Closing the Gap Strategy: A Governmental Approach to Achieve Health Equality

This article discusses the Closing the Gap strategy, a governmental approach to achieve health equality among the Aboriginal and Torres Strait Islander people. It explores the targets and initiatives aimed at reducing the health gap and improving outcomes. The article also highlights the impact of social determinants on the health of Aboriginal and Torres Strait Islander peoples and the need for a national approach to address the health inequalities.

Running head: PUBLIC HEALTH
PUBLIC HEALTH
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PART-A
Closing the Gap strategy
Closing the Gap strategy is a governmental approach which focuses to diminish the
health weaknesses amongst the Aboriginal and Torres Strait Islander people associated with
their child mortality, life expectancy, educational attainment, employment outcomes and
access to primary childhood education. This initiative is taken by the Australian government
as a formal commitment that will aim to achieve the health equality in Aboriginal and Torres
Strait Islander people by 2025 (Department of the Prime Minister and Cabinet, 2019). This
program was developed after the call for response based on Close the Gap social justice
movement and Social justice report 2005. Since the year 2008, the Australian government
with the help of the general indigenous population have aimed to provide better employment,
health and education outcomes to the Aboriginal and Torres Strait Islander populace. This
strategy also aimed to eradicate the health gap amongst the non-indigenous and indigenous
populace for better life expectancy rate.
In December 2007, the Council of Australian Governments (COAG) that includes of
state and territory, local governments and federal leaders, had committed towards “closing
the gap “in terms of life expectation among the Aboriginal and Torres Strait Islander and
non-Aboriginal Australians. The Council of Australian Governments (COAG) had also
agreed to accomplish this goal in a specific timeframe and hence this strategy initiated by
COAG was later known as “Closing the Gap” strategy (Council of Australian Governments,
2019). The change in the well-being condition of Aboriginal and Strait Islander people will
be screened and managed by the Council of Australian Governments (COAG). The Council
of Australian Governments (COAG) has established definite targets that will screen the
enhancements in the wellbeing and health of Aboriginal and Strait Islander individuals. The

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targets established by The Council of Australian Governments (COAG) area as follows
(Australian Indigenous HealthInfoNet, 2019):
 Close the Gap among the life expectation by the year 2031.
 Halve the child mortality gap by 2018
 Halve the numeracy, writing and reading gap by 2025
 Close the school attendance gap by 2018
 Halve the employment gap by 2018
The prime minister releases a closing the Gap report each year to the parliament which
exhibits the detail of the health progress achieved on the targets (Aboriginal and Strait
Islander people). Close the Gap Steering Commission, also issues report which details the
progress on two health-associated targets and therefore deliver recommendations for health
improvements of the targets to the Australian government. In 2005, the existing Aboriginal
and Torres Strait Islander Social Justice Commissioner, Professor Tom Calma, had issued the
social impartiality report that motivated the government of Australia to compel to attain
health equivalence among the aboriginal and strait islander population in next 25 years
(National Congress of Australia's First Peoples, 2019).
In 2018 December, COAG had committed to form an honest official relationship with the
Aboriginal and Torres Strait Islander to settle the “Closing the Gap Refresh” and deliver an
opportunity of implementing new agendas for enhanced ongoing engagement. A novel joint
council was created on “Closing the gap” on 27 March 2019 that marked the onset of a
historic step towards enhancing the relationships among the Australian government and
Aboriginal and Torres Strait Islander population (Close The Gap, 2019).

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The possible impact of the creativity upon the social determinants of Aboriginal and
Torres Strait Islander Peoples’ health
Aboriginal and Strait Islander people are also known as the indigenous population
who are believed to descend from Australia and other surrounding islands before the
colonisation of British era (McNiven, 2017). The overall life expectancy of the aboriginal and
strait islander people vary extensively from the non-indigenous population due to their
disadvantage health outcome and poor socio-economic condition. Substantial differences
were observed in the morbidity, disability and mortality health experience of the aboriginal
populace as likened to the non-aboriginal population. The Aboriginal and Strait Islander
population experience 2.4 times more burden of disease (BoD) as likened to the non-
indigenous population, where 70% of the total disease burden was due to chronic condition in
2011 (Australian Bureau of Statistics, 2019). 19% of the health gap among the aboriginal and
strait islander and non-aboriginal people were due to cardiovascular disease and 23% was due
to consumption of tobacco. According to the Australian Institute of Health and Welfare, the
health gap among the indigenous and non- indigenous population beings from the birth and is
persistent throughout their life. 19% of the overall disease burden result due to high mental
and substance abuse illness like depression, alcohol consumption and anxiety (Australian
Institute of Health and Welfare, 2019). Hence, it is established that the well-being condition
of the Aboriginal and Strait Islander population need a national approach that includes the
association of Australian government and the aboriginal population to reduce the increasing
health gap and burden of diseases.
Due to increasing life expectancy of the aboriginal people, the Australian government
is identifying different strategies of working with the aboriginal communities and leaders,
who will aim to assist the indigenous proprietorship and will empower true association with
the government. This association will help in recognizing the variety of culture and

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surrounding of aboriginal Australians and also ensure that the aboriginal communities are
included in the regional and local decision-making process (Conte et al., 2019). This
requirement led to the establishment of “empowered community initiatives”, which includes
the Australian government and indigenous communities to work collectively and establish
different priorities that will emphasize on strengthen the health services of the aboriginal
population and also collect adequate funds for their health betterment at the regional level.
Empowered Communities Initiatives is designed as the long-term initiative that will aim to
enhance the aboriginal ownership and also give the aboriginal and strait islander people the
authority to communicate with the leaders and state the social factors of well-being that is
resulting in their increased disease burden (National Indigenous Australians Agency, 2019).
The poor health outcome of the aboriginal and strait islander population is due to their
disadvantaged location and different social determinants such as economic factors,
environmental factors, community factors and personal factors that leads to high health
inequality amongst the aboriginal population as associated to the non-aboriginal population
(Lowe & Yunkaporta, 2018). The Australian Institute of Health and Welfare, stated that the
socio-economic disadvantage is considered as the primary risk factor that accounts for
approximately 1/3rd to ½ of the health gap within the life expectancy among the aboriginal
and non-aboriginal population. From the national health survey 2004-05, it was identified that
the major social determinants that were accountable for poor health consequence of the
aboriginal people are lack of education, poor household income, overcrowding and poor
employment status. This social determinants were considered as the major health risk factors
that result in 46% of the total well-being gap amongst the indigenous and non-indigenous
populace (Department of the Prime Minister and Cabinet, 2019).
The evidence from the Australian Institute of Health and Welfare, states that the
modifiable risk influences act in different combinations that will escalate the threat of poor

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well-being outcomes amongst the aboriginal population such as stroke, cancer, diabetes and
ischaemic heart disease. The health behaviour risk also influences the biological risk issues
like hypertension, high body mass and high level of cholesterol (Lukaszyk et al., 2018). The
other associated health behaviour include adequate diet, physical exercise and infant
breastfeeding which have a shielding influence on the health condition of the aboriginal and
strait islander population. The relationship between the health outcome and social
determinants are complex and is facilitated by connections with other associated factors
(Australian Institute of Health and Welfare, 2019). The direct relationship was observed
among the morbidity or mortality rate of aboriginal population and their poor socio-economic
inequality. 38% of the aboriginal population exhibited higher blood pressure as compared to
the non-aboriginal population, particularly for the population existing in the socio-
economically underprivileged areas. The population residing in the socio-economically
disadvantaged areas exhibit higher rate of diabetes (16%) as compared to the population
residing in the advantaged area (9%) (Department of Health, 2019). Enhanced level of
psychological distress were directly associated with the lower educational achievement,
lower income and unemployment. Hence, the Australian government must take all the require
initiatives to report the social determinants of well-being and reduce the morbidity or
mortality rate among the aboriginal and strait islander population.
The Redfern statement was launched by the Australian government to report the
health inequality and disadvantage that is accountable for high mortality rate and health gap
within the aboriginal and strait islander population. This statement is also considered as the
aboriginal and trait islander blueprint which will focus on delivering the change that the
nation’s political leaders must bring for the health betterment among the aboriginal
population (Australian Human Rights Commission, 2019). The inauguration of Redfern
statement was considered as the watershed moment for the indigenous population

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organization from the justice, health, disability, violence prevention, families and children
sectors that will come together and demand for an enhanced and better association with
Australian government. This statement was launched during the Federal Election conducted
in June 2016 and will focus on the objective to reduce the child mortality gap of indigenous
population and commit to reduce the overall gap in life expectation by the year 2030 as the
national priority. Hence, through this initiatives, the Australian government will consider the
health issues and risk factors of aboriginal population as their primary agenda and recognize
the health equality (Jordan, 2018).
PART-B
Introduction
Depression is considered as the most common and severe medical disease which
affects the individual in a negative aspect of thinking, feeling and acting. Depression leads to
the sense of loss of interest in general happenings that further result in different types of
physical and emotional issues. This issues decreases the capability of an individual to
function and work effectively (Taylor et al., 2017). This study will focus on the health
problem of depression among the aboriginal and strait islander populace. The aboriginal
Australians are considered as the marginalised population among the Australian society with
severe influence of the early European reimbursement of Australia that consist of violence,
death and diseases on the aboriginal population and the loss of out-dated land by colonisation
(Shen et al., 2018). This condition had resulted in the long-term psychological distress,
anxiety and depression amongst the aboriginal populace as compared to the non-aboriginal
populace. Rendering to the Australian Bureau of Statistics, every 1 in 3 individual belonging
to the aboriginal and strait islander community experience enhanced level of mental distress,
which is approximately twice higher than the rate of non-indigenous population. Hence,

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aboriginal and strait islander population are chosen population to exhibit the condition of
depression (Shen et al., 2018). Different mental health promotions intervention are
considered for delivering positive psychological health and well-being among the indigenous
population that will aim to reduce the psychological distress among the population and also
promote the positive mental well-being. Exercise intervention, improving social support,
depression and suicide prevention, universal intervention, indicated intervention and selective
intervention are the considered interventions that will promote health and wellbeing among
the aboriginal population (Australian Bureau of Statistics, 2019).
Understanding of depression among the Aboriginal population
Depression is defined as states where the affected individual develop low mood and
sense of worthlessness among themselves. They also tend to lose their interest from the
regular activities of life that separate them from the healthy human beings. The individual
suffering from depression also experience suicidal ideation and suffer from poor sleep,
weight loss and reduced appetite associated with impaired concentration (Balaratnasingam &
Janca, 2019). The rate of depression experienced by the aboriginal population was extremely
high as compared to the non-aboriginal population, as the aboriginal population reside in the
poor socio-economic area and disadvantaged area. According to the Australian Institute of
Health and Welfare, 1/3rd of the aboriginal population suffer from extremely high level of
mental distress, which includes anxiety and depression and is approximately 3 times more
complex and high as associated to the non-indigenous populace (Australian Institute of
Health and Welfare, 2019). Anxiety, depression and youth suicides with mental illness and
cognitive disability are high amongst the indigenous populace and hence, the healthcare
providers are facing tremendous issues to address the condition of such psychological distress
among the indigenous population (Beyond Blue support service, 2019).

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The principal determinants that are accountable for escalating the incidence rate of
depression among the indigenous population are biological factors, environmental exposures
and genetic factors. The above mentioned factors result in the complex process which result
in mental distress. The social determinants such as poor water quality, overcrowding,
inadequate access to healthy nutrition, persistent infections and alcohol consumptions leads to
the developmental delay that further result in poor neurological and physical outcomes. The
parental psychological health condition is also considered as the major factor during the
perinatal phase that might affect the mental health of the children (Australian Indigenous
HealthInfoNet, 2019). There are certain cultural factors that is responsible for creating
psychological distress among the indigenous population that includes racism, discrimination,
social exclusion, inequality, marginalisation and dispossession. The rate of depression is high
for the individuals who have experienced violence (46%), long-term health outcomes or
disability (43%), discrimination (44%) and exclusion of natural family (39%) amid the
aboriginal and strait islander populace. Hence, from the above mentioned statistics it is clear
that large number of aboriginal and strait islander population (31%) suffer or experience from
the condition of depression and require immediate intervention that will assist them to
improve from the poor health illness (The Australian Bureau of Statistics, 2019).
Intervention to prevent depression and promote mental well-being
Large number of aboriginal and strait islander societies are suffering from the
condition of depression due to various environmental, social, personal or biological factors.
The rate of depression is increasing drastically amongst the aboriginal and strait islander
populace affecting general wellbeing and health of the population (Cramer & Kapusta, 2017).
The Australian government had approached to launch different intervention program that will
aim to decrease the mortality or morbidity rate of aboriginal population suffering from
various psychological distress such as depression or anxiety. There are different factors

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(social determinants of health) that interact with each other or act solely under four different
levels to increase the risk of depression or anxiety. The ecological framework is considered
that exhibits the factors and the group of individuals, who are under high threat of depression.
The depression prevention program includes different prevention strategy that is classified
under four different categories namely primary prevention program that consist of public
awareness campaigns, secondary prevention program that consist of gate-keeper training
program, tertiary prevention program that consist of psychotherapy and postvention program
(Varcoe et al., 2019).
Depression is considered as one of the most predominant psychiatric illness that
affects approximately 340 million people all over the world and the major population affected
by this condition are the aboriginal and strait islander populace (Department of Health, 2019).
Different risk factors were responsible for the onset of mental illness and hence, different
intervention prevention program must be established that will aim to reduce the condition of
depression among the aboriginal population. Different effective community interventions are
considered for preventing the condition of depression as it includes diverse universal,
indicated and selective intervention programs (World Health Organization, 2019):
 Universal Intervention: This intervention approach consist of strengthening the
protective factor in the aboriginal and strait islander populace that will aim to reduce
the depressive symptoms. Examples of such intervention consists of public awareness
intervention program that will target to enhance the cognitive, social and problem-
solving skills of the aboriginal and strait islander population and the exercise program
that will majorly assist the elder population to reduce the symptoms of depression
among the older aboriginal population. The above mentioned intervention program is
included under the primary intervention group. Hence, the above mentioned program

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will help the population to gain relevant knowledge regarding the health condition and
the intervention program used to prevent the condition.
 Selective Intervention: This program includes the intervention that will aim to equip
the non-professionals like parents regarding the health condition and assist them to
gain relevant knowledge regarding the health condition. The example of selective
intervention program includes parenting intervention that is conducted for the parents
to focus on the health issues and aim to improve the health condition of the
individuals who are suffering from depression (Mental Health Commission, 2019).
This program will aim to train different individuals regarding their behavioural
changes and cope up with their short-term risk factors that will eventually help them
to overcome from their long-term health issues. This program, is therefore included
under the secondary intervention.
 Indicated Intervention: This intervention program are conducted for such people
who experience high depressive symptoms but are not facing any depressive disorders
and hence there is huge possibility that their mental health condition can be improved.
This type of program includes psychotherapy, where the individual exhibiting the
symptoms of depression are educated to adapt positive thinking, problem-solving
capabilities and reduce the negative thinking an approach towards life. These
programs are very effective because they will aim to change the perspective of an
individual by educating and increasing their knowledge regarding the health issues
and hence it is included under the tertiary intervention program.
Conclusion
Depression is the major psychological disorder that affects huge population all over
the world but is majorly responsible for affecting the aboriginal and strait Torres islander
population irrespective of their age or sex. This study had focused on the basic concept of

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depression and why the aboriginal and strait Torres islander populace are under high risk of
depression and other associated psychological distress. There are various factors namely
biological, social, environmental and economic issues that are accountable for escalating the
frequency of depression amongst the aboriginal populace. The aboriginal and strait Torres
islander exist in the poor socio-economic and underprivileged area that is majorly responsible
for increasing the mortality and injury rate of the aboriginal and strait Torres islander
populace due to different psychological condition. This study has also concentrated on the
dissimilar intervention program that will help the people suffering from depression to manage
their health condition and also manage the depressive symptoms. The intervention suggested
for depression in this study is divided under three categories namely primary, secondary and
tertiary intervention program.

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