The Link Between Primary Health Care and Health Outcomes for Aboriginal and Torres Strait Islander Australians
Since we began working on this report in December 2007, a new Government in Canberra has delivered an Apology to Australia’s Indigenous Peoples.
The Prime Minister’s address on 13 February 2008 to the House of Representatives, witnessed by a packed Parliamentary gallery and hundreds of thousands of people watching the broadcast live on television, was a dramatic and moving event. Few who were present or who watched the emotional scenes during and following the Apology doubted that this was an important turning point in the relationship between Indigenous and non-Indigenous Australia.
The significance of the Apology in more prosaic policy terms will develop over the months and years to come. However, part of the speech specifically committed the Australian Government to closing the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation.
The specifics of how to achieve this goal will no doubt take some time to work out, and involve reviews not just of the formal literature, an evaluation and re-affirmation of what approaches have already been shown to work, and a commitment to new approaches where necessary.
We hope that this literature review will contribute to this process.
Here we will show how the international literature demonstrates that, notwithstanding the powerful effects of the social determinants of health in general and socioeconomic class in particular, primary health care has significant positive effects on the health of populations as measured by mortality and life expectancy.
We will also see how the evidence confirms the positive effect of primary health care systems on the health of Indigenous populations in other First World nations. However, in Australia (looking at the national and jurisdictional level) the evidence is less strong. We will argue that this is predominantly because Australia is yet to fully realise the health gains that primary health care is able to deliver.
Finally, we will present some local models of primary health care delivered to Aboriginal and Torres Strait Islander people, and draw from these some lessons about the place of primary health care in changing the health of Aboriginal and Torres Strait Islander communities.
We hope this information will contribute to knowledge about how to address the issue of health inequity between Indigenous and non-Indigenous Australia. However, what we have not been able to do in this review – because its shape and scope was determined before the delivery of the Apology in February 2008, indeed before the election of the new Federal Government – is to look in depth at the question of closing the life expectancy gap.
‘Closing the gap’ requires more than just improving the life expectancy of Australia’s Indigenous peoples. Aboriginal and Torres Strait Islander life expectancy has been slowly improving for some decades, yet the gap is not significantly narrowing because the life expectancy of the mainstream population is also improving. ‘Closing the gap’ obviously requires improving the life expectancy of Aboriginal and Torres Strait Islander Australians at a greater rate than that of the rest of the nation.
It is our view, supported by the evidence, that primary health care is a necessary part of doing this. But is it sufficient by itself? If all Australians had equal access to appropriate primary health care services compared with their need for health care (which surely should be an important aim based on social justice principles alone), by how much would the life expectancy gap be reduced? At this point, we would need to consider and quantify the effects – immediate and over time – of a whole range of other determinants of health besides access to health care: housing, education, employment, equality and inclusion, life control and choice, to name a few.
Unfortunately, it is beyond the scope of this Review to attempt to map out in detail the differential effects over time of all the factors that determine health, including primary health care. However, what we can show, supported by the evidence, is that access to primary health care will lead to better health outcomes measureable by life expectancy and mortality.
Our analysis also shows that for Aboriginal and Torres Strait Islander Australians there is a significant gain yet to be made in health outcomes through the delivery of well-designed, evidence-based, properly resourced primary health care that involves the community it serves and is appropriate to its needs.
Given the nature and scale of the health problems confronting Aboriginal and Torres Strait Islander people it is also sound to conclude that this gain would contribute to closing the gap in health outcomes in Australia.