderpeoplegrewby54.2percent,whileAustralianGovernmentexpendituregrewby101.3percent.MBSandPBSbenefitswereasubstantialcomponentofthatgrowth,accountingfor50.9percentofAustralianGovernmentgrowthbetween2001-02and2010-11.2ThisgrowthinexpenditurereflectsthecommitmenttoimprovehealthoutcomesforAboriginalandTorresStraitIslanderpeoplethroughconsistent,long-termeffortandinvestments.

StrengtheningthesystemofcomprehensiveprimarycareforAboriginalandTorresStraitIslanderpeopleisintegraltoaneffectiveandefficienthealthsystemtocontributetowardsclosingthegap.In2012-13,theDepartmentofHealthandAgeingprovided$555.3millioningrantfundingtoapproximately280organisationstosupportspecificAboriginalandTorresStraitIslanderhealthactivities,includingthedeliveryofprimaryhealthcare,substancemisuseservices

andsocialandemotionalwellbeingservicestoAboriginalandTorresStraitIslanderpeople.Thisinvestmentincludedfundingtoapproximately170AboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationstodeliverarangeofcomprehensiveservices.

TheAustralianGovernmenthascommitted$777millionoverthreeyearsfrom1July2013to30June2016,asitsshareofarenewedNational Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.WhenMBSandPBSestimatesaretakenintoaccount,theCommonwealthcontributionisaround$992millionoverthreeyears.Aspartofthis,theAustralianGovernmentiscontinuingitsfundingcommitmentsandisseekingstateandterritoryagreementtocontinuefundingfortheirinitiativesunderthisNationalPartnershipAgreement.ThisfundingwillensureAboriginalandTorresStraitIslanderpeoplecontinuetobenefitfromimprovedhealthservicestosupportthecommitmenttoclosethegapinAboriginalandTorresStraitIslanderdisadvantage.

Investment to Close the gAp In IndIgenous dIsAdvAntAge

TheNational Indigenous Reform Agreement (NIRA),endorsedbytheCouncilofAustralianGovernments(COAG)in2008,commitsallgovernmentstosixambitioustargetsrelatingtolifeexpectancy,infantmortality,educationandemployment.TheNIRAissupportedbysignificantinvestmentthroughaseriesofNationalPartnershipAgreementswithstateandterritorygovernmentsinthekeyareasofhealth,earlychildhood,education,economicparticipationandremoteservicedelivery.

TheClosing the Gap Frameworkemphasisestheinter-relationshipbetweensevendifferent‘buildingblocks’notingthattherealityofachievingtargetsrequiressustainedeffortacrossallareas.GovernmentshaveagreedtoworkinpartnershipwithAboriginalandTorresStraitIslanderpeopleandcommunities.ThiscommitmentisevidencedintheClose the Gap Statement of Intent,whichidentifiestheneedtosupportanddevelopAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsinurban,ruralandremoteareasinordertoachievelastingimprovementsinAboriginalandTorresStraitIslanderhealthandwellbeing.

COAGhascommittedtoreportingtransparentlyonexpenditureonservicesforAboriginalandTorresStraitIslanderpeopletoinformbetterpolicy-makinginAboriginalandTorresStraitIslanderaffairs.TheIndigenous Expenditure Report(IER)providesanationalframework

forcollectingandreportinginformationonallCommonwealthandstateandterritorygovernmentexpenditureonbothAboriginalandTorresStraitIslanderspecificandmainstreamservicestoAboriginalandTorresStraitIslanderpeople.EstimatesonexpenditurearebroadlyalignedtotheCOAGClosing the Gapbuildingblocks,includingthehealthbuildingblock.

ThelatestIERwasreleasedin2012andreportsthatnationallyin2010-11,theAustralian,stateandterritorygovernments’directexpenditureonservicesforAboriginalandTorresStraitIslanderpeoplewas$25.4billionor5.6percentofallgovernmentdirectexpenditurein2010-11.TheIERreportsthatestimateddirectgovernmentexpenditureperpersononallserviceswas$44,128perAboriginalandTorresStraitIslanderpersonand$19,589pernon-Indigenouspersonin2010-11.Thatis,anestimated$2.25wasspentperAboriginalandTorresStraitIslanderpersonforeverydollarspentpernon-Indigenouspersoninthepopulationin2010-11.

Estimatesbybroadareaofexpenditurein2010-11includes:

• Early child development, and education and training:includesexpenditureonpreschoolandchildcare;schooleducation;andtertiaryeducation.$2.44wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson,withthelargestareaofdifferenceinexpenditureperheadofpopulationbeingschooleducation(aratioof$2.99to1),whichreflectstheyoungerageprofileoftheAboriginalandTorresStraitIslanderpopulation.

• Healthy lives:includesexpenditureonhospitalservices;publicandcommunityhealthservices;andotherhealthcaresubsidiesandsupportservices.$2.02wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson.

• Economic participation: includesexpenditureonlabourandemploymentservicesandsocialsecuritysupport.$1.96wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson;thelargestareaofdifferenceinexpenditureperpersonwaslabourandemploymentprograms(aratioof$5.22to1).

• Home environment: includesexpenditureonhousingservices;communityandenvironmentservices;andtransportandcommunicationsservices.$2.16wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson.Thelargestareaofdifferenceinexpenditureperheadofpopulationwashousing(aratioof$4.85to1),whichreflectsthehigherpercapitausebyAboriginalandTorresStraitIslanderpeopleofsocialhousingandrentalmarketassistance.

• Safe and supportive communities: includesexpenditureonpublicorderandsafety;communitysupportandwelfare;andrecreationandculture.$4.50wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson.

• Other government services: includesexpenditureongeneralgovernment(suchastheoperationsoflegislativeandexecutiveaffairsanddefenceservices);andsupporttoindustry.$1.19wasspentperAboriginalandTorresStraitIslanderpersoninthepopulationforeverydollarspentpernon-Indigenousperson.

Investments In the soCIAl determInAnts of heAlth

Avoidablehealthinequalitiesarisebecauseofthecircumstancesinwhichpeoplegrow,live,workandage,aswellasthesystemsputinplacetodealwithillness.3Thesocialdeterminantsofhealthaffectthehealthofindividualsandcanalsoinfluencehowapersoninteractswithhealthandotherservices.

Anumberofstudieshavefoundthatbetweenone-thirdandone-halfofthehealthgapbetweenAboriginalandTorresStraitIslanderandnon-IndigenousAustraliansisassociatedwithdifferencesinsocioeconomicstatussuchaseducation,employmentandincome.4,5Thesestudieshighlighttheimportanceofaddressingthesocialdeterminantsofhealthtocontributetothetargettoclosethegapinlifeexpectancy.Thefollowingexamplesofpoliciesandprogramsandreformsacrossearlychildhood,education,housingandcommunitysafetyhighlighttherangeofinvestmentinthesocialdeterminants.

eArly ChIldhood eduCAtIon, sChoolIng And tertIAry eduCAtIon

early Childhood

Foranequalstartinlife,Indigenouschildrenneedearlylearning,developmentandsocialisationopportunities.Accesstoqualityearlychildhoodeducationandcareservices,includingpre-school,childcareandfamilysupportservicessuchasparentingprogramsandsupports,iscritical.Appropriatefacilitiesandphysicalinfrastructure,asustainableearlychildhoodeducationandhealthworkforce,learningframeworksandopportunitiesforparentalengagementarealsoimportantandrequireattention.Actionintheareasofmaternal,antenatalandearlychildhoodhealthisrelevanttoaddressingthechildmortalitygapandtoearlychildhooddevelopment.6

schooling

Humancapitaldevelopmentthrougheducationiskeytofutureopportunity.Responsiveschoolingrequiresattentiontoinfrastructure,workforce(includingteacherandschoolleadersupplyandquality),curriculum,studentliteracyandnumeracyachievementandopportunitiesforparentalengagementandschool/communitypartnerships.Transitionpathwaysintoschoolingandintowork,postschooleducationandtrainingarealsoimportant.7

Closing the gap targets

• ToensureaccesstoearlychildhoodeducationforallIndigenousfouryearoldsinremotecommunities(by2013);

• Tohalvethegapinreading,writingandnumeracyachievementsforchildren(by2018);and

• TohalvethegapforIndigenousstudentsinYear12(orequivalent)attainmentrates(by2020).

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eArly yeArsEvidencesupportsthatearlyaccesstoqualityearlychildhoodeducationandcarecanleadtoincreasedschoolreadinessandimprovedparticipationinpreschoolandschool,particularlyforvulnerablechildren.

TheAustralianGovernmentisproviding$660.1millioninfundingoverthenext18monthsforanewNational Partnership Agreement on Universal Access to Early Childhood Education,including$655.6milliontostatesandterritoriestosupportcontinuedaccesstoqualityearlychildhoodeducationprogramsforallchildren,andaCommonwealthinvestmentof$4.5millionfornationalearlychildhooddatadevelopment,reviewandresearchactivities.Thisinvestmentexpandsonthe$970millioninvestedbytheAustralianGovernmentsince2008toensurethatallchildrenhaveaccesstoaqualityearlychildhoodeducationprogram,deliveredbyadegree-qualifiedearlychildhoodteacher,for600hours,intheyearbeforefull-timeschooling.

TheAustralianGovernmentisprovidingapproximately$62.7millionin2013-14tocontributetotheoperationalcostsofaround342earlychildhoodeducationandcareandschoolagecareservices.ServicesfundedundertheBudget Based Funded Programprovidechildrenandtheirfamilieswithaccessible,affordableandculturallyappropriateearlychildhoodeducationandcareandschoolagecareservicesmainlyinruralandremotecommunities.Thisprogramisbeingreviewedtoensurethattheprogramcontinuestomeettheneedsofcommunities,thatfundingistargetedinlocationswhereitismostneeded,andtosupportqualityimprovementtowardstheNational Quality Framework.

TheAustralianGovernmentisalsofundingarangeofinitiativesaspartoftheStronger Futures in the Northern Territorypackage,includingaround$28millionover10yearsforcontinuedoperationalfundingtosupportupto225earlylearningandchildcareplacesatninecrèchesinveryremoteAboriginalandTorresStraitIslandercommunitieswhichwereestablishedundertheNorthern Territory Emergency Response.

AborIgInAl And torres strAIt IslAnder eduCAtIonTheAboriginal and Torres Strait Islander Education Action Plan 2010-2014,endorsedbyCOAGin2011,commitsallgovernmentsinAustraliatoaunifiedapproachtoclosingthegapineducationoutcomesbetweenAboriginalandTorresStraitIslanderandnon-Indigenousstudents,bybringingtogethermainstreameducationreforms,witharangeofactionsspecifictoimprovingoutcomesforAboriginalandTorresStraitIslanderstudents.TheActionPlanwasdevelopedwiththesupportofstakeholdersviaawiderangingconsultationprocesswhichreceivedover100submissions.

eduCAtIon reformTheAustralianGovernmentisinvestinginanewNational Plan for School Improvementtoestablishanewschoolfundingapproachbasedontheneedsofindividualstudents.UndertheNationalPlan,anewSchoolingResourceStandardwouldincludedirectadditionalfunding,throughaloadingarrangement,tohelpAboriginalandTorresStraitIslanderstudentsachieveimprovedoutcomes.

eduCAtIon progrAmsTheAustralianGovernmentwillinvest$659milliontocontinuefundingundertheIndigenous Education(Targeted Assistance) ActtoalignwiththeimplementationoftheNational Plan for School Improvement andmaintaineducationprogramsforAboriginalandTorresStraitIslanderstudents,suchasthe:

• Parental and Community Engagement Program,acommunitydrivenprogramforparentsandcarersofAboriginalandTorresStraitIslanderyoungpeople.Itsupportsinitiativesthatassistfamiliesandcommunitiesto‘reachin’toschoolsandothereducationalsettingstoengageintheirchildren’seducationthroughparticipationineducationaldecision-making,developingpartnershipswitheducationprovidersandsupportingandreinforcingtheirchildren’slearningathome;

• Sporting Chance Program,whichisdesignedtousesportandrecreationasavehicletoengageAboriginalandTorresStraitIslanderyoungpeopleintheirschooling;

• Indigenous Youth Leadership Program,whichprovidessecondaryandtertiaryscholarshipstosupportAboriginalandTorresStraitIslanderstudentsfrommainlyveryremoteandremoteareastocompleteYear12and/oranundergraduatedegreewhiledevelopingleadershipskills;

• Indigenous Youth Mobility Program,whichsupportsyoungAboriginalandTorresStraitIslanderpeopleaged16-24years,primarilyfromremoteareas,whoneedtomoveawayfromhometogainthequalificationstheyneedtohaveagreaterchanceofobtainingsustainableemployment;and

• Focus Schools Projects,whichsupportschoolswithhighAboriginalandTorresStraitIslanderstudentenrolmentstoaccelerateimprovementsineducationaloutcomesforthosestudents,withanemphasisonengagement,attendanceandEnglishliteracyandnumeracy.

education Workforce

InvestmentunderStronger Futures in the Northern Territorywill:

• continuetosupport200teachersandengagementofficersinremoteNorthernTerritoryschools;

• provideaten-yearinvestmentinsupportandtrainingprogramstoensureteachershavetheskillstoachievebetterliteracyandnumeracyresultsforAboriginalandTorresStraitIslanderchildren.ProgramswillalsoensureteachershavetheskillstheyneedtoteachchildrenwithEnglishasasecondlanguageandhowtoensurechildrenwithhearingorlearningdifficultiesgetthebestpossibleeducation;and

• buildaround100teacherhousesinremoteNorthernTerritorycommunitiesoverthenextnineyearstoaddresscriticalstaffhousingshortagesandhelpattractandretainhighqualityteachersinremoteschools.

Teach Remote Stage 2willhelptheNationalAllianceofRemoteIndigenousSchoolstocontinueitsworktoattractandretainhighcalibreteachersinremoteareas.

financial Assistance

AboriginalandTorresStraitIslanderstudentsandapprenticesmaybeabletogetfinancialhelpfromtheAustralianGovernment.ThishelpisavailablefromCentrelinkthroughtheABSTUDYprogram.ABSTUDYprovidesameans-testedlivingallowanceandotherbenefitstoeligiblesecondaryandtertiaryAboriginalandTorresStraitIslanderstudentsandapprentices.

hIgher eduCAtIon And voCAtIonAl eduCAtIon And trAInIngTheAustralianGovernmentprovidesfinancialassistancetohighereducationinstitutionstoimproveoutcomesforAboriginalandTorresStraitIslanderpeopleandfundsarangeofprogramsthatareaimedatincreasingAboriginalandTorresStraitIslanderparticipationinhighereducation,including:

• theIndigenous Youth Careers Pathway Program,whichprovidessupporttoAboriginalandTorresStraitIslanderstudentsinYears11and12tostayinschoolandundertakeschool-basedtraineeships.6,400traineeshipswillbeoffered,toincreasethenumberofyoungpeopletransitioningfromschoolintofurthereducationandtraining.Fundingof$50.7millionhasbeenallocatedoverfouryearsuntil2014-15fortheprogram;

• Away From Base,whichcoverstravelcostsforVocationalEducationTraining(VET)andhighereducationstudentsstudyinganapproved‘mixed-mode’course,wherestudentsarerequiredtotravelfromtheirpermanenthomeforshortperiodstoundertakeapprovedcourse-relatedactivities;

• theIndigenous Support Program,whichprovidesgrantstohighereducationproviderstoassistthemtomeettheneedsoftheirAboriginalandTorresStraitIslanderstudents.ThisincludestheestablishmentofIndigenousEducationSupportUnits,assistancewithstudyskills,personalcounsellingandculturalawarenessactivities;

• theIndigenous Tutorial AssistanceScheme for Tertiary Tuition,whichprovidesfundingforsupplementarytuitiontoAboriginalandTorresStraitIslanderstudentsstudyinguniversityaward-levelcourses,andsomespecifiedAustralianQualificationsFrameworkaccreditedVETcoursesatIndigenousTutorialAssistanceSchemefundedinstitutions;

• theIndigenous Tutorial Assistance Scheme for Vocational Education Training,whichisavailabletoeligiblenon-governmentVETinstitutionstoassistAboriginalandTorresStraitIslanderstudentsundertakingVETcoursesleadingtotheattainmentofaCertificateLevelIIIorabovequalification;

• Supplementary Recurrent Assistancewhichprovidessupplementarypercapitafundingtonon-governmenteducationprovidersintheVETandpreschoolsector;and

• Arangeofawardsandscholarships,suchas:

> Endeavour Research Fellowships for Indigenous Australians,whichprovidesfinancialsupportforAboriginalandTorresStraitIslanderpostgraduatestudentsandpostdoctoralfellowstoundertakeshort-termresearch(4–6months)inanyfieldofstudyintheAsia-PacificorMiddleEast;

> Excellence in Leadership in Indigenous Education Awards,anacknowledgementofoutstandingworkandleadershipinAboriginalandTorresStraitIslandereducation,whicharepresentedtoschoolsthatexcelacrossallcriteria;

> Commonwealth Scholarships,whichprovidefinancialsupporttoeligibleAboriginalandTorresStraitIslanderstudentstoassistwiththecostsassociatedwithhighereducation;and

> Indigenous Staff Scholarships,whichprovideprofessionaldevelopmentopportunitiestoAboriginalandTorresStraitIslanderstaffworkingatuniversities.

health Workforce education and training

HealthWorkforceAustraliahasbeenfundedtosupporttheupskillingofAboriginalandTorresStraitIslanderHealthWorkersinregionalandremoteareas,toassistthemtoachievenewnationalregistrationrequirementswhichcommencedinJuly2012.Theprojecthasthreeelements:

• totrainseniorAboriginalandTorresStraitIslanderHealthWorkersinthenationallyaccreditedVETCertificateIVinTrainingandAssessment(TAE40110)toenablethemtosuperviseandassessAboriginalandTorresStraitIslanderHealthWorkersundertakingtheirtraining.Inparticular,empoweringtheroleofqualifiedon-sitementorsandassessorstosupportstudentsinhealthservicesisanessentialcomponenttothesuccessfulcompletionoftraining;

• toundertakeskillsrecognitionandgaptrainingforAboriginalandTorresStraitIslanderHealthWorkersacrossAustraliatomeetnationalAboriginalandTorresStraitIslanderHealthPractitionerregistrationrequirements;and

• toincreasethenumberofRegisteredTrainingOrganisationswhichmeettheaccreditationstandardsforthedeliveryoftheCertificateIVAboriginaland/orTorresStraitIslanderPrimaryHealthCare(Practice)requiredforAboriginalandTorresStraitIslanderHealthWorkerPractitionerregistrationafter1July2012.

review of higher education Access and outcomes for Aboriginal and torres strait Islander people

TheReportoftheReview of Higher Education Access and Outcomes for Aboriginal and Torres Strait Islander Peoplehighlightstherolethathighereducationplaysinimprovinghealth,educationandeconomicoutcomesforAboriginalandTorresStraitIslanderpeopleandrecommendsacollaborativeapproachbygovernments,universitiesandprofessionalbodiestoincreasingthenumberofAboriginalandTorresStraitIslanderstudents,staffandresearchers.

housIng

healthy homes

Ahealthyhomeisafundamentalpreconditionofahealthypopulation.Importantcontributorstocurrentunsatisfactorylivingconditionsincludeinadequatewaterandseweragesystems,wastecollection,electricityandhousinginfrastructure(design,stockandmaintenance).Childrenneedtoliveinaccommodationwithadequateinfrastructureconducivetogoodhygieneandstudyandfreeofovercrowding.8

envIronmentAl heAlthTheAustralianGovernmentisproviding$44.1millionfrom2013-14tocontinuetosupportthedeliveryofmunicipalandessentialservicesforAboriginalandTorresStraitIslanderpeopleinabout340remotecommunities.Thisfundingisinadditiontothe$206.4millioninvestmentover10yearstosupportthedeliveryofmunicipalservicesforoutstationsandhomelandsintheNorthernTerritory,underStronger Futures in the Northern Territory.$21.2millionoverfouryearsfrom2012-13isbeingprovidedtowardsarangeofenvironmentalhealthinfrastructureprojectsintheTorresStraitrelatedtowatersupplyandreticulation,sanitationandwastewater,communityroaddrainageandservicedhousinglots.

ACCommodAtIon And housIngCOAGhasidentifiedhousingaffordabilityasapressingissueforAustraliansandrecognisedtheimportanceofimprovingaffordabilityandaccesstosafeandsustainablehousing,includinginAboriginalandTorresStraitIslandercommunities.TherehavebeenarangeofCOAGagreementstosupporttheachievementoftheseoutcomesincluding:

• theNational Affordable Housing Agreement;

• theNational Partnership Agreement on Homelessness;and

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• theNational Partnership Agreement on Remote Indigenous Housing.

ThroughtheNational Affordable Housing Agreement,theAustralianGovernmentandstateandterritorygovernmentshavecommittedtoachievingIndigenous-specificoutcomes,including:

• AboriginalandTorresStraitIslanderpeoplehavethesamehousingopportunitiesasotherAustralians;and

• AboriginalandTorresStraitIslanderpeoplehaveimprovedhousingamenitiesandreducedovercrowding,particularlyinremoteareasanddiscretecommunities.

SpecificinitiativesfundedundertheNational Partnership Agreement on Homelessness includeAboriginalandTorresStraitIslanderadvocacyandtenancysupportservices,assistanceforAboriginalandTorresStraitIslanderyoungpeopleleavingcare,legalassistanceforAboriginalandTorresStraitIslanderwomenandoutreachforindividualsandfamiliesexperiencingroughsleeping.

TheNational Partnership Agreement on Remote Indigenous Housing($5.5billionovertenyearsto2018),seekstoaddresskeyenvironmentalhealthandhousingissuesincluding:

• significantovercrowding;

• homelessness;

• poorhousingconditions;and

• severehousingshortagesinremoteAboriginalandTorresStraitIslandercommunities.

FundingisbeingprovidedtothestatesandtheNorthernTerritoryover10yearsto2018to:

• deliverupto4,200newhousesandrebuildorrefurbisharound4,800existinghousesinremoteAboriginalandTorresStraitIslandercommunitiesaroundAustralia;

• deliveremployment-relatedaccommodationinregionalareastoenableAboriginalandTorresStraitIslanderpeoplefromremotecommunitiestoaccesstraining,education,employmentandsupportservices;and

• provideAboriginalandTorresStraitIslanderemploymentopportunitiesthrougha

20percentlocalIndigenousemploymenttargetoverthelifeoftheprogramfornewhousingconstruction.

Inaddition,long-termstructuralreformswillputremoteAboriginalandTorresStraitIslanderhousingonamoresustainablefootingbyensuringthat:

• securetenurearrangementsareputinplaceasapre-conditiontonewhousing;

• standardtenancymanagementarrangementsexistsothatrentscanbecollectedandrepairsandmaintenancecarriedout;and

• tenantsofnewhousesreceivelivingskillstrainingtotransitiontonewtenancyarrangementsandtohelpthemunderstandtheirrightsandresponsibilities.

Sofar,underthisAgreementover5,300homesinremoteAboriginalandTorresStraitIslandercommunitieshavebeenrefurbishedorrebuiltagainstatargetof4,876homes,significantlyexceedingtherefurbishmenttargettwoyearsaheadofschedule.Todatemorethan1600homeshavebeenconstructed,onthewaytomeetthetargettoconstruct4,200homesby2018.

AboriginalHostelsLimited’s(AHL’s)primarypurposeistoprovideAboriginalandTorresStraitIslanderpeoplewithsafe,comfortable,affordableandculturallysensitiveaccommodation.ThisaccommodationenablesAboriginalandTorresStraitIslanderpeopletoaccessessentialservicessuchaseducation,health,legaladvice,trainingandemploymentthatmightnototherwisebeavailableintheirhomecommunities,andoperateswithanincreasedemphasisonsupportingbettereconomicandsocialoutcomes,throughworkinginpartnershipwithotherorganisations.In2013-14,theAustralianGovernmentwillbeprovidingAHLwith$6.2millionovertwoyearstoundertakecapitalupgradestonineofitshostels.

TheIndigenous Home Ownership Programwillassistapproximately2,200AboriginalandTorresStraitIslanderpeopletobuytheirownhomeoverfouryearsfromJuly2013,byprovidingarangeofconcessionalhomeloansandpriorityofaccessandextraassistanceforapplicantspurchasinghomesonAboriginalandTorresStraitIslanderland.

eConomIC development, pArtICIpAtIon And employment

economic participation

Individualsandcommunitiesshouldhavetheopportunitytobenefitfromthemainstreameconomy–realjobs,businessopportunities,economicindependenceandwealthcreation.Economicparticipationneedstoextendtodisadvantagedjobseekersandthoseoutsideofthelabourmarket.Accesstolandandnativetitleassets,rightsandinterestscanbeleveragedtosecurerealandpracticalbenefitsforIndigenouspeople.Otherfinancialassets,capacitybuilding,employmentandtrainingprograms,incentivestructuresandsocialandphysicalinfrastructure,includingcommunicationsandtransport,areneededtofostereconomicparticipationandcommunityengagement.

Throughthisparticipation,parentsandotheradultscanbecomeeffectiverolemodelsfortheirfamiliesandcommunity.Thedesignanddeliveryofwelfare(bothtransferpaymentsandservices)needstopromoteactiveengagement,enhancedcapabilityandpositivesocialnorms.Ensuringthatcommunitieshavesupporttoaddressfactorsthatareabarriertoengagementsuchasproblemgamblingiscritical.Life-longlearningisimportantandattentionisalsoneededregardingadultliteracyandnumeracyskills.9

Closing the gap target

• TohalvethegapinemploymentoutcomesbetweenIndigenousandotherAustralians(by2018).

eConomIC developmentTheIndigenous Economic Development Strategy 2011–2018 isanAustralianGovernmentpolicyframeworkthataimstoincreasethepersonalandeconomicwellbeingofAboriginalandTorresStraitIslanderpeoplethroughgreaterparticipationintheeconomy.TheStrategyhasfivepriorities:

• strengthenfoundationstocreateanenvironmentthatsupportseconomicdevelopment;

• investineducation;

• encourageparticipationandimproveaccesstoskillsdevelopmentandjobs;

• supportthegrowthofAboriginalandTorresStraitIslanderbusinessandentrepreneurship;and

• assistindividualsandcommunitiestoachievefinancialsecurityandindependence.

eConomIC pArtICIpAtIon And employmentJobServicesAustraliaistheAustralianGovernment’snationalemploymentservicessystemandisthemainproviderofemploymentservicesforAboriginalandTorresStraitIslanderjobseekers.TheGovernmentlaunchedJobServicesAustraliaon1July2009withtheaimofincreasingemploymentparticipation,buildingskillsindemandandhelpingindividualjobseekers,particularlydisadvantagedparticipants,findsustainableemployment.JobServicesAustraliaprovidersworkwithlocalcommunitiestodevelopjobsandtrainingopportunities.

TofurtherenhanceJobServicesAustraliaachievementsforAboriginalandTorresStraitIslanderjobseekers,theGovernmenthasputinplacevariousmeasures,including:

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• theIndigenous Mentoring Pilot:thePilotcommencedon1July2012andaimstodetermineifongoingculturallyappropriatementoringsupportwillassistinimprovingretentionratesforAboriginalandTorresStraitIslanderjobseekers;and

• culturalawarenesstraining:theGovernmenthasdevelopedanonlineculturalawarenesstrainingpackageforproviderstofurtherstrengthentheperformanceofJobServicesAustraliaandDisabilityEmploymentServices(DES)forAboriginalandTorresStraitIslanderjobseekers.

DESistheAustralianGovernment’snationalemploymentserviceforpeoplewithdisability.TheGovernmentlaunchedDESon1March2010withtheaimofprovidingtailoredassistancetoindividualswithinjury,disabilityorahealthconditiontosecureandmaintainsustainable,openemployment.DESprovidesemploymentservicesforeligibleAboriginalandTorresStraitIslanderparticipantswhoarelocatedinnon-remoteareas.

Whererequired,DESoffersongoingsupportintheworkplacetohelpparticipantsretaintheiremployment.DESisalsofocusedontheneedsofemployers,providingparticipantswiththeskillsandtrainingtomeetemployerneeds.Providershelpbuilddisabilityconfidenceintheworkplaceandsupportemployerstomaintainqualityandsustainableoutcomesforpeoplewithdisability,includingwhereappropriate,arrangingworkplacemodificationsthroughtheEmployment Assistance Fund.DESproviderscanalsoaccessassistancetosupportemployerstoemploypeoplewithdisabilitythroughtheSupported Wage System, Wage Subsidy SchemeandtheNational Disability Recruitment Coordinator.

DESofferstwodemand-drivenprogramstohelppeoplewithinjury,disabilityorhealthconditionstofindandretainopenemployment:

• Disability Management Service,whichprovidesservicestoeligiblejobseekerswithtemporaryorpermanentinjury,disabilityorahealthconditionwhorequiretheassistanceofadisabilityemploymentserviceandwhomayrequireflexible,ongoingsupportbutarenotexpectedtoneedregular,long-termsupportintheworkplace;and

• Employment Support Service,whichisavailabletothoseeligiblejobseekerswithpermanentdisabilitywhoareassessedasneedingregular,long-term,ongoingsupportintheworkplace.TheGovernmentputtheEmployment Support Serviceouttoopencompetitivetenderforthefirsttimeinlate2012.Theresultofthetendermeansjobseekerswithdisabilitynowhaveaccesstoahigherstandardofsupport,inmorelocationsthaneverbefore.

TheIndigenous Employment Program(IEP)fundsarangeofactivitiesinurbanandregionalAustraliathat:

• encourageandsupportemployerstoprovidesustainableemploymentopportunitiesforAboriginalandTorresStraitIslanderpeople;

• encourageandsupportAboriginalandTorresStraitIslanderpeopletotakeuptrainingandemploymentopportunitiestostayinjobsandenhancetheirfutureemploymentprospects;

• assistAboriginalandTorresStraitIslandercommunities,industrybodiesandgroupsofemployerstodevelopIndigenousworkforceandeconomicdevelopmentstrategiesthatsupportregionaleconomicgrowth;and

• assistAboriginalandTorresStraitIslanderpeopletodevelopsustainablebusinessesandeconomicopportunitiesinurbanandregionalareas.

On1July2013theIEP,alongwiththeDES,CommunityDevelopmentEmploymentProjects(CDEP)andJobServicesAustralia,transitionedintotheRemote Jobs and Communities Program(RJCP)inremoteareas.TheRJCPbuildsonthestrengthsofthesefourprogramsinremoteAustralia,deliveringamorestreamlinedandflexibleapproach,providingbetterparticipationandemploymentservicesforpeoplelivinginremoteAustralia.

UndertheRJCP:

• providershaveapermanentpresenceineachofthe59identifiedremoteregionsacrossAustralia,andareasingle,localpointofcallforjobseekersandemployers;

• a‘jobsfirst’approachistakenwhichhelpspeoplebuildthefoundationalskillstheyneedtotakeupavailablejobsandsupportscommunitydevelopment.Jobseekersareprovidedwithpersonalisedsupportandcasemanagement,includingaccesstojobopportunities,skillsdevelopmentandtrainingthatmeetstheirneeds;

• RJCPprovidersworkwithcommunities,employersandindustriesintheirregiontodevelopandimplementaCommunityActionPlanthatidentifiestheregion’semployment,economicandcommunitydevelopmentgoals;

• the$500millionParticipationAccountisaflexiblefundthatcanbeusedtopurchasereasonableinterventionsthatincreaseaRJCPparticipant’semployability,overcomevocationalandnon-vocationalbarrierstoemploymentorfundeconomicdevelopmentandbusinesssupport;

• $237.5millionoverfiveyearsfrom1July2013fortheCommunityDevelopmentFundwillsupportprojectsthatprovideemploymentandparticipationopportunitiesforlocalpeoplethatareconsistentwiththedirectionoftheregion’sCommunityActionPlan;

• theAustralianGovernmenthasextendedthepaymentofCDEPwagesuntil30June2017forparticipantscurrentlyreceivinggrandfatheredCDEPwages;and

• youngpeopleinremotecommunitiesarebenefitingfroman$89millioninvestmentintheRemoteYouthDevelopmentandLeadershipCorps,whichisproviding12,000youngpeopleaged24yearsandunderwithaclearpathwayintoemploymentinremotecommunities.

TheAboriginalandTorresStraitIslanderartsandculturalsectorsarecreativeindustriesbuildingonuniquelyAboriginalandTorresStraitIslanderassetsandprovidingmeaningfulemploymentopportunitiesforAboriginalandTorresStraitIslanderpeople.Forexample,artcentres,particularlyinremotecommunitiesareoftenamajorsourceofincome.TheAustralianGovernmentisprovidingongoingfundingtogenerateincomeandemploymentopportunitieswhilemaintainingandtransmittingculturethrough:

• Indigenous Visual Arts Industry Supportfunding,whichwillprovidearound$48.8millionoverfouryearsfrom2013-14tosupportAboriginalandTorresStraitIslanderartcentresandindustrysupportorganisations,inordertohelpbuildastrongerAboriginalandTorresStraitIslandervisualartsindustry;and

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• the Indigenous Employment Initiativeintheartsandculturalsectors,whichwillprovidearound$89.4millionoverfouryearsfrom2013-14toIndigenousarts,culture,languageandbroadcastingorganisationstoemploycloseto600AboriginalandTorresStraitIslanderpeopleannuallyinrolessuchasartworkers,culturalofficers,languageassistantsandbroadcastingtechnicians.ThesejobsaredirectlyhelpingtolinkAboriginalandTorresStraitIslanderculturetothemainstreameconomyandsociety.

TheWorking on Country Indigenous Ranger Program,whichcommencedin2007,hasacommitmentof$244millionuntilJune2013toemployover690Indigenousrangerstoundertakeenvironmentalwork.From1July2013anadditional$335millionhasbeencommittedoverfiveyearstosupporttheworkoftherangersandsupporttheexpansionoftheprogramto730rangersbyJune2015.TheWorking on Country Indigenous Ranger Programaimstoencourageanactiveconnectiontocountry,whichhasapositiveimpactonhealth,economicandsocialwellbeing,andenablesculturallearningbetweenyoungandold.

sAfe CommunItIes

safe Communities Indigenouspeople(men,womenandchildren)needtobesafefromviolence,abuseandneglect.Fulfillingthisneedinvolvesimprovingfamilyandcommunitysafetythroughlawandjusticeresponses(includingaccessibleandeffectivepolicingandanaccessiblejusticesystem),victimsupport(includingsafehousesandcounselling),childprotectionandalsopreventativeapproaches.Addressingrelatedfactorssuchasalcoholandsubstanceabusewillbecriticaltoimprovingcommunitysafety,alongwiththeimprovedhealthbenefitstobeobtained.10

JustICeToreducetheoverrepresentationofAboriginalandTorresStraitIslanderpeopleinthejusticesystem,theNational Indigenous Law and Justice Framework 2009–2015providesanationalapproachtoaddressseriousandcomplexissuesthatexistforAboriginalandTorresStraitIslanderpeopleinthecriminaljusticesystem.

TheIndigenous Justice Program(IJP),fundedbytheAustralianGovernment,seekstoincreasecommunitysafetyforAboriginalandTorresStraitIslanderpeoplebyfundingprojectsdesignedtoreducetheadversecontactofAboriginalandTorresStraitIslanderpeoplewiththecriminaljusticesystem.Theseprojectsmakecommunitiessaferbyreducingtheratesofoffending,andthroughthatreducevictimisationandincarcerationofAboriginalandTorresStraitIslanderpeople.IJPhasanationalfocusandseekstocomplementstateandterritoryinitiatives.Fundingisprovidedforprisonerthroughcare,youthpreventionanddiversion,communitypatrolsandrestorativejusticeprojects.In2012-13,fundingfortheIJPwas$11.66million,with40projectsbeingfunded.In2013-14,fundingtotals$11.95million.

legAl servICesTheFamily Violence Prevention Legal Services Programprovidesculturallyappropriateassistancetovictim-survivorsoffamilyviolenceandsexualassault,toprevent,respondtoandreducetheincidenceoffamilyviolenceandsexualassault.Fourteenorganisationsprovideservicesfrom30outletsinallstatesandterritories,exceptTasmaniaandtheACT,tohigh-needrural,regionalandremotelocations.FundingfortheFamily Violence and Prevention Legal Services Programin2012-13was$19.09million.Fundingin2013-14is$19.6million.

TheIndigenous Legal Assistance and Policy Reform Programoffersculturallysensitiveandaccessiblelegalassistanceservices.AboriginalandTorresStraitIslanderorganisationsarefundedundertheprogramtodeliverlegalassistanceservicesatanumberofpermanentsites,courtcircuitsandoutreachlocationsinurban,ruralandremotesareas.Fundingfortheseorganisationsin2012-13was$68.22million,andfundingin2013-14is$73.84million,whichincludesnewfundingof$12millionidentifiedinthe2013-14AustralianGovernmentBudgettobeprovidedovertwoyears.

TheAustralianGovernmentalsofundsCommunityLegalCentres(CLCs),whichareindependentandcommunitymanagednon-profitservicesthatprovidearangeofassistanceonlegalandrelatedmatterstopeopleonlowincomesandthosewithspecialneeds.WhilstnotallAustralianGovernmentfundingprovidedundertheCommunity Legal Services ProgramistargeteddirectlytowardAboriginalandTorresStraitIslandermatters,anumberofCLCsdoprovideservicestoAboriginalandTorresStraitIslanderclients.

CommunIty sAfetyThe Indigenous Family Safety Agenda,theNational Plan to Reduce Violence against Women and their ChildrenandtheNational Framework for Protecting Australia’s Childrenacttosupportsafecommunitiesandaimtoimprovecommunitywellbeingandreducetheprevalenceofinjury.

UndertheStronger Futures in the Northern Territorypackage,fundingof$619millionisbeingprovidedbytheAustralianGovernmentoverthe10yearperiodfrom1July2012tosupportincreasedcommunitysafetyinNorthernTerritoryAboriginalcommunities.Aspartofthisfunding,theAttorney-General’sDepartmentadministerstheCommunity Night Patrol Program.Patrolsundertakeactivitiessuchassafetransportation,referraltoinformationandservices,andearlyinterventiontoimprovecommunitysafetyandpreventunnecessaryadversecontactwiththecriminaljusticesystem.Peopleatriskofcommittingorbecomingavictimofharmcanbetakentoasafeplacewheretheirneedscanbeassessed,and,whereappropriate,referredtootherservicesforfurtherassistance.FundingfortheprogramisallocatedthroughtheCommunity Safety and Justice Measure($28.83millionin2012-13and$29.29millionin2013-14)andincludessupportforsupplementarylegalservices.

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Investments to Improve the enAblers to heAlth

A CulturAlly respeCtful And non-dIsCrImInAtory heAlth system

health

IndigenousAustralians’accesstoeffective,comprehensiveprimaryandpreventativehealthcareisessentialtoimprovingtheirhealthandlifeexpectancy,andreducingexcessmortalitycausedbychronicdisease.AllhealthservicesplayanimportantroleinprovidingIndigenouspeoplewithaccesstoeffectivehealthcare,andbeingresponsivetoandaccountableforachievinggovernmentandcommunityhealthpriorities.ClosingtheIndigenoushealthgaprequiresaconcertedeffortintheprevention,managementandtreatmentofchronicdisease.Indigenouschildrenandtheirparentsneedtoaccessprogramsandservicesthatpromotehealthylifestyles.11

Closing the gap targets

• Toclosethegapinlifeexpectancywithinageneration(by2031);and

• TohalvethegapinmortalityratesforIndigenouschildrenunderfive(by2018).

TheDepartmentofHealthandAgeingprovidesfundingtoAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsfortheprovisionofhealthcareservicestoAboriginalandTorresStraitIslanderpeople.IncreasingtheaccessofAboriginalandTorresStraitIslanderpeopletoqualityprimaryhealthcareservicesthatareculturallysafeandareplannedanddeliveredaccordingtoatransparentneedsassessment,isapriority.TheDepartmentofHealthandAgeingisalsocurrentlydevelopingawiderangeofculturallyappropriatetrainingresourcesforAboriginalandTorresStraitIslanderagedandcommunitycareworkers.

TheNationalCongressofAustralia’sFirstPeoplesgivesAboriginalandTorresStraitIslanderpeopleastrongnationalvoiceonissuesthataffectthem.TheGovernmentcontinuestosupportAboriginalandTorresStraitIslanderrepresentationwithafurther$15millionbeingprovidedoverthreeyearsfrom2014-15.

Since1997,theDepartmentofHealthandAgeinghasfundedtheNationalAboriginalCommunityControlledHealthOrganisation(NACCHO)asthenationalpeakbodyforAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisations.NACCHOhasapproximately150membersnationwide,comprisingmainlyofprimaryhealthcareorganisations.

TheDepartmentprovidesfundingtoNACCHOto:

• providesupportandassistancetoAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisations;

• representandadvocateonbehalfofitsmemberorganisations;and

• provideadviceandpolicyviewsonhealthissuesaffectingAboriginalandTorresStraitIslanderpeople.

Inadditiontoprovidingcorefundingfortheactivitiesnotedabove,theDepartmentofHealthandAgeingalsoprovidesfundingtoNACCHOforspecificprojectssuchas:

• NACCHO Governance - tofacilitatepartnershipsthatcontributetogovernanceenhancementintheAboriginalandTorresStraitIslandercommunitycontrolledhealthsector;

• Smoke Free - toprovideleadershipandsupportacrossallAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsastheydevelop,implementandmonitoreffectivesmoke-freepoliciesandbecomesmoke-freeworkplaces;

• Ear Health - toprovideearhealthandhearingscreeningtrainingtoAboriginalandTorresStraitIslanderHealthWorkers.

• Indigenous Chronic Disease -toemployanIndigenousHealthProjectOfficertosupporttheimplementationofarangeofIndigenous Chronic Disease Package(ICDP)measuresrelevanttotheAboriginalandTorresStraitIslandercommunitycontrolledhealthsector;and

• Telehealth Support Program - toenhanceAboriginalandTorresStraitIslanderpeople’saccesstospecialiststhroughtheprovisionofsupportforqualityTelehealthfacilitatedpatientconsultationsusingvideoconferencingfacilitieswithinAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisations.

Whileaculturallycompetenthealthsystemiscritical,sustainablechangestoaddressracismmustbereinforcedbybroadersystemicactionacrossarangeofsettings.

TheAustralianGovernmentisaddressingracismthroughanumberofinitiatives,includingtheNational Anti-Racism Strategy,whichaimstopromoteaclearunderstandingintheAustraliancommunityofwhatracismis,andhowitcanbepreventedandreduced.

Inadditiontotheseinitiatives,inFebruary2013,theAustralianGovernmentannouncedfundingforReconciliationAustraliaof$14.4millionoverfouryearsfrom2013-14topromotereconciliationandbuildstrongerrelationshipsbetweenAboriginalandTorresStraitIslanderandnon-IndigenousAustralians.InJuly2012,theAustralianGovernmentalsoprovided$10milliontoReconciliationAustraliaovertwoyearstopromotepublicawarenessandcommunitysupportforAboriginalandTorresStraitIslanderconstitutionalrecognition.$1.3millionovertwoyearswillbeprovided

tosupporttheJointSelectCommitteeonConstitutionalRecognitionofAboriginalandTorresStraitIslanderPeoples.

heAlth system effeCtIveness And ClInICAlly ApproprIAte CAre

prImAry heAlth CAreUndertheNational Health Reform Agreement(August2011),itwasagreedthattheCommonwealthandthestateswillworktogetheronsystem-widepolicyandstate-wideplanningforgeneralpracticeandprimaryhealthcaregiventheirimpactontheefficientuseofhospitalsandotherstate-fundedservices,andtosupporteffectiveintegrationacrossAustralianGovernmentandstate-fundedhealthservices.

InApril2013,theAustralianGovernmentandthestatesfinalisedtheNational Primary Health Care Strategic Framework.TheFrameworksetsoutagreedfuturepolicydirectionsandpriorityareasforprimaryhealthcareincludingthefollowingfourstrategicoutcomes:

• buildaconsumer-focusedintegratedprimaryhealthcaresystem;

• improveaccessandreduceinequity;

• increasethefocusonprevention,screeningandearlyintervention;and

• improvequality,safety,performanceandaccountability.

Thesestrategicoutcomes,whichhaveparticularrelevanceforvulnerableandhardtoreachpopulationgroupsincludingAboriginalandTorresStraitIslanderAustralians,willbethefocusofthebilateralplansforeachstateandterritory,whichwillsupporttheimplementationoftheFramework.

ImprovIng ACCessTheabilitytoaccesshealthservices,includingtheservicesofspecialistsandalliedhealthprofessionals,isessentialtoimprovinghealthoutcomesforAboriginalandTorresStraitIslanderpeople.Arangeoffactors(bothbarriers

andenablers)affectAboriginalandTorresStraitIslanderpeople’saccesstohealthcareservicesincludinggeography,cost,appropriatecommunication,therelationshipbetweenprimary,secondaryandtertiaryhealthservices(coordinatedcare),theavailabilityofspecialistsandalliedhealthprofessionals,varyinglevelsofculturalcompetencyacrossthehealthsystem,healthworkforceandtransport.12

The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services(QAAMS)pathologyprogramsupportsbettermanagementofdiabetesinAboriginalandTorresStraitIslandercommunitiesbyenablingparticipatingAboriginalMedicalServicesandAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsinpredominantlyruralandremoteareasacrossAustraliatoprovideculturallyappropriateandclinicallyeffective‘point-of-care’diabetes-relatedpathologytestingonsite.

TheICDPincludesinitiativestoprovidefinancialincentivesforaccreditedprimaryhealthcareservicestoimprovethequalityofcareincludingbestpracticemanagementofchronicdisease.Thepackagealsoaimstoincreaseaccesstoessentialfollow-upservicessuchasalliedhealth,specialistcareandPBSmedicines.

AspartoftheICDP,fundinghasbeenprovidedtoAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsandMedicareLocalstoemployAboriginalandTorresStraitIslanderOutreachWorkers(OutreachWorkers).OutreachWorkerswillencourageandsupportAboriginalandTorresStraitIslanderpeopleto

accessprimaryhealthcareservicesandhelpensurefollowuptreatmentisaccessed.Thismayincludeassistingpeopletotraveltoandfromappointments.IndigenousHealthProjectOfficerpositionsarealsobeingfundedtoprovideleadershipinAboriginalandTorresStraitIslanderhealthissueswithintheMedicareLocalsnetworkandNACCHOanditsaffiliates,includingincreasedawarenessandunderstandingofthevariousClosing the Gapinitiativesrelevanttomainstreamprimarycare.

ThePractice Incentives Program - Indigenous Health IncentivesupportsgeneralpracticesandAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationstoprovidebetterhealthcareforAboriginalandTorresStraitIslanderpeople,includingbestpracticemanagementofchronicdisease.Incentivesareofferedforpracticesto:identifyAboriginalandTorresStraitIslanderpatientswithchronicdisease;undertakeandreviewchronicdiseasemanagementplans;andprovideatargetlevelofcare.

Access to pharmaceuticals

TheAustralianGovernmentiscommittedtoensuringAboriginalandTorresStraitIslanderpeoplehavetimelyandaffordableaccesstoPBSmedicines,aswellasQualityUseofMedicines(QUM)andmedicationmanagementsupportservices.Inrecognitionofthis,anumberofprogramshavebeenimplementedinremote,urbanandrurallocations.ThePBSalsohasarangeofmedicinesthathavebeenlistedspecificallytohelpwiththehealthneedsofAboriginalandTorresStraitIslanderpeople.

The Remote Section 100 Remote Area Aboriginal Health Service (RAAHS) ProgramisadministeredunderSection100(s100)oftheNational Health Act 1953andallowsforthesupplyofPBSmedicinestoclientsofeligibleremoteareaAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsatthetimeofmedicalconsultationwithouttheneedforanormalprescriptionform,andwithoutcharge.TheProgramaimstoaddressidentifiedbarriersexperiencedbyAboriginalandTorresStraitIslanderpeoplelivinginremoteareasofAustraliainaccessingessentialmedicinesthroughthePBS.

TheSection 100 Pharmacy Support AllowancefinanciallysupportsvisitsbypharmaciststoprovidearangeoftargetedQUMandmedicationmanagementsupportservicestoremoteareaAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationswhoparticipateinthes100RAAHSProgram.TheProgramaimstoassistinimprovinghealthoutcomesforclientsbysupportingQUMatthoseservicesthroughpharmacistvisitsandadvice.

TheQuality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples (QUMAX) ProgramisaQUMsupportinitiativethataimstoimprovehealthoutcomesforAboriginalandTorresStraitIslanderpeople.ThefocusoftheQUMAXProgramistoimproveQUMthrougharangeofsupportservicesprovidedtoAboriginalandTorresStraitIslanderpatientsthroughparticipatingAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsandcommunitypharmaciesin

ruralandurbanAustralia.TheQUMsupportservicesincludeDoseAdministrationAids,QUMdevices(e.g.asthmaspacers),andQUMeducationtoclientsandstaffofAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisations.

Addressing geographic barriers to Accessing health Care

ArangeofprojectshavebeenfundedundertheHealthandHospitalsFund(HHF)toassistinclosingthegapinhealthoutcomesbetweenAboriginalandTorresStraitIslanderandnon-IndigenousAustralians.21oftheseprojects,withatotalvalueofwellover$200million,specificallytargetAboriginalandTorresStraitIslandercommunitiesandthereareanumberofotherprojectsthatareexpectedtohaveasignificantimpactonimprovinghealthoutcomesforAboriginalandTorresStraitIslanderpeople.

regional Cancer Centres

TheAustralianGovernmentisinvestingatotalof$672millioninanationalnetworkof25regionalcancercentreprojectstohelpclosethegapincanceroutcomesbetweenthecityandthecountry.Thisunprecedentedinvestmentwilldramaticallyimproveaccesstoessentialcancercareservicesformanypeople,includingAboriginalandTorresStraitIslanderpeople.11ofthe25regionalcancercentreprojectsarecompleted,oralmostcompleted,andareoperational.13projectsareunderconstruction,withsixoftheseanticipatedtobecompletedby30June2014.

transport

AboriginalandTorresStraitIslandercommunitiesfacevariouschallengesinrelationtotransport.Thesechallengeshaveabroaderimpactonsocialandeconomiccircumstances,andspecificimpactsonaccesstohealthservicesparticularlyinregionalandremoteareasofAustraliawherepatientsmayneedtotravellongdistancestoaccesscare.

Aeromedicalservicescanplayakeyroleindeliveringemergencycareandtransportingpatientstohospitalsinlargeregionalcentresandmetropolitanareas.Tosupportthedeliveryoftheseservices,theAustralianGovernmentisproviding$59.4millionfrom2008-09to2014-15toupgraderegionalandremoteaerodromesthroughtheRegional Aviation Access Program. The Remote Aerodrome Upgrade Program,afundingcomponentoftheRegional Aviation Access Program,providesfundingwhichwillassisttheownersofremoteairstripsforcapitalworksprojectstoimprovethesafetyandaccessibilityofairstripsandfacilitatetheprovisionofnon-commercialessentialcommunityairservices.Theseairstripssupportflightsessentialtoremotecommunitiessuchasthosedeliveringfreshfoodandmail,transportingresidentsandemergencypersonnel,andtheRoyalFlyingDoctorService.TheAustralianGovernmentalsoprovides$1millionperannumthroughtheAirservices Australia Enroute Charge Payment Schemetoassistaeromedicaloperatorswiththecostofoperatinginremotelocations.Inaddition,theAustralianGovernmentprovidessupportfordriversafetyandroadmaintenanceandupgradeprogramsinremotepartsofAustralia,toaddressthenegativeimpactsoftransportuse,includingmotorvehicleaccidents.

e-health and telehealth

Thedevelopmentandimplementationofe-Health,theelectronicmanagementofhealthinformation,willalsosupportthedeliveryofsafer,moreefficientandhigherqualityhealthcare,helpingtoaddressexistingbarrierssuchasinformationsilos,geographicdistanceorhealthsectorboundaries.E-HealthincludesthePersonallyControlledElectronicHealthRecord(PCEHR),whichenablesthoseindividualswhovoluntarilyregisterforaPCEHR,andtheirauthorisedhealthcareproviders,toaccessasummaryofkeyhealthinformationonlinewhenandwhererequiredprovidingtheindividualwithhealthcare.Thisisparticularlyhelpfulforhighlymobileindividualswhoseekhealthcarefromarangeofdifferenthealthcareprovidersindifferentlocations.

Telehealthisalsoimprovingaccesstospecialisthealthcareservicesforpatientswholiveinregional,ruralandremoteareas.Insteadofhavingtotraveltothenearestmajorcitytoseeaspecialist,anincreasingnumberofpatientsareusingvideo-conferencing.Medicare-fundedhealthservicesareavailableforvideoconsultationswithspecialistsandarealsoavailabletopatientsofeligibleAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsacrossAustralia.

The National Partnership Agreement for Remote Indigenous Public Internet Access Training and MaintenancewillprovidesupportforAboriginalandTorresStraitIslandercommunitiestoaccessgovernmentservicesonline,inanefforttoreducegeographicalisolationandimproveserviceaccess.TheAustralianGovernmentwill

becontributing$6.5millionoverthreeyearsto30June2016tosupporttheongoingoperationandmaintenanceofpublicinternetfacilitiesdeliveredundertheoriginalAgreementanddelivertrainingtoAboriginalandTorresStraitIslanderpeopleintheuseofonlinetechnologies.

TheGovernmentprovidedfundingfortheTorres Strait Health Protection StrategytoenhancethehealthservicecapacityintheTorresStraittoprotectcommunitiesfromcommunicablediseases.ThisstrategyincludesbuildingaclinicandstaffaccommodationonSaibaiIsland,increasedservicedelivery,amosquitocontrolprogramandtheemploymentofacommunicationsofficer.Additionalfundingisbeingprovidedfortheperiod2013-14to2016-17tocontinuethemosquitocontrolprogramandthecommunicationsofficerrole.

heAlth lIterACyActionstoimprovehealtheducationandliteracyarefoundacrossarangeofrelatedhealthactivitiessuchashealthpromotionandprevention,healthprotection,diseaseprevention,earlyinterventionandmanagementandhealthcaremaintenance.

Healthliteracyisincreasinglybeingrecognisedasanimportantcomponentofsafeandhighqualityhealthcare.TheAustralianCommissiononSafetyandQualityinHealthCare(ACSQHC)hasidentifiedhealthliteracyasaprioritythroughanumberofnationalpolicies,including:

• theAustralian Safety and Quality Framework for Health Care,whichidentifieshealthliteracyasakeyactionarea;

• theNational Safety and Quality Health Service (NSQHS) Standards,whichimplicitlyreferstohealthliteracyinnineofthetenStandards;and

• theAustralian Safety and Quality Goals for Health Care,whichincludespartnershipswithconsumersasagoalandbecomingahealthliterateorganisationasacoreoutcome.

evIdenCe-bAsed prACtICe

heAlth surveysTheresultsfromthe2012-13 Aboriginal and Torres Strait Islander Health SurveywillmakeasignificantcontributiontothemonitoringandevaluationoftheNationalAboriginalandTorresStraitIslanderHealthPlan(HealthPlan).Thissurveybuildsonthe2004/05National Aboriginal and Torres Strait Islander Health Surveybyintroducingnewdatacollectionsonfoodandnutritionandphysicalactivityaswellasavoluntarybiomedicalcomponentthatwillprovideobjectivemeasuresofnutritionalstatusandchronicdiseaseriskfactors.High-levelresultsfortheAboriginal and Torres Strait Islander Health SurveyareduetobereleasedinSeptember2013forCOAGreportingpurposes,withmoredetailedresultsreleasedfromJune2014.FuturesurveyswillenablemonitoringofchangesinthehealthstatusofAboriginalandTorresStraitIslanderpeopleandstrengthenthemonitoringandevaluationoftheHealthPlan.

nAtIonAl heAlth And medICAl reseArCh CounCIlEvidenceisavaluabletoolinmakingtheargumentforanypolicy.Themostcompellingevidenceclearlyarticulatesbothchallengesandopportunities,providingactionableguidanceforpolicyandprogramdevelopment.AstheAustralianGovernment’speakfundingbodyforhealthandmedicalresearch,the

NationalHealthandMedicalResearchCouncil (NHMRC)investsinresearchthroughavarietyoffundingmechanismsincludinginvestigator-initiatedresearchprojectsandclinicaltrials,broadprogramsofresearch,trainingawardsforscholarsandpostdoctoralfellows,careerresearchfellowshipsandspecialstrategicresearchprograms.TheNHMRCiscommittedtosupportinghealthandmedicalresearchandstatedthatonanannualbasis,itwillaimtocommitatleastfivepercentofitstotalresearchbudgettohealthandmedicalresearchinvolvingAboriginalandTorresStraitIslanderpeople.

footprInts In tImeThe Longitudinal Study of Indigenous Children (LSIC) ‘Footprints in Time’isconductedbytheDepartmentofFamilies,Housing,CommunityServicesandIndigenousAffairsundertheguidanceoftheFootprintsinTimeSteeringCommittee,chairedbyProfessorMickDodsonAM.Thestudyaimstoimprovetheunderstandingof,andpolicyresponseto,thediversecircumstancesfacedbyAboriginalandTorresStraitIslanderchildren,theirfamiliesandcommunities.

CooperAtIve reseArCh CentreTheAustralianGovernmentisextendingfundingfortheCooperativeResearchCentreforAboriginalandTorresStraitIslanderHealth(CRCATSIH),providing$25millionoverfiveyearsfromJuly2014.TheCRCATSIH,hostedbytheLowitjaInstitute,bringstogethertheAboriginalandTorresStraitIslanderhealthsector,governmenthealthagenciesandresearchinstitutionstoensurethatresearchconductedintoAboriginalandTorresStraitIslanderhealthiscontrolledby,andbenefits,AboriginalandTorresStraitIslanderpeople.

ClosIng the gAp CleArInghouseTheClosingtheGapClearinghouseaimstobuildacumulativeevidencebaseforwhatworkstoclosethegapinAboriginalandTorresStraitIslanderdisadvantage.TheClearinghousewebsiteprovidesaccesstothefollowingevidence-basedmaterial:

• ageneralcollectionofresearch,evaluationsandreportscataloguedbytheCOAGbuildingblocks(withover4,600itemscurrentlyavailable);

• anassessedcollectionofselectedresearchandevaluations(about300peryear);

• IssuesPapersreviewingthefindingsonwhatworksonspecifictopics(2-3peryear);and

• ResourceSheetssummarisingtheevidenceonmorenarrowlydefinedtopicsanditsapplicabilityforspecificpoliciesand/orprograms(around10peryear).

Subjectspecialistsareengagedtorigorouslyassessandsummariseselectedresearchandevaluationsandratetheeffectivenessoftheparticularactivityorprogram.TheClearinghousemaintainsanonlineregisterofresearchandevaluationprojectsacrossAustraliarelevanttoAboriginalandTorresStraitIslanderoutcomes(inprogressorcompletedinthelastthreeyears).ThefocusoftheRegisterisonprojectscommissionedorfundedbytheAustralianGovernment.

IndIgenous IdentIfICAtIonOn1February2013,theAustralianBureauofStatistics(ABS)releasedanInformation Paper: Perspectives on Aboriginal and Torres Strait Islander Identification in Selected Data Collection Contexts, 2012. ThePaperexploresfactorsthatcontributetoanindividual’sdecisiontodisclosetheirIndigenousstatus.TheABSplanstoundertakefurtheranalyticalworktounderstandthedemographicandnon-demographicfactorscontributingtochangesintheAboriginalandTorresStraitIslanderpopulation.Itisanticipatedthatthefirstreleaseoftheanalyticalworkwillbein2013.

mentAl heAlth And soCIAl And emotIonAl WellbeIngTheAustralianGovernmentisinvesting$2.2billionoverfiveyearsfrom2011-12todeliverNational Mental Health Reform,includinginpreventionandprimarycare,andaccountabilityandinnovationinmentalhealthservices.Thisinvestmentaimstoensurethatpeoplelivingwithmentalillnesscanaccessthecaretheyneedwhentheyneedit.

InDecember2012COAGendorsedtheRoadmap for National Mental Health Reform 2012-22.TheRoadmapoutlinestargetedstrategiesforAboriginalandTorresStraitIslanderpeoplewithinsixpriorityareas:

• promoteperson-centredapproaches;

• improvethementalhealthandsocialandemotionalwellbeingofallAustralians;

• preventmentalillness;

• focusonearlydetectionandintervention;

• improveaccesstohighqualityservicesandsupports;and

• improvethesocialandeconomicparticipationofpeoplewithmentalillness.

TheAustralianGovernmentisworkinginpartnershipwithstateandterritorygovernmentsandkeystakeholderstodevelopamentalhealthsystemthatvaluesandpromotestheimportanceofgoodmentalhealthandwellbeing;maximisesopportunitiestopreventandreducetheimpactofmentalhealthissuesandmentalillness;andsupportspeoplewithmentalhealthissuesandmentalillness,theirfamiliesandcarerstolivecontributing,fulfillinglives.

In2013-14,newgovernanceandaccountabilityarrangementswilldirectlyengagegovernmentsandstakeholdersonfurtheringmentalhealthreform.TheCOAGWorkingGrouponMentalHealthReform(theCOAGWorkingGroup)willoverseeadetailedprogramofworktoensurethatmentalhealthreformremainsapriorityacrossgovernments.TheCOAGWorkingGroupisco-chairedbytheMinisterforMentalHealthandAgeingandtheVictorianMinisterfor

MentalHealth,andwillbeassistedbyanExpertReferenceGroupchairedbytheNationalMentalHealthCommission.

TheCOAGWorkingGroupwillfocusonactivitiesthatwillimproveaccesstomentalhealthdata;developindicatorsthattracktheprogressofnationalreform;settargetsforasmanyindicatorsaspossible,wheresupportedbyevidence;anddevelopasuccessortotheFourth National Mental Health Planbymid-2014whichwillsetouthowtheRoadmapwillbeimplemented.

Aspartofthe$2.2billioninvestment,the2011-12Budgetprovided$200millionoverfiveyears(2011-12to2015-16)foranationalfundingpooltoencouragestatesandterritoriestoaddressknownservicegapsforpeoplewithamentalillness,particularlythoseaffectingpeoplewithsevereanddebilitatingmentalillness.On13April2012,COAGagreedtotheNational Partnership Agreement Supporting National Mental Health Reform asthevehicletodisseminatethisfunding.

UndertheNationalPartnershipAgreement,fundingwillbeprovidedtostatesinthepriorityareasof:

• stableaccommodationandsupport;and

• presentation,admissionanddischargeplanninginemergencydepartmentsandmajorhospitals,andrelatedsupportservices.

ThiswillhelpmoveAustralia’smentalhealthsystemawayfromcrisis-drivenactivitytowardsprevention,earlyinterventionandcareinthecommunity.Itwillparticularlybenefitpeoplewithsevereandpersistentmentalillnesswhoarefrequentusersofemergencydepartmentswhoneedstableaccommodationtokeepwellandbreakthecycleofhospitalisationandhomelessness.

Thefirstnationalwhole-of-governmentstrategyspecificallyaddressingAboriginalandTorresStraitIslandersuicideissupportedby$17.8millioninnewfundingoverfouryears.TheNational Aboriginal and Torres Strait Islander Suicide Prevention Strategyfocusesonearly

interventionandbuildingstrongercommunitiestoreducetheprevalenceofsuicideandtheimpactonindividuals,theirfamiliesandcommunities.

TheStrategyidentifiessixbroadactionareas,whichare:

• buildingstrengthsandcapacityinAboriginalandTorresStraitIslandercommunities;

• buildingstrengthsandresilienceinindividualsandfamilies;

• targetedsuicidepreventionservices;

• coordinatingapproachestoprevention;

• buildingtheevidencebaseanddisseminatinginformation;and

• standardsandqualityinsuicideprevention.

TheNational Suicide Prevention Program supportssuicidepreventionprojectsatboththenationalandlocallevel.Italsofundsarangeofuniversalprogramsaswellastargetedprogramsforindividualsandpopulationsathigherriskofsuicide.$9.4millionofthe$49.4millionallocatedover2011-12and2012-13isforprojectstargetingAboriginalandTorresStraitIslandercommunitiesspecifically.Thisisinadditiontofundingof$6millionfrom2011-12to2014-15providedthroughtheCommunity Prevention for High Risk Groups Initiative ofthe Taking Action to Tackle Suicide packageforsuicidepreventionactivityspecificallytargetedatAboriginalandTorresStraitIslanderpeople.

Supportingaholisticviewofhealth,theAustralianGovernmentiscommittedto,andinvestingin,initiativestogrowandsupportthesocialandemotionalwellbeingofAboriginalandTorresStraitIslanderpeople.

TheDepartmentofHealthandAgeingisleadingtherenewaloftheNational Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social Emotional Wellbeing (2004-2009).TheFrameworkwillbeanimportantdocumentforgovernmentsandserviceproviderstouseinmakingdecisionsabouthowpoliciesandpracticestoimprovethesocialandemotionalwellbeingofAboriginalandTorresStraitIslanderpeoplesshouldbedeveloped,includingwherefundingshouldbespent,how

servicesandpoliciesshouldbeprioritisedandthestandardsthatshouldbeappliedtoservices.TheFrameworkneedstoreflectthecurrentknowledgeandunderstandingofAboriginalandTorresStraitIslandersocialandemotionalwellbeingandtheexperiencesofAboriginalandTorresStraitIslanderpeople.

In2013-14,theSocial and Emotional Wellbeing Programwillcontinuetoenhanceexistingcounselling,familytracingandreunionservicestoAboriginalandTorresStraitIslandercommunities,includingmembersoftheStolenGenerations,throughtheexistingnetworkofeightLinkUpServicesandstaffinover90AboriginalandTorresStraitIslandercommunitycontrolledhealthorganisations.

Inaddition,fundingof$269.3millionoverfiveyearsfrom2011-12isbeingprovidedthroughtheTargeted Community Care (Mental Health) ProgramfornewandexpandedPersonalHelpersandMentors,additionalMentalHealthRespite:CarerSupportservices,andafurther40FamilyMentalHealthSupportservices.Thisincludesfundingforthedeliveryofspecialistremoteservicesthathaveastrongfocusoncultural,mentalandphysicalhealingforAboriginalandTorresStraitIslanderpeople.

Inthe2013-14Budget,theAustralianGovernmentcommittedanadditional$26.4million,until2017,totheAboriginalandTorresStraitIslanderHealingFoundation.RecognisingtheimportanceofexistingframeworksforhealingwithinAboriginalandTorresStraitIslandercommunities,theHealingFoundationseekstobuildthesocialandemotionalwellbeingofAboriginalandTorresStraitIslanderpeoplebyfundingculturallystrongcommunityhealingprograms.MembersoftheStolenGenerationsareaparticularfocusfortheworkoftheFoundation.TheHealingFoundationalsofundseducationandtrainingprogramstobuildtheleadershipandcapacityofcommunitiesandworkerstodealwithtraumaanditsintergenerationalimpacts,inadditiontofundingresearchandevaluationprojectstobuildtheknowledgebaseonculturallyappropriatehealingmodels.

Investment In keepIng Culture strong ACross the lIfespAnTheAustralianGovernmentiscommittedtosupportingAboriginalandTorresStraitIslanderpeopletokeeptheirculturestrong.Throughitsnationalculturalpolicy,Creative Australia,theAustralianGovernmentarticulatesthegoalofrecognising,respectingandcelebratingthecentralityofAboriginalandTorresStraitIslanderculturestotheuniquenessofAustralianidentity.

TheAustralianGovernmentiscontinuingtosupportAboriginalandTorresStraitIslanderpeople’sculturethrough:

• Indigenous Culture Supportfunding,whichwillprovidearound$31.6millionoverfouryearsfrom2013-14toassistthecontinueddevelopment,maintenanceandtransmissionoftraditionalcultureandcontemporaryAboriginalandTorresStraitIslanderculturalexpression;

• Indigenous Languages Supportfunding,whichwillprovidearound$54.2millionoverfouryearsfrom2013-14toaddresstheseriousconditionofAustralia’sIndigenouslanguages.Thisincludes$11.98millioninnewfundingfrom2013-14forthedevelopmentofinnovativedigitalandmulti-medialanguagelearningresourcesprovidedunderthenationalculturalpolicy,Creative Australia.IndigenouslanguagesfundingisdeliveredinthecontextoftheAustralianGovernment’sNational Indigenous Languages Policy,whichisacommitmenttohelpAboriginalandTorresStraitIslanderpeopletokeeptheirlanguagesaliveandconnecttotheirlanguagesandculture;and

• theIndigenous Repatriation Program,whichwillprovidearound$5.7millionoverfouryearsfrom2013-14tofacilitatethereturnofAboriginalandTorresStraitIslanderancestralremainsfromoverseasinstitutionsandancestralremainsandsecretsacredobjectsheldinmajorAustralianmuseumstotheircommunitiesoforigin,therebyaddressingtheinjusticeofAustralia’ssharedpastasitrelates

totheremovalofancestralremainsandsecretsacredobjectsandempoweringAboriginalandTorresStraitIslanderpeopletomeettheirculturalobligations.

TheIndigenous Broadcasting ProgramsupportsIndigenousradioandmediainmetropolitan,regionalandremotecommunitiesbyprovidingassistanceforoperationalexpenses,contentproduction,trainingandprofessionalskillsdevelopment.TheprogramfundsprojectswhichcontributetotheAustralianGovernment’sClosing the Gapagendathroughthebroadcastingofkeyeconomic,education,employment,environmental,health,emergencyservicesandothercommunityservicesinformation.ThemainobjectivesoftheIndigenous Broadcasting ProgramaretohelpAboriginalandTorresStraitIslanderbroadcastersbecomestrongerandbuildamoresustainableAboriginalandTorresStraitIslanderbroadcastingsector.In2013–14,$15.8millionwillbemadeavailableinfundingtoadministerthe Indigenous Broadcasting Program.

substAnCe mIsuseTheNational Drug Strategy,acooperativeventurebetweenAustralian,stateandterritorygovernmentsandthenon-governmentsector,isaimedatimprovinghealth,socialandeconomicoutcomesforAustraliansbypreventingtheuptakeofharmfuldruguseandreducingtheharmfuleffectsoflicitandillicitdrugsinoursociety.

ANational Aboriginal and Torres Strait Islander Peoples Drug Strategy(NATSIPDS)(asub-strategytotheNational Drug Strategy)iscurrentlybeingdeveloped,withtheNationalIndigenousDrugandAlcoholCommittee(NIDAC)undertakingconsultationsinsixlocationsinAustraliatoinformthedevelopmentoftheNATSIPDS.TheconsultationsbeingconductedbyNIDACwillbuildonworkthathasbeenundertakenbytheNATSIPDSWorkingGroupandfeedbackfromtheevaluationoftheNational Aboriginal and Torres Strait Islander Peoples Complementary Action PlanandtheYarningCircle,conductedatthe2ndNationalIndigenousDrugandAlcoholConferenceheldinFremantle,WesternAustraliainJune2012.

TheAustralianGovernmentalsosupportsinvestmentinprogramsthroughtheSubstance Misuse Service Delivery Grants Fund.In2013-14,$75millionwillbedirectedtoassistingAboriginalandTorresStraitIslandercommunitiestoprovideservicedeliveryortosupportservicesfocusingonAboriginalandTorresStraitIslanderpeople.

ThePetrol Sniffing Strategyisawhole-of-governmentinitiativethataimstoreducetheincidenceandimpactofpetrolsniffingandsubstancemisuseinremotecommunitiesacrossWesternAustralia,Queensland,NorthernTerritoryandSouthAustralia.Adramaticreductioninpetrolsniffinghasbeenachievedunderthestrategy,primarilythroughtherolloutoflowaromaticfuelandtheintroductionofadditionalyouthservices.TheAustralianGovernmentisproviding$113.3millionoverfiveyearsfrom2011-12tosupporttherolloutoflowaromaticfuel.Complementaryprojectsincludingyouthactivitieswillsupporttherollout.

AdramaticreductioninpetrolsniffinghasbeenachievedundertheStrategy,primarilythroughtherolloutoflowaromaticfuelandtheintroductionofadditionalyouthservices.

$20millionoverthreeyearsfrom2011-12willassistanumberofcommunitiesinremote,regionalorurbanareasaddressalcoholandsubstancemisuseissuesthroughtheBreaking the Cycle of Alcohol and Drug Abuse in Indigenous Communities Program.Thoughthisprogram,communitiesaresupportedtoworkwithgovernmentandnon-governmentorganisationsatalocalleveltodevelopaCommunityAlcoholandSubstanceAbuseManagementPlanandprovidepreventionprogramstotackleyouthsubstanceabuse.

IntheNorthernTerritory,throughtheStronger Futures in the Northern Territorypackage,$75.6millionhasbeenprovidedtosupportcommunitiestodevelopandimplementalcoholmanagementplansand$13.7millionhasbeenprovidedtocontinueinvestmentintheAlice Springs Transformation Planforarangeofprojectsthatincludealcoholtreatment,schoolenrolmentandattendance,safetyandwellbeingofwomenandchildren,parentingskillseducationandsupportforat-risktenants.

buIldIng bloCk

humAn And CommunIty CApAbIlIty

governance and leadership

Strongleadershipisneededtochampionanddemonstrateownershipofreform.Effectivegovernancearrangementsincommunitiesandorganisationsaswellasstrongengagementbygovernmentsatalllevelsareessentialtolongtermsustainableoutcomes.Indigenouspeopleneedtobeengagedinthedevelopmentofreformsthatwillimpactonthem.ImprovedaccesstocapacitybuildingingovernanceandleadershipisneededinorderforIndigenouspeopletoplayagreaterroleinexercisingtheirrightsandresponsibilitiesascitizens.13

The National Partnership Agreement on Remote Service DeliveryisacommitmentfromAustralian,stateandterritorygovernmentstoimprovethelevelofgovernanceandleadershipwithinAboriginalandTorresStraitIslandercommunitiesandcommunityorganisations.

ThroughtheNational Partnership Agreement on Remote Service Delivery,theAustralianGovernment,relevantstatesandtheNorthernTerritoryareinvesting$291.2millionfrom2009-10to2013-14,tochangethewaytheyworkwithAboriginalandTorresStraitIslanderpeopleacrossanumberofprioritycommunities.TheAgreementalsoaimstoachievebettercoordinatedgovernmentservices,improvefamilies’accesstoarangeofgovernmentservicesandtoraisetheseservicestothestandardprovidedtootherAustralianslivingincommunitiesofsimilarsizeandlocation.

TheNationalPartnershipAgreementisbeingimplementedthroughLocalImplementationPlans(LIPs).TheobjectiveofLIPsistoreflectservicedeliveryprioritiesagreedbetweencommunitygroupsandgovernments,aswellasnon-governmentandprivatesectororganisations,inawaythatisconsistentwiththeCOAGtargets.LIPsareoverseenbytheCoordinatorGeneralfor

RemoteServiceDelivery,whoreportstwiceayear.

TherearearangeofprogramsdesignedtoimprovegovernanceandleadershipfundedbytheAustralianGovernment,suchastheIndigenous Leadership Program,whichencouragesparticipantstocontinuetheirjourneyinbecominginspiringandeffectiveleaderswhowillmakeapositivedifferencetothelivesofAboriginalandTorresStraitIslanderpeople.

heAlth WorkforCeInrecognitionoftheimportancetohealthoutcomesofAboriginalandTorresStraitIslanderpeople’sinvolvementinthedeliveryofhealthservices,theAustralianGovernmentissupportingthegrowthandretentionoftheAboriginalandTorresStraitIslanderhealthworkforce.

TheAustralianGovernment’seffortisguidedbytheoverarchingNational Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011-2015),andimplementedthroughprogramsthatprovideeducation,training,mentoring,supportandscholarships.Itstargetistoachieve2.6percentoftheAustralianhealthworkforcebeingAboriginalorTorresStraitIslanderby2015.ThiswasendorsedbytheAustralianHealthMinisters’AdvisoryCouncil(AHMAC)inFebruary2011.AllstatesandterritoriesandNACCHOhavedevelopedtheirstrategicframeworksandactionplansbasedontheStrategicFramework.ThedocumentwasdevelopedbytheAboriginalandTorresStraitIslanderHealthWorkforceWorkingGroup(ATSIHWWG).Eachjurisdiction,NACCHOandthepeakAboriginalandTorresStraitIslanderhealthgroupsregularlyreportagainstKeyPerformanceIndicatorsatATSIHWWGmeetings.The2.6percenttargetisalsoinlinewiththeCOAGagreedtarget.

TherearearangeoftargetedAustralianGovernmentprogramsassistinginthesupportoftheStrategicFramework.TheseareaimedatincreasinganddevelopingtheAboriginalandTorresStraitIslanderhealthworkforceandareadministeredand/ordeliveredbyarange

oforganisationsincludingHealthWorkforceAustralia,peakorganisationsandnetworks,andtheVETsector.

Specificprogramsinclude:

• theNational Aboriginal and Torres Strait Islander Health Workforce Training Package,whichprovidesfundingto:

> theAustralianIndigenousDoctors’Association;

> theNationalAboriginalandTorresStraitIslanderHealthWorkerAssociation;

> IndigenousAlliedHealthAustralia;

> theCongressofAboriginalandTorresStraitIslanderNurses;

> theWorkforceInformationPolicyOfficersNetwork;

> theAboriginalandTorresStraitIslanderHealthRegisteredTrainingOrganisationNationalNetwork;and

> theLeadersinIndigenousMedicalEducationNetwork.

• thePuggy Hunter Memorial Scholarship Scheme;

• theAboriginal and Torres Strait Islander Pharmacy Scholarship SchemeandPharmacy Assistant Training Scheme;

• theIndigenous Transition Pathways to Medicine Program;

• measuresundertheICDP;and

• theIndigenous Public Health Capacity Building Project whichdeliversamainstreamMastersofPublicPolicyProgram,tailoredspecificallyforAboriginalandTorresStraitIslanderstudentsnationally.

On24May2013,theMason Review of Australian Government Health Workforce Programs wasreleased.TheReviewmakes87recommendationscoveringAustralianGovernmentprogramsthattargetthemedical,dental,alliedhealth,nursingandmidwiferyandAboriginalandTorresStraitIslanderhealthworkforces.Currentruralandworkforceclassificationsystemswereconsideredaspartofthereview,includingtheAustralianStandardGeographicalClassification–RemotenessAreasandDistrictsofWorkforceShortagesystems.TheReviewprovidesanoverviewofthecurrentstatusoftheAboriginalandTorresStraitIslanderhealthworkforceandAustralianGovernmenthealthworkforceprogramsthatareintendedtostrengthenAboriginalandTorresStraitIslanderhealthworkforcecapacityandimprovetheabilityofthebroaderhealthworkforcetoaddresstheneedsofAboriginalandTorresStraitIslanderpeople.

Investments to Improve outComes ACross the lIfe Course broAder heAlth ACross the lIfe Course

dIsAbIlItyAboriginalandTorresStraitIslanderpeoplehaveasignificantlyhigherrateofdisabilitycomparedtonon-Indigenouspeople,duetoincreasedratesofriskfactorssuchaslowbirthweight,chronicdisease,infectiousdiseases(e.g.otitismedia),accidentsandviolence.Thisiscompoundedbybarrierstoaccessingsupportasmainstreamdisabilityservicesmaynotbeculturallyappropriateoraccessible.RemotenessisalsoasignificantbarriertoaccessingappropriateservicesforsomeAboriginalandTorresStraitIslanderpeople.Withlimitedaccesstoearlytreatmentprogramsandrehabilitationservices,theriskofacquiringdisabilityincreases.

TheNational Disability Strategy 2010-2020 (NDS),aten-yearpolicyreformframeworkendorsedbyCOAGinFebruary2011,acknowledgesthemultiplelayersofdisadvantageexperiencedbyAboriginalandTorresStraitIslanderpeoplewithdisability.ItrecognisesandalignsitselftoCOAG’sClosing the GapagendaandcallsonpolicymakersandserviceproviderstoengageeffectivelywithAboriginalandTorresStraitIslanderpeoplewithdisabilitytobetterunderstandandrespondtotheirneeds.This

objectiveisdemonstratedinthedevelopmentofDisabilityCareAustraliawhichisoneofmanyimportantreformsbeingpursuedundertheNDS.

TheAustralianGovernmentwillinvest$19.3billionoversevenyearsfrom2012-2013torolloutDisabilityCareAustralia,theNational Disability Insurance Scheme.Thisinvestmentcontributestothecostofindividualcareandsupportpackages,administrationofthenationalschemeandothersupportsforpeoplewithdisability,theircarersandfamilies.UnderDisabilityCareAustralia’sSectorDevelopmentFund,theFirstPeople’sDisabilityNetworkAustraliawillbeprovided$900,000overthreeyearstoprovideservicestoassistAboriginalandTorresStraitIslanderpeopletobenefitfromDisabilityCareAustralia.

DisabilityCareAustraliawillbeworkingwithalljurisdictionstoensureimprovedsupportforpeoplewithdisability,theirfamilyandcarers,andtodeliverthefirststageofDisabiltyCare.ThefirststagecommencedinJuly2013inlaunchsitesinSouthAustralia,Tasmania,theHunterinNewSouthWalesandtheBarwonareaofVictoriaprovidingcareandsupportforthousandsofpeoplewithsignificantandpermanentdisabilities.LaunchsitesintheACTandtheBarklyregionoftheNorthernTerritorywillcommenceinJuly2014.

DisabilityCareAustraliaislookingtoensurethattheschemeisabletomeetthespecificneedsofAboriginalandTorresStraitIslanderpeople,andwillbe:

• workingwithlocalcommunitiestounderstandthebestwaysthatAboriginalandTorresStraitIslanderpeoplewithdisabilitycangetthesupportsthattheyneed;

• buildingrelationshipswithAboriginalandTorresStraitIslandercommunitiesthroughtrustedintermediaries;

• trainingLocalAreaCoordinatorsandplannersinthebestwaystoworkwithAboriginalandTorresStraitIslanderpeoplewithdisability,theirfamilies,carersandcommunities;

• ensuringthatAboriginalandTorresStraitIslanderpeoplewithdisabilityandtheir

families,carersandcommunitiesareawareofDisabilityCareAustraliaandthesupportsavailableunderthescheme;

• lookingatwaystomakesurethesupportsthatanAboriginaland/orTorresStraitIslanderpersonwithadisabilityreceivesmakeadifferencetotheirlife;and

• gatheringinformationabouthowsupportsassistapersontohelptheschemetoworkproperly.

DisabilityCareAustraliaisalsoseekingtoemployAboriginalandTorresStraitIslanderplannersandlocalareacoordinatorswhereverpossible,andisengagingatalocallevelwithAboriginalandTorresStraitIslanderorganisations.Also,DisabilityCareAustraliaisdevelopingculturaltrainingpackagesforitsstaffaswellasdevelopinginformationabouttheschemeforAboriginalandTorresStraitIslanderpeopleusingculturallyappropriatemethods,includingoutreachandinterpreters.

On16May2013,theMinisterforFamilies,CommunityServicesandIndigenousAffairsandMinisterforDisabilityReform,theHonJennyMacklinMPannouncedaproposednewtargettoconcentrateeffortsonclosingthegapforAboriginalandTorresStraitIslanderpeoplewithdisabilityandensuretheyarenotleftbehindintheimplementationofDisabilityCareAustralia.

ToassistjurisdictionstointegrateappropriateprinciplesintotheirserviceaccessandplanningframeworkstoincreaseAboriginalandTorresStraitIslanderpeoples’accesstodisabilityservices,aNational Indigenous Access FrameworkhasbeendevelopedundertheNational Disability Agreement.TheFrameworkaimstoensurethattheneedsofAboriginalandTorresStraitIslanderpeoplewithdisabilityareaddressedthroughaccessibleandappropriateservicedeliveryarrangements.

TheNational Carer Strategycontainsavision,anaimandsiximportantpriorityareasforaction:recognitionandrespect;informationandaccess;economicsecurity;servicesforcarers;educationandtraining;andhealthandwellbeing.Collectively,thesepriorityareasoutlinehowthe

contributionofAustralia’scarerswillbebettervalued,supportedandshared.TheNational Carer Strategy Action Plan (2011-2014)setsouttangibleshort-termactionswithscorecardstomeasuresuccessagainsteachoftheStrategy’ssixpriorityareas.Manyoftheseactionsaredesignedtomakesurethatbroaderreformagendasconsiderandsupportthecrucialroleofcarersinthecareandsupportsystem.

nutrItIonTheAustralianGovernmentwillleadthedevelopmentofaNational Nutrition Policy withinputfromstateandterritorygovernments.IndevelopingtheoverarchingframeworkforaNational Nutrition Policy,publichealthandindustrystakeholdersandnutritionexpertswillbeengagedtoensureobjectivesarepracticalandachievableandmeettheneedsoftheAustralianpopulationnowandinthefuture.TheNational Nutrition PolicywillconsiderhowvulnerablegroupsandAboriginalandTorresStraitIslandernutritioncanbebetteraddressed.ItisanticipatedthatdevelopmentoftheNational Nutrition Policywillbecompletedin2014.

TheAustralianGovernmenthasdevelopedAustralia’sfirsteverNational Food Plantohelpensurethatthegovernment’sfoodpolicysettingsarerightforAustraliaovertheshort,mediumandlongterm.TheAustralianGovernment’sNational Food Planisaroadmapthatsetsthedirectionforgovernmentpolicyonfoodintothefuture.TheNational Food Planisunderpinnedbythefourkeythemesof‘growingexports’,‘athrivingindustry’,‘people’and‘sustainability’andcontains16goals,includingagoalwhichstatesthatby2025“Australiawillhavebuiltonitshigh

leveloffoodsecuritybycontinuingtoimproveaccesstosafeandnutritiousfoodforthoselivinginremotecommunitiesorstrugglingwithdisadvantage”.TheNational Food Planidentifiesseveralpathwaystoachievethisgoal,includingaplantoreviewtheNational Strategy for Food Security in Remote Indigenous Communitiesandimplementanychangesarising.

Theissueofhealthandnutritionissignificantandthereforerequiresaspecific,strongandmultifacetedfocusseparatefrom,butcomplementaryto,theNational Food Plan.

TheAustralianGovernmentisinvestinginimprovingtheaffordability,qualityandavailabilityofhealthyfoodstoreducethediet-relatedburdenofdiseaseforAboriginalandTorresStraitIslanderpeopleinremoteAustralia.Alongwitharangeoftargetednutritionandhealthactivitiesandinitiatives,forexamplesocialmarketinginitiativestoaddresspoornutritionandinactivity,theAustralianGovernmentisproviding$40.8millionover10yearsthroughStronger Futures in the Northern Territory,tocontinuethelicensingofstoresintheNorthernTerritory.Thisinvestmentwillexpandtheschemetoincludemorestoresandprovidemoresupporttohelpstoresstayopentoservicelocalpeopletocontinuetoimprovetheavailabilityoffreshandhealthyfoodintheselocations.

Inaddition,theAboriginals Benefit Account hasprovided$55.8milliontoupgradeandconstructnewstoresandstoremanagers’housingin18communitiesthroughouttheNorthernTerritory.Participatingstoresarecurrentlyownedby,orintheprocessoftransferringownershipto,licencedIndigenouscorporations.Workcommencedin2012andisexpectedtocontinuethroughto2015.

dentAl heAlthUnderthe2012-13Budget,$344millionofadministeredfundswasallocatedforaNational Partnership Agreement on Treating More Public Dental Patientswiththestatesandterritoriestoalleviatepressureonpublicdentalwaitinglists.Thefundingwillbeusedtoprovideadditionaldentalservicesforupto400,000publicdentalpatientsestimatedtobeonwaitinglists.ThisprogramhasaparticularfocusonAboriginalandTorresStraitIslanderpatients,patientsathighriskof,orfrom,majororalhealthproblemsandthosefromruralareas.

On29August2012,theMinisterforHealth,theHonTanyaPlibersekMP,announcedapackageofdentalreformsthattargetedspecificareasofthepopulationmostinneedofdentalcare.Thepackageincludes:

• $2.7billionforGrow Up Smiling,achildren’sdentalschemethatwillcommenceon1January2014for2-17yearoldswhoreceive,orwhosefamilyreceives,arangeofgovernmentpaymentsincludingFringeBenefitsTax-AandABSTUDY;

• $1.3billionforstatesandterritoriesfrom1July2014toexpandservicesforadultsinthepublicsystem;and

• a$225millionFlexibleGrantsProgramcommencingin2014toprovidedentalinfrastructure(bothcapitalandworkforce)inoutermetropolitan,ruralandregionalareas.

mAternAl heAlth And pArentIngTheAustralianGovernmentiscommittedtoimprovingthehealthofAboriginalandTorresStraitIslandermothersandchildren.Inparticular,theGovernmentisfocusedonaddressinglowbirthweightsforbabies,improvingratesofchildhoodimmunisationandencouragingmorewomentoadopthealthylifestylebehavioursbefore,duringandafterpregnancy.

The2009National Partnership Agreement on Indigenous Early Childhood Development provided$564millionoversixyearsto30June2014,toimproveoutcomesforAboriginalandTorresStraitIslanderchildrenintheirearlyyears.TheAustralianGovernment’scontributiontothisNationalPartnershipAgreementthroughtheHealthandAgeingportfolioconsistsof$107millionforElementTwo(AntenatalCare,Pre-pregnancyandTeenageSexualandReproductiveHealth)andupto$34millionperannumforElementThree(IncreaseAccesstoandUseofMaternalandChildHealthServicesbyIndigenousFamilies,alsoknownastheNewDirectionsMothersandBabiesServicesprogram).

TheAustralianGovernmentwillprovideongoingsupportforthefollowingAboriginalandTorresStraitIslanderhealthprograms:

• New Directions: Mothers and Babies Services-$145.7millionoverfouryearsfrom2013-14toprovideAboriginalandTorresStraitIslanderfamilieswithyoungchildrenaccesstoantenatalcare;informationaboutbabycare,includingpracticaladviceandassistancewithbreastfeeding,nutritionandparenting;monitoringofdevelopmentalmilestones;immunisationservices;andhealthchecksforAboriginalandTorresStraitIslanderchildrenbeforestartingschool.

• Healthy for Life-$191.8millionoverfouryearsfrom2013-14toprovideAboriginalandTorresStraitIslandermothersandtheirchildrenwithsupportinmakinghealthylifestylechoices.

TheAustralianGovernmentisproviding$24.3millionin2013-14tostatesandterritoriesundertheNational Partnership Agreement on Indigenous Early Childhood Development,toincreaseaccesstoanduseofantenatalcarebyyoungAboriginalandTorresStraitIslandermothersandsupportyoungpeopletomakeinformeddecisionsabouttheirsexualandreproductivehealth.TheAgreementalsoaimstoincreaseaccesstomaternalandchildhealthservicesbyyoungAboriginalandTorresStraitIslanderpeople.

TheAustralian Nurse Family Partnership Program(ANFPP)($32.4millionoverfouryearsfrom2013-14)isanevidence-basedprogramthataimstoimprovepregnancyoutcomesbyhelpingwomenengageingoodpreventivehealthpractices,supportmotherstoimprovetheirchild’shealthanddevelopment,andhelpparentsdevelopavisionfortheirownfutureincludingcontinuingeducationandfindingwork.TheANFPPiscurrentlyatthreesites.Theseare:

• WuchopperenHealthService–Cairns;

• CentralAustralianAboriginalCongress–AliceSprings;and

• WellingtonAboriginalCorporationHealthService–Wellington.

Strong Fathers Strong FamiliesaimstoincreaseaccessforAboriginalandTorresStraitIslandermalestoculturallyappropriatehealthservicesandantenatal,parentingandotherrelatedprogramsandhealthmessages;helptoimproveAboriginalandTorresStraitIslandermales’abilitytocontributepositivelytothehealthandwellbeingofthemother’spregnancyandanurturingandsupportingfamilyenvironment;andsupportthedevelopmentneedsofchildrenbyencouragingfathers,unclesandgrandfatherstobehealthyrolemodelsandengagefullyinthechild’slifeasearlyaspossible,withinthecontextoflocalcommunityneedsandculturalpractices.

TheNational Maternity Services Plan recognisestheexistinghealthgapbetweenAboriginalandTorresStraitIslanderandnon-Indigenouspopulationsandtheimportantrolematernitycarecanhaveinaddressingthisgap.ThePlanconsidersculturalpracticesincare,andbirthingoncountry.In2013-14theNational Antenatal Care Guidelineswillbecompletedandmadeavailabletohealthprofessionals.TheGuidelinesarebeinginformedbyadvicefromaworkinggroupwithexpertiseinAboriginalandTorresStraitIslanderwomen’santenatalcare.Thecompletedguidelineswillhelphealthprofessionalstoprovideevidence-basedandculturallyappropriatehealthservicestoAboriginalandTorresStraitIslanderwomenthroughoutpregnancy.

UndertheNational Tobacco Campaign – More Targeted Approach,theAustralianGovernmentlaunchedanewcampaign‘QuitforYou,QuitforTwo’.Thecampaigntargetspregnantwomen,andthoseplanningonbecomingpregnantandtheirpartnerswhosmokefromsociallydisadvantaged,AboriginalandTorresStraitIslanderandculturallyandlinguisticallydiversecommunities.Thecampaigncomprisedtwotelevision,printanddigitalcommercials,aradioadvertisementandaniPhoneandAndroidapp.

ChIldhood heAlth And developmentFamily-centredprimaryhealthcaretakesalifecourseapproach,which,withoutneglectingadulthealth,focusesattentiononchilddevelopment,specificallyearlyliferesilienceandadvantages.Thisapproachmovesbeyondprovidingcareandsupporttoanindividual,asitseestheindividualembeddedinafamily-withservicesprovidedonthatbasis.Thisapproachattemptstodrawareasnormallyconsideredonlyaspartofthesocialdeterminantsofhealthbackground,forexampleeducationandfamilywelfare,intotheforegroundofprimaryhealthcarepractice.14ThisapproachisreflectedininitiativessuchastheNational Early Childhood Development StrategywhichwasendorsedbyCOAGon2July2009.TheStrategyincludesexistingcommitments,areasforimmediateactionwithincurrentresources,andfutureareasforreformacrossthehealth,communityandeducationdomains.

TheNational Early Childhood Development Strategyprovidestheframeworkforgovernmentandcommunityresponsetoachievethevisionthat,by2020,allchildrenhavethebeststartinlifetocreateabetterfutureforthemselvesandforthenation.TheStrategyidentifiestheoutcomesthatallgovernmentsareseekingtoachieveforchildrenby2020,andcapturesexistingcommitments,areasforimmediateactionandfutureareasforreform,includingsupportforvulnerablechildren,strengtheningtheworkforceacrossearlychildhooddevelopmentandbuildingbetterinformationandasolidevidencebase.

TheAustralianGovernmentisinvesting$333.5million,overthreeyears,from2011to2014,toprovidewhole-of-community,locallytailoredpreventionandearlyinterventionservicestoincreasechildsafetyandwellbeingindisadvantagedcommunitiesthroughoutAustralia,throughtheCommunities for ChildrenProgram.Thisinvestmentincludes$91.3millionforanIndigenousParentingServicescomponent,whichprovidesfundingforservicessuchasparentingsupportprograms,

supportedplaygroupsandhomevisitingservicestoaddressknownriskfactorsthatimpactontheparentingcapacityoffamilies.$99millionovertenyears(to2022)isbeingprovidedforIntensiveFamilySupportServiceswhichwillprovidecontinuingpracticalparentingsupportinupto23locationsforfamilieswithchildrenatriskofenteringthechildprotectionsystem.Thisprogramwillbeimplementedin15remoteNorthernTerritorycommunitiesinthreephases.ThefirstfivecommunitiestoimplementtheStronger Communities for Children ProgramfromJuly2013areNgukurr,SantaTeresa,Ntaria(Hermannsburg),WadeyeandGaliwinku.ThenextfivecommunitiestoimplementtheProgram,currentlyscheduledfromJuly2014,areGunbalanya,Lajamanu,Maningrida,UtopiaHomelandsandEngawala.

UndertheNational Partnership Agreement on Indigenous Early Childhood Development,38ChildrenandFamilyCentresarebeingestablishedacrossAustralia.Thecentresareconcentratedinareaswherethereisdemonstratedneed,highdisadvantageandahighproportionofAboriginalandTorresStraitIslanderchildrenunderfiveyearsofage.Thesecentreswillprovidearangeofservices,includingchildcareandearlylearningforchildrenandsupportforparentsandfamilies.

Participationinqualityserviceshelpsveryyoungchildrenandtheirparentstoestablishlearningandattendancehabitswhichcanbeastrongbasisforsuccessinschoolingandlaterinlife.TheAustralianGovernmentcommitted$55.7millionfromthe2012-13BudgettocontinuetheHome Interaction Program for Parents and Youngsters(HIPPY)intheexisting50locationsandexpandtheprogramtoanadditional50locations,withanemphasisonAboriginalandTorresStraitIslandercommunities,with25newlocationscommencinginearly2014andtheremaining25commencinginearly2015.HIPPYisatwoyearhome-basedparentingandearlychildhoodenrichmentprogramthatempowersparentsandcarerstobetheirchild’sfirstteacher.Theprogrambuildstheconfidenceandskillsofparentsandcarerstocreatea

positivelearningenvironmenttopreparetheirchildforschool.

‘Get Up and Grow’: Healthy Eating and Physical Activity Guidelines for Aboriginal and Torres Strait Islander Early Childhood Settingsprovidespracticalinformationandadviceonnutritionandphysicalactivitytopromotehealthybehavioursinchildrenaged0-5yearsattendingearlychildhoodservices.TheseresourceshavebeendevelopedtomeettheneedsofAboriginalandTorresStraitIslanderearlychildhoodeducationstaff,parentsandcarersnationallyandhelpsupportaconsistentnationalapproachtohealthyeatingandphysicalactivity.Theresourcesarebasedonthreekeynationalhealthydocuments:

• theInfant Feeding Guidelines (2012) andtheAustralian Dietary Guidelines (2013)whichformthebasisfornutritionpolicyinAustralia;

• theNational Physical Activity Recommendations for Children 0 to 5 Years,whichhasbeendevelopedtoguidepolicyandpracticearoundphysicalactivityforyoungchildren;and

• theNational Quality Frameworkwhichappliestolongdaycare,familydaycare,preschool(orkindergarten)andoutsideschoolhourscareservices.TheNational Quality Frameworkaimstoraisequalityanddrivecontinuousimprovementandconsistencyineducationandcareservices.

TheAustralianGovernmentadministersanumberofimmunisationprogramsforAboriginalandTorresStraitIslanderpeoplethroughtheNational Immunisation Program(NIP)andtheNational Indigenous Pneumococcal and Influenza Immunisation (NIPII) Program.TheNIPaimstoincreasenationalimmunisationratesbyfundingfreevaccinationprograms.AboriginalandTorresStraitIslanderchildrenlivinginsomestatesandterritoriesalsohaveaccesstoaHepatitisAvaccine.Thenationalschool-basedHuman Papillomavirus (HPV) Vaccination Program,providedthroughtheNIP,hasbeenextendedtoincludemales.FromFebruary2013,malesandfemalesaged12-13yearswillreceivetheHPVvaccineatschool.Malesaged14-15yearswillalsoreceivethevaccineaspartofacatch-upprogramuntiltheendofthe2014schoolyear.

TheAustralianGovernment’sHearing Services Programprovidestertiaryhearingservices,includinghearingassessmentsanddevices(ifrequired),toeligibleAboriginalandTorresStraitIslanderpeoplethroughtheCommunityServiceObligations(CSO).Inadditiontotheeligibilitycategoriesthatapplygenerally,AboriginalandTorresStraitIslanderpeoplewhoareeligiblefortheProgramincludethose:

• under26yearsofage;or

• over50yearsofage;or

• whoparticipateinspecifiedemploymentprojects.

CSOservicesaredeliveredbytheAustralianGovernmenthearingservicesprovider,AustralianHearing,througharound115permanenthearingcentres,350visitingsitesand220AboriginalandTorresStraitIslanderoutreachsitesnationally.TheseservicesincludetheAustralian Hearing Specialist Program for Indigenous Australians(AHSPIA),whichprovidesforthedeliveryofservicesthroughculturallyappropriateoutreachlocations,including100AboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsinurban,ruralandremoteareasofAustralia.AHSPIAservicesarecollaborativelynegotiatedwithindividualcommunitiestomeettheneedsofcommunitymembers.Inmost

casestheagreedservicesaredocumentedinserviceagreementsbetweenAustralianHearingandthecommunity.

The2013-14Budgetcommittedapproximately$66millionoverfouryearsfortheClosing the Gap - Improving Eye and Ear Health Services for Indigenous Australiansmeasure.Theearhealthcomponentofthispackagewillcontinuetosupportprimaryhealthcareservicestobettermanageeardiseasethrough:

• trainingofAboriginalandTorresStraitIslanderHealthWorkersandotherprimaryhealthcareproviders;

• provisionofearandhearingscreeningequipment;

• implementationofup-to-dateclinicalcareguidelines;and

• earhealthpromotionresourcesforparents,carersandhealthprofessionals.

Fundinghasalsobeenprovidedtostatesandterritoriesforadditionalearhealthservices.

Eyehealthfundsmaintainthefocusoneliminatingtrachoma(aninfectiouseyediseasethatcanleadtoblindness),expansionofvisitingoptometryservices,andeyesurgery.

AdolesCent And youth heAlthAboriginalandTorresStraitIslanderyoungpeoplecurrentlyexperiencehigherratesofpoorhealthacrossarangeofhealthareas,andarethreetimesmorelikelytoreporthighlevelsofpsychologicaldistressasnon-Indigenousyoungpeople.15Youngpeopleinthisagegrouptendtobelowusersofprimaryhealthcareservices.ItisimportanttofindwaystoengageyoungAboriginalandTorresStraitIslanderpeopleandencouragepositivelifechoicestoimprovewellbeing,asthisagegrouphasthebestopportunitytosetupahealthyadulthood.Inparticular,itisimportanttoworkwithyoungpeopleonpreventivehealthandwellbeing,includingencouragingthemtouseappropriateservices,whileensuringthatservicesavailabletothemareaccessibleandconfidential.

Throughthe$2.2billionMental Health Reformpackage,anadditional$197.3millionoverfiveyearsfrom2011-12hasbeenprovidedtoexpandyouth-focusedmentalhealthservicesthroughtheheadspaceprogram.Theheadspacemodelprovidesaserviceplatformforholisticcareinmentalhealth,relatedphysicalhealth,alcoholandotherdruguse,andsocialandvocationalsupport.Asamainstreamservice,headspaceisensuringthedeliveryofculturallyappropriateservicesthroughanAboriginalandTorresStraitIslanderStrategyManagementCommitteewhichprovidesexpertandhighlevelstrategicadviceoneffectivemechanismstoengageandmeettheneedsofAboriginalandTorresStraitIslanderyoungpeople.StrongengagementisbeingachievedwithoversixpercentofallyoungpeopleseenbyheadspacecentresidentifyingasbeingofAboriginalandTorresStraitIslanderdescent.

Therearearangeofprotectivefactors(positivemoderatorsofriskoradversity)forthisagegroupthathavethepotentialtoencourageresilienceandincreaseself-careandself-esteem,includingparticipationincommunityevents,attendingorre-engagingwithschool,contributingtocommunitywellbeingandengagingin

culturalactivities.TheAustralianGovernmentisinvestingover$100millionoverthenextdecadeto2022intheYouth in Communities Program,amajoryouthinitiativethatishelpingthousandsofyoungAboriginalandTorresStraitIslanderpeopleintheNorthernTerritorybecomemoreengagedwithschool,workandcommunitylife.TheYouth in Communities ProgramsupportslocaldiversionaryactivitiesinremotecommunitiesforAboriginalandTorresStraitIslanderyouthaged10-20years,particularlythoseatriskofsubstanceabuse,suicideorself-harm,enteringthejusticesystemanddisengagementfromeducation,training,employmentandcommunity.

heAlthy AdultsTherearearangeofhealthriskfactorsthatcontributetotheburdenofdiseaseexperiencedbytheAboriginalandTorresStraitIslanderpopulation.Thesehealthriskfactorsimpactontheonset,maintenanceandprognosisofavarietyofchronicdiseases.Prematuremortalityfromchronicdisease,suchascirculatorydisease,cancer,diabetesandrespiratorydiseasesisamajorconcernforthisagegroup.16

Chronicdiseasepreventionandmanagementprogramsarevitaltoaddresstheearlieronsetofchronickidneydisease,diabetes,andcardiovasculardiseasethatAboriginalandTorresStraitIslanderpeopleexperienceintheir20s,30s,40s,and50s.

TheCOAGNational Partnership Agreement on Preventive Health(NPAPH)isprovidingupto$932.7millionovernineyearsfrom2009-10toaddresstherisingprevalenceoflifestyle-relatedchronicdiseasethroughthepromotionofhealthybehavioursincommunities,earlychildhoodeducationandcareenvironments,schoolsandworkplaces.

TheNPAPHalsosupportsinfrastructurerequiredtomonitorandevaluatetheprogressofinterventions,includingtheestablishmentoftheAustralianNationalPreventiveHealthAgency.TheAgencyassistsallgovernmentstosupportpeopletoadoptandmaintainhealthylifestylechoices,educateallAustraliansabouttherisksofchronicdisease,andaddressobesity,tobaccoandalcoholuse.

TheICDP,theAustralianGovernmentcontributiontotheNational Partnership Agreement on Closing the Gap in Indigenous Health Outcomes,hasthreemainelements:

• tacklingchronicdiseaseriskfactors;

• improvingchronicdiseasemanagementandfollow-upcare;and

• workforceexpansionandsupport.

Throughtheseelements,theICDPprovidessignificantfundingforpreventivehealthfocusingonAboriginalandTorresStraitIslanderindividuals,familiesandcommunities.Italsoprovidessupportandfundingformorecoordinatedandpatient-focusedprimaryhealthcare,bothinAboriginalandTorresStraitIslandercommunitycontrolledhealthorganisationsandmainstreamprimaryhealthcareandgeneralpractices.ThiswillensurethatAboriginalandTorresStraitIslanderpeople,regardlessofwheretheylive,willreceivehighqualityandculturallysecuremedicalcare.

TheNational Tobacco Strategy 2012-2018,developedaspartoftheNational Drug Strategy,prioritisesactiontoprotectpublichealthpoliciesfromtobaccoindustryinterference,eliminatetheremainingadvertising,promotionandsponsorshipoftobaccoproducts,andreducetheaffordabilityoftobaccoproducts.ThegoaloftheStrategyistoimprovethehealthofallAustraliansbyreducingtheprevalenceofsmokinganditsassociatedhealth,socialandeconomiccosts,andtheinequalitiesitcauses.Italsodetailsobjectivesandtargetsfortobaccocontroluntil2018andsetsoutninepriorityareasforaction,includingapriorityactionto“bolsterandbuildonexistingprogramsandpartnershipstoreducesmokingratesamongAboriginalandTorresStraitIslanderpeople.”

heAlthy AgeIngAged Care

TheLiving Longer Living Better,agedcarereformpackagewasannouncedon20April2012.Thepackageinvolvesacomprehensivetenyearplantoreshapeagedcare,andwillprovide$3.7billionoverfiveyearstobuildabetter,fairerandmorenationallyconsistentagedcaresystem.

TherearetwoIndigenous-relatedmeasuresunderLiving Longer, Living Better:

• thecontinuationofpreviousbudgetmeasurestobecomeanongoingpartoftheviabilitysupplementtoproviders,(aviabilitysupplementiscurrentlypaidtoeligibleprovidersoperatinginregional,ruralandremoteareasaswellasthosethatcareforspecificgroupsofhighlyvulnerableolderAustralians,includingAboriginalandTorresStraitIslanderpeopleandolderpeoplewhoarehomelessoratriskofbeinghomeless).Thesemeasuresare:

> a40percentincreaseintheleveloftheviabilitysupplement;

> additionalfundingforagedcarehomesinveryremotetomoderatelyaccessiblelocationsthattargetlowcare;

> continueexistingfundingforeligibleagedcarehomesthatprovidespecialistagedcareservicestoAboriginalandTorresStraitIslanderpeople;and

> continueexistingfundingforeligibleagedcarehomesthatprovidespecialistagedcareservicestopeoplewithahistoryof(orwhomaybeatsevereriskof)homelessness.

• theexpansionoftheNational Aboriginal and Torres Strait Islander Flexible Aged Care Program.Thismeasurewillresultintheestablishmentofnewresidentialagedcareservicesinareasofhighneed,includingintheNorthernTerritoryatMutitjulu(CentralAustralia)andNhulunbuy(EastArnhemLand).Theexpansionwillseearound200additional

agedcareplacesbeingmadeavailableforAboriginalandTorresStraitIslanderpeoplelocatedinremotecommunities.

TheNational Aboriginal and Torres Strait Islander Flexible Aged Care Program,establishedin1994,seeksto:

> providequality,flexible,culturallyappropriateagedcareservicestoolderAboriginalandTorresStraitIslanderpeopleclosetotheirhomeandcommunity;

> enablethesecommunitiestoprovidearangeofserviceswhichareabletorespondtotheindividualneedsofolderpeoplewithinthecommunity;

> developfinanciallyviable,efficient,andcoordinatedservices,outsidetheexistingconventionalprogramstructures;and

> facilitatecommunityinvolvementinthecareoftheirolderpeoplethroughthemanagementoftheservice.

pAllIAtIve CAreTheAustralianGovernmentcurrentlysupportsculturallyappropriatetrainingandeducationinpalliativecareandendoflifeissuesforhealthcareworkersprovidingservicesforAboriginalandTorresStraitIslanderpeoplethroughfundingvariousnationalpalliativecareprojectsincluding:

• theGuidelines for a Palliative Approach in Residential Aged Care anditscompaniondocument, theGuidelines for a Palliative Approach for Aged Care in the Community Setting,aimtoprovidesupportandguidanceforthedeliveryofapalliativeapproachinresidentialandcommunityagedcareacrossAustralia.BothGuidelinesincludeprinciplesandstrategiestosupportpalliativecarewhichisculturallyappropriatetoAboriginalandTorresStraitIslanderpeople;

• theAustralian Palliative Care Knowledge Network (CareSearch) isaninteractivewebsitethatincludesasearchabledatabaseofpalliativecareliteratureandonlineforumsthatallowgroupstoshareresearch,reportsandinformation.Thewebsiteprovidesinformationresourcesforresearchersandpalliativecarespecialists,alongwithinformationforpatientsandtheirfamilies,carers,generalpractitioners,otherhealthcareprofessionalsandthegeneralpublic.TheinformationincludespracticeprinciplesandeducationalresourcestosupporthealthprovidersinprovidingculturallyappropriatepalliativecaretoAboriginalandTorresStraitIslanderpeople;

• thePalliative Care Curriculum for Undergraduates (PCC4U)isdevelopingandpromotingtheuseofpalliativecareeducationalresourcesinallhealth-relatedundergraduateandentrytopracticecourses.ThePCC4UsuiteofmodulesincludesoneentitledCaringforAboriginalPeoplewithLifeLimitingConditions.ThemoduleisintendedtodeveloptheknowledgeandskillsneededtoprovidequalitycaretoAboriginalandTorresStraitIslanderpeoplewithlifelimitingillnessesandtheirfamiliesacrossavarietyofsettings;

• theProgram of Experience in the Palliative Approach(PEPA)providesaworkplacementtrainingprogramforhealthprofessionalsthroughclinicalplacementsinspecialistpalliativecareservicesorinteractiveworkshops.PEPAhasadedicatedsub-programforAboriginalandTorresStraitIslanderhealthworkersunderpinnedbytheprincipleofculturalrespect.Thissub-programhasbeendevelopedinconsultationwithrepresentativesfromAboriginalandTorresStraitIslanderhealth,policyandeducationsectorsandiscustomisedtolocalneedswithineachstateandterritory;and

• theRespecting Patient Choices(RPC)projecttodevelopanationalprogramforadvancecareplanningpromotionandcapacitybuildingthatcanbeimplementedacrossAustralia.RPCiscurrentlydevelopingtargetedadvancecareplanningapproachesforpeoplefromAboriginalandTorresStraitIslandercommunities.

referenCes1AustralianInstituteofHealthandWelfare2012,Australia’shealth2012,Australia’shealthseriesno.13.Cat.No.AUS.156,Canberra:AIHW.

2Ibid.

3AustralianGovernment,Development of a National Aboriginal and Torres Strait Islander Health Plan, DiscussionPaper,2012.

4AboriginalandTorresStraitIslanderSocialJusticeCommissioner2005,Social Justice Report 2005,Sydney.

5Booth,A&Carroll,N2005,The health status of Indigenous and non-Indigenous Australians, Centre for Economic Policy Research,AustralianNationalUniversity,Canberra.

6CouncilofAustralianGovernments(COAG)ReformCouncilNationalIndigenousReformAgreement:COAGReformCouncil,(www.federalfinancialrelations.gov.au/content/npa/health_indigenous/indigenous-reform/national-agreement_sept_12.pdf)

7Ibid.

8Ibid.

9Ibid.

10Ibid.

11Ibid.

12AustralianHealthMinisters’AdvisoryCouncil,2012,Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report,AHMAC,Canberra.

13CouncilofAustralianGovernments(COAG)ReformCouncil,op.cit.

14Griew,R,Tilton,E,Stewart,J,Eades,S,Lea,T,Peltola,C,Livingstone,Harmon,KandDawkins,Z2007,Family Centred Primary Health Care.

15AustralianInstituteofHealthandWelfare2011,Young Australians: their health and wellbeing 2011, Cat.No.PHE140Canberra:AIHW.

16AustralianHealthMinisters’AdvisoryCouncil,2012,op.cit.

NAtioNAl AborigiNAl ANd torres strAit islANder HeAltH PlAN – ComPANioN doCumeNt oN CommoNweAltH goverNmeNt strAtegies ANd reforms

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