Gap narrows, but more work needed

There are still many obstacles facing the 2030 aim of health equality for indigenous Australians. By Amie Larter

Although it appears Australia is starting to minimise the disparity between quality of life for indigenous and non-indigenous Australians, there is still more to be done.

Julia Gillard has tabled the annual Closing the Gap: Prime Minister's Report 2013, which covers the main areas of life expectancy, child mortality, education and employment.

This year, health was once again high on the agenda.

The report identified that while the health of Aboriginal and Torres Strait Islander people is improving, there are still hurdles to cross to meet the target of equality in health for indigenous and non-indigenous Australians by 2030.

It also confirmed that the government is working with indigenous people and providing funding to indigenous community-controlled health organisations to reaffirm this is a high priority and strengthen its capacity to deliver services.

According to the shadow report released by the Closing the Gap campaign steering committee, 2013 is a critical year for Aboriginal and Torres Strait Islander health.

The report outlines three critical events that will likely determine whether future equality is achieved: the scheduled completion and implementation of a National Aboriginal and Torres Strait Islander health plan; the renewal and adequate funding of the National Partnership Agreement on

Closing the GAP in Indigenous Health outcomes (set to expire on June 30); and the September 14 federal election - an opportunity to strengthen support and commitment.

According to Mick Gooda, the Aboriginal and Torres Strait Islander social justice commissioner, the 2005 Social Justice Report framed the issue of health inequality between indigenous and non-indigenous people as a human rights issue and not one solely confined to the health system.

When the Labor Party was elected in 2007, minimising the gap was made a major plank in its election platform, and the Closing the Gap strategy was initiated the next year.

"In the five years since this process started we have seen some good building blocks put in place, such as funding arrangements agreed between the Commonwealth and state government, a source of endless frustration for those of us who try to work our way through a web of programs, policies and administrative arrangements," Gooda said.

"But importantly, we are now seeing other building blocks such as the increase in the birth-weight of our babies, and I reckon we are on track to meet the target of halving the infant mortality rate by 2018. These two indicators are so important in predicting what each person's health status will be from children into adulthood."

The Australian government committed $805.5 million from 2009-2013, working with different organisations and state and territory governments to improve health outcomes.

Gooda believes that we are just beginning to see the dividends from that investment, and that vigilance is still required in all areas.

"The rate of tobacco use, social and emotional health and wellbeing, obesity and maternal and child health would be the areas that require special attention," he said. "Again, these are addressing the underlying causes and not just the symptoms of ill-health."

Closing the Gap campaigners have argued extensively for the implementation of a national plan to be developed in coordination with the indigenous health sector. It's one of the ways Gooda sees of formalising agreed milestones, targets and resources that are needed to meet the equality target.

"This, with well-founded monitoring measures, will ensure accountability to those targets and milestones and will inform the community, and I mean the general community, on the rate of progress. Or the lack thereof," Gooda said.

How can nurses help?

Australia has a high-quality health workforce and making sure Aboriginal and Torres Strait Islander people have access to the appropriate professionals should be high on the agenda when aiming for equality.

Gooda suggests that this means building a workforce that is not only professionally equipped "but also one that is culturally competent".

"So take time to get to know your community, wherever it may be, get to know the people and this will build the trust and understanding of each other that is necessary to close this gap," he said.

Sandy Smyth, a Remote Area Health Corps clinical educator and remote area nurse, agrees. She suggests that nurses are the key link between an indigenous patient and their health outcomes on a daily basis.

"Nurses who are committed to delivering high quality, equitable health care in a respectful and culturally safe manner are an essential component to any strategy which seeks to continue closing the gap," she said.

"They are involved everyday in pursuing the PHC principles of education, health promotion, illness prevention, treatment and management with the goal of developing effective, principled partnerships with individuals, families and communities to see improved outcomes."

Organisations like RAHC, which offer short-term paid placements to urban-based health professionals, can help nurses keep up-to-date with what's going on in the sector.

RAHC offers a range of free e-learning modules that provide insight into the major clinical areas of focus in the Northern Territory.

Currently, the NT is experiencing nursing shortages in child and maternal health and preventable chronic disease, both which are target areas for the Closing the Gap strategy.

"RANs are particularly good at developing the skills required to accomplish tasks facing them, which includes managing PCD and early childhood programs," Smyth said.

"There are opportunities available for education and upskilling in both areas and there appears to be a greater emphasis on recruiting specifically to these positions in the past few years."

For those nurses wishing to play a role in helping indigenous communities reach equality, Smyth suggests that taking a proactive approach to keeping informed is imperative.

She said that nurses should assess their own skills, background and experience, and ask themselves, 'Could I be part of this strategy?' The answer is invariably, yes.

"Invest in your career, address gaps and up-skill," said Smyth.

"Take a risk, expose yourself to the compelling exhausting, exhilarating, frustrating, satisfying world of health care delivery in remote indigenous Australia."

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