Close the Gap?

Dr Tom CalmaCo-Chairperson,

Close The Gap on Indigenous Health Equality Steering Committee

ACTCOSS 5 November 2010

'It is not credible to suggest that one of the wealthiest

nations of the world cannot solve a health crisis affecting less than 3% of its citizens’

Social Justice Report 2005

Life-expectancy

Most Indigenous deaths occur in the middle adult ages

Source: Darren Benham analysis mortality data

Death Contributors

• Post secondary education — post secondary attainment increased slightly between 2001 and 2006.

• Disability and chronic disease — the level almost twice that for non-Indigenous people

• Household and individual income —Median incomes of Indigenous households were 65 per cent of those of non-Indigenous households in both 2001 and 2006.

• Substantiated child abuse and neglect — the rate of substantiated notifications for child abuse or neglect increasing from 4 to 6 times the non-Indigenous rate.

• Family and community violence —limited data on the prevalence but violence a continuing issue for many Indigenous communities.

• Imprisonment and juvenile detention — the imprisonment rate increased by 46 per cent for Indigenous women and by 27 per cent for Indigenous men between 2000 and 2008. – adults were 13 times; juvenile 28 times greater than non

Indigenous

Headline indicators

Not all doom and gloom

• Indigenous school retention rates: to Year 10, Year 11 and Year 12 have steadily increased over the last 5 to 10 years.

• Literacy and numeracy levels: have improved at years 3, 5 & 7, particularly for reading and writing.

• Completed year 12: has increased between 2001 and 2006 (from 21% to 25%).

• Unemployment rates: are more than twice as high, however declined between 1996 and 2006 (from 13% to 9%).

• Functional housing: the proportion of the population living in discrete Indigenous communities that were connected to a town water supply almost doubled between 2001 and 2006 (from 17% to 30%).

• Home ownership: has increased slightly from 27% in 1996 to 29% in 2006 and with the current policies in relation to housing and home ownership should see increases in the years to come.

Major policies in Indigenous affairs

• First Indigenous University Graduate 1965

• Equal Wages (1966)

• Referendum (1967) – count Aboriginal people in the census

• Mabo (1992) – overturn the Doctrine of Terra Nullius

• Close the Gap (2005)

• NTER & Welfare Reform (2007)

• Closing the Gap (2007)

• UN Declaration on the Rights of Indigenous Peoples (2007)

• National Apology (2008)

• National Congress of Australia’s First Peoples (2010)

• Referendum to recognise First Australians (2013)

The campaign for health equality

OVERALL TARGET:

HEALTH STATUS EQUALITY WITHIN 25 YEARS

Targets and benchmarks as appropriate.

FOUNDATION TARGET:

EQUALITY OF OPPORTUNITY TO BE HEALTHY WITHIN 10 YEARS

Sub-target 1: Equality of access to primary health care within 10 years.

Sub-target 2: Equal standard of health infrastructure within 10 years

A human rights based approach

• All policies and programs relating to indigenous peoples must be based on the principles of non-discrimination and equality, which recognize the cultural distinctiveness and diversity of indigenous peoples.

• Indigenous peoples have the right to full and effective participation in decisions which directly or indirectly affect their lives.

• Such participation shall be based on the principle of free, prior and informed consent.

A human rights based approach (cont)

• Capacity building always needs to be considered and resources made available to facilitate meaningful participation by indigenous peoples as equal partners in planning, design, negotiation, implementation, monitoring and evaluation of policies that affect them.

• Independent dispute resolution mechanisms should be put in place for the parties.

Principle of Progressive Realisation

• Create a plan

– ‘ambitious yet realistic time frame’, – set equality as a target, – set a time frame;

• Commit sufficient resources; and

• Be accountable to the plan by setting benchmarks

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What is the Close the Gap Campaign?

- A movement that is growing- Lead by Indigenous people- Embraced by the Australian

population- Bi-partisan political

agreements signed or pledged at federal level and in all mainland states and territories

- Supported by over 80 non-Indigenous health peak bodies and affiliates and human rights advocacy groups and organisations

The truth is, a business as usual approach towards Indigenous Australians is not working. Most old approaches are not working. We need a new beginning — a new beginning which contains real measures of policy success or policy failure; a new beginning, a new partnership, on closing the gap with sufficient flexibility not to insist on a one-size-fits-all approach for each of the hundreds of remote and regional Indigenous communities across the country but instead allowing flexible, tailored, local approaches to achieve commonly-agreed national objectives that lie at the core of our proposed new partnership; a new beginning that draws intelligently on the experiences of new policy settings across the nation.Prime Minister Kevin Rudd, Apology to Australia’s Indigenous Peoples, 13 Feb 2008[i]

Statement of Intent

• PM• Minister of Health and

Minister of Indigenous Affairs

• Opposition Leader• Every major

Indigenous and non Indigenous peak health and human rights body

• First and only bipartisan agreement

20 March 2008

Statement of Intent

“……commits the Government of Australia, Indigenous Australians, supported by non-Indigenous Australians and non-Indigenous health organisations to work together to achieve equality in health status and life expectancy between Indigenous and non-Indigenous Australians by the year 2030.”

NRL Round, Indigenous All Stars and Reconciliation Cup

Community Involvement

RAPs

Reconciliation Australia is dedicated to closing the

unacceptable life expectancy gap between Indigenous and

non-Indigenous children.

One of our key strategies in achieving that ambition is to

support and encourage organisations to sign up to

their own tailored Reconciliation Action Plan

(RAP).

Philanthropy

Greg Poche - Health care philanthropy. Poche Centre for skin care research and

treatment in Sydney (Melanoma Institute) and

Poche Centres for Indigenous Health in Sydney and Adelaide

• To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequalities in health services, in order to achieve equality …;

• To ensuring the full participation of Aboriginal and Torres Strait Islander peoples …; and

• To supporting and developing Aboriginal and Torres Strait Islander community controlled health services in urban, rural and remote areas….

Close the Gap story

• Social Justice Report 2005• March 2006 – CTG Coalition formed• April 2007 – National Launch• December 2007 – COAG commitment• May 2008 SOI signing• November 2008 – COAG $1.6 billion• 25 March – National CTG Day• August each year – NRL CTG Round• Indigenous All Stars and Reconciliation Cup • Opening of Parliament – PM’s Report• All state and territory governments signing SOI

REINSTATE THE MINISTER FOR INDIGENOUS HEALTH ON 14 SEPTEMBER

$1.2 billion since 2007 to improve the health and safety of children in the NT

• an extra 62 police, 80 night patrols in remote communities and 22 safe houses

• over 10,600 health checks for children and more than 19,000 follow-up specialist services

 

• Eighteen new temporary police stations are now operational and upgraded five permanent police stations in remote communities

 

• We have also committed $1.7 billion over ten years to address the huge backlog in remote NT housing

 

• 750 new houses, 230 rebuilds of existing houses and 2,500 refurbishments across the NT by 2013

Media Release Ministers Macklin and Snowdon 18 October 2010

Engaging local communities

• Engagement with local communities is varied– most effective where existing governance

mechanisms were strong (Fitzroy Futures Forum).

• The capacity of some government offices to effectively engage with Indigenous communities. – recruitment of community based staff – has paid

strong dividends.

• Only South Australia uses interpreters routinely.

• Governments must consider community capacity to engage in negotiations in an informed way.

Coordinator-General’s 2nd Six Monthly Report (December 2009-August 2010).

Governance in communities

• Coordinator-General commissioned a project on Governance and Capacity. Findings included:

– Need for genuine decision-making power at the local level. This implies acceptance of local responsibility for local decisions.

– Inconsistent and moving policy platform undermines the development of community governance – creating a ‘governance gap’.

– Holistic approach to governance addressing community-level governance capacity and improving the governance of government.

• Coordinator-General believes there has been insufficient attention to building community and organisational governance capacity

Coordinator-General’s 2nd Six Monthly Report (December 2009-August 2010).

Need to work together in partnership

“What can I do to achieve equality for all Australians?”

““From self respect comes dignity From self respect comes dignity and and

from dignity comes hope”from dignity comes hope”

Questions?

Further information on the Close the Gap Campaign can be found at:

www.humanrights.gov.au/social_justice/health/index.html