As has been widely reported, the Council of Australian Governments (COAG) has agreed to move forward on disability reform, following the recent release of recommendations from the Productivity Commission.

A Select Council of Ministers from Commonwealth, States and Territories is to start work immediately on developing a National Disability Insurance Scheme (NDIS), and is due to report back at COAG’s first meeting next year.

Rhonda Galbally, a longstanding advisor to governments on health and disability issues, writes below that the reforms have important implications for health.

Disability reforms will address the social determinants of health

Rhonda Galbally writes:

A recent report by the ABS[1] indicates that almost 69 per cent of people with profound or severe disability report having four or more long-term health conditions, six times the rate reported by people without disability.

This same group tends to have higher rates of most conditions, across most age categories—arthritis; ischaemic heart disease; hypertensive disease; cardiovascular disease; type 2 diabetes; asthma; and be taking medication for a mental health condition. Of people aged 18 years and over with profound or severe disability, only 17.4 per cent considered their overall health to be very good or excellent, compared with almost 69 per cent of people without disability.

In fact, there exists a history of poor response from the health sector overall – from prevention to treatment, people with disabilities have lower levels of risk identification and treatment of their needs[2].

We know beyond doubt that health status and wellbeing impact broadly on a person’s life. We know that good health outcomes are positively correlated with social inclusion and connectedness, employment and workforce participation and higher incomes[3].

And the population group that is highly interactive with the health sector is people with disability and chronic illness – also disadvantaged on all social determinant measures.

A recent report, Shut out: The experience of people with disabilities and their families in Australia, describes the social, cultural and political isolation experienced by many people with disability. It noted:

A lack of social inclusion and the multiple barriers to meaningful participation in the community faced by people with disabilities were the most frequently raised issues…People with disabilities and their families, friends and carers reported daily instances of being segregated, excluded, marginalised and ignored. At best they reported being treated as different. At worst they reported experiencing exclusion and abuse, and being the subject of fear, ignorance and prejudice.[4]

This brief snapshot of the status of Australians with disability borders on scandalous, and urgent action is required.

The solution must be based on major reform

In February 2011, Australian governments endorsed the National Disability Strategy, an ambitious, whole-of-government, 10-year plan, which will help give practical effect to the United Nations Convention on the Rights of Persons with Disability (to which Australia is a signatory).

As expected, the Strategy covers health and well-being: Australia’s mainstream health services are not always well informed or well equipped to respond to the needs of people with disability. Research indicates that despite increased longevity, the mortality and morbidity rates for adults with disability/impaired decision-making capacity are still significantly higher than for the general population.[5]

It also defines the desired policy outcome: “All health providers (including hospitals, general practices, specialist services, allied health, dental health, mental health, population health programs and ambulance services) have the capabilities to meet the needs of people with disability.”[6]

Other domains addressed are: economic security; learning and skills development; rights and justice; accessible communities; and personal support – all of these resolute to health status.

The links between the social determinants of health and the National Disability Strategy are clear. Improving the capacity of many people with disability to exercise their rights to be treated as equal citizens will improve their health.

But there is one critical step to achieving this. What is needed is major reform so that people with disability have sufficient levels of high-quality support to actively engage in their communities – in quality education and training, at work, or participating in community and civic life.

Australian government agrees to implement the National Disability Insurance Scheme

The solution lies in implementing the Productivity Commission’s recommendation for the creation of a National Disability Insurance Scheme. Such a Scheme is the best buy  to improve health status because it would enable people with disability from whatever cause including chronic illness, to participate in their communities, exercise their rights, undertake education and training, and find employment. It would change their lives.

The Australian Government therefore should be congratulated for its recent commitment to proceeding with the National Disability insurance Scheme (NDIS) based on:

• Doubling current resources for a national scheme – with uniform provision of services across Australia

• A no-fault universal insurance scheme for disability similar to Medicare for treatment,

• Eligibility based on need rather than the type of disability or cause. It will be equitable

• Shifting choice and power away from the service sector to individuals and their families

• Principal benefits will include: national standard-based early intervention, support services, therapies, aids and equipment, home modification

• All based on functional impairment – needs met on a timely basis

• Case management to facilitate independence, maximise potential and plan transitions over the life course, when required.

• Training, development and access to work to build self-esteem and reduce long term costs.

• Insurance principles and the ability to drive best practice based on national evidence  – critical to long term efficiency and cost containment.

• Market place for service provision to drive efficiency and innovation.

You can follow Rhonda Galbally on Twitter


For more information:

• Every Australian Counts

• Jenny Macklin, Minister for Families, Housing, Community Services and Indigenous Affairs, at The Drum on why reform is needed

An overview of what the reforms entail – and the challenges they face – is at The Conversation by Dr Alex Collie, Chief Research Officer of the Institute for Safety, Compensation and Recovery Research (ISCRR)

• Jessica Irvine, economics correspondent at the SMH, argues the case for reform on a number of grounds.


References to Rhonda Galbally’s article

[1] ABS 2010, Health and disability: Aspects of the Australian Experience, cat.4367.0, ABS, Canberra.


[3] VicHealth 2005, Background paper to VicHealth position paper on health inequalities, VicHealth, Melbourne

[4] National People with Disabilities and Carer Council 2009, Shut Out: The experience of people with disabilities and their families in Australia, FaHCSIA, Canberra, p. 3.

[5] Commonwealth of Australia 2011, 20102020 National Disability Strategy, Attorney General’s Department, Canberra, p. 60.

[6] ibid. p.60.