Warren Snowdon (Lingiari, Australian Labor Party, Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) Share this | Hansard source

by leave—Let me first acknowledge the First Australians, one of the oldest continuing cultures in human history and the traditional owners of the land on which we meet, and their ancestors past and present.

Two weeks ago the Prime Minister tabled the second annual report on closing the gap. The Closing the gap report demonstrated the commitment by the Rudd government to an open and transparent reporting of progress to the Australian people. From the outset we do acknowledge that there is much to be done to improve Indigenous disadvantage. We recognise that this is a national priority which will not be achieved in a parliamentary term. We can, we must and we will continue to work together to improve the status of First Australians.

We are acutely aware of the gap in life expectancy between Indigenous persons and non-Indigenous persons born today, which is 11.5 years for males and 9.7 years for females. Aboriginal and Torres Strait Islander children are twice as likely to die before the age of five as their non-Aboriginal or Torres Strait Islander counterparts in this country. In particular, babies that are underweight are at greater risk of dying during the first year of life and are prone to ill health as they grow older. Evidence shows that chronic disease such as heart and respiratory disease, diabetes and cancer are responsible for more than 60 per cent of the health gap. Almost 20 per cent of this gap is attributable to smoking alone.

We know that the data needs improvement and we are working towards addressing this. However, this will not detract from the fact that, in 2010, Aboriginal and Torres Strait Islander people are still dying earlier than non-Aboriginal and Torres Strait Islander people in this country, and from unnecessary disease.

I acknowledge the Close the Gap Steering Committee for Indigenous Health Equality’s recently released Shadow report on the Australian government’s progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians. The close the gap steering committee report represents the voice of our key stakeholders and provides an assessment on government progress against the close the gap statement of intent, signed by the Prime Minister, the Minister for Health and Ageing, the Minister for Families, Housing, Community Services and Indigenous Affairs, the Leader of the Opposition, Aboriginal health leaders and others in 2008.

The report identifies three commitments that need continuing effort, which I will now respond to. Firstly, there is a comprehensive, evidence based long-term and targeted plan of action. The shadow report calls for a comprehensive long-term plan of action that is targeted at need, that is evidence based and is capable of addressing the existing inequalities in health services in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030. Addressing Indigenous disadvantage is a national responsibility. COAG has agreed to a comprehensive national plan for closing the gap in Indigenous disadvantage which is broadly articulated through the National Indigenous Reform Agreement and the National Integrated Strategy for Closing the Gap in Indigenous Disadvantage. This is the basis of a long-term strategy, and investment is targeted, guided by evidence and outcome based.

The government has committed an unprecedented $4.6 billion to tackle disadvantage through early childhood schooling, health services and economic participation, healthy homes, safe communities, governance and leadership. In health alone the Commonwealth is committing more than $805.5 million to tackle chronic disease, which research has shown is the single largest contributor to the current life expectancy gap. For the first time under COAG governments have agreed to targets. In the health arena they are to close the gap in life expectancy within a generation and halve the gap in mortality rates for Indigenous children under five by 2018. This is the measure of our action and a clear demonstration of our commitment.

The shadow report calls for the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs. Consultation and partnerships with Aboriginal and Torres Strait Islander people are central to implementing the COAG Indigenous chronic disease package. The state and territory level Indigenous health partnership forums—comprising the Aboriginal community controlled health sector, the Commonwealth government, state and territory governments and a number of divisions of general practice—are the primary vehicle for providing advice on the implementation of this package. The National Indigenous Health Equality Council, comprising key stakeholders and individuals in Indigenous health, provides the government with regular policy advice and monitoring of the government’s progress with Indigenous health. This council reports to me. More broadly, the government is establishing a new representative body, the National Congress of Australia’s First Peoples, in recognition of the need for a strong voice for Indigenous Australians.

The shadow report also calls for support and development of Aboriginal and Torres Strait Islander community controlled health services in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal and Torres Strait Islander health and wellbeing. The Commonwealth government is investing more than $324 million per year across more than 170 community controlled health services to improve access to health care tailored to meet the needs of Indigenous Australians. This represents a 33 per cent increase over funding in 2007-08.

The government’s commitment was recently brought to the fore when a historic agreement called Pathways to Community Control was developed. This is a four-year strategy for Aboriginal community controlled health services to design plans to address their own health needs in the Northern Territory. Since 2007-08, approximately $13 million has been invested to support those community controlled health organisations to meet best practice and quality standards accreditation. Since we were elected to government, funding of almost $1 billion was allocated across the Health and Ageing portfolio in 2009-10 to health programs specific to Aboriginal and Torres Strait Islander peoples. These recent investments equate to a 57 per cent increase in Indigenous health funding across the portfolio since the 2007-08 budget.

Not only are we targeting chronic disease; a total of $112 million will be invested as part of COAG’s ‘New Directions: an Equal Start in Life for Indigenous Children’ to help tackle health problems during early childhood. Earlier this month I joined the Prime Minister and Ministers Macklin and Roxon to announce the funding of 10 new services to provide child and maternal health services to Indigenous mums and bubs. This is in addition to the 43 existing services that have been funded and are currently operating. That means a total of 11,000 Indigenous mothers and their babies will be assisted over five years, and this is just one of a number of ways we are helping close the gap in infant mortality.

Significant activity has taken place within my own community of the Northern Territory. Between July and December 2009, a total of 390 ear, nose and throat consultations were provided to 385 children with an ENT referral. In addition, a total of 1,990 dental services were provided to 1,429 children who live in the Northern Territory. A workforce of 273 additional health professionals have been placed in remote primary healthcare services on short-term placements as part of the Remote Area Health Corps, RAHC. This included 31 GPs, 178 registered nurses, 22 allied health professionals and 42 dental personnel.

We also acknowledge the need to increase the capacity of our primary healthcare workforce to ensure effective health care is delivered. As part of our COAG commitment we have directed $170 million to workforce expansion. In the Closing the gap report released this month the government announced the appointment and recruitment of 94 new Indigenous project officers and 83 Aboriginal and Torres Strait Islander outreach workers in health clinics and organisations across the country. These new positions can help individuals move towards Aboriginal and Torres Strait Islander health worker positions or enrolled nursing. In addition, the Commonwealth will provide 75 extra health professionals and practice managers in Indigenous health services, 38 new GP registrar training places in Indigenous health services and expanded nurse scholarships and clinical placements.

Just last month I launched the National Aboriginal and Torres Strait Islander Health Workers Association to provide advocacy, support and mentoring for the existing 1,600 Aboriginal and Torres Strait Islander health workers across the country. This is an initiative the sector has been calling for for more than 30 years.

In particular, there is an area where we believe much more needs to be done. This is to address smoking in Aboriginal and Torres Strait Islander communities. Last week I was able to announce the appointment of Tom Calma as the national tobacco coordinator to help address the unacceptably high risks of smoking in Aboriginal and Strait Islander communities. The Commonwealth has committed $100.6 million in the COAG Indigenous health national partnership agreement to tackle Indigenous smoking. That is in addition to the $14.5 million made available in 2008.

A number of tobacco control projects are being implemented to assist Indigenous Australians to quit smoking. Six projects are currently underway in New South Wales, Queensland and the Northern Territory. I will be announcing a further 14 projects next week. These projects focus on building an evidence base for reducing Indigenous smoking rates by trialling various interventions in different communities.

We need to understand the importance of this. Tobacco accounts for 20 per cent of deaths amongst Aboriginal and Torres Strait Islander Australians and 12 per cent of the burden of disease. We must reduce smoking amongst Aboriginal and Torres Strait Islander people if we are to effectively close the gap in life expectancy between Aboriginal and Torres Strait Islander Australians and the rest of us.

I want to make some observations about the importance of the Aboriginal community controlled health sector. I have been fortunate to have been associated with people in the Aboriginal community controlled health sector for over 30 years. I am constantly reassured by the level of professionalism, dedication and commitment of the professionals who work in these health services across the country. They are extremely good examples of what comprehensive primary healthcare organisations can look like. The fact that we have in excess of 150 of them operating across the country is an example of what can be done when you invest appropriately in community based services.

In a number of states, the Aboriginal and Torres Strait Islander health sector is embracing the COAG Indigenous Chronic Disease Package. Earlier this month I helped promote free health checks for Aboriginal and Torres Strait Islander people with former rugby league star Steve Renouf at the National Rugby League All Stars game on the Gold Coast, which was a resounding success. It was a great privilege to be there. It was a very important community event. This event was pioneered by Queensland’s peak body for the Aboriginal community controlled health sector, the Queensland Aboriginal and Islander Health Council, QAIHC, in partnership with their national affiliate. This promotion is a key first step in detecting a chronic disease and providing the necessary prevention and intervention that is required and can be accessed through the COAG Indigenous Chronic Disease Package.

Change is happening. The Prime Minister’s second Closing the gap statement is a demonstration of this government’s commitment to ongoing, open and transparent reporting of progress. Closing the gap is a national priority that should be above party politics, and I hope it is. This government is committed to delivering action, not just words, but we must keep up the momentum. We must ensure that we take along as partners in this process people who work in the public sector and the private sector and that, most importantly, we provide as far as we possibly can a capacity for ownership and decision making by the Aboriginal and Torres Strait Islander communities.

I am enthused by the way in which the state and territory governments have embraced the obligations under the closing the gap initiatives. We have a joint partnership of $1.6 billion for health initiatives. I am committed to making sure that these initiatives meet their objectives. It is really very important that we understand that it is not just health that we need to address; we need to look at social determinants of health, which include such things as housing, education and employment.

Whilst it is important that we have first-rate primary healthcare services, as we do, it is also important that we understand that the best way to ensure the long-term health outcomes for Aboriginal and Torres Strait Islander Australians is to prevent them from getting these chronic diseases in the first place. Prevention is very much at the forefront of what we are about. Again, we will do this in partnership with the Aboriginal and Torres Strait Islander health community and the Aboriginal and Torres Strait Islander communities generally. I am enthused by the desire for participation, engagement and ownership by the Aboriginal and Torres Strait Islander health community and I am looking forward to continuing to work closely with them.

See this speech in context