In 2008 the Rudd government launched the Close the Gap Strategy which, among other things, was meant to bring equity in health and wider wellbeing into the lives of Indigenous Australians.
After more than a decade, most of the targets set by government have not been reached, despite years of hard work and the expenditure of vast amounts of public funds. The reasons for under-achievement are complex and under review by government. How much of the funds allocated were misused? And can previous mistakes be avoided in the so-called ‘refresh’ strategy?
Indigenous Australians bear a heavy burden of ill-health, disabilities and premature deaths. Much of this excess load is due to degenerative diseases like diabetes, cardiovascular disease, liver disease, and chronic respiratory and kidney diseases. Cancers, accidents, violence, and smoking- and drug-related disorders and mental illness are other important contributors. Collectively, these disorders result in Indigenous people having substantially shortened life expectancy compared with other citizens.
Bringing equity in health and wellbeing to the Indigenous population is bound to be expensive. This is partly due to the existing heavy disease burden as well as the additional costs involved in providing clinical and related services and infrastructure to rural and remote areas. But the price to pay for health is not in question; this is a matter of fairness which all of us must acknowledge. However, the precise targeting of funding and its transparent accountability are issues which need much closer scrutiny.
This is how the taxpayer can know whether the monies spent are bringing the expected “bang for their buck”. In some instances, this has not been the case. Some examples are given to show what can, and sometimes has, happened.
There have been instances when metropolitan and regional Indigenous-specific clinical services have been fined or legally forced to close, for example at Mount Druitt and in Dubbo in NSW, because of financial mismanagement and insolvency. These episodes of mismanagement and their disruption to clinical services are detrimental to the health of their patients and their families and communities.
Wastage or mismanagement of funds intended for health-related purposes has occurred on a much larger scale than in those examples. For instance, multiple government agencies spent more than $50 million on about 800 residents in the Roebourne district in the Pilbara running short-term, uncoordinated programs. That is an average of more than $60,000 per person over one year.
The WA Department of Premier and Cabinet reviewed this matter and reported on the failure to improve outcomes for a community with entrenched social and health problems. This experience exposes bureaucratic dysfunction and a need for more visible accountability.
Millions of dollars paid to the Western Desert Lands Aboriginal Corporation (WDLAC) by mining companies in the Pilbara since 2008 did not benefit the local Martu people who hold native title over the land being mined. Claims of mismanagement of the money earned led to the corporation being put into administration by the Registrar of Indigenous Corporations.
The Mining and Pastoral MP, Mr Robin Chapple, said investigations by the Registrar of Indigenous Corporations were too often shrouded in secrecy. Meanwhile, the Perth-based, non-Indigenous acting chief executive of the WDLAC, with a staff of fewer than twelve, was being paid as much as the Prime Minister. Unsurprisingly, the local Martu people were frustrated, angry and their health service was disrupted and dysfunctional.
The Indigenous Advancement Strategy (IAS) allocated billions of dollars towards projects and programs to improve the lives and wellbeing of Indigenous people. However, much of the funding has gone towards desk jobs and less than half of the funds have been provided to Indigenous organisations.
More than half of the $4.1 billion of recent IAS grants went to charitable or tax-exempt bodies and more than half of $1 billion worth of IAS grants supposed to benefit very remote areas went to city- or town-based organisations. Fred Chaney, a former Federal Indigenous Affairs Minister and founding co-chair of Reconciliation Australia, said the IAS could be “innovative” and beneficial for Indigenous people, but it is bogged down in bureaucracy.
Trying to bring equity in health and wellbeing into the lives of Indigenous Australians since the Closing the Gap strategy was introduced over a decade ago has been a difficult and expensive task. Regrettably, most of the government-nominated targets have not been achieved. This has brought frustration and disappointment to all involved, especially the Indigenous people who expected that the program would bring them better lifelong prospects.
This has led to an ongoing attempt by the government in consultation with Indigenous stakeholders to revise and refresh the strategy with a new set of targets and timelines. It is hoped that this will help remove the inequalities in health borne by Indigenous Australians, thus removing one of this country’s worst embarrassments.
It is imperative that financial responsibility and transparent accountability become cornerstones of the soon to be announced, revised strategy which is to replace the current Closing the Gap model. This should ensure that the efforts to achieve better Indigenous health are maximised and that the public is aware that the work is being undertaken to its best possible effect. This should help to maintain the goodwill which has been a continuing feature of the nation’s efforts to bring better health to its original inhabitants.
Michael Gracey is a paediatrician who has worked with Aboriginal patients , their communities, and organisations for more than forty years. He was Principal Medical Adviser on Aboriginal Health to the West Australian Department of Health, became Australia's first Professor of Aboriginal Health, and is a previous President of the International Paediatric Association.
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