The 13th February, 2017 marked the 9th anniversary of the apology to Aboriginal and Torres Strait Islander people by former Prime Minister Kevin Rudd. Expectations for improvement in the lives of Aboriginal and Torres Strait Islander people and communities were high yet the latest Closing the gap: Prime Minister’s report 2017 suggests that we are still below expectations on most targets. The Redfern Statement states that the challenges facing Aboriginal and Torres Strait Islander people remain at the margins of national debate p.2. The national peak bodies that came together to formulate the Redfern Statement have been unequivocal and forthright in their assertion and belief that urgent government action must be underpinned by a firm commitment to support Aboriginal and Torres Strait Islander stewardship and leadership in both the debate and the actions to progress our national aspirations to close the gap between Aboriginal and Torres Strait Islander people and other Australians.
As reported in our Overview last year, regrettably it is still clear that Aboriginal and Torres Strait Islander people remain the least healthy sub-population in Australia. However, since last year there has been an even greater shift in the rhetoric from a deficit based narrative towards a fuller appreciation of the importance of focusing on Aboriginal and Torres Strait Islander led strengths based approaches . The Redfern Statement asserts that ‘it is time that Aboriginal and Torres Strait Islander voices are heard and respected’ and that its plans for action ‘are acted upon as a matter of national priority and urgency’ (p.6). Both the Prime Minister Malcolm Turnbull and the leader of the opposition Bill Shorten have publicly acknowledged the importance of Aboriginal and Torres Strait Islander leadership and stewardship in pursuit of sustainable solutions. The Prime Minister stated, ‘We are building new ways of working together with Indigenous leaders and their communities to create local solutions - putting Aboriginal and Torres people at the centre of decision making in their regions’ , p.4.
The importance of continuing to honour these bipartisan commitments is highlighted by the Closing the gap: Prime Minister’s report 2017 which reported limited success in meeting the targets:
- The target to halve the child mortality rate by 2018 was not met in the reporting period. This is somewhat ameliorated by the fact that there has been an overall decline in both the rate and gap in child mortality since 1998.
- While there has been an overall decline in Aboriginal and Torres Strait Islander mortality since 1998 the target to close the life expectancy gap by 2031 is not on track.
- Reading and numeracy targets and employment gaps are not on track.
- Progress on school attendance rates will need to speed up if the target is to be met (CTG).
Despite these results, there have been some noticeable and measureable improvements in the health of Aboriginal and Torres Strait Islander people and communities. The following selected statistics indicate that progress is being achieved albeit slowly.
- Between 1998 and 2013, there was a 16% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
- From 1998 to 2014, the IMR for Aboriginal and Torres Strait Islander infants 0-4 years has declined from 217 per 100,000 to 159 deaths per 100,000 . This was a greater decline than for non-Indigenous children (from 115 per 100,000 to 73 deaths per 100,000) narrowing the gap from 102 per 100,000 to 86 per 100,000.
- Between 1998 and 2012, after age-adjustment, there was a 27% decline in the death rate from avoidable causes for Aboriginal and Torres Strait Islander people aged 0-74 years living in NSW, Qld, WA, SA and the NT .
- During 2013-2015, the median age at death for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 57.9 years (up from 53.8 years in 2003-2005). The median age at death for Aboriginal and Torres Strait Islander males, 54.9 years in 2013-2015, increased from 50.9 years in 2003-2005; and for females to 61.5 years from 58.4 years for the same period. The non-Indigenous median age at death was nevertheless substantially higher at 81.9 years in 2013-2015.
- The gap in CVD mortality rates between Aboriginal and Torres Strait Islander and non-Indigenous people narrowed between 1998 and 2014 . After adjusting for age, the gap narrowed from 169 deaths to 88 deaths per 100,000 population.
- In 2014-2015, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
- The 2013-2014 NATSISS showed that 92% of Aboriginal and Torres Strait Islander people aged 15 years and over were able to obtain emotional, physical, or financial help from someone else during a time of crisis.
- Age-standardised death rates for respiratory disease in NSW, Qld, WA, SA and NT declined by 26% over the period 1998-2012 for Aboriginal and Torres Strait Islander people.
- Between September 2008 and August 2013, 90% of children under three years of age living in remote communities in the Top End region of Australia had some form of otitis media (OM) . However, changes in vaccination schedules in the NT have been concomitant with a sustained improvement in the severity of OM seen in these children .
- In 2014-15, the proportion of 4-14 year old children with reported tooth or gum problems was 34%, a decrease from 39% in 2008 .
- Over the five year period 2011-2015, there was a 22% decline in the HBV notification rates for Aboriginal and Torres Strait Islander people from 85 per 100,000 in 2011 to 66 per 100,000 in 2015. It is suggested that this reduction is due to immunisation programs for HBV.
- Since 2011, notification rates for gonorrhoea among Aboriginal and Torres Strait Islander people declined by 22%, whereas the rates among non-Indigenous people increased by 94% during the same period.
- In 2016, 95% of Aboriginal and Torres Strait Islander children aged five years were fully immunised against the recommended vaccine-preventable diseases.
- The proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy has decreased (from 50% in 2009 to 45% in 2014).
- In 2012-2013, 23% of Aboriginal and Torres Strait Islander adults abstained from alcohol; this level was 1.6 times higher than among the non-Indigenous population.
- For 2010 to 2013, there was a significant decline for risky drinking in the proportion (from 32% to 23%) of Aboriginal and Torres Strait Islander people aged 14 years and older.
- In 2014-2015 there was an increase in the proportion of Aboriginal and Torres Strait Islander people aged 15 years and older who reported they had never used illicit substances (69% up from 52% in 2012-2013).
It is important to acknowledge that many challenges remain in our collective efforts to make a positive difference to the health of Aboriginal and Torres Strait Islander people and communities. Our focus on the positive outcomes in these concluding remarks is not intended to obscure or minimise these challenges but to highlight the many positive achievements that form the basis of a better understanding of the importance of strength based approaches. It is hoped that these achievements - coupled with the ongoing and strengthening commitment from governments to the importance of authentically and respectfully engaging Aboriginal and Torres Strait Islander people, organisations and communities - offers true promise of closing the health gap between Aboriginal and Torres Strait Islander people and other Australians.