Contemporary Indigenous Health: Evaluating the Closing the Gap Policy and its Benefits for a Case Study on Type 2 Diabetes Management

This article evaluates the Closing the Gap policy and its benefits for managing type 2 diabetes in Indigenous communities. It explores the history, challenges, and achievements of the policy, and provides a case study on the holistic diabetes management plan for a patient. The benefits of the policy, such as financial relief, remote care services, and culturally safe care, are also discussed.

Running head: CONTEMPORARY INDIGENOUS HEALTH
Contemporary indigenous health
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Aboriginal health and wellbeing had been a sector that has been neglected for a long
period of time after the European colonization in the late 18th century. However the revolutionary
advocacy by the activists and social welfare agencies has been successful in implementing a
number of key changes in the social privileges rights that the aboriginals are deserving of (Alford
2015, p. 403). The Government reforms and funding for Aboriginals and Torres Strait islanders
have given rise to a number of different policies, especially in health care, in order to address the
health disparities or inequities present in the health care delivery. One prime example if such a
policy movement which has considerably reinvented health care service delivery for the ATSI
communities in the closing the gap initiative (Bové et al. 2018, p. 106852C). This assignment
will attempt to explore and evaluate aspects of this policy, its history and benefits provided with
respect to a case study.
Closing the gap can be defined as the strategic action taken by the Australian government
in the year of 2008 that aimed to reduce the disparities and inequalities present among the ATSI
people. On a more elaborative note, the initiation of closing the gap Policy was the formal
commitment made to the people to establish health equality within the coming 25 years in the
nation for all members. Tom Calma, ATSI Social Justice commissioner released the Social
Justice report in the year of 2005 which elaborated statistical data points indicating at the gaming
inequalities and disparities present for indigenous and non-indigenous Australian (Boyle, Zhang
& Chan, 2014, pp. 217-222). The start differences and disadvantages faced by the first people of
Australia was sufficient for the strain in government to finally make a formal commitment to
facilitate equality in all aspects of social privilege including healthcare and living conditions
within the next 25 years. The next year National Indigenous Health equity campaign began, a

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social justice campaign which aimed to eradicate the inequalities present in healthcare within
2030 with the power of coalition of more than 40 ATSI and non-indigenous health organizations
and human rights entities launched in Sydney on 2007. The cumulative efforts taken by these
government and non-government bodies finally resulted in establishment of National Indigenous
Reform Agreement which was later named closing the gap by Council of Australian
governments in March 2008 (Chan 2014, p. 217).
In 2011 National Health leadership forum was established as a steering committee for the
policy. It acted as a national representative body for ATSI organizations and working with
Australian government in order to improve the ATSI health outcomes set forth in the close the
gap policy. A remarkable achievement for the closing the gap policy had been in July 2013 when
Australian government introduced National aboriginal and Torres strait islander health plan; a
ten year health policy plan focusing on the government role in ensuring the flexibility of the
health system to the different needs expressed by this minority community so that they can make
healthy choices and have culturally safe and equal access to quality care. In the 10 years that
closing the gap policy has been established and implemented, there have been various
improvements made in the health status in life expectancy of the ATSI people. For instance, the
mortality rates for the aboriginal population has decreased by 14% since the last 10 years
especially for the people dying of chronic circulatory disorders. A progress has been reported in
management of chronic respiratory disorders and reduction of smoking in the aboriginal
population although there is still a significant gets left behind that are needed to be addressed. On
a similar note a few challenges that are contributed to the inability of this revolutionary policy to
achieve all of its 7 outcomes includes financial burden, lack of adequate funding, scarce
resources including transport and lacking time management. Moreover the lack of cultural safety

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and culturally appropriate care training in the existing health workforce and lack of recruitment
from the ATSI backgrounds with respect to healthcare workforce is another considerable
challenge that is restricting the smooth success of this policy (McKenna et al. 2015, p.881).
With respect to the case study the patient Judy is suffering from type 2 diabetes which is
one of the world's fastest growing chronic diseases and is widespread among Australian
population. Exploring further as per the details research reports the socially disadvantaged and
minority groups such as the search people of Australia are more prone to develop type 2 diabetes
due to their lifestyle, dietary habits and lack of health promotion behaviour that can prevent the
disease, which is fundamentally due to lack of health literacy among these people (Dimer et al.
2013, pp. 79-82). In order to better manage her diabetes Judy will require proper nutritional
management, pharmacological management, lifestyle modifications including exercises.
Exploring further as per the details research reports the socially disadvantaged and minority
groups such as the search people of Australia are more prone to develop type 2 diabetes due to
their lifestyle, dietary habits and lack of health promotion behaviour that can prevent the disease,
which is fundamentally due to lack of health literacy among these people (Baba, Brolan & Hill
2014, p.56).
The patient has been admitted to the health care facility due to her foot ulcer which is a
common manifestation of poorly managed diabetes, requiring daily dressing. Hence, she would
require a holistic diabetes management plan that was not only address a physical manifestation of
the disease but will also attract emotional spiritual and psychological impact of that type 2
diabetes on her living. With respect to closing the gap strategy, an aboriginal struggling with a
chronic disorder, requires holistic overall care plan that addresses her physical health needs

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educational needs and lifestyle modification needs as well for her to attain recovery (Harris et al.
2013, pp.S191-S196). Closing the gap initiatives have identified that certain historical social
cultural and community left factors are considerable determinants of aboriginal health which also
facilitates chronic conditions such as obesity and diabetes. It has two dimensions low levels of
physical activity, for a healthy diet and obesity is intricately linked socio-cultural factors
associated with a bottle and communities with very little awareness of these factors impacting on
the health of the community members. Closing the gap as a policy attempts to address all the
socio-cultural factors one by one why do fighting healthcare to the aboriginal patients so that the
therapeutic measures combined with these lifestyle changes and modifications facilitating help
emotional behaviour time together help the patient attain faster recovery (Adegbija, Hoy &
Wang 2015, p.e0123788).
There are various benefits that Judy will be able to avail while being registered to the
closing the gap scheme to manage her diabetes and its manifestation. Financial burden of
managing a chronic disorder is primarily the most concerning factor for aboriginals with lower
socioeconomic standard which is also one of the primary reasons for the lower health seeking
behaviour and destructive care services which leads to further exercise basins and higher
mortality rates. Closing the gap provides a co-payment program named as indigenous chronic
disease package which provide a significant reduction of the costs that a patient is required to
pay while availing care with the aid of government funding encouraging the patience to avail
care services for better living (Healthinfonet.ecu.edu.au 2018). Even in case of purchasing
medicines which is a very important aspect of diabetes management closing the gap policy
provides concessional reliefs letting the patient pay at least 5 times lesser for the medicine.
Closing the gap registration also provides the opportunity for aboriginal patients to avail remote

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diabetes care services from organizations such as Baker heart and diabetes Institute as a part of
the outreach health service program of the closing the gap policy. This will provide Judy the
opportunity to avail diabetic care services even in remote locations in case she lives territory
outskirts in aboriginal communities. This policy also has attempted to incorporate 90 % of
indigenous family diet to be consisting of healthy food basket for less than 25 % of the income
which will help her better manage her body weight and blood sugar without a high financial risk.
Lastly, closing the gap policy will also allow Judy to have culturally safe and culturally
appropriate home care services by community nursing enters which will help her better manage
her foot ulcer and her diabetes effectively (Abbott et al. 2012, pp.55-59).
AMS stands for aboriginal medical service which is a community controlled health care
facility providing culturally safe and specialist care to the ATSI populations. ALO on the other
hand is aboriginal liaison officer, acting like the mediator between healthcare providers and the
aboriginal patient and their family safeguarding emotional social as well as cultural aspects of
the healthcare service provided to the patient. They are the first point of contact for the
indigenous patients who provide consultation reference and educational suggestions to the
patients regarding how they can avail different care services and how they can manage their
diseases. ALOs understand patient concerns and provide referral suggestions to facilities such as
the AMS for similar community controlled primary care services for availing necessary care
benefits (Baba, Brolan & Hill 2014, p.56).
On a concluding note, closing the gap has been a revolutionary change in the Healthcare
sector of the ATSI populations. Closing the gap has only been able to achieve one of the seven
intended outcomes till now and yet it is providing considerable benefits to these aboriginal

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people which has significantly improved the health status and life expectancy. It can be hope that
with equal effort from the government and the society this strategy can successfully achieve all
of its outcome eradicating all inequalities and establishing justice based healthcare network in
Australia.

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References:
Abbott, P.A., Davison, J.E., Moore, L.F. & Rubinstein, R., 2012. Effective nutrition education
for Aboriginal Australians: lessons from a diabetes cooking course. Journal of nutrition
education and behavior, vol. 44, no. 1, pp.55-59.
Adegbija, O., Hoy, W. & Wang, Z., 2015. ‘Predicting absolute risk of type 2 diabetes using age
and waist circumference values in an aboriginal Australian community’, PloS one, vol. 10, no. 4,
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Alford, K.A., 2015. ‘Indigenous health expenditure deficits obscured in Closing the Gap
reports’, Med J Aust, Vol. 203 no, 9, p.403.
Australian Indigenous HealthInfoNet. 2018, History of Closing the Gap - Closing the Gap -
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Brisbane communities’, International Journal for Equity in Health, vol. 13, no. 1, p.56.
Baker.edu.au. 2018, Closing the gap in diabetes How is it going to be achieved?. [online]
Available at: https://www.baker.edu.au/-/media/documents/news/ET2017-04-031-COHEN.ashx?
la=en [Accessed 14 Aug. 2018].

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Bové, H., Steuwe, C., Saenen, N., Rasking, L., Nawrot, T., Roeffaers, M. & Ameloot, M., 2018,
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