Raising Aboriginal life expectancy to that of the general population is a key part of the federal government’s “closing the gap” crusade — but a report out this week shows little if any progress is being made.
Indigenous health experts are sceptical of the efforts being taken to close the gap in life expectancy between Aboriginal and non-Aboriginal Australians — currently 11.5 years for males and 9.7 for females — and believe it could actually be widening. The ABS estimates that for indigenous males, life expectancy at birth is 67.2 years compared to 78.7 years for non-indigenous males. For indigenous females it’s 72.9 years, compared to to 82.6 years. Indigenous mortality is falling at a slower rate than non-indigenous mortality.
Released Wednesday, the Closing the Gap report says meeting the target remains “extremely challenging” and will not be closed by 2031 (which is the government’s target) unless the indigenous mortality rate declines at a much faster pace. Indigenous health experts told Crikey that with chronic diseases on the rise, there are not enough preventative health initiatives in place.
One researcher — who didn’t want to be identified in case their comments jeopardised funding — thinks progress is going backwards and the life expectancy gap could be increasing. Another researcher believes the public are unaware of how difficult the task is, and are “seduced” by the government’s targets.
The report shows two thirds of indigenous deaths are from chronic diseases that have lifestyle-related risk factors. Circulatory disease, diabetes, cancer, injury are the leading cause of death for indigenous people and experts say they are largely preventable by treating lifestyle factors.
Dr Lesley Russell, senior research fellow at the ANU’s Australian Primary Health Care Research Institute, believes that with a focus on early intervention, mortality rates could be reduced. “We know for things like cancer the death rates are increasing. The risk factors are largely preventable and mortality and morbidity rates can be affected by good intervention and treatment,” Russell said.
While there are measures outlined in the report, researchers believe they don’t go far enough. “One of the big problems is existing diseases,” said Dr Kerin O’Dea, professor of population health and nutrition at the University of South Australia. “Once you’ve got diabetes at an early age you’re not going to reverse it.”
According to data published by HealthinfoNet, indigenous people are seven times more likely to die of diabetes than non-indigenous Australians. Indigenous people die of cancer at a rate higher than non-indigenous people and are “significantly more likely to have cancers that have a poor prognosis; usually diagnosed with cancer at a later stage; less likely to receive optimal treatment; and are more likely to die from cancers than other Australians”.
Dr Neil Thomson, professor of indigenous health at Edith Cowan University, agrees addressing upstream factors that contribute to chronic disease is critical. He’s encouraged by the latest data but wants to see more anti-smoking measures — smoking rates in some indigenous communities are as high as 60% and indigenous people smoke at a rate three times higher than non-indigenous people.
Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda believes efforts to reduce smoking have failed due to a lack of proper engagement with and involvement of indigenous people. “[Anti-smoking measures] won’t work unless Aboriginal people are there delivering the programs. I’m forever having a go at the government for lack of proper engagement with the Aboriginal community,” he said. Russell agreed: “We can’t do these things to Aborigines, we need to do it with them.”
The idea that programs can only be effective if indigenous people can lead them is not new; it has been championed for decades by Aboriginal leaders. Another issue is the need for a wider concept of indigenous health. For Gooda, any measure of health and wellbeing must address the high indigenous incarceration rate.
“It’s the biggest gap we’ve got, and it’s growing. An important part of our health is social and emotional wellbeing. It [indigenous incarceration] contributes to our ill health,” he said.
A recent report found 26% of Australia’s adult prison population is indigenous, despite making up 2.5% of the population. And the problem is getting worse: Aboriginal imprisonment rates increased by 31.9% between 20o0 and 2006. Half of all juveniles in detention are indigenous.
With indigenous people dying from intentional self harm at twice the rate of non-indigenous people, Aboriginal leaders believe addressing the incarceration is critical. “We’re lobbying very hard for incarceration rates to be included as a [CTG] target. I think they are receptive,” Gooda said.
While indigenous health experts are critical of aspects of the CTG report, they recognise the significance of the document, the political capital invested in it, and its bipartisan support. “I think it’s very important we document progress or lack of it. It’s very good the government is confronting the data,” O’Dea said.
Gooda believes a hallmark of indigenous policy has been a lack of continuity. “The real fault in Aboriginal affairs is we always start something new,” he said.
Not this time. This is the fifth CTG report and Gooda is “very confident” the initiative will continue, and new national partnership agreements will be signed. The release of the report produced a rare moment of bipartisanship in the Parliament. That at least, is cause for hope.