Aboriginal and Torres Strait Islander people experience the worst health outcomes of any cultural group in Australia. There is an increasing understanding of the broader social, cultural, and environmental determinants that drive these health outcomes. Improvements in health status can be further impeded by system and service limitations and gaps, and by community and personal behaviours.
Poor health outcomes for Aboriginal and Torres Strait Islander people include a total burden of disease two and a half times that of non-Indigenous Australians.1 Chronic diseases contribute to two-thirds of premature deaths. Aboriginal and Torres Strait Islander people are twice as likely to die from cardiovascular disease, four times more likely to die from renal disease, nine times more likely to die from diabetes and 1.5 times more likely to die from cancer than a non-Indigenous person.2 These diseases have common risk factors: smoking, poor nutrition, and lack of exercise. There is also evidence that exposure to some risk factors during pregnancy and early childhood, such as poor nutrition and smoking, contribute to chronic disease later in life. Much of this risk and excess burden of disease can be prevented and managed with better access to health services, education and support for lifestyle modification.
In November 2008, the Australian Government committed to addressing the health needs and social determinants of health, such as education, housing and access to quality health services through a number of Council of Australian Governments agreed National Partnerships under the National Indigenous Reform Agreement (NIRA).
The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (NPA) aims to close the gap in life expectancy within a generation. The Commonwealth's Indigenous Chronic Disease Package (ICDP) is an example of a major policy instrument of several measures aimed at supporting the prevention, better identification and management of chronic disease among Indigenous Australians and includes the development of a relevant workforce and enhancement of the Indigenous health workforce.
Addressing risk factors for chronic disease is necessary from a preventive health perspective as well as to improve outcomes for those who are already sick.1,3 The ICDP targets risk factors by supporting lifestyle modification through education and information strategies.4 The combination of local Indigenous community campaigns targeting better health, the appointment of Dr Tom Calma as the National Tobacco Coordinator, and the roll out nationally of teams of regional tobacco coordinators, tobacco action workers and healthy lifestyle workers will support positive individual and community behaviour change.
Access to primary health care for Indigenous Australians is lower than for non-Indigenous Australians and is accompanied by an over-utilisation of hospital services. Medicare Benefits Schedule (MBS) expenditure is estimated to be 58% of the non-Indigenous average, and Pharmaceutical Benefits Schedule (PBS) expenditure is estimated at 60% of the non-Indigenous average.5 Access to effective primary health care can be supported by addressing the barriers that Indigenous Australians experience; namely affordability, complex needs and location/transport barriers.6 The ICDP provides an expanded Indigenous health workforce of project officers, care co-ordinators, tobacco workers and healthy lifestyle workers, working to complement other health professionals. This will provide support to Aboriginal and Torres Strait people and communities for lifestyle modification and self-management of chronic disease.
The ICDP uses economic incentives to facilitate better access and use of health services for Aboriginal and Torres Strait Islander people. Payments through the Practice Incentives Program (PIP) Indigenous Health Incentive are available to support general practices and accredited Indigenous health services to provide better health care including the early identification and best practice management of chronic disease. There is a requirement for participating PIP Indigenous Health Incentive services to participate in cultural awareness training. PBS Co-payment measures will improve the affordability of medicines to eligible Aboriginal and Torres Strait Islander people.
An ICDP monitoring and evaluation framework is being developed to inform the ongoing implementation of this Package. More information on the ICDP can be found at the website: http://www.health.gov.au/tackling-chronic-disease.
As the Minister for Indigenous Health, I commend the Australian and New Zealand Journal of Public Health for coordinating this Special Issue, which provides a forum for sharing information that can guide Indigenous health policy development and implementation.