Australia: the healthiest country by 2020
National Preventative Health Strategy - Overview
6. Indigenous Australians – contribute to ‘Close the Gap’
In the current context of high levels of chronic disease in the Indigenous population, obesity, alcohol and tobacco make significant contributions to the burden of sickness, injury and death in Indigenous communities. Together, these factors contribute to almost a quarter of the ‘health gap’.
The proportion of the health gap attributable to obesity, tobacco and is also distributed unevenly. While Indigenous people in remote areas make up 26% of the total Indigenous population, they contribute 34% of the total health gap attributable to tobacco, 38% of the health gap due to high body mass, and a full 50% of the health gap due to alcohol.
The announcement of the ‘Close the Gap’ commitment by all Australian governments in December 2007 recognised the extent and urgency of the problems facing Indigenous Australians. To be successful in raising the life expectancy of Indigenous Australians to that enjoyed by non-Indigenous Australians within a generation, the disparity in levels of sickness and death attributable to obesity, tobacco and alcohol must be addressed.
Key principles for successful programs include:
- Genuine local Indigenous community engagement to maximise participation, up to and including formal structures of community control
- Integration of vertical, targeted programs on alcohol, tobacco and obesity with broad-based comprehensive primary healthcare
- Ensuring programs are adequately resourced for evaluation and monitoring so they can contribute to program and policy knowledge
- Evidence-based approaches that are reflective and that involve the local community in adapting what is known to work elsewhere to local conditions and priorities
- Adequate and secure resourcing to allow for actions to be refined and developed over time
- Performance indicators and measurement that are linked to accountability and action
How can prevention help bridge the gap?
Broad, multifaceted action is needed to address the contribution made by alcohol, tobacco and obesity to the health gap between Indigenous and non-Indigenous Australians, combining specific programs addressing these issues with broad action on the social determinants of health, and action to strengthen and extend health services, particularly comprehensive primary healthcare.
For Indigenous Australians, primary healthcare has come to be recognised by policy makers, health professionals and the Indigenous community as the key strategy for improving the health of Indigenous Australians. To the extent that there have been health improvements, these have been credited to improved primary healthcare. Even where measurable improvements are limited (for example, in chronic disease mortality rates), the conclusion has been drawn that while the social determinants continue to drive high levels of ill health, improved primary healthcare services are at least providing a brake on what would otherwise be accelerating mortality rates.
Actions will need to include:
- Support and resourcing for community agency and action through the establishment of local community leadership groups
- Adequate long-term investment in social marketing campaigns to shift social norms of smoking and alcohol consumption amongst Indigenous people
- Action to promote smoke-free workplaces, community spaces and events, especially through work with Indigenous organisations, possibly through the employment of tobacco control workers in National Aboriginal Community Controlled Health Organisation (NACCHO) affiliates
- Resourcing of multi-component community-based programs, including effective and professional evaluation
- Strengthening antenatal, maternal and child health systems for Indigenous communities
- Strengthening effective screening, intervention and referral pathways in primary healthcare and between primary healthcare and specialist services
- Reform and increased support for treatment and rehabilitation services for alcohol-related problems
- Actions on pricing of alcohol, including a broad review of Australia’s alcohol taxation policy as part of a comprehensive approach to alcohol problems in Australia, as recently called for by the Royal Australasian College of Physicians
- Action to restrict alcohol supply, including the numbers and types of licences and hours of sale, especially for takeaway licences