Close the Gap or Closing the Gap?

Today is National Close the Gap Day. A few months ago, there I was publicising it on Twitter, and I got into a conversation with someone critical of the campaign. They said it “raised money to promote government interference in Aboriginal communities.” I think the Close the Gap campaign and Closing the Gap were being thought of interchangeably.

I’ve seen confusion about this, both in social media and in real life, even among those who are quite involved in working in Aboriginal and Torres Strait Islander communities. (Alright, that was me. But I’m not the only one!)

So here is your cut out and keep guide (Warning – print off before attempting to do any cutting!) to Close the Gap and Closing the Gap.

Close the Gap

This is the campaign which started in 2008, responsible for the National Close the Gap days. It was kickstarted by the Social JusticeReport written by Tom Calma setting out a human rights based approach to health. A broad coalition of Aboriginal and Torres Strait Islander organisations and non-indigenous health and social care organisations worked together to promote and build support for the cause and set out how equity might be achieved. The Steering Committee is co-chaired by the Social Justice Commissioner, Mick Gooda, and the co-chair of the National Congress ofAustralias First Peoples, Jody Broun. You probably know Oxfam are involved, as they have been responsible for the campaigning expertise, but there are many other organisations involved, such as NACCHO, AIDA, the Healing Foundation, the AMA, the RACGP, ANTAR, even the NRL. You can see a full list here. Close the Gap an unprecedented coalition of support across many organisations. To date 185,000 people have pledged their support. You can do so too. (And you won’t find it asking for a donation, though you can buy some nifty merchandise!) You could argue that the campaign has been such a success that government used the same terminology!

Closing the Gap

This is the name given to a series of government programs with the aim of achieving indigenous equity. It has set 6 goals, not all of them health related, and each year at the opening of parliament the government makes a statement to parliament of progress on the goals. (The Close the Gap produce a parallel Shadow Report, and it’s worth reading both!) In the health arena, Closing the Gap is responsible for initiatives like the PracticeIncentives Program, the Closing the Gap PBS Co-payment to make prescriptions affordable, and measures to promote access to specialist and multidisciplinary medical care.

Why do I need to know this?

I’m biased, but I think it’s worth knowing this difference. The Close the Gap campaign is independent of government and is able to offer policy advice and criticise policy. As it is led by Aboriginal and Torres Strait Islander organisations it is able to represent what indigenous communities around Australia need to improve their health. The Campaign itself is not just a campaign, but models the ways of working in partnership for which it advocates. You can confidently support the campaign knowing that you are supporting Aboriginal and Torres Strait Islander people making decisions for themselves and taking leadership in health.

That’s not to say that Closing the Gap should not be supported. Seeing bipartisan support for one of the most important issues facing Australia today is not to be taken for granted, especially in the current political climate. There are some undoubtedly good things in the Closing the Gap measures, and the program certainly talks about working in partnership with Aboriginal and Torres Strait Islander communities, and I believe they do genuinely want to do so.

Looked at from an Aboriginal or Torres Strait Islander person’s perspective, though, government initiatives and commitments need to work hard to develop trust in communities. For over 200 years now, governments have been engaged in doing things to Aboriginal people, starting with massacresand missions and continuing with the forced removal of children from theirfamilies, which continued up to 1970. Every day in my clinical work, I am dealing with the consequences of this right now. It’s easy for non-indigenous people to think this is all in the past, but right now the Northern Territory Emergency Response, initially called the Northern Territory Intervention, is going on. Human Rights legislation had to be suspended to do this, and it is an action that has been widely criticised by Aboriginal communities across Australia and the UN Special Rapporteur on Human Rights.(PDF). For Aboriginal people, this is part of a continuing history of governments doing things to them. It’s worth noting in passing that this program is now called Closing the Gap in theNorthern Territory.

(Incidentally, for some insight into how policy is determined by its media coverage, read my Croakey post)

You can see the effect of this history, just by listening to what Aboriginal people are saying. For example in this paper about the care provided in Aboriginal Medical Services, there is a poignant exchange between Aboriginal health workers which speaks volumes about trust. 

In this poignant interaction between a board member (P1) and AHW (P2) both felt there was a hidden agenda to eliminate AMSs altogether, replacing them with poor quality ‘mainstream’ health care.

P1: They (government community health services) shouldn’t think that they are superior to the AMS team. That sort of an attitude, they should cut it out.

P2: That attitude will stay around for a long time until the boss of this organisation says something to them.

P1:They say that we need their services but that doesn’t mean they should come and tell us to do this, do this, do this… They try to bung low grade services onto us… If we look a little bit further down the track, say five or ten years, there won’t be any more AMSs. They will have become mainstream services.

P2: That’s a plan of the minister… low grade services.

The tweep I quoted at the beginning goes on to say “solutions to aboriginal health must prioritise stopping govt interference in family & community”

Close the Gap  is led Aboriginal and Torres Strait Islander organisations themselves with links back into communities across Australia. It has built a broad based coalition of support and is being listened to by governments. It is not responsible for the delivery of policy, but is able to set out what needs to be done to achieve health equity in a generation.

A final word – it is hard to remember, so here’s a handy mnemonic I made up: To remember the difference between Close the Gap and Closing the Gap, just think that the ING stands for In Government. Easy.

Now all you need to do is support the Close the Gap Campaign, sign the pledge and join an event today. It’s a cause that all Australians can support.

Trying to be exciting about dull stuff – or a note about terminology!

Words are important. Sticks and stones might break bones, but words can certainly cause quite a bit of harm. So it’s worth just taking a moment to set out some of the thinking behind terminology I’ll be using on the blog, and my thinking behind it. Have you ever read a more boring blog sentence? Well, let’s see if we can make this a fun post. Or failing that, a short one.

The thinking behind what we call Aboriginal and Torres Strait Islander peoples has been heavily influenced by colonisation without us even noticing. Aboriginal is an English word which has come to mean the diverse group of peoples who are the original inhabitants of the land masses we now call mainland Australia and Tasmania. Torres Strait Islanders are the group of people who originally inhabited the islands between the northcoast of Queensland and Papua New Guinea. It’s intriguing that the name we’ve given references a Spanish explorer. I’ll try to write Aboriginal and Torres Strait Islander people when that’s what I mean. Much of the time I’ll write Aboriginal and I’ll mean to include Torres Strait Islanders too, really just for clear English purposes – which I am a bit sorry about, as should English trump the needs of Aboriginal and Torres Strait Islanders once again? I won’t be using the term Aborigine, as I find that dehumanising – it’s all too easy to forget we’re talking about people. And I won’t be using ATSI either, as abbreviations are usually a way of using jargon that allows us to forget the concepts behind the words.

I’ll use indigenous in the context of non-indigenous, meaning people who are not Aboriginal or Torres Strait Islander. I’ll also use indigenous when I want to talk about the indigenous people of other countries, as, for example, in the UN Declaration onthe Rights of Indigenous Peoples.

Other phrases it’s worth being clear on are AMS or Aboriginal Medical Service, which is a primary care service servicing predominantly Aboriginal and Torres Strait Islander people. An Aboriginal Community Controlled Heath Organisation (ACCHO), are essentially owned and run by their local communities. Not all AMSs are ACCHOs – Inala in Queensland is an example – and there are some ACCHOs which are not AMSs, providing social rather than health care. Often, the term Medical Service doesn’t do these organisations justice, as that is only a part of what they do, and they are much more than a doctor’s surgery that happens to see Aboriginal patients.

And, just to put a nice cap on all the confusion, there’s Close the Gap and Closing the Gap. Surely they must be the same thing? I’m afraid not. Closethe Gap is the campaign that you’ve heard of, kick-started by the then Social Justice Commissioner, Tom Calma, and supported by Oxfam and led by a range of Aboriginal organisations supported by a large number of non-indigenous health and reconciliation organisations. If you’re reading this, take a moment to sign the pledge, and think about joining or organising a morning tea for National Close the Gap day on March 22^nd.

Closing the Gap on the other hand, is the government program with 6 targets across a range of health, education, and social measures to, er, close the gap. Oh, it does get confusing.

So, that’s cleared that up, then. And with a hop and a skip we move on to the next post.

Initial thoughts on the Closing the Gap report

Each year the PM reports to parliament on progress against the Closing the Gap goals, and this year’s report has just been released. It’s not the most exciting read in the world, but it does highlight a lot of good work being done around the country. It seems we’re making progress in numeracy and literacy, pre-schools for 4 year olds and childhood mortality. The biggest problem, though, is the lack of good data, and without this it’s going to be really hard to tell how well we’re going.

If you want a more independent (and critical) review of progress towards the goals, as well as being shorter and easier to read you should go to the Close the Gap Steering Committee’s Shadow report.  Again, data issues are highlighted, but it explains much better the meaning of the statistics, and is much clearer on what needs to happen now. You wouldn’t know it from the PM’s report, but it’s actually an exciting time for Aboriginal leadership in health. The Indigenous Leadership Group of the Close the Gap Steering Committee is also now the National Health Leadership Forum of the National Congress of Australia’s First Peoples. It means that there is a real opportunity, if government wishes to make a real difference, of the plans to Close the Gap being developed by Aboriginal people. The government certainly makes the right noises on this in their report – it’s quite lovely to read these bits – but it’s worth remembering that there is still a whole big pile of mistrust over the continuation of the Northern Territory intervention among Aboriginal people, which is one of the reasons for anger (not riots) on Australia day.

Oh, and I should declare that I have represented the RACGP on the Close the Gap steering committee for about 18 months now, so of course I think their work is great!

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