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Close The Gap Community Guide

Close the Gap community guide coverClose The Gap

Campaign for Aboriginal and Torres Strait Islander health equality by 2030

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A Community Guide

The poor health of Aboriginal and Torres
Strait Islander peoples is no secret – and
something can be done about it. Since
2006, Australia’s peak Indigenous and non-
Indigenous health bodies, NGOs and human
rights organisations have worked together to
secure the support of Australian governments
for a human rights based approach to
achieving health and life expectation equality
for Australia’s Aboriginal and Torres Strait
Islander peoples. This is known as the Close
the Gap Campaign.

This Community Guide sets out how the
Campaign partners propose to achieve
Aboriginal and Torres Strait Islander health
equality by 2030. It also explains how you can
learn more and get involved.

It does not have to be the case that an
Indigenous Australian will live 17 years less
than other Australians or that Aboriginal or
Torres Strait Islander babies will die at almost three
times the rate of non-Indigenous babies.

We should not accept that Indigenous Australians will
end up in hospitals at twice the rate of other Australians,
or suffer significantly higher rates of heart disease,
cancer, kidney failure or diabetes.

In a wealthy and fair-minded country like Australia, such
gross inequality cannot be allowed to continue.
The Close the Gap Campaign’s goal is to close the health
and life expectancy gap between Indigenous and non-
Indigenous Australians within a generation.

This goal is achievable. By joining our efforts we can
make sure that by 2030 any Aboriginal or Torres
Strait Islander child born in this country has the same
opportunity as other Australian children to live a long,
healthy and happy life.

Tom Calma
Aboriginal and Torres Strait Islander Social Justice
Commissioner and Chair of the Close the Gap Steering
Committee for Indigenous Health Equality

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The problem

Picture of a health worker administering eye drops to a patient

What is the cause of the Aboriginal
and Torres Strait Islander health
equality gap?

Over the last 50-years the health of Australians has
improved significantly due to major advances in
medical care and rising prosperity. Aboriginal and
Torres Strait Islander Australians, however, have not
shared in the same benefits.

The current 17-year life expectation gap is not a ‘normal’
state of events. It is the result of decades of neglect.

The 1967 Referendum, which enabled the federal
government to take greater control over Indigenous
affairs, was meant to be a starting point to turn around
the poor health of the Aboriginal and Torres Strait
Islander population.

Since then the health of Aboriginal people and Islanders
has improved – but not enough to reach the health
standards enjoyed by the broader community.

Today cardiovascular disease is the single biggest killer
of Indigenous Australians. Other serious health problems
include diabetes, respiratory diseases, musculoskeletal
conditions, kidney disease and eye and ear problems.

These are all preventable.

While most women in
Australia can expect to live
to an average age of 82 years,
Aboriginal and Torres Strait
Islander women can expect
to live to only 64.8 years.
The situation is even worse
for Indigenous Australian
men whose life expectancy
is just 59.4 years.

The main causes of health inequality are clear.

Aboriginal peoples and Torres Strait Islanders have less
access to essential health services than other Australians.
Too often they don’t get the health care they need, when
and where they need it.

A particular problem facing Aboriginal and Torres Strait
Islander communities is the relative lack of access to
primary health care. Primary health care aims to prevent
disease from occurring in the first place, or to detect
it early. As a result, illnesses that could be prevented
become chronic problems.

Overcrowded and poor quality housing in many
Aboriginal and Torres Strait Islander communities, and
limited access to fresh and healthy food, are also major
contributors to health inequality.

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The solution

It is not credible to
suggest that one of the
wealthiest nations in
the world cannot solve
a health crisis affecting
less than three per cent
of its citizens.

Tom Calma
Aboriginal and Torres Strait
Islander Social Justice
Commissioner

Close the Gap – Achieving Indigenous health and life expectation equality by 2030

The key elements of the Close the Gap Campaign are:

  • A comprehensive national plan of action that is
    properly resourced and that has the goal of achieving
    Indigenous health equality by 2030.
  • A partnership with Indigenous peoples and their
    representatives.
  • A targeted approach to achieving Indigenous
    health equality, focusing on a wide range of health
    conditions and health determinants.
  • Support for Aboriginal Community Controlled Health
    Services.

And the good news is that Australian governments have
already committed to this approach:

  • through the Close the Gap Statement of Intent, signed
    by the Prime Minister in March 2008 (see inside): and
  • at the December 2007 Council of Australian
    Governments meeting where Australian governments
    committed to closing the life expectancy gap within
    a generation, and halving the mortality gap between
    Aboriginal and Torres Strait Islander and non-
    Indigenous children under 5-years of age.

Picture of three Aboriginal childrenProgress has been slow, however, in turning these
commitments into action. This remains the challenge of
the Campaign partners. How you can get involved is set
out on the back page of this brochure.

Building on success

The Close the Gap Campaign is built on evidence
that shows that significant improvements in
the health status of Aboriginal and Torres Strait
Islander peoples can be achieved within short
time frames.

Providing primary health care services to the
Aboriginal and Islander population, particularly
through Aboriginal Community Controlled
Health Services, is likely to result in significant
increases in life expectancy within a decade. The
life expectancy of Native Americans increased
by about nine years between the 1940s and the
1950s, and in New Zealand the life expectancy of
Maori increased by about 12 years over the two
decades from the 1940s to the 1960s, when such
services were provided.

Programs targeting specific diseases also
demonstrate that rapid improvements to
Indigenous peoples’ health are possible.
For example, death rates among Aboriginal
people from pneumonia have dropped by 40
per cent since 1996, following the roll-out of
pneumococcal vaccinations, The ‘Strong Babies,
Strong Culture’ maternal health program has
shown that significant reductions in the number
of low birth weight babies can occur within a
matter of years.

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The Close the Gap Statement of Intent

Canberra, March 20, 2008

Close The Gap Statement of Intent

Preamble

Our challenge for the future is to embrace a new partnership between Indigenous and non-Indigenous Australians. The core of this partnership for the future is closing the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities. This new partnership on closing the gap will set concrete targets for the future: within a decade to halve the widening gap in literacy, numeracy and employment outcomes and opportunities for Indigenous children, within a decade to halve the appalling gap in infant mortality rates between Indigenous and non-Indigenous children and, within a generation, to close the equally appalling 17-year life gap between Indigenous and non-Indigenous when it comes to overall life expectancy.

Prime Minister Kevin Rudd, Apology to Australia’s Indigenous Peoples,
13 February 2008

This is a statement of intent – between the Government of Australia and the Aboriginal and Torres Strait Islander Peoples of Australia, supported by non-Indigenous Australians and Aboriginal and Torres Strait Islander and non-Indigenous health organizations – to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030.

We share a determination to close the fundamental divide between the health outcomes and life expectancy of the Aboriginal and Torres Strait Islander peoples of Australia and non-Indigenous Australians.

We are committed to ensuring that Aboriginal and Torres Strait Islander peoples have equal life chances to all other Australians.

We are committed to working towards ensuring Aboriginal and Torres Strait Islander peoples have access to health services that are equal in standard to those enjoyed by other Australians, and enjoy living conditions that support their social, emotional and cultural well-being.

We recognise that specific measures are needed to improve Aboriginal and Torres Strait Islander peoples’ access to health services. Crucial to ensuring equal access to health services is ensuring that Aboriginal and Torres Strait Islander peoples are actively involved in the design, delivery, and control of these services.

Accordingly we commit:

  • To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities 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.
  • To ensuring primary health care services and health infrastructure for Aboriginal and Torres Strait Islander peoples which are capable of bridging thegap in health standards by 2018.
  • To ensuring the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs.
  • To working collectively to systematically address the social determinants that impact on achieving health equality for Aboriginal and Torres Strait Islander peoples.
  • To building on the evidence base and supporting what works in Aboriginal and Torres Strait Islander health, and relevant international experience.
  • To supporting and developing 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.
  • To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples.
  • To respect and promote the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable, and of good quality.
  • To measure, monitor, and report on our joint efforts, in accordance with benchmarks and targets, to ensure that we are progressively realising our shared ambitions.

We are:
Signatures:

  • Representative of the Australian Government
  • National Aboriginal Community Controlled Health Organisation
  • Congress of Aboriginal and Torres Strait Islander Nurses
  • Australian Indigenous Doctors Association
  • Indigenous Dentists Association of Australia
  • Aboriginal and Torres Strait Islander Social Justice Commissioner,
    Human Rights and Equal Opportunity Commission

On a separate sheet, the following signed this Statement of Intent: the Hon. Dr Brendan Nelson MP, Leader of the Opposition; Dr Rosanna Capolingua, President, Australian Medical Association; Ms Kate Carnell, Chief Executive Officer, Australian General Practice Network; Dr Vasantha Preetham, President, Royal Australian College of General Practitioners; Professor Napier Thomson, President, Royal Australasian College of Physicians; Mr Andrew Hewett, Executive Director, Oxfam Australia; Professor Michael Dodson, AM, Co-Chair, Reconciliation Australia; Ed Cooper, Get Up!; Gary Highland, National Director, Australians for Native Title and Reconciliation; Catherine Freeman, Catherine Freeman Foundation; Ian Thorpe, Ian Thorpe’s Fountain for Youth; and Mr Andrew Schwartz, President, Australian Doctors Trained Overseas Association.

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Developing a national plan for
Aboriginal and Torres Strait Islander
health equalityicture of Aboriginal woman and child

The Close the Gap Campaign partners organised the
first-ever National Indigenous Health Equality Summit
in Canberra in March 2008.

At this, the Prime Minister, the Minister for Health and
Ageing, the Minister for Indigenous Affairs (representing
the Australian Government), the Leader of the
Opposition, and the Close the Gap Campaign partners
signed the historic ‘Close the Gap Statement of Intent’.
In this they committed to work in partnership with
Aboriginal and Torres Strait Islander peoples and their
representatives to achieve health and life expectation
equality by 2030.

A central commitment in the Close the Gap Statement
of Intent is for a comprehensive national plan for the
achievement of Aboriginal and Torres Strait Islander
health and life expectation equality by 2030 to be put in
place as soon as possible. This should include:

  • a coordinating body to oversee and guide the work of
    the many Australian, State and Territory government
    agencies responsible for delivering health services for
    the Aboriginal and Torres Strait Islander population.
  • a monitoring body to ensure that the responsible
    government agencies are working effectively and
    that measurable progress is being made towards
    achieving the goal of health equality for Indigenous
    Australians.

Picture of Prime Minister Kevin Rudd MP and Nicola Roxon MP signing the Statement of Intent

The plan should address all the factors that contribute
to Indigenous health inequality. In particular, it should
ensure:

  • That the necessary primary health care – preferably
    delivered by Aboriginal Community Controlled
    Health Services – is in place by 2018.
  • That an adequate number of health professionals
    (preferably Aboriginal and Torres Strait Islanders)
    are trained to deliver primary health care and other
    health care services to Indigenous communities.
  • That the necessary housing, water supplies and waste
    systems to support the achievement of health equality are in place in Indigenous communities by 2018.
    Ensuring supplies of fresh healthy food are available
    by 2018 is also vital.

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A partnership for Aboriginal and
Torres Strait Islander health equality

Picture of two Aboriginal girlsAboriginal and Torres Strait Islander peoples and their
representative bodies must be active participants with
government in developing and implementing a national
plan for Indigenous health equality.

Aboriginal Community Controlled Health Services must
be involved in health planning at the local and regional
level with the National Aboriginal Community Controlled
Health Organisation (NACCHO), and State/Territory
NACCHO Affiliates at national and state and territory
levels respectively. Additional partners would include
the Indigenous health professional bodies and a national
Indigenous representative body when it is established.

Aboriginal Community Controlled
Health Services

Services operated and controlled by the
Aboriginal communities they serve is the
preferred model for the delivery of primary
health care in the Close the Gap Campaign.
These are called ‘Aboriginal Community
Controlled Health Services’. They provide a vast
range of care supporting complex health needs,
and in a way that is culturally appropriate to the
communities they operate in.

Our services have existed for
over 30 years and we have seen
governments come and go.
When there is a true collaboration
between governments and
their departments with our
organisations, in the development
and implementation of programs
that we believe are needed, that
will be the time when the gap
in health status will begin to be
closed.

Dr Mick Adams, Chair of the
National Aboriginal Community
Controlled Health Organisation

By knowing what any given communities health
needs are and how to address them, they give
strength to the community. In this way they are
able to reach under-served Aboriginal patients,
which is the key intent in closing the gap in
Aboriginal disadvantage.

Because they are best placed to know what
any given communities health needs are,
the Close the Gap Campaign advocates
Australian governments adopt a partnership
approach with these services for regional
and community planning for health equality.

Picture of Cathy Freeman and Ian Thorpe holding a Close the Gap banner

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The National Indigenous
Health Equality Targets

Specific targets and benchmarks should be used in the
national plan for Aboriginal and Torres Strait Islander
health equality. The Close the Gap Campaign partners
have developed a comprehensive set of National
Indigenous Health Equality Targets to guide this
target-setting process. These were presented to the
Australian Government in July 2008.

Developed by leading experts in Indigenous health, the
targets are based on the need to address:Picture of the publication Close the Gap: National Indigenous Health Equality Targets - Outcomes from the National Indigenous Health Equality Summit Canberra, 18 – 20 March, 2008

  • the leading causes of Indigenous child mortality –
    including low birth weight, respiratory and other
    infections and injuries
  • the leading contributing factors to the life expectancy
    gap – chronic disease, injuries and respiratory
    infections
  • mental health and social and emotional well being –
    which are crucial to achieving better health.

The Close the Gap Campaign partners have developed
targets to support the achievement of Indigenous health
equality over many areas. Key targets include those to
support:

  • significant reductions in the rates of Aboriginal and
    Torres Strait Islander death and illness from diseases
    and chronic conditions;
  • the delivery of the necessary primary health care
    services for health equality to Aboriginal and
    Torres Strait Islander communities, particularly by
    Aboriginal Community Controlled Health Services;
  • big improvements to housing (so that it supports
    good health) in Aboriginal and Torres Strait Islander
    communities;
  • a dramatic increase in the availability of fresh and
    healthy food supplies in Aboriginal and Torres Strait
    Islander communities; and
  • significant reductions in the rate of smoking among
    Aboriginals and Torres Strait Islanders.
We need to continue
to implement a range
of targeted initiatives
which will deliver more
Indigenous doctors, nurses,
dentists, psychologists,
Aboriginal health workers
and allied health workers.
An Aboriginal and Torres
Strait Islander workforce
is critical to ‘close the gap’.

Dr Tamara Mackean
President, Australian
Indigenous Doctors’ Association

An additional set of targets is being developed by the
Close the Gap Campaign partners to address the broad
range of social and cultural factors that have a profound
influence on the health of Indigenous Australians, such
as housing, education, community safety, employment,
community development, culture and language and
contact with the criminal justice system.

Targets are important because they help maintain a
focus on the achievement of Aboriginal and Torres Strait
Islander health equality by 2030.

They will also help keep Australian governments
accountable for the achievement of this goal.

For details on the National Indigenous Health Equality
Targets – including timelines for their achievement and
the resources required –
go to
www.humanrights.gov.au/
social_justice/health/targets
.

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Get involved

We stand at a watershed moment in the history of
Indigenous health.

Who are the Close the Gap
Campaign
partners?

The Close the Gap Campaign
is led
by
a
Steering
Committee
(the partners),
which
includes:

- The Aboriginal and Torres

Strait
Islander
Social Justice
Commissioner,
Australian

Human
Rights
Commission
(Chair)
- National Aboriginal
Community
Controlled

Health
Organisation
- Australian Indigenous
Psychologists’
Association
- Australian Indigenous
Doctors’
Association
- Congress of Aboriginal
and
Torres
Strait
Islander

Nurses
- Australian General
Practice
Network
- Australian Medical
Association
- Australians for Native
Title
and
Reconciliation
- Cooperative Research
Centre
for
Aboriginal

Health
- The Fred Hollows
Foundation
- Heart Foundation
- Indigenous Dentists’
Association
of
Australia
- Menzies School of

Health
Research
- Oxfam Australia
- Royal Australian College

of
General
Practitioners
- Royal Australasian
College
of
Physicians,

and
Torres
Strait
and

Northern
Peninsula
District

Health
Service.

Leadership from Aboriginal
peoples
and their

representative
bodies is a

hallmark of the

Close
the
Gap
Campaign.

Through our members –
particularly
the
National

Aboriginal
Community

Controlled

Health

Organisation

(NACCHO)

and the

Indigenous

health

professional
bodies

we

draw
on

broader
Aboriginal

community

support.

For

example,

NACCHO

represents

over 140

Aboriginal

Community

Controlled

Health

Services
across

Australia,
each

governed

by
elected

community
representatives.

The commitment of Australia’s governments to work
in partnership with Indigenous peoples and their
representatives to plan for Indigenous health equality
by 2030 marks the start of an ambitious, but ultimately
achievable, process to bring Indigenous health inequality
to an end within our lifetimes.

To be successful, however, the Close the Gap Campaign will
need support from all corners of the Australian community.
You can get involved and play a part in consigning
Indigenous health inequality to the history books.

Learn

Subscribe

Join the ‘Indigenous Social Justice’ electronic mailing
list and keep up to date with the latest news:
www.humanrights.gov.au/about/mailing_lists/

Contribute

Share examples of success stories in Indigenous
health – and be inspired by others:
www.antar.org.au/issues_and_campaigns/health/
success_stories

Participate

  • Join with over 120,000 other Australiana and pledge
    your support to the ‘close the gap’:
    www.oxfam.org.au/campaigns/indigenous-health/
  • Hold an event on National Close the Gap Day or write
    to the Minister or your local MP

Visit

Contact us

Australian Human Rights Commission
Phone: +61 2 9284 9600, 1300 369 711
Fax: +61 2 9284 9611
Website: www.humanrights.gov.au
Email: paffairs@humanrights.gov.au

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‘I believe that the basic attribute of
mankind is to look after each other’
.
Professor Fred Hollows AC

Financial support for this
publication was provided by
The Fred Hollows Foundation.