Labor targets Indigenous health priorities, but where’s the workforce?

After an obsessive focus on health for white Australians in the first week of its election campaign, Labor has finally released its Indigenous health policy: a $115 million package “that will put First Australians at the centre of decision-making”.

The targeted areas hit some of the right notes. The largest chunk, $33 million, will be targeted at rheumatic heart disease. Indigenous Australians have shockingly high rates of rheumatic heart disease — 26 times higher than non-Indigenous Australians, according to the Heart Foundation, with the rate of acute rheumatic fever, the precursor to RHD, something like 50 times higher among Indigenous compared to non-Indigenous Australians.

Around $30 million will be aimed at Indigenous youth suicide, which has been at crisis levels for some time; suicide rates among Indigenous Australians have failed to follow the long-term decline in non-Indigenous suicide rates, and remain a matter of national shame; Indigenous children between the ages of 1 and 14 are around 8 times more likely to commit suicide than non-Indigenous Australians, according to ABS data; between 15 and 25 years old, Indigenous Australians are five times more likely to take their own lives.

There’s $20 million for sexual health promotion and another $16.5 million to health and lifestyle promotions like Deadly Choices, which can address problems like smoking. Indigenous Australians die from lung diseases, including lung cancer, at least twice as often as non-Indigenous Australians, fueled by stubbornly high rates of smoking, which is a common problem among Indigenous people in colonial societies worldwide.

Most critically, Labor promises its plans “will be co-designed with and led by First Nations peoples”, saying it “will prioritise Aboriginal Community Controlled Health Organisations by ensuring they have a primary role in delivering culturally appropriate and regionally specific primary healthcare services” and re-establishing the National Aboriginal and Torres Strait Islander Health Equality Council, abolished by Tony Abbott.

The overwhelming evidence is that effective Indigenous health programs are those designed and implemented by Indigenous communities, using Indigenous health workers. Aboriginal GPs and other health workers are far more likely to provide the kind of culturally appropriate primary care that evidence shows encourages Indigenous people to use health services, including in urban areas, while Aboriginal health workers are more likely to improve the effectiveness of lifestyle modification campaigns around diet, smoking and exercise that can contribute significantly to reductions in heart disease, diabetes, lung cancer and emphysema, as well as a host of less lethal chronic diseases. 

It’s here that there’s a hole in Labor’s plan. While the Indigenous health workforce is substantially bigger now than 20 years ago, it’s still far smaller than needed and an expansion of the Indigenous health workforce needs to be a priority. Along with state-level Indigenous health workforce plans, there is currently a National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework that aims for “the representation of Aboriginal and Torres Strait Islander people in the health workforce being proportional to the composition of the total population”. We’re a long way short of that. 

In Queensland, Aboriginal and Torres Strait Islanders make up just 1.7% of Queensland Health’s workforce, well below the ~4% of Queenslanders who are Indigenous. In WA, just over 1% of the state’s health workforce is Indigenous. Only NSW has made substantial recent progress; Indigenous people make up 2.5% of the health workforce, not far short of the overall Indigenous proportion of the NSW population, 2.9%. But these figures relate primarily to staff employed in acute care and hospital-related services, not primary care or allied health services, where Aboriginal health professionals can make the greatest difference.

The other issue is evaluation. Community-designed and -led programs are more likely to be subjected to scrutiny about their performance than programs imposed from Canberra or Perth or Darwin. But the persistent problem of Indigenous health programs, one pointed out frequently by advocates from a wide range of perspectives, is the lack of effective evaluation of programs, which requires money to put in place at the planning stages.

There’s one jarring note in Labor’s media release. “Only Labor cares about a public health system for all Australians and is committed to addressing the injustice of poor health outcomes for First Nations peoples,” it says. That’s profoundly offensive to Ken Wyatt, the Indigenous Health minister who, before being elected to parliament as the first Indigenous MP, was director of Aboriginal health in the West Australian Department of Health for three years, and held a similar position in NSW for four years before that, following a long-term career in Indigenous education. Wyatt’s done more hard yards on Indigenous health at a senior level than virtually any other Australian. Claiming that he doesn’t care about Indigenous health says more about Labor than about the man himself.