Broader Policy and Program Environment: a context

This Report outlines the broader Australian Government policy and program directions in Aboriginal and Torres Strait Islander health and how the Healthy for Life program sits within them.

Positioning Healthy for Life in the broader policy and program environment: A Context, 2005

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Table of Contents

1. Introduction
2. The Aboriginal and Torres Strait Islander health context
3. Department of Health and Ageing and Office for Aboriginal and Torres Strait Islander Health policy context
4. The whole-of-government approach to Indigenous Affairs
5. Policy and program precursors to Healthy for Life

5.1 Continuous Improvement Projects (CIPs)

5.2 Child and Maternal Health Exemplar Sites

5.3 Literature Review

6. Broader context in child and maternal health and chronic disease policy
7. A population health approach
8. A quality improvement approach
9. Conclusion

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1. Introduction

In the 2005-06 Budget, the Australian Government announced a new Healthy for Life program. Healthy for Life provides $102.4 million over four years to improve the health of Indigenous mothers, babies and children, improve the early detection and management of chronic disease and, over time, reduce the incidence of adult chronic disease. Healthy for Life takes a quality improvement and population health approach to support the achievement of these objectives.

Healthy for Life is focussed on primary health care services that deliver health care to Aboriginal and Torres Strait Islander populations. Healthy for Life will sit within, and align with, the broader context of child and maternal health and chronic disease initiatives and activities, both Aboriginal and Torres Strait Islander specific and mainstream. Healthy for Life will also align with broader Australian Government arrangements for Indigenous Affairs.

The purpose of this context paper is to describe how Healthy for Life sits within the broader Australian Government policy and program directions for Aboriginal and Torres Strait Islander health and the whole-of-government Indigenous Affairs arrangements.

2. The Aboriginal and Torres Strait Islander health context

Aboriginal and Torres Strait Islander people experience higher rates of maternal mortality, poorer pregnancy outcomes and higher levels of neonatal and infant mortality than other Australians.¹ A higher incidence of low birth weight, combined with other early life risk factors, predisposes Aboriginal and Torres Strait Islander people to poorer adult health outcomes. High rates of chronic disease and their predisposing risk factors also occur in Aboriginal and Torres Strait Islander populations.² Many of the pathways to poor health outcomes provide opportunities for early intervention, and evidence exists for the effectiveness of specific interventions in improving Aboriginal and Torres Strait Islander peoples health outcomes. Healthy for Life targets child and maternal health and chronic disease because of the high burden of disease in these areas, and because there is evidence that interventions in these areas will make a difference to health outcomes.

The National Strategic Framework for Aboriginal and Torres Strait Islander Health ² (‘NSF’), developed by the National Aboriginal and Torres Strait Islander Health Council, sets the framework for action by governments in Aboriginal and Torres Strait Islander health for the period 2003-2013. The NSF also outlines nine key result areas for action in Aboriginal and Torres Strait Islander health, inclusive of child and maternal health and chronic disease. Healthy for Life aligns with the principles and priorities of the NSF.

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3. Department of Health and Ageing and Office for Aboriginal and Torres Strait Islander Health policy context

The Australian Government Health Portfolio’s Outcome 7, Improved health status for Aboriginal and Torres Strait Islander peoples, is managed within the Department of Health and Ageing by the Office for Aboriginal and Torres Strait Islander Health (OATSIH).³ All programs within the department have a responsibility to meet the specific needs of Aboriginal and Torres Strait Islander Australians.

The department pursues a three-pronged approach to achieving sustainable gains in health status for Aboriginal and Torres Strait Islander people that aims to:

• improve the responsiveness of the mainstream health system;
• provide complementary action through Indigenous-specific health programs; and
• work collaboratively across governments and the health sector to improve service delivery and outcomes.

The long-term strategy of OATSIH is to improve the access of Aboriginal and Torres Strait Islander peoples to comprehensive primary health care services. The aim is to provide coordinated clinical care and population health and health promotion activities to facilitate illness prevention, early intervention and effective disease management. The Australian Government has a commitment to collaboration amongst Indigenous communities, mainstream health providers and Aboriginal Community Controlled Health Services to achieve better health outcomes. Under the whole-of-government arrangements for Indigenous Affairs, collaboration with other agencies, including education, science and training, family and community services, as well as with State and Territory governments, local government and communities, is a high priority.

Healthy for Life has been developed in the context of the approaches and directions of the Department of Health and Ageing in Aboriginal and Torres Strait Islander health.

4. The whole-of-government approach to Indigenous Affairs

Improved coordination and accountability of Indigenous-specific and mainstream policy and programs for Aboriginal and Torres Strait Islander Australians has been identified as a key objective of the whole-of-government Indigenous Affairs arrangements. The Office of Indigenous Policy Coordination (OIPC) in the Australian Government Department of Family, Community and Indigenous Affairs is coordinating a whole-of-government approach to programs and services for Indigenous Australians.⁴

Early childhood is identified as one of three key priority areas under the whole-of-government arrangements. The Early Childhood Interventions Working Group of the Secretaries’ Group on Indigenous Affairs was established in early July 2004 to provide strategic and cohesive advice to Secretaries and the Ministerial Taskforce on Indigenous Affairs on innovative ways to address the early childhood needs of Indigenous Australians. Under this initiative, various policy and program options are being explored for implementation from 2005-06.

The Council of Australian Governments (COAG) is the peak inter-governmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association (ALGA).⁵ COAG has agreed to a National Framework of Principles for Delivering Services to Indigenous Australians.⁶ The principles of this framework address sharing responsibility, harnessing the mainstream, streamlining service delivery, establishing transparency and accountability, developing a learning framework and focussing on priority areas.

COAG priority areas include early childhood development and growth, early school engagement and performance, positive childhood and transition to adulthood and substance use and misuse. COAG has also committed to Aboriginal and Torres Strait Islander participation at all levels and a willingness to engage with representatives, adopting flexible approaches and providing adequate resources to support capacity at the local and regional levels. Healthy for Life aligns with the principles, priority areas and intent of the COAG commitments.

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5. Policy and program precursors to Healthy for Life

A number of activities funded by OATSIH provided information and examples of best practice which contributed to the development of Healthy for Life. These included the Continuous Improvement Projects for the Early Detection and Management of Chronic Disease, the Child and Maternal Health Exemplar Site Initiative and the development of Improving health in Aboriginal and Torres Strait Islander mothers, babies and young children: A literature review. The broader policy environment as described in this paper and internal policy work also contributed to the development of Healthy for Life.

5.1 Continuous Improvement Projects (CIPs)

In 2003-05 the department provided support to 14 Aboriginal and Torres Strait Islander primary health care services to refine their approaches to the early detection and management of preventable chronic disease. The CIPs aimed to improve clinical organisation and systems, through a continuous improvement approach, to deliver improvements in clinical processes and intermediate health outcomes. The CIPs model used facilitators to provide support and guidance to services to undertake continuous improvement activities. CIPs workshops were also held to share information and learnings in continuous quality improvement and chronic disease in primary health care settings. Components of the CIPs, such as the use of facilitators and workshops, have been retained in Healthy for Life.

5.2 Child and Maternal Health Exemplar Sites

A Child and Maternal Health Exemplar Site is an Aboriginal Community Controlled Health Service selected as a 'best practice' site in the regional delivery of child and maternal health services in a comprehensive primary health care setting. The primary purpose of the Child and Maternal Health Exemplar Site Initiative was to establish a service level mechanism to inform national, regional and local Aboriginal and Torres Strait Islander child and maternal health policy and program development. Learnings from the Child and Maternal Health Exemplar Sites have been incorporated into the supporting material for Healthy for Life.

5.3 Literature review

Improving health in Aboriginal and Torres Strait Islander mothers, babies and young children: A literature review was published in 2005.⁷ The review was conducted to collate information on interventions which have been shown to improve health outcomes or intermediate health measures in Aboriginal and Torres Strait Islander mothers, babies and young children. It describes interventions in antenatal and mother/baby programs; nutrition and growth; infectious diseases; and housing and environment. The review also notes the limited amount of high quality information available in the area of Aboriginal and Torres Strait Islander child and maternal health.

6. Broader context in child and maternal health and chronic disease policy

A number of national mainstream and Indigenous-specific initiatives exist or are emerging that align with the objectives of OATSIH in relation to Australian Government Aboriginal and Torres Strait Islander child and maternal health and chronic disease policy development. These include:

• The National Agenda for Early Childhood (Australian Government Taskforce for Child Development, Health and Wellbeing)
• National Strategic Framework for Child Public Health (National Public Health Partnership’s Child and Youth Inter-governmental Partnership)
• The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (National Public Health Partnership’s Strategic Inter-governmental Nutrition Alliance)
• Healthy Horizons: Outlook 2003-2007. A framework for improving the health of Rural, Regional and Remote Australia
• The Department of Health and Ageing National Child Nutrition Program
• The Rio Tinto Aboriginal Health Partnership
• Research initiatives, including the work of Cooperative Research Centre for Aboriginal Health, National Medical Health and Research Council, Kulunga Research Network, Institute for Child Health Research, and the Longitudinal Study of Indigenous Children
• The National Health Priority Areas Initiative
• The National Chronic Disease Strategy
• The National Diabetes Strategy
• The National Strategy for Heart, Stroke and Vascular Health in Australia
• Healthy Weight 2008: Australia’s Future. The National Action Agenda for Children and Young People and Their Families (National Obesity Taskforce)
• The Smoking, Nutrition, Alcohol and Physical Activity (SNAP) Framework for GPs
• The National Tobacco Strategy 1999 to 2002-03 : A Framework for Action
• The National Strategic Improvement Frameworks.

Healthy for Life complements these initiatives, focussing specifically on Aboriginal and Torres Strait Islander primary health care settings.

State and territory governments carry responsibility for a significant proportion of service delivery aspects of child and maternal health and chronic disease management, including, but not limited to, birthing services, community based primary health care, food and nutrition, immunisation and sexual health. Healthy for Life will coordinate with state and territory activities to increase effective service provision to Aboriginal and Torres Strait Islander communities.

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7. A population health approach

Healthy for Life takes a population health approach to improving health outcomes. In this context population health is defined as an organised response to protect and promote health, and to improve health outcomes of the service population. Within Healthy for Life this approach is particularly intended to emphasise the need to assess health impacts and outcomes for specific population groups within the clients of a service, and to plan service improvements which will impact on these outcomes. Evidence based interventions, data collection and evaluation are important components of this approach. The population health approach also includes disease prevention and health promotion, and acknowledges social and environmental determinants of health.

8. A quality improvement approach

There has been an increasing focus on quality improvement in the health care sector, starting with tertiary institutions and extending to primary care. The quality improvement approach is intended to improve effectiveness, efficiency, acceptability, access, appropriateness and safety of health care services. The aim of this model is to increase the likelihood that health services for individuals and populations are functioning consistent with current knowledge of best practice and are achieving the desired health outcomes.

Many aspects of health service functioning and government funding are aimed at improving quality. These include procedures and protocols consistent with best practice clinical guidelines, accreditation, compliance with standards, audit and feedback cycles, continuing professional development, staff training, adverse incident review mechanisms and electronic patient information and recall systems.

Healthy for Life uses the PDSA cycle (Plan-Do-Study-Act) approach to continuous quality improvement and service development. This model allows health services to assess their present service delivery, plan changes, implement changes and then reassess their progress. This cycle allows ongoing improvements over time, with the ultimate aim of improving health outcomes for clients. The model also allows for improvements to specifically meet the needs identified by individual services and can be directed at improving the priority health outcomes for those services.

Quality improvement initiatives that have informed Healthy for Life include:

• The National Primary Care Collaboratives⁸;
• The Office for Aboriginal and Torres Strait Islander Health Quality Improvement Initiative; and
• The Menzies School of Health Research Audit and Best Practice for Chronic Diseases - the ABCD Project.

9. Conclusion

Healthy for Life has been developed within the broader environment of Aboriginal and Torres Strait Islander health, whole-of-government Indigenous Affairs arrangements, and policy/program development in child and maternal health and chronic disease management. Healthy for Life also had some specific precursors in the Continuous Improvement Projects and the Child and Maternal Health Exemplar sites.

Healthy for Life was designed to complement and build on this broader context, focussing on primary health care services. It is intended that the lessons from other programs will benefit Healthy for Life, and that Healthy for Life will fill a gap that has not been met by other programs.

Healthy for Life uses population health approaches and quality improvement processes and tools in its design, providing a targeted boost to service delivery in the areas of child and maternal health and chronic disease. The development of Healthy for Life has benefited from the broader context described in this paper, and over time should result in improved health outcomes for Aboriginal and Torres Strait Islander people.

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1 Australian Bureau of Statistics and the Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. 4th ed. Canberra: Australian Bureau of Statistics and the Australian Institute of Health and Welfare; 2003. Available at: http://www.aihw.gov.au/ publications/index.cfm/title/9226

2 National Aboriginal and Torres Strait Islander Health Council. National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013, Framework for Action by Governments. Canberra: Commonwealth of Australia; 2004. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-imp07-13

3 More information on OATSIH can be found at: http://www.health.gov.au/indigenous

4 More information on COAG can be found at: http://coag.gov.au/index.htm

5 Available at: http://coag.gov.au/meetings/250604/index.htm#attachments

6 Herceg A. Improving health in Aboriginal and Torres Strait Islander mothers, babies and young children: A literature review . Canberra: Commonwealth of Australia; 2005.

7 For more information on the Australian Primary Care Collaboratives see: http://www.apcc.com.au

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