If the Prime Minister wants to make good his promise of closing the gap in life expectancy between Indigenous and other Australians, he will have to start broadening his government’s focus well beyond the borders of the NT.

Over the past year, much political and policy attention has been devoted to the 73 remote communities and five town camps in the NT. These communities encompass only around 10 percent of Australia’s Indigenous population and just 17,200 of the more than 22,000 children under 16 in the Territory.

The Federal Government has pledged $1.2 billion in new and directed funding for Indigenous measures, just over half of which is

for the Northern Territory Emergency Response.

New spending on national programs for Indigenous health averages less than $40 million/year over five years. This is not sufficient to close the gap. In fact, based on the estimates of the AMA, the National Aboriginal Community Controlled Health Organisations and the Close the Gap campaign, it is only about one-tenth of what is needed.

In terms of where Indigenous people live, 2008 ABS data shows that just over half the population lives in major cities or inner regional areas — up slightly from a decade ago. Only one-quarter of the population lives in remote and very remote areas. As many Indigenous people live in Sydney as in the NT, for example.

Gary Johns from the Bennelong Society, Helen Hughes from the Centre for Independent Studies and others have proposed that if Indigenous people relocated to urban areas, then their health outcomes would improve. However the evidence shows that the poor health status of Indigenous people is found in all areas where they live.

Barriers to health care can be classified as problems of availability, affordability, acceptability and appropriateness. All these barriers are relevant for Indigenous people living in urban areas, but the acceptability and appropriateness of services are particularly relevant, and are related to cultural issues.

Almost one in ten urban Indigenous people report difficulties in understanding or being understood by health service providers. There is evidence that Indigenous people in urban areas are less satisfied than people in remote areas with their access to health care.

The Aboriginal Community Controlled Health Services were initially established in urban areas to overcome the failure of mainstream services to address Indigenous needs. Despite evidence of an increasing urban Indigenous population, there has not been an expansion in the number of urban community controlled health services in recent years.

The Federal Government, through the health programs under its direct control, spends only 92 cents on Indigenous people for every $1 spent on the rest of the population. To reach dollar parity would require the expenditure of another $200 million/year.

And there are some major anomalies. For example, Indigenous use of the Pharmaceutical Benefits Scheme in major cities is considerably less than in remote areas, where there are special schemes to facilitate access.

The States and Territories spend much more — about $2.50 on Indigenous health for every $1 on the rest of the population, but so much of this goes on hospital-based care.

We need to improve primary care services, and integrate these with acute and rehabilitation services. We need to get people into these services earlier, and better manage their care, to mitigate the huge costs of chronic illness. We need to ensure that when Indigenous people are hospitalised they get the same treatment as other Australians. And we need to ensure the quality and sustainability of all services to our Indigenous people.

Of course, it is not only the health sector that must work smarter and harder if the gap is to be closed. As Anthony Dillon, a Lecturer at the University of Sydney’s Yooroang Garang School of Indigenous Health Studies, told a seminar in Sydney last night, there is a clear and profound link between education and health.

As he put it, Aboriginal children who leave school early are more likely to die early.

Unfortunately, if we continue on our current course, it seems that this will continue to be the outcome for too many Indigenous people.

Dr Russell moderated a forum on Indigenous health in Sydney last night