Australian Government policy dealing specifically with the health of Aboriginal and Torres Strait Islander Australians dates from the 1967 referendum, which gave the Australian Government powers to legislate for Aboriginal and Torres Strait Islander people. Prior to 1967, all existing services including health for Aboriginal and Torres Strait Islander people were exclusively a state responsibility and were not delivered within a national policy framework.
Between 1967 and 1995 there was little action at the Commonwealth level in the mainstream heath system to improve services for Aboriginal and Torres Strait Islander people. In 1995-96, responsibility for Aboriginal and Torres Strait Islander health and substance misuse programs was transferred from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the then Department of Health and Aged Care.
National Aboriginal and Torres Strait Islander Health Strategy (1989)In 1989 the National Aboriginal Health Strategy (NAHS) was established as a landmark document in Aboriginal and Torres Strait Islander health policy which articulated Aboriginal and Torres Strait Islander people’s health aspirations and goals within a rights-based framework.
The 1994 Report of the Evaluation of the NAHS found that it was ‘never effectively implemented’. 55 It cited that one of the significant challenges in its implementation was that the Strategy lacked any concerted partnership approach to support implementation by all the necessary stakeholders and lacked commitment by Australian Governments.56
Aboriginal and Torres Strait Islander Health Goals and Targets (interim) (1991)In 1991, Aboriginal and Torres Strait Islander Health Goals and Targets (interim) was published. The goals and targets proposed in the paper built on the National Aboriginal Health Strategy, and were designed to promote discussion about target setting in Aboriginal and Torres Strait Islander health. To capture the holistic approach to understanding and monitoring Aboriginal and Torres Strait Islander health the interim goals and targets were grouped into five sections including: health outcomes; access; health support; education; and training.
The framework sought to avoid unbalanced targets by selecting a range of complementary targets including:
- 1. Health status targets - addressing death, disease and disability;
2. Risk reduction targets - aimed at behavioural risks to health;
3. Public awareness targets - intended to increase public awareness about health risks or appropriate prevention;
4. Professional Education and Awareness targets - encouraging an increase in the proportion of professionals who are aware and trained to provide appropriate interventions; and
5. Service and Protection targets - addressing the need to increase comprehensiveness and accessibility of services. 57
Aboriginal and Torres Strait Islander Health Framework Agreements (Framework Agreements) (1996)Between 1996 and 1999 all jurisdictions (including the Torres Strait) signed Framework Agreements between the Commonwealth, state/territory governments, the community controlled health sector, and ATSIC. Top of page
Since 1996, the Framework Agreements through their Aboriginal and Torres Strait Islander Health Forums or Partnerships were established to oversee the following key areas of work:
- 1. joint planning;
2. access to both mainstream and Aboriginal and Torres Strait Islander specific health, and health related services;
3. increased level of resources allocated to reflect need; and
4. improved data collection and evaluation.
COAG Whole of Government approach to Indigenous affairs (2002)In 2002, COAG agreed to a trial of a whole-of-governments cooperative approach in up to 10 communities or regions (the Department of Health and Ageing’s Trial Site was the Anangu Pitjantjatjara Yankunytjatjara Lands in South Australia). The aim of the trials was to improve the way governments interacted with each other and with communities to deliver more effective responses to the needs of Aboriginal and Torres Strait Islander people. As part of this approach the government implemented Shared Responsibility Agreements and Regional Partnership Agreements.
In 2002, COAG leaders also agreed to commission the Steering Committee for the Review of Commonwealth/State Service Provision (SCRCSSP) to produce a regular report to COAG against key indicators of Indigenous disadvantage. The framework includes three priority outcomes to reflect a vision of how life should be for Indigenous people, and includes:
- twelve headline indicators which measure the major social and economic factors to be improved; and
- seven ‘strategic areas for action’ which potentially have a significant and lasting impact in reducing Indigenous disadvantage, and are amenable to policy action, so that, over time, improvements in the headline indicators and priority outcomes can be achieved. Each ‘strategic area for action’ is linked to a set of ‘strategic change indicators’. These indicators are designed to show whether activities are making a difference, and to identify areas where more attention is needed.
To underpin government effort to improve cooperation in addressing this disadvantage, in June 2004, COAG also agreed to a National Framework of Principles for Government Service Delivery to Indigenous Australians. The principles addressed sharing responsibility, harnessing the mainstream, streamlining service delivery, establishing transparency and accountability, developing a learning framework and focusing on priority areas.
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National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013The National Aboriginal Health Strategy (NAHS) was a foundational document for developing the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH). The NSFATSIH was intended to complement, rather than replace it, and address contemporary approaches to primary health care and population health within the current policy environment and planning structures.
The NSFATSIH aimed to provide government with sound advice about evidence-based approaches for improving health outcomes for Aboriginal and Torres Strait Islander people. The Framework clearly articulated that health gains cannot be made in isolation, therefore, it adopted a multi-sectoral approach to improve housing, education and employment to support and sustain improvements in health.
The NSFATSIH committed governments to work together on joint and cross-portfolio initiatives to improve health system deliverables and address the social determinants of health so that Aboriginal and Torres Strait Islander people can enjoy a healthy lifestyle equal to that of the general population.
The agreed policy priorities in the NSFATSIH were developed without imposing specific targets or benchmarks on the Commonwealth, state and territory governments in recognition of the different histories, circumstances and priorities of each jurisdiction. This approach allowed jurisdictions to surface local and regional issues and address them through specific strategies or programs.
Specific strategies were subsequently developed by state and territory governments to support the overall goals and objectives of the NSFATSIH. The flexibility of NSFATSIH allowed jurisdictions to develop strategies that sought to address their local and regional issues, while complementing the overall strategic direction of the NSFATSIH.
An appraisal of the NSFATSIH was conducted to identify key learning’s, which have been incorporated into this Health Plan to ensure a cumulative learning approach to Aboriginal and Torres Strait Islander health policy.
Aboriginal and Torres Strait Islander Community Controlled Health OrganisationsThe first Aboriginal medical service was established in the Sydney suburb of Redfern in 1971, with the aim of improving access to health services for the local Aboriginal community by creating a culturally appropriate environment. According to the National Aboriginal Community Controlled Health Organisation (NACCHO), the national body representing Aboriginal and Torres Strait Islander community controlled health organisations throughout Australia, these organisations are primary health care service initiated and operated by local Aboriginal and Torres Strait Islander communities to deliver holistic, comprehensive and culturally appropriate health care to the community that controls it (through a locally elected board of management). There are currently over 170 Aboriginal medical services in Australia. These services are unique in their management and funding structure, and their community base.
National Health ReformAustralia’s health system is amongst the best in the world. However, demands on the system are increasing due to an ageing population, increased rates of chronic and preventable disease, new treatments becoming available and rising health care costs.
Working in partnership with states and territories, the Australian Government has taken action to address these challenges and in August 2011, secured a national agreement that will deliver the funding public hospitals need, with unprecedented levels of transparency and accountability, less waste and less waiting for patients.
Key components of the National Health Reform Agreement (and the related National Partnership Agreement on Improving Public Hospital Services and the National Healthcare Agreement 2011) that are directing the changes to Australia’s health system include:
- a new framework for funding public hospitals and an investment of an additional $19.8 billion in public hospital services over this decade;
- a focus on reducing emergency department and elective surgery waiting times;
- increased transparency and accountability across the health and aged care system;
- a stronger primary care system supported by joint planning with states and territories and the establishment of Medicare Locals; and
- the Australian Government taking full policy and funding responsibility for aged care services, including the transfer to the Australian Government of current resourcing for aged care services from the Home and Community Care (HACC) program, in most states and territories except Victoria and Western Australia.