For progress on closing the health and life expectancy gap:
There have been some improvements to Indigenous child mortality with this target on track to be met by 2018. However, despite narrowing the gap in life expectancy, the rate of improvement is far too slow to close the gap. The situation is particularly bad for Indigenous people living in the Northern Territory, whose life expectancy is nearly 15 years shorter than non-Indigenous Australians.
The National Aboriginal and Torres Strait Islander Health Plan is a framework designed to guide future investment in Indigenous health care until 2023. An Implementation Plan is currently being developed.
On 1 July 2014, the government established the Indigenous Advancement Strategy, which combined over 150 programs into 5 streams, one of which is Safety and Wellbeing. Alongside this, the Indigenous Australians Health Program consolidated 4 previous funding streams to reduce costs and provide better flexibility of services. This program now encompasses primary health care, maternal and child health care, the Stronger Futures Health stream and a chronic disease fund. The government also dedicated $11.9 million to increasing access to essential primary health care for Indigenous people living in remote areas of the Northern Territory.
The Care for Kids' Ears program has achieved a 4% decrease in the number of Indigenous children with hearing conditions through raising awareness and promoting check-ups, but the rate remains double that of the non-Indigenous population.
Target #1: halve the gap in mortality rates for Indigenous children under 5 by 2018
A baseline of 1998 was chosen for this target so that trends would be more easily identifiable over the longer timeframe. Since 1998, child mortality rates have declined in Indigenous communities by 31%, resulting in a narrowing of the gap by over a third. The rate of improvement has slowed since 2006, however the target remains achievable.
This result means that, compared to 1998, seventy-one more Indigenous babies per thousand are surviving past their fifth birthday every year. However, despite concrete gains being made, Indigenous children are still twice as likely to die under the age of five relative to non-Indigenous children.
The leading cause of Indigenous child mortality in infants (<1yr) is pregnancy complications and disorders in fetal growth. The last decade has seen a 9% decrease in low birthweight babies as well as a 4% decrease in women smoking while pregnant (although this rate is still 4 times higher than non-Indigenous women). The leading cause for child mortality in Indigenous children between 1- 5 years old is injury and poisoning.
Child mortality rates are significantly influenced by factors such as the mother's smoking habits, diet, exercise, socio-economic status and education level. Therefore, further reductions to child mortality rates will require an integrated approach. The Better Start to Life program has been expanded to improve access to child and maternal health programs.
Target #2: close the life expectancy gap within a generation (by 2031)
The national gap between Indigenous and non-Indigenous death rates has decreased by 15% since 1998, however little progress has been made since 2006. At the rate the gap is currently narrowing, it will take 495 years to 'close the gap'. Therefore, more action needs to be taken as this target is not on track to be met.
In 2012, when the last statistics on life expectancy were collected, the gap had only decreased by 0.8 years for males and 0.1 years for females since 2005. This was partly due to gains made by the non- Indigenous population at the same time. The 2015 Close the Gap Report noted that such a small improvement may actually be statistically insignificant as it is within the margin of error and could in fact mean that the small improvement in life expectancy is non-existent. The next data on life expectancy will be collected by the Australian Bureau of Statistics in 2018.
In the Indigenous Reform 2012-13: Five Years of Performance report, the COAG Reform Council has expressed particular concern for Indigenous people living in the Northern Territory, especially women. Male life expectancy is only 63 years, while female life expectancy has actually fallen 0.7 years since 2005 to 68.7 years. Therefore, Indigenous Australians living in the Northern Territory are expected to live 6 years shorter than Indigenous people in other parts of Australia. Additionally, the Northern Territory has the largest gap between Indigenous and non-Indigenous life expectancy, with Indigenous men and women both expected to live 14.4 fewer years (compared to 10 years nationally).
Other 'gaps': chronic disease and mental health
In several other areas not specified as 'Closing the Gap' targets, Indigenous health is actually getting worse. Rates of disability and chronic disease amongst Aboriginal and Torres Strait Islander people rose from 21 to 23 per cent between 2009 and 2013. Three quarters of Indigenous deaths were classified as potentially avoidable during this period, compared to two thirds of non-Indigenous deaths. Indigenous Australians are 3 times more likely to have diabetes and twice as likely to have chronic kidney disease as the non-Indigenous population. This likelihood increases 2.5 times for people living in remote areas. Additionally, Indigenous Australians tend to develop these chronic diseases at an earlier age. These chronic diseases account for 81% of the health gap that currently exists.
Co-morbidity is also an issue since these conditions often intersect. 70% of Australia's Indigenous population are overweight or obese, which further increases the risk of chronic disease. Smoking also increases the risk of respiratory disease, although Indigenous smoking rates have declined 10% in the decade from 2002-12.
The gap between Indigenous and non-Indigenous mental health is also getting wider. Poor mental health can also be a risk factor for chronic disease. Just under a third of the indigenous population reported high levels of psychological distress. Indigenous rates of suicide are twice as high as in non-indigenous populations and their rate of hospitalisation for self-harm has risen 50% since 2004. There have been some successes, such as a 40% decrease in circulatory disease since 1998. However, overall chronic disease rates have increased 2% from 2009-13. In 2015, the Healthy for Life program was granted $36.2 million to expand its work on the management of chronic disease in Indigenous communities.