Analyzing the Closing the Gap Policy on Indigenous Health

This essay delves into the 'Closing the Gap' (CTG) policy in Australia, focusing on its historical context, objectives, and impact on Aboriginal and Torres Strait Islander people's health. It examines the factors that led to the policy's creation, highlighting the significant health disparities between Indigenous and non-Indigenous populations, including issues like cardiovascular disease, diabetes, and chronic respiratory diseases. The essay focuses on ear disease, particularly otitis media, as a key health challenge addressed by the CTG policy, and evaluates the effectiveness of various interventions, such as vaccination programs, in reducing its prevalence. It also discusses challenges like lack of surveillance data and cultural competency in healthcare delivery. The essay references government reports, academic studies and other sources to present a comprehensive overview of the CTG policy and its implications for Indigenous health outcomes, including a discussion of the successes and ongoing challenges in achieving health equality.

Running Head: CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
Contemporary Indigenous Health and Wellbeing
Name of the Student
Name of the University
Author Note

1CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
The essay deals with “Closing the Gap” (CTG) policy in Australia. The essay briefly
explains the topic, about the history of the policy and the factors that influenced the creation of
the policy. Further the essay discusses the significance of the policy on Aboriginal & Torres
Strait Islander People’s health outcomes using relevant literature and statistics. The policy
addresses several health issues. In this essay, one health issue will be focused that is covered
under CTG. The policy in this regard is evaluated to identify the impact the CTG policy has had
on Aboriginal & Torres Strait Islander people’s health since it was introduced. The essay briefly
highlights the challenges that have affected the changes.
The Australian government launched closing the Gap or CTG policy for Aboriginal and
Torres Strait Islander people. The policy aims to .reducing health inequalities among this group
of population. The policy addresses the disadvantages in relation to the child mortality, life
expectancy, employment outcomes, education achievement and access to early education. The
policy was formulated in response to the “Social justice report 2005” and the “Close the Gap
social justice campaign” (Australian Human Rights Commission 2016).
The social justice report showed the Indigenous Australians had poorer health when
compared to the non-Indigenous population. This refers to the health gap and includes six
main drivers. There was 20% of the health gap in respect to cardiovascular disease, 16% gap in
diabetes, 9% in chronic respiratory disease, 7% intentional injuries, and estimated 6% in cancers.
This altogether contributes the gap of 70%. Thus, the Indigenous Australian were highly
represented in mortality rate, low birth weight of children, and high prevalence of clinical,
emotional and behavioural disorder. The health gap was due to 11 risk factors including high
blood pressure and high cholesterol, smoking alcohol and drug abuse, child sexual abuse, unsafe
sex, and intimate partner violence, poor nutrition and obesity (Jamieson et al. 2016). Close the

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Gap social justice campaign was initiated in 2006 with the aim to “close the life expectancy gap”
between the Indigenous and non-Indigenous Australians. This campaign was the joint effort from
NGOs and human rights organisation (Holland 2014).
The council of Australian Government proposed this policy and included the leaders of
local, state, territory and federal government to commit for closing the gap. In 2007, the
government and the Indigenous Australians agreed to work together to active health equality.
The goal of this agreement is to establish equal health status between the Indigenous and non-
Indigenous Australians (Taylor et al. 2013). The government targets to accomplish the goal by
2030. The “Indigenous health equality summit statement of intent” signed the agreement. During
this summit the targets of the policy was presented to the delegates. The council of Australian
Government committed $4.6 billion to this agenda in 2008. These funds were allocated for
economic participation, early childhood, health and housing and remote service delivery
(Productivity Commission, 2015).
The name of the policy is closing the gap because the targets of the policy is to reduce
the gap in various health aspects. Firstly, to close the life expectancy gap. Secondly, to reduce
the mortality rate gap of the Indigenous children under five to its half within 10 years. Thirdly, to
improve an access to early childhood education for all the 4-year-old children, dwelling in
remote areas. Fourthly, reduce the gap in numeracy, reading, and writing skills of the Indigenous
students by 50%. Fifthly, reduce the gap in attainment of year 12 in this population by 50%.
Lastly, reduce the gap to its half in regards to employment outcomes within 10 years (Brueckner
et al. 2014). Every year the government releases the CTG reports to track the progress and
recommend the government about solutions. The above-mentioned targets have helped the
government to identify the disadvantages experienced by the Indigenous Australians and the

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improvement in heath and well-being can be achieved by meeting these targets (Griffiths et al.
2016).
Ear disease and the associated hearing loss is one of the significant health problems for
the Indigenous children. In this community, children mostly suffer from chronic ear disease
particularly related to otitis media. The rate of the prevalence of this disease exceeded 4% of the
threshold limit and is thus regarded as major public health issue. Ear disease is the cause of poor
educational achievement among indigenous children is due to hearing loss. It highly contributes
to the unemployment. The prime factors contributing to this disease are household overcrowding,
malnutrition, passive smoking, bottle-feeding, and premature birth. Overall, this disease has
substantial impact on the Indigenous children and the health gap (Jervis-Bardy et al. 2014).
The target of closing the gap policy undertaken by the Queen’s land government in 2009
after the reports of the evaluation of “Deadly ears deadly kids’ deadly communities framework”
was published. The framework aims to significantly reduce the rate of otitis media in the
Indigenous children. The policy aims to reduce the interaction between the medical and the
environmental causes of the disease. Intervention is targeted at different level under this policy to
decrease the incidence of the hearing loss and its impact ((www.aihw.gov.au. 2017).
Antibiotic preventive treatment for otitis media was found effective in preventing the
disease however, the long term effects are uncertain. The Australian government administered
pneumococcal vaccination program as it was successful in preventing the ear disease.
Vaccination against Haemophilus influenzae type b introduced in 1993, have significantly
reduced the invasive Hib infectionby 98% in Indigenous children. Several meta analysis
studies have evaluated the effectiveness of inactivated influenza vaccine. The findings showed

4CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
that this vaccine can successfully prevent the onset of the disease. On the other hand, some
studied showed mixed results that in Indigenous children, the pneumococcal vaccination might
not be fully active (NSW Health 2011).
The council of Australian Governments in 2009 agreed to “universal neonatal hearing
screening”. Since 2009, babies born in all the states were screened after first month. Since 2011,
the government have started another program named “Healthy Start for School”. It involves
health check ups and hearing tests for all the four year olds. Nelson et al. (2008) evaluated the
“New South Wales Otitis Media Screening Program” (2004-2008) that has the screening target
of 85%. The findings showed that the program was ineffective in decreasing the prevalence of
the disease. It failed to address the “social and environmental determinants”. The program
should be disbanded according to the ARTD consultants. This issue need a broad public health
approach to resolve. It is suggested that the ear health program should be integrated with other
health and surveillance programs (www.aihw.gov.au. 2017).
The challenge to achieve the close of ear disease gap was lack of surveillance data. The
government has not initiated any national population-based surveillance program. There was no
monitoring of the ear disease. There is a need to take both the chronic and the acute aspects of
the disease. Following this issue being highlighted the Australian government funded the
“Northern Territory Government” in 2007 to provide services related to the ear, nose, throat and
audiology services. These were funded in 2009-2012 as a part of the initiative taken by close the
gap (Holland 2014). This initiative also led to SFNT Hearing Health Program. Children living
with hearing loss were recommended for rehabilitation. These programs have positive impact on
the Indigenous children. The proportion of the middle ear condition cases decreased by 13% and
the hearing loss cases by 15%. These programs also showed long-term improvement in children

5CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
ear health. The proportion of the cases with moderate, to profound hearing impairment was
decreased by 15% (Northern and Downs 2014).
The other challenge was the lack of specific evidence on strategies effective for
improving delivery of “culturally competent healthcare” to Indigenous people. These strategies
have been identified and found successful in US and will be useful in Australia. The challenges
in achieving the targets of close the gap policy was poor cultural awareness training. In addition,
there was lack of cultural-tailoring during program transfer and implementation (Aihw.gov.au,
2017). The Darwin Otitis Guidelines Group 2010 is the revised guidelines for “Indigenous-
specific management of the otitis media”. The current evidence still shows higher prevalence of
ear disease among communities of Indigenous people, when compared to the non-Indigenous
counterparts. Therefore, the ear health gap remains (www.aihw.gov.au. 2017).
The essay presents the importance of closing the Gap strategy in Australia. In response to
this policy, ear health of the Indigenous children was studied. Otitis media is one of the prime
contributors of health gap between the Indigenous and non-Indigenous children. There is a
sufficient awareness created in this regard. Various treatment programs have been developed and
implemented for improving this condition. Influenza vaccinations have been effective in
reducing the infection by 98%. The long-term effects are uncertain. However, the current reports
do not indicate rigorous evaluated evidence about significant ear health improvement among
Aboriginals and the Torres Strait Islanders. How much gap has been closed by these arrays of
local and national programs is not known due to lack of national profile on this community and
prevalence of ear disease.

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References
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Griffiths, K., Coleman, C., Lee, V. and Madden, R., 2016. How colonisation determines social
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Zealand, and Canada. Journal of dental research, 95(12), pp.1375-1380.
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Otology, 128(S1), pp.S16-S27.

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