Closing the Gap: Policy, Diabetes, and Health Determinants Analysis

This essay examines the Australian government's "Closing the Gap" (CTG) policy, initiated in 2008 to address health inequalities faced by Indigenous Australians. The essay traces the policy's history, stemming from the Social Justice Report 2005 and the "Close the Gap" campaign, and outlines its six key targets across health, education, and employment. It analyzes the barriers to achieving these targets, including financial constraints, lack of cultural awareness, and workforce shortages. The essay then presents a case study of Judy, a 57-year-old Aboriginal woman with type 2 diabetes, and assesses the impact of CTG strategies on her health management, considering both pharmacologic and non-pharmacologic interventions. It highlights the role of social determinants of health, such as health literacy and financial stability, and emphasizes the need for culturally competent care. The essay also discusses the Closing the Gap PBS Co-payment Program and the support provided by Aboriginal Liaison Officers and Aboriginal Medical Services. Overall, the essay underscores the importance of the CTG policy in promoting health equity and improving the quality of life for Indigenous Australians, while also acknowledging the ongoing challenges and the need for continued efforts.

Running head: CLOSING THE GAP
CLOSING THE GAP
Name of the student:
Name of the university:
Author note:

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In the month of March in the year 2008, the Australian government understood the depth
of the issue of health inequality and health inequity faced by the indigenous people of the nation
and therefore proposed the “closing the gap” policy. They agreed to work with indigenous
people for achieving the equality in health as well as in the life expectancy between the non-
Indigenous Australians and the Aboriginal and Torres Strait Islander people by the year 2030
(Pyne et al. 2016). The Council of Australian Governments (COAG) mainly took the
responsibility of establishing six ambitious targets across the areas of the health, employment
and even in education for making progress and developing the quality of lives of the indigenous
people (Taigman et al. 2014). This assignment would show how different strategies have been
initiated by CTG and how these would help a patient to manage her diabetes effectively by
overcoming various barriers.
The history of the strategy dates back to the year 2008 when it was established in
response to the call of the Social justice report 2005 along with the close the Gap social justice
campaign. In the year 2005, Tom Calma, who was the Aboriginal and Torres Strait Islander
Social Justice Commissioner had released the Social justice report 2005. This important report
showed the different data and statists which called for the government of the nation for
committing to the achievement of the equality for both the indigenous people and the non-
indigenous people in the area of health as well as life expectancy within the period of 25 years
(Perso 2016). Another important aspect that contributed to the formation of the Closing the Gap
policy was the “Close the Gap” campaign. This campaign aimed at the achievement of the health
equality for the native people by 2030 and began as the National Indigenous Health Equality
Campaign in the year 2006 with different governmental and non-governmental organizations. It
was launched in the city of Sydney in 2007 and was organized by

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NACCHO, ANTaR and Oxfam Australia. It mainly helped in uniting the voices of about 40
organizations with an urge to the state, territory and federal governments for committing to the
closing of the health and life expectancy gap between the native and non-native people. This
paved the way for the emergence of closing the gap policy in 2008 (Chikarovski 2015).
The main areas where special attention had been provided for the development of
condition of the native people and closing the gaps are child mortality, schools attendance, early
childhood education, reading as well as numeracy, Year 12 or equivalent attainment,
employment as well as life expectancy. It put an important focus on the development of primary
healthcare services that would help in addressing the healthcare problems of the native people
and solving them accordingly (Pace 2015). Addressing the behavioral and social factors leading
to poor health had been identified and accordingly funds and interventions were incorporated for
the development of quality of life for the patients. Effective partnership with the native people,
supporting the indigenous Australians with disabilities, school nutrition projects in the northern
territories, social and emotional well-being and many others were all planned by the
professionals. National Indigenous Critical Response Service, aged care services,
Encouragement of healthy lifestyle choices, reduction in the substance abuse misuse and harm
are intricately associated with the objectives of the Closing the Gap program. Immunization as
well as development of the housing quality all helped in meeting the perspectives (Chan 2014).
Between the periods of 2005 - 2007 and that of another phase of 2010 - 2012, there was
seen to be a significant amount of reduction in life expectancy of gap. This gap was seen to be
of 0.8 years for males and that of 0.1 years for females. Over the long term, although the
mortality rates of the indigenous people have declined by a whooping number of 14 percent
since the year of 1998, there has been no improvement since the year of 2006 baseline.

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Therefore, it can be stated that the target is not on track. Again, there had large number of
significant improvements mainly to be seen in the mortality rate of the native people from the
chronic disorders particularly from circulatory diseases. However, number of cancer cases is
rising and gap is widening (Boyle et al. 2014). Again, there had been improvements in early
detection and management of the chronic disorders and reductions in smoking. This would be
helpful in the health improvement of the native people.
Some of the barriers had been identified which state the reason f some of the targets not
meeting their desired goals. One of them is the financial barrier including the direct costs that
seems to be associated with that of medication, consultations, and lack of knowledge about the
bulk-billing practices as well as others. Lack of funding for the indigenous health programs are
also other causes. Inadequate poor timetabling, public transport services, health services not
easily accessible by the public transport and many others also act as barriers in meeting the aims
of the closing the gap strategy (Kozlowska et al. 2017). Again, lack of cultural awareness as well
as sensitivity in the different types of the mainstream care, staffs being not confident in asking
patients about the indigenous status are some of the barriers. Workforce shortages, like that of
particularly in the rural and remote areas, lack of staffs ability to take extra initiatives in closing
the gap additional work all resulted in creating barriers in meeting the targets.
Judy has been diagnosed with diabetes and therefore she has to go through proper
lifestyle management so that her blood glucose level remains under control. Besides her
pharmacologic treatment, she also requires non-pharmacological interventions. Conducting
vigorous exercises for about 30 minutes every day is important along with taking of quality
nutrient dense food that is free from calories (Al Khalaileh et al. 2016). Here, weight should be
kept under control and her blood pressure should be maintained. This would not only help in

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prevention of obesity which I turn complicates the condition of diabetes in the patient but other
disorders like cerebro-vascular disorders would also be prevented. In order to help her to live
quality life, it needs to be ensured that all the interventions and guidelines mentioned in the
closing the gap policy are followed by the professionals. She might not have enough knowledge
about her condition of the disorder due to poor health literacy. It is one of the most important
social determinants of health and proper education system to help her understand her disorder
should be introduced. This would ensure development of self-care and management strategies
reducing the risk of any further complication (Deutsche et al. 2016). Moreover, she might not
have financial stability to pursue costly treatments and therefore following the “Closing the gap”
strategy, care should be taken that she does not face any inequality and inequity while accessing
healthcare services. Culturally competent evidence based care should be provided to her as that
would have given to the non-native patients with the same background without any racial
discrimination and stigmatization. Poverty, economic inequality and social status are important
determinants of health along with material deprivation, lack of education as well as social
exclusion. All the aspects should be cared for by the professionals to ensure patient satisfaction
and better quality lives. A holistic approach aligning with the full cultural, social, emotional and
economic context of Indigenous people’s lives should be considered while treating her and this
should include an awareness of the ongoing legacy of trauma, grief and loss associated with
colonization. This would help the patient to develop trust and mutual respect for the
professionals, the later would be empathetic and a compassionate with along with development
of physiological condition of the patient would also assure psychological stability, satisfaction
and compliance with western healthcare (Trivedi et al. 2017).

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The closing the Gap initiatives had proposed a new scheme for helping the native people
in enjoying equity in healthcare. The Closing the Gap PBS Co-payment Program had been
implemented in the year 2010 on first July. It is one of the 14 measures in the indigenous
Chronic Disease Package (ICDP). It was established for the reduction of the cost of the PBS
medication for those native people who are eligible and are suffering from the risk of chronic
disorder or are diagnosed with chronic disorders. When the patients would need to obtain the
PBS medicines that are present at their local pharmacy, the general patients who are eligible
would be given the opportunity to normally pay the full PBS co-payment which is currently $
39.50 per item pay the concessional arte of only $ 6.40 per item. Those who are seen to normally
pay the concessional price receive their PBS medicines without being required to pay for the
PBS co-payment (Alford 2015). The main eligibility of this initiative is that patients would be
experiencing setbacks in the prevention as well as the ongoing management of the chronic
disorders if the person fails to take the prescribed medications. Eligibility is that the patients are
unlikely to adhere to the different medications regimens without the assistance through the
programs. Therefore, the patient in the case study would be highly benefiting herself from the
initiative as this would be helping her to tackle her financial constraints properly, get easy access
to healthcare and support and overcome ant negative effects that would have resulted if she
would not have been able to buy medicines because of her poor economic background.
The Aboriginal Liaison Officer mainly helps the Aboriginal and Torres Strait Islander
people mainly by providing emotional, social as well as cultural supports to the patients as well
as their families. They are also seen to provide liaison services for the patients as well as the
families. They also provide information about the different services provided at the hospital and
they mainly help in acting as a linkage between the hospitals as well as the indigenous

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community services. They do not directly provide clinical healthcare services but mainly help
patients in talking to the healthcare professionals for making the patients understand medical
procedures as well as routines. They mainly help patients in taking decisions about their care.
Therefore, although they are providing support but they cannot help Judy by providing her the
service of community nurses. They can only refer Judy to AMS or the Aboriginal Medical
Service. The later is mainly responsible in acting as the aboriginal community controlled
healthcare services in the nation (Bove et al. 2018). They are mainly responsible for the
establishment of community based primary health-care services. The later can take the
responsibility of sending Judy healthcare professionals who would be responsibly conducting the
dressing sessions helping her to develop her quality of life.
From the above discussion, it is clear that Closing the Gap policy is helpful for the
Aboriginal and Torres Islander people, helping to get over the different social determinants of
health through their initiatives and helping them to achieve health equity and equality. Different
schemes like medication schemes had been introduced which help them to purchase medicines at
lesser cost helping them to overcome economic barriers. Aboriginal Liaison Officer and the
Aboriginal Medical Service have their own specific roles helping the patients to meet their needs
and requirement successfully and live better quality lives.

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