National Aboriginal and Torres Strait Islander Health Plan 2013-2023: A Critical Analysis

This article provides a critical analysis of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, highlighting its shortcomings and proposing recommendations for improvement. It discusses the background of the plan, its progress across different domains, and the need for substantial improvements. The article also suggests recommendations for addressing social determinants of health, enhancing accountability, and involving Aboriginal and Torres Strait Islander people in the decision-making process. The overall goal is to improve the health outcomes and well-being of the indigenous community.

SOCIAL POLICY

TABLE OF CONTENTS
Formal Briefing Letter.....................................................................................................................3
Proposal.......................................................................................................................................3
Background..................................................................................................................................3
Discussion....................................................................................................................................4
Recommendations........................................................................................................................5
REFERENCES................................................................................................................................7

Formal Briefing Letter
To Mr. Kenneth George Wyatt AM
Minister for Indigenous Australians
(Commonwealth Government of Australia)
Proposal
It is proposed that following changes be made to the National Aboriginal and
Torres Strait Islander Health Plan 2013-2023 for the Aboriginal and Torres Strait Islander
People in relation to health targets of the policy, as the policy has been ineffectively and
partially implemented and has not brought any relevant changes in the condition of the
health and well-being of the indigenous community.
Background
Indigenous community refers to the people who lie within a geographically
distinct ancestral territory and are identified as a part of a traditional cultural group
descended from the areas before colonisation or occurrence of modern borders (Head and
Crowley, 2015). Aboriginal and Torres Strait Islander People refer to indigenous
community from Torres Strait Islands in Queensland, Australia. (Shakespeare and et.al.,
2020).
National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was
established by the Australian government for the achievement of equality in health of the
non-indigenous Australians and indigenous community by the year 2023 (Browne and
et.al., 2017). It is built on the United Nations based rights for indigenous people and
consists of principles like human rights approach-based health equality, community
engagement and control, accountability and partnership (Spolander, Engelbrecht and
Pullen Sansfaçon, 2016). The social policy focuses on empowering the marginalised
community and provide them a right to live a safe and healthy life apart from a
connection to country and culture. This health plan is being implemented as a part of
closing the gap initiative. As per the current developments in the policy since inception of

its implementation, it has worked towards various targets. These are effectiveness of
health system and appropriateness of clinical care, mental health and emotional and
social well-being, culturally respectful health system, evidenced based practices,
capabilities of humans and community. The holistic goals of the policy include six
domains which are health system effectiveness, maternal parenting and health, childhood
development and health, adolescent and youth health, healthy adults and healthy aging.
Discussion
As per the annual reports on the progress of the policy and individual targets,
there is a dire need of substantial improvements in the health policy. According to Parter,
and Skinner, (2020) the National Aboriginal and Torres Strait Islander Health Plan 2013-
2023 has progressed moderately across the six domains. In case of effectiveness of health
system, only 28 out of 44 deliverables have been completed (Australia. Department of
Health, 2013). The measures to tackle systemic racism and improvement of cultural
safety is still to be achieved entirely (Parter, and Skinner, 2020). The domain for maternal
parenting and heath has seen significant improvement with 14 out of 19 deliverables
completed (Department of Health, 2015). In 2016, around 87% of women from the
marginalised community have attended 5 or more antenatal care visits although only 60%
women are likely to receive antenatal care in the first trimester (Parter, and Skinner,
2020). In case of childhood health and development, only 3 deliverables out of 11 have
not been completed (Department of Health, 2015).
As of December 2018, almost 88% of 1-year old children have been immunised
and 97% children above the age of 5 years have been immunized. One- third of children
from the age range of 4 to 14 had gum and dental issues, and were not being resolved due
to cost barriers (Revision of the Implementation Plan 2013-2023). The Child Dental
Benefits Schedule have covered all parts of dental care since its commencement in 2014,
but its actual benefits are still limited. The rate of health check-ups varies by jurisdiction,
with only 8% in Tasmania to 41% in Queensland in the year 2017-18 (Australia.
Department of Health, 2013). In case of Youth health, only 50% progress has been made.
The indigenous teenagers aged 15-17 were 5 times more likely to smoke than non-
indigenous teenagers and there has to be an increase in the rate of health check-ups by

2023 to meet the targets (Revision of the Implementation Plan 2013-2023). In case of
healthy adults, the number of health checks have increased from 71, 400 to 217,700. That
is 11 percent increase across all health groups including prevention and treatment of
chronic diseases, which is still limited and needs faster approaches (NATSIHP, 2013-
2023). In the sixth domain of healthy aging, flexible aged care program has risen from
200 places in 2013 to 860 places in 2019, which infers that the progress is not on track
and data for other targets have not become available as of now (Altman, 2018). Cross
domain targets like kidney function test for type 2 diabetes have increased only up to 7%,
which means the health plan is lacking in progress (Department of Health, 2015).
The overall progress and reach of the National Aboriginal and Torres Strait
Islander Health Plan 2013-2023 have been slow with 35% of the goals not being achieved
(NATSIHP 2013-2023). There are major issues with this plan and the approach should be
in manner that is cognisant with frameworks that are relevant to the social determinants
of health and not limited to closing the gap between indigenous and non-indigenous
community (Fisher and et.al., 2019). The health plan has to be comprehensive in
improvement of all domains of health of the Aboriginal and Torres Strait Islander people
from prevention, treatment and management along with access to healthcare. In the
formulation of this health plan, the policy makers need to revisit recommendations of the
social justice report of 2005 which has criticised the framework of this plan (Gal and
Weiss-Gal, 2013). The plan covers ninety performance indicators into three tiers
addressing health outcomes, performance of health system and determinants of health.
Inspite of the extensive system being implemented, the plan has failed in providing
timeframes of achievement (Altman, 2018).
Recommendations
 The health plan has to comprehensively address and measure all social determinants of
health like income, occupation, education and expand current range of indicators for
social and cultural inclusion (Althaus, Bridgman and Davis, 2013). Accountability has to
present both upwards in community controlled and health service sectors and downwards
from government to community (Head and Crowley, 2015).

 A systematic and centralised approach for capacity building has to be done to implement
the health plan consistently and extensively across Australia (Garrett, 2018). More
financial support, workforce upskilling, health planning, investment in health
infrastructure is needed. Support and recognition of ACCHO workforce which presently
combats high turnover staff in the services for the marginalised community (Head and
Crowley, 2015).
 The target inputs and measures have to be in agreement with health leaders of Aboriginal
and Torres Strait Islander People and Federal government, and include culturally safe
care through controlled health and primary healthcare services, enabling innovation and
engagement activities, setting comprehensive guidelines for all people and uplifting their
representation and involvement (Curtain, 2020).
 The ministry has to further take initiatives for expanding the evidence base for increasing
efficiency of culturally based education, health and economic participation programs
which have recourse to community experience and development of policies and program
which are evidence-based (Garrett, 2018). The health plan should address the health
needs of indigenous people from the bottom-up and should be determined by Aboriginal
and Torres Strait Islander people. The capacity of local people to has to be increased by
developing relevant mechanisms and procedures otherwise the health plan could never
bring any significant changes (Althaus, Bridgman and Davis, 2013).
 The health plan has to gather a mutually inclusive support of workforce which is
integrated through state funded and Federal positions support (Adams, Dominelli and
Payne, 2017). Apart from that the health literacy has to be focussed upon, care planning
with patient advocacy, referrals, ensuring primary acute care services and taking care of
complex healthcare needs. A holistic approach to address the social determinants of
health has to be taken (Curtain, 2020).

REFERENCES
Books and Journals
Journals
Browne, J., and et.al., 2017. A network approach to policy framing: A case study of the National
Aboriginal and Torres Strait Islander Health Plan. Social Science & Medicine, 172,
pp.10-18.
Fisher, M., and et.al., 2019. How the social determinants of Indigenous health became policy
reality for Australia's National Aboriginal and Torres Strait Islander Health Plan. Journal
of Social Policy, 48(1), pp.169-189.
Parter, C.D.R. and Skinner, J.C., 2020. Implementing Indigenous cultures and Indigenous
knowledges: A public policy dilemma. European Journal of Public
Health, 30(Supplement_5), pp.ckaa166-741.
Shakespeare, M., and et.al., 2020. Theories of Indigenous and non-Indigenous wellbeing in
Australian health policies. Health Promotion International.
Books
Adams, R., Dominelli, L. and Payne, M. eds., 2017. Social work: Themes, issues and critical
debates. Palgrave Macmillan.
Althaus, C., P. Bridgman & G. Davis 2013, The Australian Policy Handbook, 5th edn,
Altman, J., 2018. Beyond closing the gap: Valuing diversity in Indigenous Australia. Canberra,
ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian
National University.
Curtain, R., 2020. Engaging citizens to solve major public policy challenges. In Beyond the
Policy Cycle (pp. 121-142). Routledge.
Gal, J. and Weiss-Gal, I. eds., 2013. Social workers affecting social policy: An international
perspective. Policy Press.
Garrett, P.M., 2018. Social Work and Social Theory 2e: Making connections. Policy Press.
Head, B. & K. Crowley (eds) 2015, Policy Analysis in Australia, Policy, Bristol
Spolander, G., Engelbrecht, L. and Pullen Sansfaçon, A., 2016. Social work and macro-
economic neoliberalism: Beyond the social justice rhetoric. European Journal of Social
Work, 19(5), pp.634-649.
Government reports
Australia. Department of Health, 2013. National Aboriginal and Torres Strait Islander Health
Plan: 2013-2023. Department of Health.
Department of Health, 2015. Implementation plan for the national aboriginal and torres strait
islander health plan 2013–2023. Commonwealth of Australia.
Online
National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) 2013-2023, viewed on
26th October, 2020
<https://www1.health.gov.au/internet/main/publishing.nsf/Content/natsih-plan>
Report card for the implementation plan for the National Aboriginal and Torres Strait Islander
Health Plan 2013-2023, viewed on 26th October, 2020
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<http://healthbulletin.org.au/articles/report-card-for-the-implementation-plan-for-the-
national-aboriginal-and-torres-strait-islander-health-plan-2013-2023/>
Revision of the Implementation Plan for the National Aboriginal and Torres Strait Islander
Health Plan 2013-2023, The department of Health, Australian Government, viewed on
26th October, 2020
<https://www1.health.gov.au/internet/main/publishing.nsf/Content/natsi-implementation-
health-plan-revised>
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