Close the Gap program

Topic:”Close the Gap”is a program initiative committed to closing the health and life
expectancy between Australian Aboriginal and Torres Strait Islander people and non-
Indigenous Australians by 2030. While measurable improvements take time, there have
been some demonstrated improvements in reducing smoking rates, improvements in
maternal and child health outcomes and behaviours that lead to chronic diseases.

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Introduction

The Australian Aboriginal and Torres Strait Islander have been experiencing
disproportionate levels of education achievement, social disadvantage and employment. This has
been associated with poor health outcomes as compared to the other Australians, often with
lower life expectancy rates than the other Australian communities. To get a clear picture of the
Aboriginal health status, it is imperative to consider the Aboriginals historical context. In the past
few decades, the healths of Aboriginal people have shifted from being significantly better to
worse as compared to the non-Aboriginal people. Research attributes this to the socio economic
disadvantage which is a direct consequence of the past practices of exclusion, oppression and
dispossession (Zubrick, Holland, Kelly, Calma, Walker, 2014).
In this regard, this essay will critically analyze the current health status of the Aboriginal
people in order to identify the improvement, failures and health demands in this population. This
will be done by evaluating the various policies introduced by the government with the aim of
identifying why the policies have been adequate or inadequate. The essay will focus on “Closing
the Gap policy” to explore its relevance in health promotion strategies. The benefits of these
strategic approaches will be explored. In addition, the role of nurses in meeting the current and
future health demands of Aboriginal population will be explored. The information will be

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obtained from the sources that are up-to-date including the government reports and all relevant
scientific studies.
Critical analysis of current health status of the Australian Aboriginal and Torres Strait
Islander
According to information from 2011 census, it is estimated that the total population of
Aboriginal and Torres Strait people is 729,048. In 2015, approximately 33% of the populations
are major city dwellers and almost half of the population live remotes areas. The population is
much younger as compared to the non indigenous population; only 3.5% of the indigenous
people are above 65 years as compared to 14% of the non-indigenous (Australian Indigenous
HealthInfoNet, 2016).

Fig. 1. Population pyramid: Aboriginal and Strait Islander vs. non indigenous

population

By 2014, approximately 17,779 new births registered were Aboriginal and Torres Strait
Islander. This indicates that there were about 6 in every 100 births. Approximately 17% of the
new births were from teenagers as compared to 2.5% of the non indigenous population. In
addition, the babies were likely to be of low weight (below 2500 g) as compared to the non-
indigenous population. The low birth weights are associated with increased risk of developing

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health related problems. The infant mortality rates are 3 times folds that of the national average
(Holland, 2016).
The indigenous people are two time likely to be hospitalized as compared to the non-
indigenous people. The main causes of hospitalization in young adults below 15 years are
respiratory disorders, ENT and injuries. The main causes of hospital admissions in adults are
digestive system disorders, injuries from accidents and cardiovascular disorders. Women have
higher pregnancy related issues and the reproductive system disorders as compared to the non-
aboriginal population. The indigenous populations have shorter life expectancy of about 18-19
years less as compared to the non-indigenous population. The most common causes of mortality
include cardiovascular diseases, which are estimated to be two folds that of the non-indigenous
population. Diabetes is the most common endocrine health issue, which is approximately six
times higher as compared to that of the non indigenous people(Watkins et al. 2014). About 30%
of the indigenous people suffer from diabetes. Other causes of mortality include injuries, lung
cancer, liver cancer and cervical cancer. This is a clear indication that although indigenous health
policy has been the key Agenda on Australian public policies and politics, there are still huge
health disparities (gap) between the indigenous health and the non-indigenous health (Australian
Indigenous HealthInfoNet, 2016).
The issue of health inequality has been a great concern for Australia. Although the
overall health status of Australia has improved, the health status of the indigenous Australians
continues to score below those of non-indigenous populations. Although a lot has been done to
address the health disparities, the statistics illustrate that the policies established to address the
health disparities have been ineffective (Australian Institute of Health and Welfare, 2010, p.29).
Information with historical context of the Indigenous Health is scare. However, it is well

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illustrated that the health status of indigenous population has been poor from the time the
European settlers arrived. The indigenous people had no contact with the outside world before
colonization; thus, there were minimal incidences of infectious diseases. The arrival of
European settlers led to the introduction of new illnesses such as reproductive diseases due to
consensual contact of the colonizers (Australian Human Rights Commission, 2011).
In addition, the indigenous health was also largely impacted by the change in diet. For
instance, before colonization, the indigenous food consisted of vegetables and animal proteins.
They were also physically active as they obtained their food from hunting and gathering.
Colonization led to changes in these lifestyles, which led to increase of heart diseases, diabetes
and obesity observed among the indigenous people today. Poor mental health is associated with
socio-economic disadvantage which leads to substance abuse. The lack of commitment in
addressing the mental health has resulted into increased suicidal rates among the indigenous
community. In addition, the populations have low access to medical care. This is due to language
barriers where voice can be misinterpreted. From my experience, what one would consider as
polite is sometimes conceited by other people. Other issues identified includes inadequate
health facilities in rural areas and high cost of services such as travelling costs and treatment
costs (Steering Committee for the Review of Government Service Provision, 2014).
Anthropological studies indicate that indigenous people have spiritual connection to their
lands. Land to the indigenous people connects them to their ancestors. It was their sense of
belonging. The colonizers did not understand this world perspective, and when the more they
grabbed the land, the more the indigenous people mental health status deteriorated. Their
psychological health issues increased when they were forcefully evacuated from their lands into

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reserves and settlements. This created disturbances from family, which exacerbated their mental
health due to low self esteem and low sense of belonging (Gee et al., 2014).
Evidently, the concept of health among the indigenous population is very complicated by
the diverse world perspectives of the indigenous and the non-indigenous populations. The lack of
understanding between these two populations has led in a series of health policies with the aim of
eradicating health inequality among the Aboriginal and Torres Strait population. The first health
policy implemented to address the health disparity was established in 1968. There were a total of
35 reforms that were done between the period and 2006. In general, each of amendments was
done by various bodies and institutions which had been created to address the disparities issues
that had been inadequately expressed previously. However, the main responsibility was allocated
to government, which assigned the various programs to the local authorities. The changes in
government led to constant changes in the way the health issues were perceived and addressed
(Australian Indigenous HealthInfoNet, 2010).
From my analysis on the policies that have been established to adequately address the
issue of health disparities among the indigenous population, I found that comparative analysis
was used to identify strategies that have been successful in other countries; which would be
implemented in Australia. This kind of analysis is very sufficient in some cases, but when it
comes to the Indigenous population, such strategies would hardly align to the indigenous
populations and culture because our world perspective is complex and unique. Although the
health issues incidences are similar to those in other parts of the world, world perspectives
impact the indigenous people health and well being very considerably (Gee et al., 2014).
This ideology is well exemplified by the closure of Aboriginal and Torres Strait Islander
Commission (ATSIC) in 2004. This led to greater health disparities as the government could not

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understand the intricacies of indigenous Australian culture as well as the implications of the
actions on the indigenous people’s health. Of all the programs that have been implemented to
address the health inequalities in Australia, Closing the Gap policy has seems to be the most
promising. The policy focuses the concept of health in a different approach, one which perfectly
suits the needs of the Indigenous people. The policy is cultural competent and aims to reduce the
health inequality gap by 2030, half the children mortality rates by 2018, improve access to
education by 2013 and half the unemployment gap by 2018 (Department of the Prime Minister
and Cabinet, 2016).
Health promotion strategies: Strategic approaches used to address the challenges
The concept of Closing the Gap policy is an effective approach that is being applied by
the government to promote the indigenous well being and health. The governments have
acknowledged that to close the gap in health inequalities, it must recognize the rich cultural
practices of the Aboriginal and Torres Strait Islander community. This strong cultural identity is
very important in promoting the indigenous health as well as their emotional wellbeing. The
council of Australian Governments (COAG) has established sustained commitment from all
arms of the government, which has led to initiatives that are directed towards seven building
blocks including, early childhood, education, establishing effective economic participation,
healthy homes, safe communities and in establishing leadership and governance. This is an
effective strategy because it is the destruction of the Aboriginal and Australian culture that has
led to the despair and confusion which are associated with the irreconcilable cultures (Australian
Institute of Health and Welfare, 2013).
For instance, the early child initiatives, the government has established activities that
engage with culture, and ones which are essential in the development of resilient Aboriginal and

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Torres Strait Islander. The Australian Indigenous Psychologists Association (AIPA) increased
connection to family, culture and land results to spiritual protection to psychological distress and
ill health. This is associated with the wellbeing factors such as kinship networks increases self
identity, and self esteem. This is associated with improved academic performance due to reduced
school absenteeism due to health issues. The initiatives also aims at improving education and
schooling reduces dropout rates, results in better reading and communication skills in both their
language and English communication. Research associates low literacy with negative impacts
due to language barriers (Parker and Milroy, 2014).
Evidently, the aboriginal people have strong connection with their culture. Research
indicates that when these indigenous people participate in cultural activities, it improves their
physical and mental health. The National Mental Health Policy 2008 states that such activities
improve their cultural identity which connected to lower mortality and morbidity to the
population. In this policy, there are initiatives that have been established to allow the indigenous
community to participate in activities which promote preservation of their culture (Holland,
2016). This includes activities such as visual arts production, performing in theatre and music.
The socio-cultural wellbeing’s have been identified as the building blocks of the overall health of
Aboriginal and Torres Strait communities. This is supported by a qualitative study which found
out that participation in cultural ceremonies such as the Kanyirninpa reduces suicide and
effectively prevents self harm in communities living in the southeast region. This is because such
programs are associated with numerous benefits for participants such as capacity building,
social capital as well as empowerment through provision of activities that prides in their cultural
identity (Department of the Prime Minister and Cabinet, 2016).

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In order to help in closing the gap, nurses should understand the statistics regarding the
health status on the Aboriginal and Torres Strait community. These includes the birth rates, the
death rates, domestic violence and disease incidences. These are the main sources of mental
illness, and statics represents the number of lives that have been destroyed by pain and suffering.
Societal issues such as drug abuse, poor living conditions and poor socioeconomic status are the
leading causes of such diseases. Understanding these statistics will help the nurses establish care
plans are cultural competent and safe (Watkins et al. 2014).
Conclusion
The study analysis indicates relative limited progress against the Closing the Gap 2030
policy. Although there is some good report that have led to fundamental improvements in
Aboriginal and Torres Strait health outcomes, the government still have a long way in order to
effectively address the issue of inequality among the indigenous people. Although an ambitious
task, closing health equality by 2030 is an achievable task. Fortunately, it is also the government
priority. Over 200,000 Australians supports the policy, which indicates that it is clear that there is
high public demand that government must continue to establish partnership with the indigenous
people in order to build a close gap platform that will meet this challenge. I believe we can and
should be the people to finally close the gap.

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References

Australian Institute of Health and Welfare. (2013). Indigenous statistics: quality and availability.

Australian Indigenous HealthInfoNet .(2016). Summary of Aboriginal and Torres Strait
Islander health, 2015
Department of the Prime Minister and Cabinet. (2016). Closing the gap Prime Minister’s report

  1. Canberra: Department of the Prime Minister and Cabinet
    Gee, G., Dudgeon, P., Schultz, C., Hart, A., Kelly, K .(2014). Aboriginal and Torres Strait
    Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds.
    Working together: Aboriginal and Torres Strait Islander mental health and wellbeing
    principles and practice. 2nd ed. Canberra: Department of The Prime Minister and
    Cabinet: 55-68
    Holland, C. (2016). Close the Gap: progress and priorities report 2016. Canberra: Close the Gap
    Campaign Steering Committee
    Parker, R., and Milroy, H. (2014). Mental illness in Aboriginal and Torres Strait Islander
    peoples. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and

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Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed.
Canberra: Department of The Prime Minister and Cabinet: 113-124
Steering Committee for the Review of Government Service Provision. (2014). Overcoming
Indigenous disadvantage: key indicators 2014: Table 11A.1.2.6 Alcohol induced deaths
(rate per 100 000), age standardized, by sex, NSW, Queensland, WA, SA and the NT,
2008−2012. Canberra: Productivity Commission
Watkins, R.E., Elliott, E.J., Wilkins, A., Mutch, R.C., Fitzpatrick, J.P., Payne, J.M., O’Leary,
C.M., Jones, H.M., Latimer, J., Hayes, L., Halliday, J., D’Antoine, H., Miers, S., Russell,
E., Burns, L., McKenzie, A., Peadon, E., Carter, M., Bower, C. (2013).
Recommendations from a consensus development workshop on the diagnosis of fetal
alcohol spectrum disorders in Australia. BMC Pediatrics; 13: 156
Zubrick, S.R., Holland, C., Kelly, K., Calma, T., Walker, R. (2014). The evolving policy context
in mental health and wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working
together: Aboriginal and Torres Strait Islander mental health and wellbeing principles
and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet:
69-90 (chapter 5)

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