UTS Community Health: Closing the Gap Policy and Indigenous Health

This essay delves into the Closing the Gap (CTG) policy, examining its historical context, data influencing its creation, and its significance in shaping health outcomes for Aboriginal and Torres Strait Islander peoples. The discussion encompasses the challenges and barriers that have affected these outcomes, alongside an analysis of the impact of diabetes on Judy, a 57-year-old Aboriginal woman, and how the CTG addresses her condition, including its long-term consequences on health and social determinants. Furthermore, the essay explores the benefits of Judy's registration with the CTG, its influence on her social determinants, and defines the roles of the Aboriginal Medical Service (AMS) and the Aboriginal Liaison Officer (ALO). It also explains the reasons behind the referral of Judy to the community health center by the AMS and ALO, outlining the services they provide and the relationship between the health systems, ultimately aiming to provide a comprehensive understanding of the policy's impact and the support structures available to Indigenous Australians.

CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
1. Introduction
Australian policymakers have been concerned about the long-standing health inequality
between non-indigenous and indigenous groups in Australia. While Australia's overall health
is improving, the indigenous population remains well below the non-indigenous population
stage. Since 2006, the "close the gap" campaign has coordinated most indigenous and non-
indigenous health organisations, human rights organisations and NGOs in Australia to narrow
the inequalities of health and life expectancy for the indigenous populations of Australia. The
aim of this campaign is to ensure that any indigenous baby born in this country, by 2030 has
a comparable open door to a long, sound and happy life as other Australian children
(Australian Indigenous HealthInfoNet, 2014). The Government of Australia's initiative is to
close the gap.
2. Discussion
2.1 Different morbidity and mortality rates have been well recorded and continue between
Aboriginal and non-Aboriginal Australians despite devoted public financing over the years to
tackle the problem (Australian Institute of Health and Welfare, 2014). The word Aboriginal is
the most important word used in the Health Department of Western Australia (WA) by
describing the Local Indigenous Population (Ww2.health.wa.gov.au, 2014). Among
Aboriginal Australians, life expectancy is about ten years less than other Australians
(Australian Institute of Health and Welfare, 2014). In 2008–2012, 15 per cent of Indigenous
fatalities were attributable to internal causes of death in comparison with 6.1 per cent of non-
Indigenous fatalities. During this era, 61 fatalities per 100,000 population were caused by
external causes among indigenous populations. Suicide (4.8% of all deaths) and accidents
involving transport (3.9%) were the most prevalent internal causes of death for indigenous
individuals (Australian Institute of Health and Welfare, 2014). This is a consequence of a
number of complicated causes, including the adverse consequences of colonization,
dispossession and racism, transgenerational, and socioeconomic causes of reduced levels of
education and jobs and greater levels of imprisonment (Australian Institute of Health and
Welfare, 2014).
Access to mainstream facilities is challenging for Aboriginal people. These include
uncomfortable hospital conditions, absence of transportation, absence of confidence in
mainstream healthcare, the feeling of alienation and inflexible therapy choices. As a result,
there has been a general reluctance to participate (Durey et al., 2016). Research has also
shown that the issue is exacerbated by bad contact between health care suppliers and the
shortage of Aboriginal health services employees (Durey et al., 2016). In order to solve this
situation, health facilities must engage in respectful relationships with local Aboriginal
groups and boost the ability of services to meet the needs of Aboriginal people (Durey et al.,
2016).
To enhance health and life expectancy for Aboriginal peoples, the Council of Australian
Governments (COAG) decided, in 2008, on “Closing the Gap (CtG)” in Indigenous Health
Outcome by funding through National Partnership Agreements (NPA)

(Federalfinancialrelations.gov.au, 2009). Partnerships between public and service suppliers
and the local Aboriginal groups were a key feature of the NPA. The anticipated results were
to improve cooperation among healthcare suppliers and improve the access of Aboriginal
people to health services. Effective involvement with the Aboriginal community is essential
to achieving this (Durey et al. 2016).
Engagement from the Community was defined in different ways. It can imply consultation,
communication, training, involvement, partnership, cooperation and empowerment
depending on the environment (Durey et al., 2016). The Aboriginal Community needs
partnership building and capacity building to be involved in decision-making (Durey et al.,
2016). The obstacle to the participation of Aboriginals in a health promotion program and the
role of enabler were explained in a Queensland research.
The key variables involved acknowledging the significance of indigenous and cultural
understanding, getting acquainted with local indigenous communities and creating a network
of local leaderships (Durey et al., 2016). Not only did these variables help to create
confidence, but they were essential before any action was taken. The achievement of
community involvement also depends on seeing advantages that overrule the cost of
involvement for the Aboriginal community members (Durey et al., 2016). Barriers to
previous interactions with healthcare workers included the adverse effect of a limited notion
of health and a failure to understand cultural differences (Durey et al., 2016).
The metropolitan health services in Western Australia's Department of Health recognized an
effective commitment with the local Aboriginal groups to improve Aboriginal health and
increase access to healthcare. In recent years, the Aboriginal Health Team at the South
Metropolitan Health Service Population Health Unit (PHU) in Perth (SMHS) has created and
developed powerful ties with local Aboriginal groups. The process was strengthened with
financing for Aboriginal health from the aforesaid Council of Australian Governments
(COAG) (Nacchocommunique.com, 2015). This financing has been used to support a number
of “local Aboriginal health” projects, including the jobs of “Aboriginal health liaison
officers” in local hospitals, a Community-based “Aboriginal diabetes education” and
“Aboriginal maternity program” (Durey et al., 2016).
2.2 Appreciating the historic causes of ongoing health inequalities between the health of
Aboriginal peoples and the Torres Strait Islands is critical if we are to be aware of and plan
ahead with Aboriginal peoples and Torres Strait Islanders. In comparison with the remainder
of the population from Australia, Australia's Aboriginal and Torres Strait Islanders are poor.
There is no equal opportunity for indigenous peoples to become just as safe as indigenous
Australians (Markwick et al., 2014). Compared to other non-Indigenous individuals,
Aboriginal and Torres Strait Islanders are at higher danger of exposure to behavioural and
environmental health risks because of their comparative socioeconomic disadvantage.
Aboriginal and Torres Strait Islanders experience health inequalities due to systemic
discrimination. The Aboriginal population has not historically had the same chance as non-
Indigenous individuals of Torres and Strait Islander (Markwick et al., 2014).
This is due to the inaccessibility of mainstream facilities and less accessibility to medical
facilities in certain Aboriginal and Torres Strait Islander groups, including primary health
care and insufficient provision of health infrastructure. According to the “Aboriginal Medical
Services” guidelines, the Aboriginal liaison officer (ALO) has notified the community nurse

of going to Judy's house to dress the wound daily. In addition, ALO is still to arrive for an
introduction to Judy's house. Although the rules exist, inequality still persists. The health care
provider plans to visit Judy's home for the first time.
2.3 “Indigenous health Incentive” promotes overall practices and facilities of health. The aim
of the incentive is to assist Aboriginal and Torres Strait Islander patients receive better health
care. This involves the best practice for chronic disease management. The patient should be
eligible for registration under CTG. Patients are eligible if they have a chronic illness, have
Aboriginal or Torres Strait Island origin and their age should be15 years or older.
The Practice Incentives (PIP) Program supports operations of general practice, such as the
post-hour incentive, eHealth incentives, general practitioner pension incentives for old care,
Indigenous Health income and General Procedural Practitioners’ payment. It also offers
home-services to community nurses (Meteor.aihw.gov.au, 2014).
An “Aboriginal Community Controlled Health Service” (ACCHS), a subset of AMS is the
main health service established and operated by local Aboriginal communities that provides
the community with holistic, thorough, and culturally suitable health care that it supervises
via a local management board. Skills and knowledge of ALOs should be culturally suitable
(McKenna et al., 2015). The liaison officer should be effective, work with others, and be able
to negotiate and communicate (Katzenellenbogen et al., 2015). He should be fully conscious
of and sensitive to the cultural aspect of society in working with the indigenous communities.
The liaison officers ' duties and roles are explained below (Alfredhealth.org.au, 2019):
1. They must make appointments for Aboriginal females, assist them and transport them to
the designated hospitals.
2. They must help customers with reminders and follow-up calls.
3. They must assist in the organization of appropriate community activities, including group
meetings, one-to-one instructional event and recreation.
4. In diverse cultural problems, they must educate different people in the group.
5. They must lead customers to various health training sessions.
6. They have to keep a list of customers and resourceful individuals.
7. They must help in reviewing appropriate resources for use by the community and
customers.
2.4 Judy is eligible to be covered under AMS as she was 57 years old, belongs to the
Aboriginal community and is suffering from diabetes 2 which is a chronic disease. To save
Judy’s life both AMS and ALO have to support Judy so that she can get the desired medical
service for the treatment of the dreaded disease (NACCHO, 2015).
Community control is a method which, in accordance with any protocol and processes
established by the Community, enables the local Aboriginal society to participate. The word
"Aboriginal Control Community" comes from the right to self-determination of Aboriginal
peoples. The “Aboriginal Community Controlled Health Service” is a local Aboriginal
community-based, aboriginal organization run by a local aboriginal community and
controlled by a local aboriginal community-elected aboriginal body. They provide the

Community that regulates them with a holistic and culturally suitable health service. The
AMS is the apex body who controls the ALOs and the community health services
(NACCHO, 2015).
3. Conclusion
Though a number of initiatives are taken by the Australian Government and the local bodies
to bridge the gap of inequality of medical services available to Aboriginal people and other
Australian people, still the inequality persists. To make closing the gap initiative to be made a
success, existing initiatives are to be continuously monitored and confidence has to be
brought to the indigenous groups. The development of AMS was a critical achievement factor
in the commitment process and led to Aboriginal people being empowered to be leaders, to
drive the process and to communicate health issues to service suppliers. The action was the
main function of the group instead of just planning. Health care providers must operate with
members of society in order to enhance their services' cultural safety.
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