Thursday, May 10, 2012

What the budget means for Indigenous health - a personal view

Our family sat down together  to watch the Budget the other night. (“Isn’t there anything else on?” asked one of my daughters. Would the politicians give them fewer nightmares than Doctor Who?) When it got the health parts of the budget, here is what I thought I heard Wayne Swan say: “Hospitals hospitals hospitals hospitals hospitals hospitals....”
I’ve skimmed over quite a bit of the budget coverage, but there isn’t a great deal of commentary on the parts of the budget affecting Aboriginal and Torres Strait Islander health. Croakey has a good summary and there was some good Twitter opinion.
However, I haven’t seen much other analysis more than just listing the components, but I think there are some implications that we need to watch for, so here, for what it’s worth, is my analysis. 

Insert disclaimer- I’m not an economist, just a practitioner enjoying trying to make sense of stuff. My analysis could be very wrong, (I don’t think it is, though!) but it’s a useful starting point for a discussion. This is also my opinion – I do work for some organisations who have official opinions on this, which may or may not coincide with mine!

Overall, the government has increased spending on Indigenous health – up from $1.032 billion to $1.074billion. The headline figure that the government has relating to Indigenous health is $5.2 billion, which is a lovely big sum of money. However, $3.4 billion over 10 years of this is for the Stronger Futures in the Northern Territory.  This also includes $6.4million (it actually says $6.4 but I don’t think that’s what it means!) for preserving AITSISIS collections and the money for SBS to set up a National Indigenous Free to Air TV service. (It’s not clear what happens to NITV). Also included in this sum are a number of projects in local Aboriginal and Torres Strait Islander communities, that all look very good. For people who don’t live in these communities though, there’s not a great deal , and there doesn’t seem to be an overall strategy.

Perhaps an overall strategy is to be found in the “Outcome 8” Indigenous Health documents from the Department of Health and Aging. This lists the budget under the Closing the Gap program around preventing chronic disease. It looks like these haven’t changed much. I don’t see any extra money or new initiatives there, but neither do I see a stripping out of money, which is good, given the context of this budget and the promise for a surplus.

There is also $67.9million dollars being cut from health workforce programs in "streamlining" workforce initiatives, with the money going to other government priorities. Given that the workforce dealing with Aboriginal and Torres Strait Islander health is somewhat understaffed, there could be a problem if there is not the workforce o deliver all these marvellous programs.

There is another pattern to be found in this budget, however. $75 million dollars have been removed from infrastructure projects in indigenous health. This has been redirected towards the Aboriginal and Torres Strait Islander Health program and the Health and Hospitals Fund. Given that  this latter fund includes $48.6million for indigenous health infrastructure in 10 remote communities, this looks like a funding cut to me. Apparently, DoHA say the money has been taken from low priority projects, though I don’t imagine they were low priority when the money was applied for or granted!
In a similar vein, money has been removed from indigenous literacy projects and redirected into Stronger Futures in the Northern Territory. While the right noises are made about primary care and education in the Stronger Futures initiatives, there is a significant amount of opposition to Stronger Futures in Aboriginal communities, because, once again, it continues the European tradition of doing to not working with. Stronger Futures started out as the Northern Territory Emergency Response, then became the Intervention, then became Closing the Gap in the NT and is now Stronger Futures. While the government have done more consulting around this, and there is a wide range of opinions in Aboriginal communities (as you would expect in any community) you could not argue that there was broad support for the measure in Aboriginal communities. The problem is that this will undermine the effectiveness of primary care initiatives and education initiatives done as part of this. There is clear evidence that real partnerships with Aboriginal communities are necessary to make progress in this area.

The other potential for a big narrative in this budget is in the measures for a National Disability Insurance Scheme, the Dental arrangements and the Aged Care measures. Aboriginal people have twice the rate of disability as non-indigenous people, and these disabilities occur at a younger age. There are also well recognised problems with oral health, which have knock on effects for diabetes and cardiovascular health. So these measures have great potential to provide support and much needed care for Aboriginal and Torres Strait Islander people. However, don’t forget that Aboriginal people have had much less access to Medicare and to the Pharmaceutical Benefits Program, and it has needed specific measures to address this. I see no reason why the National Disability Insurance Scheme would be any different with thought put to this. We will not Close the Gap if 10 years from now we have a lovely NDIS operating and Aboriginal people are accessing it at half the rate of non-indigenous people. This needs to be thought about at this stage.
So, I think the budget is a mixed bag for Indigenous Health. It’s worth checking out the media releases from some other organisations on their budget reaction, though, because I was surprised to find myself at the more negative end of the spectrum!
I've not seen a release from NACCHO’s yet, though these were tweets during the budget!
So, as the AMA say, “the devil will be in the detail” and it is worth watching this space closely to see that this significant investment gets to where it is needed and is used in the most effective way. I have no doubt that that will involve partnerships with Aboriginal and Torres Strait Islander communities, rather than impositions.
I’m looking forward to the day when I hear a treasurer stand up to present the budget and hear them saying “Primary Care, Primary Care, Primary Care, Primary Care. Oh. And consultation. Real consultation.”

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