Closing the Gap Program and its Impact on Indigenous Health Outcomes

This essay explains what the policy is, its relevance on the health results of the indigenous Australians along with challenges which might have impacted their change. Moreover, it analyses the possible long term consequences of diabetes to social health determinants, the advantage of being registered on the program, the responsibilities of Aboriginal Medical Service (AMS) together with Aboriginal Liaison Officer (ALO) and the services they deliver. Lastly, the essay states the connection between the AMS, ALO and community health centres.

NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institutional Affiliation
Professor’s Name
City
Date

NURSING ASSIGNMENT 2
Introduction
The closing the gap program necessitates people to raise insights from a focus on deficits
and issues to actively realizing and supporting the full engagement of the aboriginal people in the
economic along with social life of the country. The essay explains what the policy is, its
relevance on the health results of the indigenous Australians along with challenges which might
have impacted their change. Moreover, it analyses the possible long term consequences of
diabetes to social health determinants, the advantage of being registered on the program, the
responsibilities of Aboriginal Medical Service (AMS) together with Aboriginal Liaison Officer
(ALO) and the services they deliver. Lastly, the essay states the connection between the AMS,
ALO and community health centres.
Body
Closing the gap is a governmental program with the target of improving Aboriginal and
Torres Strait Islander individuals’ lives by minimizing disadvantage among the people. This is
concerning educational accomplishment, life expectancy, child mortality, access to early
childhood education and employment outcomes (Parter, Wilson, and Hartz, 2019, p.5).
The policy was created in reaction to the demand of the social justice report and the close
the gap report social justice campaign of 2005 (Chino et al., 2019, p.1). In collaboration with
Aboriginal and Torres Strait Islander individuals, the Australian government agreed to combine
efforts to realize equity in life expectancy along with health status amidst aboriginal individuals
and non-aboriginal individuals (Head and O’Flynn 2015, p.341). It happened in March 2008
when they endorsed the indigenous health equality summit statement of intent (Das et al., 2018,
p.328) where they spend 1.6 billion dollars through four years on its aboriginal long-term disease

NURSING ASSIGNMENT 3
package (Trivedi et al., 2017, p.502). The package focused on the expansion of the indigenous
workforce, primary health care along with preventive health.
The relevance of the closing of the gap strategy on aboriginal people is that it has
improved the health outcomes since fewer people die as a result of long-term illnesses. As an
illustration, the aboriginal and non-aboriginal mortality rate over the long term of 1998 to 2012
has decreased by 13.2 deaths and 7.5 deaths per 100,000 per annum accordingly (Ring et al.,
2016). For child mortality, there is a notable decline of 5.5 deaths per 100,000 per annum of the
indigenous people and 2.1 deaths per 100,000 per annum of the non-indigenous people (Ring et
al., 2016).
However, the cardiovascular disease has a notable decrease in the mortality proportion
for aboriginals and non-aboriginals of 12.3 and 7.7 deaths per 100,000 per year accordingly. For
cancer, it has a declined mortality proportion of 1.3 deaths per 100,000 per annum but an
inflation of 2.1 deaths per 100,000 per year of the aboriginal people (Ring et al., 2016).
The challenges which might have impacted the change in the wellbeing outcomes of the
aboriginal people may include the staff shortages particularly in remote areas (Kirkham et al.,
2017, p.524) along with the non-existence of indigenous team who could take a subsidiary
closing the gap exercise. Inadequate public transport services and the non-existence of cultural
awareness together with impartiality in general care also affected their change in health results.
Furthermore, the direct consultation and medication costs along with poor understanding
on immense billing operations and the deficiency of financing for aboriginal wellbeing strategies
was a challenge. Lastly, the health services not having the knowledge of the figure of the
aboriginal patients end up not identifying themselves because the staffs is not self-confident of

NURSING ASSIGNMENT 4
asking clients on their indigenous condition and the aboriginal people hence affecting the health
outcomes (Freeman et al., 2016, p.335).
Type II Diabetes results in the damage of the small blood vessels called microvascular
complications (Herrmann et al., 2015, p.521) which lead to issues of nerves, eyes, kidneys, and
feet. Moreover, macrovascular complications may be an impact of Type II Diabetes on Judy
which leads to a build-up of plaque hence vandalizing the large blood vessels of the brain, heart,
and legs (A Adeshara, G Diwan and S Tupe 2016, p.1309). The possible long term consequences
of Judy's diabetes may comprise depression, blindness, kidney failure, amputation, heart attack,
and stroke.
Diabetes affects work as it impacts community and employers by bringing about work
loss along with health affiliated work shortage for persons who retain their employment. Also,
diabetes has an impact on income in that savings are reduced because of the increase of the
diabetic-affiliated disbursements on medicines and therapy leaving less income to invest and
provide education (Schofield et al., 2015, p.e0116860). Lastly, Judy’s illness affects education in
that it impacts learners' cognitive functioning and the capacity to concentrate on their studies
leading to poor performance.
Within the CTG policy, diabetes has been reviewed via the initiation of Aboriginal
Community Controlled Health Services (ACCHS) (Gardner et al., 2018, p.541). It has facilitated
the taking part in health at a community level, resulting in the establishment of health results and
elated hospital consultations.
The strategy of closing the gap identifies and contributes to advanced health results for
indigenous people with severe illnesses through supporting them to navigate the healthcare
system and improve access to coordinated and multidisciplinary care. Consequently, the policy

NURSING ASSIGNMENT 5
helps to better manage chronic illnesses and help patients to gain access to specialists. Through
it, nurses’ help patients understand their concerns and provide them with guidance to find the
best care along with tools to manage their conditions well enough hence avoid hospitalization.
When registered on closing the gap on Judy’s social health determinants, she would have
the advantage of being registered for the Pharmaceutical Benefits Scheme (PBS) Safety Net
where the CTG PBS Co-payment measure does not interfere with the amount that could be
included in a family's Safety Net Threshold (Mellish et al., 2015, p.634). Moreover, Judy will
have access to free PBS medications as a result of the CTG PBS Co-payment Program that was
initiated to decrease the costs of PBS therapy available for aboriginals at risk of life-threatening
illnesses. The policy also ensures that for a patient like Judy she gets full health potential and has
barrier-free and equitable care disregarding a person’s economic or social position.
After being registered on CTG, Judy will be involved in paid employment hence leading
to higher incomes which she will use for her care. This is possible since few indigenous diabetic
patients are allowed to engage in paid jobs (McDermott et al., 2015, p.68). The income she gets
can be used in improving her diet and also improve where she lives to improve her health.
Aboriginal Medical Service (AMS) is a health service that is subsidized to allot services
to the indigenous people (Anderson, and Brady 2018). It was the initial Aboriginal Community
Controlled Health Service in Australia and currently, it is the core aboriginal community
organization. On the contrary, Aboriginal Liaison Officer (ALO) helps with access to health
services and their objective is to elevate the cultural awareness along with the sensitivity of
health services to the various wants of the indigenous Australians. They offer cultural, social,
emotional and spiritual support to indigenous patients alongside their family members should
they use the health facility at GV health.

NURSING ASSIGNMENT 6
Aboriginal Medical Service has several services that can be accessed throughout all of
life's attention. The services offered comprise of chronic disease management, sexual health
services, and postnatal services, allied health services inclusive of optometry and general
practitioner clinics along with Audiometry (Hawthorne, M., 2018, p.8). Furthermore, other
services offered include community-based programs, dental health services, counselling, hearing,
women's and men's health programs, mental health programs and nutrition and exercises.
On the other side, Aboriginal Liaison Officer provides services such as arranging
transport, planning discharge, support counselling, assessment, accommodation, and family
meetings (Grant and Draper 2018, p.499). Furthermore, they impact the lives of indigenous
customers alongside their loved ones and enhancing involvement with clinical practitioners
(McKenna et al., 2015, p.881).
The reason why AMS and ALO would be referring Judy is because she needs to be
dressed up daily as per the request from the Aboriginal Liaison Officer. This is not offered by
Aboriginal Medical Service hence Judy had to be dismissed from the facility to go home for the
community nurses to visit her every day at home. Also, since the Aboriginal Medical Service
does not do home visits, Judy had to be moved to the UTS community health center which can
visit her at home (Franco-Trigo et al., 2019, p.31).
Aboriginal Medical Service together with Aboriginal Liaison Officer are related in that
the Aboriginal Liaison Officer gives support and information to GV health staff to help them
provide culturally prime health services (Jones, Lattof and Coast 2017, p.267). As the Aboriginal
Medical Service offers those services, the Aboriginal Liaison Officer takes the responsibility of
helping the patients acquire those services at community health centers. Moreover, to advance

NURSING ASSIGNMENT 7
access to these health services, Aboriginal Liaison Officer is expected to cooperate
constructively with Aboriginal Medical Service and community health centers.
Conclusion
The closing the gap program has improved the wellbeing of the aboriginal Australians as
it is seen in the reduction of mortality proportion. However, the change in the outcomes of the
indigenous health is impacted by staff shortages, inadequate public transport and deficiency
funding. The policy also helps to better manage chronic illnesses and help patients to gain access
to specialists. The importance of registering to the program is that it ensures patients gets full
health potential and has barrier-free and equitable care disregarding a person’s economic or
social position.

NURSING ASSIGNMENT 8
References
A Adeshara, K., G Diwan, A. and S Tupe, R., 2016. Diabetes and complications: cellular
signaling pathways, current understanding, and targeted therapies. Current drug targets, 17(11),
pp.1309-1328.
Anderson, I. and Brady, M., 2018. Performance indicators for Aboriginal health services.
Chino, M., Ring, I., Pulver, L.J., Waldon, J. and King, M., 2019. Improving health data for
indigenous populations: The international group for indigenous health measurement. Statistical
Journal of the IAOS, (Preprint), pp.1-7.
Das, M., Kini, R., Garg, G. and Parker, R., 2018. Australian Aboriginal and Torres Strait
islanders' mental health issues: A litany of social causation. Indian Journal of Social
Psychiatry, 34(4), p.328.
Franco-Trigo, L., Tudball, J., Fam, D., Benrimoj, S.I. and Sabater-Hernández, D., 2019. A
stakeholder visioning exercise to enhance chronic care and the integration of community
pharmacy services. Research in Social and Administrative Pharmacy, 15(1), pp.31-44.
Freeman, T., Baum, F., Lawless, A., Javanparast, S., Jolley, G., Labonté, R., Bentley, M., Boffa,
J. and Sanders, D., 2016. Revisiting the ability of Australian primary healthcare services to
respond to health inequity. Australian Journal of Primary Health, 22(4), pp.332-338.
Gardner, K., Sibthorpe, B., Chan, M., Sargent, G., Dowden, M., and McAullay, D., 2018.
Implementation of continuous quality improvement in Aboriginal and Torres Strait Islander
primary health care in Australia: a scoping systematic review. BMC health services
research, 18(1), p.541.

NURSING ASSIGNMENT 9
Grant, R. and Draper, N., 2018. The importance of Indigenous Health Liaison Officers and
family meetings to improve cardiovascular outcomes in Indigenous Australians. Australian and
New Zealand journal of public health, 42(5), pp.499-500.
Hawthorne, M., 2018. A new model of indigenous health care. Australian Medicine, 30(21), p.8.
Head, B.W. and O’Flynn, J., 2015. 15. Australia: building policy capacity for managing wicked
policy problems. The International Handbook of public administration and governance, p.341.
Herrmann, M., Sullivan, D.R., Veillard, A.S., McCorquodale, T., Straub, I.R., Scott, R., Laakso,
M., Topliss, D., Jenkins, A.J., Blankenberg, S. and Burton, A., 2015. Serum 25-hydroxyvitamin
D: a predictor of macrovascular and microvascular complications in patients with type 2
diabetes. Diabetes Care, 38(3), pp.521-528.
Jones, E., Lattof, S.R. and Coast, E., 2017. Interventions to provide culturally-appropriate
maternity care services: factors affecting implementation. BMC pregnancy and childbirth, 17(1),
p.267.
Kirkham, R., Boyle, J.A., Whitbread, C., Dowden, M., Connors, C., Corpus, S., Mccarthy, L.,
Oats, J., McIntyre, H.D., Moore, E. and O’Dea, K., 2017. Health service changes to address
diabetes in pregnancy in a complex setting: perspectives of health professionals. BMC health
services research, 17(1), p.524.
McDermott, R.A., Schmidt, B., Preece, C., Owens, V., Taylor, S., Li, M. and Esterman, A.,
2015. Community health workers improve diabetes care in remote Australian Indigenous
communities: results of a pragmatic cluster randomized controlled trial. BMC health services
research, 15(1), p.68.

NURSING ASSIGNMENT 10
McKenna, B., Fernbacher, S., Furness, T. and Hannon, M., 2015. “Cultural brokerage” and
beyond: piloting the role of an urban Aboriginal Mental Health Liaison Officer. BMC Public
Health, 15(1), p.881.
Mellish, L., Karanges, E.A., Litchfield, M.J., Schaffer, A.L., Blanch, B., Daniels, B.J., Segrave,
A. and Pearson, S.A., 2015. The Australian Pharmaceutical Benefits Scheme data collection: a
practical guide for researchers. BMC research notes, 8(1), p.634.
Parter, C., Wilson, S., and Hartz, D. L. (2019). The Closing the Gap (CTG) Refresh: Should
Aboriginal and Torres Strait Islander culture be incorporated in the CTG framework? How?
Australian and New Zealand Journal of Public Health, 43(1), 5-7.
Ring, I., Dixon, T., Lovett, R. and Al-Yaman, F., 2016. Are Indigenous mortality gaps closing:
how to tell, and when?.
Schofield, D., Cunich, M., Kelly, S., Passey, M.E., Shrestha, R., Callander, E., Tanton, R. and
Veerman, L., 2015. The impact of diabetes on the labor force participation, savings and
retirement income of workers aged 45-64 years in Australia. PloS one, 10(2), p.e0116860.
Trivedi, A.N., Bailie, R., Bailie, J., Brown, A. and Kelaher, M., 2017. Hospitalizations for
chronic conditions among indigenous Australians after medication copayment reductions: the
closing of the gap copayment incentive. Journal of general internal medicine, 32(5), pp.501-507.