I’ve had it with Close the Gap!

Sorry, I know this is an article that should have been written 2 weeks ago, but I just needed time to calm down. I’ve had it with Closing the Gap. I’ve had it with each consecutive government standing in front of the cameras and telling us how much they care, but the outcomes are still the same. They care alright, right up until the lights go down and the journalists walk away. And that’s why the timing of this article is right. Discussions of improving Aboriginal health does not have a date. These issues are happening year-round.

So, let’s talk!

For over a decade we have heard the same thing, that Aboriginal people deserve better and that we have not achieved that yet.

“The level of Aboriginal ill health will only be reduced if there are dramatic improvements in the physical environment, if there Is maximum participation by Aboriginals in all stages of the planning and delivery of health care, and if Aboriginals, like all Australians, are given the opportunity to choose the type of health care they consider best suits their needs.”

This quote was not taken from the 2020 Closing the Gap Report, even though it consists of the same themes mentioned by our current Prime Minister. It’s not even taken from the Social Justice Report of 2005, that sparked the whole Closing the Gap campaign. No, this was taken from the first ever National Report on Aboriginal Health, back in 1979.

Yes, 1979!

So, it’s been 41 years since the government first acknowledged that the physical environment needs to change, and that Aboriginal people need involvement at all levels, yet we are still hearing the same statements. Granted, we now have better involvement than we did in 1979, but how much control do Aboriginal people really have?

Who really controls which programs are run, and where the money goes?

The Aboriginal Community Controlled Health Organisations are still held to ransom by non-Indigenous groups who act as gate keepers to funding dollars. They must go cap in hand to these gate keepers and beg for funding, often competing with non-Indigenous groups. They only ever receive the funding if they agree to spend the money the way the non-Indigenous funding body tells them to. If they don’t agree, there is no contract, and no money. The only ‘control’ or ‘contribution’ Indigenous groups have is in trying to convince the funding bodies about what needs to be done. Whether or not the non-Indigenous funding body agrees with the Indigenous community on how things should be done will determine whether they get the money.

Just think about that.

Who would know more about what Indigenous community’s needs, than those living in that community? Yet, it’s those living outside that community that will often decide. ‘Community-controlled’ health is still a myth. It’s more like ‘community-guided’ health!

If we expect to close the gap, Indigenous communities need true control. We need to be able to spend the funds on programs that the community need, in a way that will provide the outcomes sought. Sure, there must be accountability, but Indigenous health groups have no problem with that as our programs are already more scrutinised that any others.

Part of the problem is that we are taking a system that isn’t working for non-Indigenous people and expecting it to work for Indigenous people. The report by the Grattan Institute (2016), ‘Chronic Failure in Primary Care’, reports that less than 50% of all Australians who have been diagnosed with diabetes ever achieve ideal blood sugars readings. We have a reversible disease like type 2 diabetes, and we can’t even get half the people to achieve good blood sugars.

We then provide this to the Indigenous community, where type 2 diabetes is more prevalent and occurs at a younger age and lower BMI and expect it to work!

Let’s cut the rhetoric and put into place a real structure around Aboriginal health. As Scott Morrison noted in his speech, non-Indigenous people do not understand the lived experience of Indigenous people. How can they possibly design a program that would work?

Aboriginal people need full control over which programs are integrated and how the funding is spent. To ensure outcomes are met, every program must undergo evaluation at its completion, something not often done. If reasonable outcomes are not met, then funding is ceased. This will motivate providers to provide better quality services as well as provide an opportunity to learn from each program and build upon that.

There are also other areas where the government can do better.

There are many communities that could have better access to quality food but governments and councils restrict the Aboriginal land owners ability to utilise them. For example, we have people in Cape York who are supposed to own their land, but they cannot kill the wild cattle. The rangers can shoot them as part of a culling process, and leave them to rot into the soil, but the landowners are not allowed to kill them and feed their families.

Everyone knows that those in remote areas are held to ransom by the local stores. Quite often fresh foods are not so fresh and either way they are expensive. This means that processed foods are most often the easiest, and cheapest option. There needs to be infrastructure in place for growing the fresh foods. There are many plants that thrive in the local environment and these need to be utilised.

Providers of medical care need to improve their systems as well. Research has shown that many patients do not receive regular HbA1c and blood pressure checks when they attend an appointment. This is an ideal opportunity to discuss ways to improve their condition as well as catch any negative changes in the early stages.

We also need stop using ‘engagement’ (in the form of attendance) as an outcome. Attendance should not be an outcome, it should be a requirement for funding! Outcomes need to be focused around reductions in HbA1c and blood pressure as well as measures of overall wellness. The latter should be determined by the local community.

Finally, all major decisions must have this one question in the discussion process, “What does it mean for those on the ground?”. If quality of life and longevity is not improved, then it can’t be approved.

Closing the Gap needn’t be difficult, we just need to follow what has already been shown to work. And we have a history of over 60,000 years of good health to start this learning process. We just need to look back past 1788.