Introduction to Closing the Gap policy

Discuss about the Contemporary Indigenous Health and Wellbeing.

The essay deals with “Closing the Gap” (CTG) policy in Australia. The essay briefly explains the topic, about the history of the policy and the factors that influenced the creation of the policy. Further the essay discusses the significance of the policy on Aboriginal & Torres Strait Islander People’s health outcomes using relevant literature and statistics. The policy addresses several health issues. In this essay, one health issue will be focused that is covered under CTG. The policy in this regard is evaluated to identify the impact the CTG policy has had on Aboriginal & Torres Strait Islander people’s health since it was  introduced. The essay briefly highlights the challenges that have affected the changes.

The Australian government launched closing the Gap or CTG policy for Aboriginal and Torres Strait Islander people. The policy aims to .reducing health inequalities among this group of population. The policy addresses the disadvantages in relation to the child mortality, life expectancy, employment outcomes, education achievement and access to early education.  The policy was formulated in response to the “Social justice report 2005” and the “Close the Gap social justice campaign” (Australian Human Rights Commission 2016).

The social justice report showed the Indigenous Australians had poorer health when compared to the non-Indigenous population. This refers to the health gap and includes six main drivers. There was 20% of the health gap in respect to cardiovascular disease, 16% gap in diabetes, 9% in chronic respiratory disease, 7% intentional injuries, and estimated 6% in cancers. This altogether contributes the gap of 70%. Thus, the Indigenous Australian were highly represented in mortality rate, low birth weight of children, and high prevalence of clinical, emotional and behavioural disorder.  The health gap was due to 11 risk factors including high blood pressure and high cholesterol, smoking alcohol and drug abuse, child sexual abuse, unsafe sex, and intimate partner violence, poor nutrition and obesity (Jamieson et al. 2016).  Close the Gap social justice campaign was initiated in 2006 with the aim to “close the life expectancy gap” between the Indigenous and non-Indigenous Australians. This campaign was the joint effort from NGOs and human rights organisation (Holland 2014). 

The council of Australian Government proposed this policy and included the leaders of local, state, territory and federal government to commit for closing the gap. In 2007, the government and the Indigenous Australians agreed to work together to active health equality. The goal of this agreement is to establish equal health status between the Indigenous and non-Indigenous Australians (Taylor et al. 2013). The government targets to accomplish the goal by 2030. The “Indigenous health equality summit statement of intent” signed the agreement. During this summit the targets of the policy was presented to the delegates. The council of Australian Government committed $4.6 billion to this agenda in 2008. These funds were allocated for economic participation, early childhood, health and housing and remote service delivery (Productivity Commission, 2015). 

History and factors influencing the policy

The name of the policy is closing the gap because the targets of the policy is to reduce the gap in various health aspects. Firstly, to close the life expectancy gap. Secondly, to reduce the mortality rate gap of the Indigenous children under five to its half within 10 years. Thirdly, to improve an access to early childhood education for all the 4-year-old children, dwelling in remote areas. Fourthly, reduce the gap in numeracy, reading, and writing skills of the Indigenous students by 50%. Fifthly, reduce the gap in attainment of year 12 in this population by 50%. Lastly, reduce the gap to its half in regards to employment outcomes within 10 years (Brueckner et al. 2014). Every year the government releases the CTG reports to track the progress and recommend the government about solutions. The above-mentioned targets have helped the government to identify the disadvantages experienced by the Indigenous Australians and the improvement in heath and well-being can be achieved by meeting these targets (Griffiths et al. 2016).

Ear disease and the associated hearing loss is one of the significant health problems for the Indigenous children. In this community, children mostly suffer from chronic ear disease particularly related to otitis media. The rate of the prevalence of this disease exceeded 4% of the threshold limit and is thus regarded as major public health issue. Ear disease is the cause of poor educational achievement among indigenous children is due to hearing loss. It highly contributes to the unemployment. The prime factors contributing to this disease are household overcrowding, malnutrition, passive smoking, bottle-feeding, and premature birth. Overall, this disease has substantial impact on the Indigenous children and the health gap (Jervis-Bardy et al. 2014).

The target of closing the gap policy undertaken by the Queen’s land government in 2009 after the reports of the evaluation of “Deadly ears deadly kids’ deadly communities framework” was published. The framework aims to significantly reduce the rate of otitis media in the Indigenous children. The policy aims to reduce the interaction between the medical and the environmental causes of the disease. Intervention is targeted at different level under this policy to decrease the incidence of the hearing loss and its impact ((www.aihw.gov.au. 2017). 

Antibiotic preventive treatment for otitis media was found effective in preventing the disease however, the long term effects are uncertain. The Australian government administered pneumococcal vaccination program as it was successful in preventing the ear disease. Vaccination against Haemophilus influenzae type b introduced in 1993, have significantly reduced the invasive Hib infectionby 98% in Indigenous children. Several meta analysis studies have evaluated the effectiveness of inactivated influenza vaccine. The findings showed that this vaccine can successfully prevent the onset of the disease. On the other hand, some studied showed mixed results that in Indigenous children, the pneumococcal vaccination might not be fully active (NSW Health 2011).

The council of Australian Governments in 2009 agreed to “universal neonatal hearing screening”. Since 2009, babies born in all the states were screened after first month. Since 2011, the government have started another program named “Healthy Start for School”. It involves health check ups and hearing tests for all the four year olds. Nelson et al. (2008) evaluated the “New South Wales Otitis Media Screening Program” (2004-2008) that has the screening target of 85%. The findings showed that the program was  ineffective in decreasing the prevalence of the disease. It failed to address the “social and environmental determinants”. The program should be disbanded according to the ARTD consultants. This issue need a broad public health approach to resolve. It is suggested that the ear health program should be integrated with other health and surveillance programs (www.aihw.gov.au. 2017).

The challenge to achieve the close of ear disease gap was lack of surveillance data. The government has not initiated any national population-based surveillance program. There was no monitoring of the ear disease. There is a need to take both the chronic and the acute aspects of the disease. Following this issue being highlighted the Australian government funded the “Northern Territory Government” in 2007 to provide services related to the ear, nose, throat and audiology services. These were funded in 2009-2012 as a part of the initiative taken by close the gap (Holland 2014). This initiative also led to SFNT Hearing Health Program. Children living with hearing loss were recommended for rehabilitation. These programs have positive impact on the Indigenous children. The proportion of the middle ear condition cases decreased by 13% and the hearing loss cases by 15%. These programs also showed long-term improvement in children ear health. The proportion of the cases with moderate, to profound hearing impairment was decreased by 15% (Northern and Downs 2014).

The other challenge was the lack of specific evidence on strategies effective for improving delivery of “culturally competent healthcare” to Indigenous people. These strategies have been identified and found successful in US and will be useful in Australia. The challenges in achieving the targets of close the gap policy was poor cultural awareness training. In addition, there was lack of cultural-tailoring during program transfer and implementation (Aihw.gov.au, 2017). The Darwin Otitis Guidelines Group 2010 is the revised guidelines for “Indigenous-specific management of the otitis media”. The current evidence still shows higher prevalence of ear disease among communities of Indigenous people, when compared to the non-Indigenous counterparts. Therefore, the ear health gap remains (www.aihw.gov.au. 2017).

Evaluation of the policy on Indigenous health since it was introduced

The essay presents the importance of closing the Gap strategy in Australia. In response to this policy, ear health of the Indigenous children was studied. Otitis media is one of the prime contributors of health gap between the Indigenous and non-Indigenous children. There is a sufficient awareness created in this regard. Various treatment programs have been developed and implemented for improving this condition. Influenza vaccinations have been effective in reducing the infection by 98%. The long-term effects are uncertain. However, the current reports do not indicate rigorous evaluated evidence about significant ear health improvement among Aboriginals and the Torres Strait Islanders. How much gap has been closed by these arrays of local and national programs is not known due to lack of national profile on this community and prevalence of ear disease.

References

Aihw.gov.au., 2017. Cultural competency in the delivery of health services for Indigenous people. [online] www.aihw.gov.au. Available at: https://www.aihw.gov.au/ClosingTheGap/Content/Our_publications/2015/ctgc-ip13.pdf [Accessed 14 Aug. 2017].

Australian Human Rights Commission, 2016. Close the Gap: Indigenous Health Campaign.

Brueckner, M., Spencer, R., Wise, G. and Marika, B., 2014. Indigenous entrepreneurship: Closing the Gap on local terms. Journal of Australian Indigenous Issues, 17(2), pp.2-24.

Griffiths, K., Coleman, C., Lee, V. and Madden, R., 2016. How colonisation determines social justice and Indigenous health—a review of the literature. Journal of Population Research, 33(1), pp.9-30.

Holland, C., 2014. Close the Gap: progress and priorities report 2014. Close the Gap Campaign Steering Committee.

Jamieson, L.M., Elani, H.W., Mejia, G.C., Ju, X., Kawachi, I., Harper, S., Thomson, W.M. and Kaufman, J.S., 2016. Inequalities in Indigenous oral health: findings from Australia, New Zealand, and Canada. Journal of dental research, 95(12), pp.1375-1380.

Jervis-Bardy, J., Sanchez, L. and Carney, A.S., 2014. Otitis media in Indigenous Australian children: review of epidemiology and risk factors. The Journal of Laryngology & Otology, 128(S1), pp.S16-S27.

Nelson HD., Bougatsos C, and Nygren P., 2008. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force recommendation. Paediatrics 122(1):e266–e276.doi:10.1542/peds.2007–1422.

Northern JL., and Downs MP., 2014. Hearing in children. 6th edition. San Diego, CA: Plural Publishing, Inc.

NSW Health., 2011. NSW Aboriginal Ear Health Program Guidelines. Sydney: New South Wales Health. Viewed 20 February 2014.

Productivity Commission, 2015. National Indigenous Reform Agreement, Performance Assessment 2013-14. Canberra: Commonwealth of Australia.

Taylor, H.R., Boudville, A., Anjou, M. and McNeil, R., 2013. The roadmap to close the gap for vision. Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne.

www.aihw.gov.au. 2017. Ear disease in Aboriginal and Torres Strait Islander children. [online] Available at: https://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc-rs35.pdf [Accessed 14 Aug. 2017].