Now there is another gap, between the city and the bush
Yesterday’s Prime Ministerial address to the nation on Closing the Gap with Aboriginal Australia showed just how complex this historic undertaking will be. Now in its fifth year, the simple measures like service access are promising, but evidence of utilisation and outcomes remains elusive.
Australia’s Aboriginal population will pass 600,000 later this year. That is a 45% jump since the 2001 Census; mostly in our eastern seaboard cities and towns.
Contrast this with the remote Aboriginal population which has stabilised at just over 100,000. It still grows at 1-2% annually in Queensland and the Northern Territory but is falling at an even faster rate in remote South and Western Australia.
Because much of this urban Indigenous growth is self-identification. Remote Aboriginals living in appalling conditions are increasingly outnumbered.
That factor alone may be creating an impression of closing gaps. At the same time, life in remote Australia may be either unchanged or in some cases deteriorating.
This boom in urban Aboriginality will further undermine political influence of those living remotely. That’s because every Aboriginal Australian entitles their State to 105% of per capita federal health funding, regardless of where they actually live or how healthy they are.
Just under half the nation’s remote Aboriginals live in the Northern Territory; so solutions must start there. Darwin is expected to administer this massive challenge; yet it is a city the size of Geelong or Toowoomba.
Compared to national averages, Territory hospitals are burdened with more than twice as many admissions per head which stay far longer due to complex disease and lack of discharge options. Surgery costs are around 25% more and death rates are double.
Given those challenges, the Australian Institute of Health and Welfare reports that the Territory carries most of their burden. The Commonwealth funds 36% of state hospital costs, but less than a quarter of the Territory’s hospital bill. Canberra funds 62% of the nation’s overall health system, but only 43% in the Territory.
Recent hospital reforms won’t fix these inequities. They calculate national weighted activity units to fund health activity with top-ups for Aboriginality and remoteness.
Virtually all the 5% indigenous loading will end up back in cities where health service access is satisfactory. The additional 8-19% remoteness loading will barely cover travel costs for patients and staff in locations like Darwin.
Medicare also fails where it is needed most, because the Territory lacks doctors to bulk-bill and write prescriptions. Thanks to these shortages, around $100 million of Medicare and pharmaceutical benefit funds which should be available to the NT are spent in other parts of Australia where doctors prefer to practice.
As VACCHO’s Jill Gallagher so aptly put it recently, “If you’re going to close the life expectancy gap, you’ve got to look at education and employment opportunities. Anyone whether you’re black or white, if you’ve got a job you’re going to be a lot more healthy.”
Economic engagement is actually at the heart of better health. Obscured by nation-wide gap statistics is the devastating reality that remote Aboriginal Australians are two and a half times less likely to have work than remote whites.
Mining companies may be boosting their Aboriginal workforce to ten percent and in rare cases beyond. But many of these workers travel in from elsewhere. That leaves communities closest to mining enterprises effectively unchanged.
Welfare as currently delivered traps remote Aboriginal families in their communities and discourages many from travelling for work. The only solution is to transition the entire school leaving cohort into training and case-manage every capable non-primary caring working-age adult into real work.
That means rewarding those electing to move for employment. That contrasts with current arrangements, where the most dysfunctional communities are rewarded with extra night patrols, rehabilitation, detoxification and diversion services.
Back in 2008, eight Labor administrations settled on six ‘Close the Gap’ targets which failed to mention the economic activity gap. The closest they got was an employment target, which merely invites more publicly-funded artificial jobs which are too often activity-for-welfare.
Many of these gaps to be closed require tougher and more frequent interim targets in urban areas. At the same time, we need to specifically report the much larger gaps in remote Indigenous Australia.
Ironic as it sounds, remote Aboriginal Australia must grab the mining boom as a once-in-a-century opportunity to preserve the traditional life. That is because culture is far safer in the hands of kinship groups comprising confident capable working adults.
Custodianship of the future is safest in the hands of children who attend and enjoy school and ultimately graduate into training and work. Only then, does health become a condition to be pursued, rather than a service pursuing them.
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