What's Needed to Close the Indigenous Health Inequality Gap!

Transcription

1 What's Needed to Close the Indigenous Health Inequality Gap! Professor Tom Calma AO National Coordinator Tackling Indigenous Smoking and Patron & Chair, Poche Indigenous Health Network

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3 What's Needed to Close the Indigenous Health Inequality Gap! There is no single solution to closing the Indigenous health inequality gap. Social and cultural determinants need to be addressed to close the gap - how far have we come in the last decade. Aboriginal and Torres Strait Islander Population Some of the challenges Some solutions Close the Gap Indigenous Health Equality Justice Reinvestment Incaseration Mental Health, Suicide Prevention and SEWB

4 260 language at colonisation 100 languages still spoken 80 languages under threat 18 languages spoken by all age groups within a community

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6 Demographics At 30 June 2006, the Indigenous estimated resident population of Australia was 517,200 or 2.5% of the total pop Just over 50% under 30 years old 194,000 Indigenous children aged 14 years (38%, compared with 19 % for the non-indigenous pop) Fastest growing population group in Australia 75% live in urban and regional environments Is likely to reach between 713,300 and 721,100 by about the same as estimated population at the time of colonisation in

7 Arrow points to where the projected population would be following 2006 census The Indigenous population is projected to grow from around 670,000 in 2011 to around 1,060,000 by 2031.

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9 ACR case study for National Disability Insurance Scheme 9

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14 Life Expectancy at birth Australian Institute of Health and Welfare 2011

15 The main causes of deaths among Indigenous Australians in the period, contributing to two thirds of the health gap, were: circulatory disease (26%) cancer (19%) external causes (including suicide and transport accidents) (15%) endocrine, metabolic and nutritional disorders (including diabetes) (9%), and respiratory diseases (8%). The most recent Indigenous Burden of Disease study for Australia (Vos et al. 2007b) found that 49% of the health gap could be explained by 11 Behavioural risk factors: smoking (17%) obesity (16%) physical inactivity (12%) high blood cholesterol (7%) high blood pressure (6%) low fruit & vegetable intake (5%) alcohol (4%) illicit drugs (4%) intimate partner violence (3%) child sexual abuse (2%), and unsafe sex.

16 The campaign for health equality requires a comprehensive national plan 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 16

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21 Key Findings This is the fifth report against the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) see Figure 1. The HPF monitors progress in Aboriginal and Torres Strait Islander health outcomes, health system performance and the broader determinants of health. The health of Aboriginal and Torres Strait Islander peoples is improving for a number of measures, although there remain many areas where further concerted effort will be needed to achieve improvements in health outcomes.

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23 Contributors to mortality gap According to AHMAC, over the greatest contributors to the avoidable and preventable mortality gap were: 19 percent - ischaemic heart disease (22 percent of the gap); 18 per cent cancer (14 percent of the gap); and 10 percent diabetes (17 percent of the gap). As a result, AHMAC report that the greatest opportunities to reduce avoidable mortality for Aboriginal and Torres Strait Islander peoples relate to: primary prevention (53 percent of avoidable deaths); secondary interventions (24 percent); and tertiary interventions (23 percent). AHMAC p 74

24 More than one million Australians have type 2 diabetes, however it is estimated there is another 500, 000 undiagnosed. Of those living with the condition, the onset of depression is far more likely compared to the general population with some research stating it is more than twice as common. Experts agree that depression among people with type 2 diabetes is often invisible", which is a problem because the relationship between the two is likely to be bidirectional -- with one worsening the other.

25 Diabetes was responsible for one-in-twelve deaths (201 deaths) of Indigenous people living in NSW, Qld, SA, WA and the NT in Diabetes was the second leading cause of death for Indigenous people. The overall death rate was seven times higher for Indigenous people than for non-indigenous people.

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27 Diagnoses normal/abnormal heart rhythm in 30 secs Anyone who has been trained can use it ECGs can be ed to the GP or health centre Works on most smart phones Poche Centres intend to conduct 1,500 opportunistic screens in 2016 to: Detect heart rhythm problems Encourage treatment Increase understanding of cardio vascular disease Local Aboriginal Health Workers, Drivers, Dental Assistants and Assistant Nurses will conduct the screens with their patients over 45 years iecg

28 Healthy kids, Healthy teeth, Healthy hearts Facts at a glance 50% Aboriginal staff 77 Aboriginal scholars 27 community partnerships 10,000 services 4 major collaborative research projects granted ethics approval through the AH&MRC 4 post doctoral research fellows Expenditure $2.93m $3.3m committed by government & others in 2015 for future years

29 Poche Sydney Denture Van

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31 Closing the Gap Targets and Other Already Agreed Government Targets Oct 2015 Close the gap in life expectancy in a generation by Halve the gap in mortality rates for children under 5 by Ensure access to early childhood education for all Indigenous 4 year olds in remote communities by Close the gap between Indigenous and non-indigenous school attendance within five years by Halve the gap in reading, writing and numeracy achievements for Indigenous students by Halve the gap in Aboriginal and Torres Strait Islander students Year 12 attainment rates by Halve the gap in employment outcomes between Indigenous and non-indigenous Australians by Increase the representation of Aboriginal and Torres Strait Islander employees across the Commonwealth public sector to 3% by Three per cent of new domestic Commonwealth contracts will be awarded to Indigenous suppliers by Interim targets will apply from 1 July 2015 to drive and track performance.

32 Overview of the Government s priorities for Indigenous Affairs There are three priority areas that have been proven to have a positive effect on the lives of Aboriginal and Torres Strait Islander peoples: getting children to school to provide the best chance of enjoying success in school and later in life getting adults into work to ensure Indigenous Australians participate in the modern economy making Indigenous communities safer for people to live, work and raise their families.

33 Indigenous Advancement Strategy

34 National Health Leadership Forum Chaired by Rom Mokak, CEO Lowitja Institute Australia's National Institute for Aboriginal and Torres Strait Islander Health Research 34

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41 Aboriginal and Torres Strait Islander Smoking story Current Smokers Overall outcome % Ex-smokers % Never smokers % Source: ABS Aboriginal and Torres Strait Islander Health Survey

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43 What is health literacy? Skills / Abilities HEALTH LITERACY Demands / Complexity Individual health literacy Skills, knowledge, motivation and capacity of a person to access, understand, appraise and apply information.to make effective decision and about and health care and take appropriate action Health literacy environment Infrastructure, policies, processes, materials and relationships that make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services Parker, Measures of Health Literacy: Workshop Summary; Roundtable On Health Literacy, 2009 ACSQHC, Health literacy: Taking action for safety and quality, 2014

44 Everyone has a role in addressing health literacy Consumers, patients and families Discuss with healthcare providers any difficulties in understanding information Ask for more information about any part of care that is unclear Healthcare providers Assume most people will have difficulty understanding and applying complex health knowledge and concepts Use a range of communication strategies to ensure information is understood Healthcare organisations Develop and implement health literacy policies and programs Governments Raise awareness about health literacy Embed health literacy principles into health policy development Education and training organisations Provide education for healthcare providers about health literacy and communication Develop education programs for consumers

45 Adult imprisonment per population Indigenous Non-Indigenous Figure : Adult imprisonment rate, at 30 June, 2000 to 2013 Source: Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage 2014 Chapter 4: data/assets/pdf_file/0003/179346/04-keyindicators-2014-chapter4.pdf 45

46 Source: Australian Bureau of Statistics Corrective Services, Australia, June Quarter Estimated resident Aboriginal and Torres Strait Islander population, Proportion of Aboriginal and Torres Strait Islander persons in full-time custody, by sex 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% Jun Qtr 15 Resident population 30.0% 20.0% 10.0% 0.0% Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females NSW Vic. Qld SA WA Tas. NT ACT Australia

47 Re-imprisonment Per cent NSW Vic Qld WA SA Tas ACT NT Aust Indigenous males Non-Indigenous males Indigenous females Non-Indigenous females Figure : Proportion of prisoners with known prior adult imprisonment under sentence, by sex, 30 June 2013a Source: Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage 2014 Chapter 11: data/assets/pdf_file/0009/179352/11-keyindicators-2014-chapter11.pdf 47

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50 Situational factors predictive of repeat offending can include: unemployment education and schooling those with lower educational attainment are more likely to reoffend residential location those living in low socioeconomic areas or who are homeless are more likely to reoffend family attachment those with limited family attachment are more likely to reoffend poor mental health drug use.

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52 gov.au/pages/correctiveservices/sm oke-free-prisons.aspx New Zealand mid 2011 Northern Territory July 2013 Queensland May 2014 Tasmania January 2015 Victoria July 2015 NSW August 2015 South Australian maybe 2016 Western Australia and the ACT no date flagged

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54 Genesis of Justice Reinvestment Initial efforts to implement and test the justice reinvestment concept, with some modifications, began in Connecticut in 2004, with Kansas and Texas following suit in Prominent successes in states such as Texas which averted $684 mil in new prison construction and operating costs in 2007 and reinvested $241 million of those savings into in-prison and community-based treatment and diversion programs spurred the adoption of justice reinvestment in several other jurisdictions.

55 Other states that have pursued a justice reinvestment approach with technical assistance from The Pew Charitable Trusts or the Vera Institute of Justice include: Arkansas, Delaware, Georgia, Kentucky, Mississippi, Missouri, Oregon, South Carolina, South Dakota, and Utah.

56 Major JR players in Australia

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60 From self respect comes dignity; from dignity comes hope; and from hope comes resilience The Pledge is: As a citizen of the world community, I stand with the United Nations against Racism, Discrimination and Intolerance of any kind. Throughout my life I will try to promote equality, justice and dignity among all people, in my home, my community and everywhere in the world. United Nations Pledge against Racism December 2001