Question

Hello can you healp me with this question and provide the references also:

2. Despite increases in funding, explain why in Australian Indigenous health outcomes are still an issue? Provide examples to illustrate your points.

A high level response should identify where there has been increase s in funding to Australian Indigenous health, before discussing how and why this remains an issue. A high level response will draw on examples to support your claims.

Answer 1

The poor health status of Aboriginal and Torres Strait Islander peoples is a well known fact. Substantial inequalities exist between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, particularly in relation to chronic and communicable diseases, infant health, mental health and life expectation.

Perceived helath satus

In 2018–19, among Indigenous Australians aged 15 and over, it was estimated that:

• 45% (238,600) rated their health as ‘excellent’ or ‘very good’, another 32% (168,900) rated their health as ‘good’ and 24% (128,200) rated their health as ‘fair’ or ‘poor’. This health rating has improved since 2014–15 when 40% of Indigenous Australians rated their health as excellent or very good, 35% as good and 26% as fair or poor
• more males rated their health as ‘excellent’ or ‘very good’ than females (47% compared with 43%, respectively)
• across both Remote (Remote and Very remote) and Non-remote (Major cities, Inner regional and Outer regional) areas, 45% of Indigenous Australians rated their own health as ‘excellent’ or ‘very good’
• those living in Remote areas were more likely to rate their health as ‘good’ than those living in Non-remote areas (36% and 30% respectively). Similarly, those living in Remote areas were less likely to rate their health as ‘fair’ or ‘poor’ than those living in Non-remote areas (20% and 25% respectively)

REASONS FOR ENTRENCHED HEALTH CRISIS

• High rates of chronic diseases such as renal failure, cardio-vascular diseases and diabetes;
• continued higher rates of poor health among Aboriginal and Torres Strait Islander infants, as well as far too common occurrence of otitis media (middle ear infection) and eye conditions such as trachoma, which can impact on educational attainment and employment.
• Deficiencies in the information available for some important areas. Best example is cancer, the second most common cause of death among Indigenous people.
• Tend to be selective rather than comprehensive in their coverage of the various health topics.
• Time periods for which detailed information is available tend to vary substantially,documents like this Overview need to draw on information from various time periods in attempting to compile a comprehensive picture.
• a continuing tendency towards poor access to primary health care, as evidenced by high rates of sexually transmitted infections and relatively high rates of HIV/AIDS prevalence; and
• high rates of unhealthy and risky behaviour, including an increased prevalence of substance abuse and alcohol and tobacco use.
• governments of all persuasions have not activated their commitments by setting them within an achievable time frame. Governments have instead left the achievement of equality to an unspecified future time.
• Australian governments have been unaccountable for progress in achieving health equality. Second, they have not matched their commitments with the necessary funds and program support to realise them.
• While they have accepted in health frameworks the need to address Aboriginal and Torres Strait Islander health in a holistic manner, they have not engineered their health programs consistent with this understanding nor considered the impact of their broader policy and program approach on Aboriginal and Torres Strait Islander health.

• Chronic diseases caused 64% of the total disease burden among Indigenous Australians. These include cardiovascular diseases, mental and substance use disorders, cancer, chronic kidney disease, diabetes, vision and hearing loss and selected musculoskeletal, respiratory, neurological and congenital disorders (AIHW 2016).

Based on ABS (Ausrlian Beaureu of Statistics) and AIHW (Australian Institute of Health and Welfare)the following problems have identified in indegenous health.

1) Burden of disese

• it is is a measure of the impact of different diseases or injuries on a population. It combines the years of healthy life lost due to living with ill health (non-fatal burden) with the years of life lost due to dying prematurely (fatal burden). Fatal and non-fatal burden combined are referred to as total burden, reported as the disability-adjusted life years (DALYs) measure.

• Indigenous Australians experienced a burden of disease that was 2.3 times the rate of non-Indigenous Australians.

• Chronic diseases caused 64% of the total disease burden among Indigenous Australians

• Specifically, the leading causes of total disease burden experienced by Indigenous Australians were:

• mental and substance use disorders (19%)
• injuries (including suicide) (15%)
• cardiovascular diseases (12%)
• cancer (9.4%)
• respiratory diseases (7.9%) (AIHW 2016).

2)Disability

• Indigenous Australians are at greater risk of disability due to higher prevalence of low birthweight, chronic disease, infectious diseases, injury and substance use (AIHW 2018).

• In 2018–19, among the total Indigenous Australian population, an estimated 38% (306,100) had some form of disability that restricted their everyday activities, with 27% (220,300) reporting a core activity limitation or schooling/employment restriction and a further 11% (85,700) reporting an impairment with no specific limitation or restriction.

• Those living in Remote areas were less likely than those living in Non-remote areas to report a core activity limitation or schooling/employment restriction (21% and 28% respectively), however this may be influenced by under-reporting or lack of access to services in Remote areas (ABS 2019).

• Based on age-standardised rates, Indigenous Australians reported a disability or restrictive long-term health condition in 2018–19 at 1.8 times the rate for non-Indigenous Australians (ABS 2019).

3)Long-term health conditions

Long-term health conditions and the social and economic consequences of these conditions may affect people’s quality of life and could contribute to premature mortality and morbidity.

In 2018–19, among Indigenous Australians it was estimated that:

• 67% (545,200) reported at least 1 current long-term health condition
• 38% (307,300) reported eye or sight problems

• Indigenous Australians in Remote areas were less likely to report 1 or more current long-term health condition than those in Non-remote areas (56% compared with 70%), although this difference may be due to under-reporting or lack of access to services in these areas (ABS 2019).

• 24% (187,500) reported a mental health or behavioural condition (ABS 2019).
• 4) Social and emotional well being

• Mental health conditions include a wide range of disorders varying in severity. Self-reported data is from an ABS survey, in which respondents were asked if they had been diagnosed with a long-term mental health (for example depression and anxiety) and behavioural condition (for example alcohol and drug problems, attention deficit hyperactivity disorder, conduct disorders and schizophrenia).

  In 2018–19, among the total Indigenous Australian population:

• an estimated 24% (187,500) reported a mental health or behavioural condition, with a higher rate among females than males (25% compared with 23%, respectively)
• anxiety was the most commonly reported mental health condition (17%), followed by depression (13%) (ABS 2019)

• In 2018–19, among Indigenous Australian adults, an estimated:

• 66% reported ‘low or moderate’ levels of psychological distress, while 31% reported ‘high or very high’ levels
• 32% of those living in Non-remote areas reported ‘high or very high’ levels of psychological distress, compared with 27% of those living in Remote areas (ABS 2019).
• FUNDING IN INDEGENOUS HEALTH SECTOR AUSTRALIA
• In 2010–11, health care expenditure for Indigenous people was estimated to be $4.6 billion, accounting for 3.7% of total recurrent health expenditure by government and non-government sources (including out-of-pocket payments by individuals).
• On average, health care expenditure was $7,995 per Indigenous Australian, compared with $5,437 per non-Indigenous Australian—thus $1.47 was spent on health care per Indigenous person for every $1.00 spent per non-Indigenous person.
• Based on Budjet 2018,
• 

• In 2010–11, average per person expenditure for:

• Medicare Benefits Schedule benefits was lower for Indigenous Australians ($493 per person) than for non-Indigenous Australians ($737) (a ratio of 0.7)
• Pharmaceutical Benefits Scheme benefits was also lower for Indigenous Australians ($291) than for non-Indigenous Australians ($366) (a ratio of 0.8).

• Among people in non-remote areas, 20% of Indigenous adults had private health insurance in 2012–13, compared with 57% of all Australian adults

• 

Health funding

• Health expenditure refers to what is spent, and is reported in terms of who incurs the expenditure, rather than who ultimately provides the funding.

• The Australian Government funded 45% of health expenditure for Indigenous people, state and territory governments funded 47%, and non-government sources funded 8.6% in 2010–11. This compares with 44%, 24% and 32%, respectively, of health expenditure for non-Indigenous people.

Welfare expenditure

• In 2012–13, government expenditure on welfare for Indigenous Australians was an estimated $9.8 billion—accounting for 6.7% of total government welfare expenditure.

• In 2012–13:

• just under half (46%) of government welfare expenditure for Indigenous people was for social security payments, followed by 42% for community support and welfare services, and 12% for housing and homelessness assistance
• of the $4.5 billion spent on social security payments for Indigenous people, nearly half (48%) was in the form of cash payments to assist families and children (compared with 26% for non-Indigenous people)
• of the $4.1 billion spent on community support and welfare services for Indigenous people, the largest proportion (29%) was spent on child protection and out-of-home care services (compared with 6.5% for non-Indigenous people)
• of the $1.1 billion spent on housing and homelessness assistance for Indigenous people, 74% was spent on social housing, 15% on rental market assistance and 12% on assistance for homeless people (compared with 34%, 59% and 6.7%, respectively, for non-Indigenous people).

Indigenous people employed in health and welfare sectors

In 2011:

• there were around 8,500 Indigenous people employed in health-related occupations, representing 5.7% of all employed Indigenous people aged 15 and over; of these, one-quarter (26%) were nurses or midwives, and 15% were Indigenous health workers
• 1.6% of the Indigenous population were employed in health-related occupations compared with 3.4% of the non-Indigenous population.

• In 2012, there were 221 Indigenous employed medical practitioners in Australia—accounting for 0.3% of employed medical practitioners who indicated their Indigenous status.

Housing and homelessness assistance

• Of the $1.1 billion spent by governments on housing and homelessness assistance for Indigenous people in 2012–13: • 74% was spent on social housing,
• 15% on rental market assistance and 12% on assistance for homeless people (the corresponding proportions for non-Indigenous people were 34%, 59% and 6.7%)
• • just under half (46%) was for assistance provided through Indigenous-specific services and programs

Community support and welfare services

Of the $4.1 billion spent by governments on community support and welfare services for Indigenous people in 2012–13:

• 29% was spent on child protection and out-of-home care services (this compares with 6.5% for non-Indigenous people)

• 12% was spent on general family and youth support services (6.1% for non-Indigenous people) • 12% was spent on people with disability (21% for non-Indigenous people)

• 8.7% was spent on the aged (48% for non-Indigenous people)

Social security payments

• Of the $4.5 billion spent by governments on social security payments for Indigenous people in 2012–13: •
• nearly half (48%) was in the form of cash payments to assist families and children; this compares with 26% for non-Indigenous people
• 25% was to assist people with disability; this compares with 21% for non-Indigenous people • 17% was to assist the unemployed; this compares with 7.3% for non-Indigenous people
• 7.3% was to assist the aged; this was substantially lower than the 38% for non-Indigenous people .

REFERENCES

1.The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015: AIHW

2.ABS (Australian Bureau of Statistics) 2019. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. ABS cat. no. 4715.0. Canberra: ABS.

3.AIHW (Australian Institute of Health and Welfare) 2018. Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report 2017. Cat. no. IHW 194. Canberra: AIHW. Viewed 06 May 2020.

4.AIHW 2016. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW.

5.(Google images have been used to show the funding )