RDAA Aboriginal & Torres Strait Islander Health Policy[1] · • making Indigenous health...
Transcript of RDAA Aboriginal & Torres Strait Islander Health Policy[1] · • making Indigenous health...
ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH
TheroleofRDAAinaddressingthehealthneedsofAboriginalandTorresStraitIslanderpeople.
INTRODUCTION
TheinequitiesthatexistwithrespecttoaccesstohealthservicesandinhealthoutcomesforAboriginalandTorresStraitIslanderpeoplearewidelyrecognisedandhavebeenaconcernofRDAA,itsStateandTerritorymemberorganisationsandtheirindividualmembersformanyyears.RuralDoctorsAssociations(RDAs)invariousStatesplayedapivotalroleinthedevelopmentofthefirstAboriginalhealthcurriculaandinlobbyingtoensuretheybecamepartofmainstreamsystems.Nationally,RDAAhasbeeninvolvedinpolicydevelopmentandsupportingthedeliveryofmedicalcaretoimprovethehealthstatusofFirstAustralians.
RDAAremainsconcernedthat,althoughtherehasbeensomeimprovementinmarkersofhealthandhealthrisk,including infantandchildmortalityratesandavoidablemortalityrelatedtocardiovascularandkidneydiseases1,FirstAustraliansstilldieatyoungeragesandathigherratesthanotherAustralians2,withchronicdiseasesbeingsignificantcontributorstothemortalitygap3.
Approximately65%ofAboriginalandTorresStraitIslanderpeopleliveoutsidemajorcities4andrelyonaccesstohealthservicesinrural,regionalandremotecommunities.EnsuringaccesstoruralandremotedoctorsandotherhealthprofessionalswhoaretrainedinculturalcompetenciesandsupportedtoprovideholistichealthcareisessentialtoachieveClosingtheGaptargets.
BACKGROUND
ItiswidelyrecognisedthatAboriginalandTorresStraitIslanderpeoplegenerallyhavesignificantlypoorerhealthoutcomesandmortalityratesthannon-IndigenousAustralians.FindingsfromtheNationalAboriginalandTorresStraitIslanderHealthMeasuresSurveyshowedthatAboriginalandTorresStraitIslanderpeopleare:
• morethanthreetimesaslikelytohavediabetes(rateratioof3.3)• twiceaslikelytohavesignsofchronickidneydisease(rateratioof2.1)• nearlytwiceaslikelytohavehightriglycerides(rateratio1.9)• morelikelytohavemorethanonechroniccondition,forexamplehavingbothdiabetesand
kidneydiseaseatthesametime(53.1%comparedwith32.5%).5
AboriginalandTorresStraitIslanderpeoplealsoexperiencehigherratesofmentalhealth-relatedproblems.ThesuiciderateforAboriginalandTorresStraitIslanderpeople(basedonage-standardisedrates)wasalmosttwicetheratefornon-IndigenousAustraliansin2008-2012overall.For15-19yearolds,theratewasfivetimesashighasthenon-Indigenousrate(334and7per100,000population).6
OverthelastdecadetheCommonwealthGovernmenthasendeavouredtoaddresstheseissuesthroughtheClosingtheGapinitiative.InDecember2007theCouncilofAustralianGovernments(COAG)agreedtargetstoclosethegapbetweenIndigenousandnon-IndigenousAustraliansincluding:
• toclosethegapinlifeexpectancywithinageneration(by2031),and• tohalvethegapinmortalityratesforIndigenouschildrenunderfiveby2018.7
Tothisendthe2008NationalPartnershipAgreementonClosingtheGapinIndigenousHealthOutcomesidentifiedfivepriorityareasforaction:
• tacklingsmoking• providingahealthytransitiontoadulthood• makingIndigenoushealtheveryone'sbusiness• deliveringeffectiveprimaryhealthcareservices,and• bettercoordinatingthepatientjourneythroughthehealthsystem.8
In2013,theNationalAboriginalandTorresStraitIslanderHealthPlan2013-20239,astrategicframeworkforactionwhichidentifiedunderlyingprinciplesandprioritiesforspecificactionsforthenextdecade,wasintroduced.AnImplementationPlanfortheNationalAboriginalandTorresStraitIslanderHealthPlan2013–202310waspublishedin2015,andinDecember2017areportonnationalconsultations11toinformthe2018iterationoftheImplementationPlanfortheNationalAboriginalandTorresStraitIslanderHealthPlan2013-2023wasreleased.
TheimportanceofmaintainingtheseeffortstoachieveClosingtheGaptargetsishighlightedbytheClosingtheGap:PrimeMinister’sReport2017whichindicatedthat,althoughtherewasanoveralldeclineinAboriginalandTorresStraitIslandermortalityratesbetween1998and2015,Australiawasnotontracktoclosethegapinlifeexpectancyby203112.TheClosingtheGap:PrimeMinister’sReport2018reiteratedthisoutlookandpointedoutthattherehasbeennoimprovementsincethe2006baseline13.Further,between2005-2007and2010-2012,therehasbeenonlyasmallreductioninthelifeexpectancygapforbothmalesandfemales14.
ThetargettohalvethemortalityratesforIndigenouschildrenby2018isnowontracktobemet.Whileoverthelongerterm(1998to2016)childmortalityrateshavedeclinedandthegaphasnarrowedtherehasbeenslowerprogresssincethe2008baseline15.
Thesereportsindicatethatsomeprogresshasbeenmadeinsomeareas,butin2018onlythreeofthesevenClosingtheGaptargetsthatspanhealth,educationandemploymentareontracktobemet16.Targetstodrivesustainedeffortareessentialbutcannotbeachievedwithoutappropriateresourcing.
Atthetimeofwriting,aClosingtheGapRefreshconsultationprocessisunderwaywithsubmissionsdueby31March2018.ThroughthisprocesstheClosingtheGapagendamaybeexpandedorcontracted17.COAGhasalso“committedtomoreaccuratelymeasureprogressandincreaseaccountabilitybysettingnationalaswellasstateandterritorytargets”18.
RDAA’SPOSITION
RDAArecognisesthatspecialeffortsarerequiredtoraisethehealthstatusofAboriginalandTorresStraitIslanderpeopletothatoftherestoftheAustraliancommunityandbelievesthatthesemustinclude:
• recognitionofthefundamentalimportanceofsocio-economic,environmentalandculturalfactors–includingconstitutionalrecognitionofAboriginalandTorresStraitIslanderpeople,intergenerationaltraumaandnegativehealtheffectsthatstemfromit,theimportanceofHomeland,infrastructure,education,transportandemployment–onhealthstatus.Thesemajordeterminantsofhealthandwell-beingmustbefactoredintoallstrategiestosupportAboriginalandTorresStraitIslanderpeopleandcommunities.Accesstobasiclivingrequirementsandconditionssuchascleancontinuouswatersupply,housing,functionalsewerage,areasonabledietandnutritionalrequirementsisessentialforhealth.RDAAthereforeemphasisestheneedtoprioritiseaddressingbroaderinfrastructureissuesaswellasprovidingformorespecifichealthservices
• involvement,partnershipandleadershipfromlocalAboriginalandTorresStraitIslanderpeopleindeterminingthetypeofhealthservicesbestsuitedtolocalneedsandresourcesindevelopinganddeliveringhealthpolicyandprograms
• supportforAboriginalCommunityControlledHealthServices
• aculturallyrespectful,consultativeapproachtopolicyandprogramdevelopmentonallAboriginalandTorresStraitIslanderhealthissues
Inaddition,RDAAbelievesthatthefollowingarenecessarytosupportqualityhealthcareforFirstAustralians:
• policyandprogramdevelopmentatalljurisdictionallevelswhichcontinuestoevolvetoachieveClosingtheGaptargets
• aprimaryhealthcareapproachandmulti-disciplinarystrategiesbasedonaholisticviewofthehealthoftheindividualandthecommunity
• appropriateincentivestostrengthentheroleandabilityofruralandremotegeneralpracticeinmaintainingandimprovingthehealthofAboriginalandTorresStraitIslanderpeople
• specialattentiondirectedto
o AboriginalandTorresStraitIslanderchildrentoaddresstheissuesthatimpactondevelopmentofchildrenandbreakthecyclesofpoorerhealthandwellbeing
o thepreventionofchronicdisease
• areviewandupdateofthe2004CDAMSIndigenousHealthCurriculumFramework19withafocusonprovidingpractical,bestpracticeapproachestoimprovetheconsistencyofcurriculumimplementation,andachieveminimumstandardsforeducationinAboriginalandTorresStraitIslanderhealth,culturalawarenessandrespect,culturalsafetyandcompetencies,andincross-culturalcommunicationthatarealignedwiththebroader2014
AboriginalandTorresStraitIslanderHealthCurriculumFramework20andtheAustralianMedicalCouncil’sStandardsforAssessmentandAccreditationofPrimaryMedicalPrograms21
• theprovisionofadvancedskillstraininginAboriginalandTorresStraitIslanderHealththatisalignedwithlocalneedswithintheNationalRuralGeneralistPathway
• employmentorientationprogramsthatincludesawarenesseducationandexposuretolocalcommunityculture
• specialmeasurestoattractandretainmedicalpractitionerstoAboriginalMedicalServiceswhichrecogniseclearroledelineation,comparableremuneration,appropriatemanagementandacceptableandsecurelivingandworkingconditionsasprerequisitesforastablemedicalworkforce
• ongoingaccesstointernalandexternalprofessionaldevelopmentopportunitiesforthoseinvolvedinthedeliveryofAboriginalandTorresStraitIslanderhealthservices
• specificmeasurestoincreasethenumberofAboriginalandTorresStraitIslanderpeopleattainingqualificationsinthehealthprofessionsandenteringtheruralhealthworkforce,includingprogramstoencourageAboriginalandTorresStraitIslanderpeopletoconsideracareerinruralmedicine,nursingandalliedhealth
• increasedsupportforAboriginalandTorresStraitIslanderpeopletoundertaketraininglocallyforhealthroles,includingAboriginalHealthWorkers,AssistantsinNursing(AINs)andalliedhealthassistants
RDAA,inlinewithitsReconciliationActionPlan,seekstoestablish,buildandmaintainpartnershipswithkeyAboriginalandTorresStraitIslanderorganisations,includingtheAustralianIndigenousDoctors’Association(AIDA)andtheNationalAboriginalCommunityControlledHealthOrganisation(NACCHO),toachieveidentifiedgoals.
RDAAwillworkto
• ensurethattheinterestsofruralmedicalpractitionersprovidingcareforAboriginalandTorresStraitIslanderpeoplearerecognisedandpromotedinrelevantforums,andsupportstrategiestobuildasustainablemedicalworkforcewhichisadequatelytrainedandresourcedtoprovidehealthcareforFirstAustralians,includingby
o providingaccesstoappropriateonlineculturalcompetenciestraining,withakeyfocusonAboriginalandTorresStraitIslanderpeople,forRDAmembersandtheirstaff
RDAAwillsupportotherstakeholdersintheirworktoimprovehealthoutcomesforallAboriginalandTorresStraitIslanderpeople.
ENDNOTES
1. Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW. p228.
2. In 2010-12, the estimated life expectancy at birth for Indigenous males was 69.1 years – 10.6 years lower than for non-Indigenous males (79.7 years) – and 73.7 years for Indigenous females – 9.5 years lower than for non-Indigenous females (83.1 years). In the 5-year period 2008-2012, 65% of deaths among Indigenous people occurred before the age of 65 compared with 19% of deaths among non-Indigenous people and the mortality rate for Indigenous people was 1.6 times that of non-Indigenous people.
Australian Institute of Health and Welfare 2015. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW. p110.
3. Ibid p115.
4. Drawn from Australian Bureau of Statistics 2016. Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016: Aboriginal and Torres Strait Islander Population 2016 Census Data Summary. http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/2071.0~2016~Main%20Features~Aboriginal%20and%20Torres%20Strait%20Islander%20Population%20Data%20Summary~10. Viewed 10 February 2018.
5. Australian Bureau of Statistics 2014. Australian Aboriginal and Torres Strait Islander Health Measures Survey: Biomedical Results, 2012-13, ABS, September 2014. Available at http://www.abs.gov.au/ausstats/[email protected]/mf/4727.0.55.003. Viewed 10 February 2018.
6. Op cit AIHW 2015. p80.
7. Council of Australian Governments. Council of Australian Government’s Meeting: Communiqué. December 2007. https://www.coag.gov.au/meeting-outcomes/coag-meeting-communiqué-20-december-2007. Downloaded and viewed 10 February 2018.
8. Council of Australian Governments, 2008. National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes http://www.federalfinancialrelations.gov.au/content/npa/health/_archive/ctg-health-outcomes/national_partnership.pdf. Downloaded and viewed 10 February 2018.
9. Commonwealth of Australia 2013. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Available at http://www.health.gov.au/natsihp. Viewed 10 February 2018.
10. Commonwealth of Australia, Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-implementation-plan. Downloaded and viewed 10 February 2018.
11. Commonwealth of Australia, Department of Health, My Life My Lead - Opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: Report on the national consultations December 2017. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-ipag-consulation. Downloaded and viewed 10 February 2018.
12. Commonwealth of Australia, Department of the Prime Minister and Cabinet, Closing the Gap: Prime Minister’s Report 2017. https://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf Downloaded and viewed 08 February 2018. p81.
13. Commonwealth of Australia, Department of the Prime Minister and Cabinet, Closing the Gap: Prime Minister’s Report 2017. http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2018.pdf?a=1 Downloaded and viewed 19 February 2018. p104.
14. Loc cit.
15. Ibid p37.
16. Ibid p08.
17. Closing the Gap: The Next Phase Public Discussion Paper. p5. https://closingthegaprefresh.pmc.gov.au/sites/default/files/resources/ctg-next-phase-discussion-paper.pdf. Downloaded and viewed 17 January 2018.
18. Loc cit.
19 Committee of Deans of Australian Medical Schools, August 2004. CDAMS Indigenous Health Curriculum Framework. Available at http://www.medicaldeans.org.au/projects-activities/indigenous-health/cdams-indigenous-health-curriculum-framework/.
20. Commonwealth of Australia, 2014. Aboriginal and Torres Strait Islander Health Curriculum Framework. http://www.health.gov.au/internet/main/publishing.nsf/Content/aboriginal-torres-strait-islander-health-curriculum-framework.
21. Australian Medical Council. December 2012. Standards for Assessment and Accreditation of Primary Medical Programs. Available at http://www.amc.org.au/accreditation/primary-medical-education. Under review as at 07 February 2018.