Closing the Gap in Queensland

What is 'Closing the Gap'?

'Closing the Gap' refers to reducing the gap in inequalities that exist between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Australians.  Under the National Indigenous Reform Agreement the Council of Australian Governments (COAG) committed to achieving six targets for closing the gap in health, education and employment outcomes.

The two health-specific targets are:

• to close the gap in Aboriginal and Torres Strait Islander life expectancy within a generation (by 2033); and
• to halve the gap in mortality rates for Aboriginal and Torres Strait Islander children under five within a decade (2018).

The health gap is the difference between the Aboriginal and Torres Strait Islander burden of disease estimates and those for the general population.  In Queensland the life expectancy gap is currently estimated at 10.4 years for males and 8.9 years for females.
The six leading drivers of the health gap between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Queenslanders, which together explain 80% of the health gap:

• Cardiovascular disease – an estimated 28% of the health gap;
• Diabetes – an estimated 16% of the health gap;
• Chronic respiratory disease – an estimated 11% of the health gap;
• Cancers – an estimated 9% of the health gap;
• Injuries - an estimated 8% of the health gap; and
• Mental disorders – an estimated 8% of the health gap.

Cardiovascular disease and diabetes and chronic respiratory diseases are the leading contributors to the health gap in major cities, regional centres and remote areas, together accounting for 55% of the health gap in Queensland.

11 risk factors explain 37.4% of the total burden of disease including:

• smoking, alcohol and other drugs;
• obesity, low rates of physical activity and poor nutrition;
• high blood pressure and high cholesterol;
• unsafe sex; and
• child sexual abuse and intimate partner violence.

Of these, smoking was the largest cause of health loss, contributing 17% to the health gap and one fifth of all Aboriginal and Torres Strait Islander deaths nationally. 

In April 2008, the Queensland 'Close the Gap: Indigenous Health Equality Summit Statement of Intent'  was signed by the Honourable Anna Bligh MP, the former Premier of Queensland, the Queensland Aboriginal and Islander Health Council, the Australians for Native Title and Reconciliation, Oxfam Australia and General Practice Queensland.  The parties to the Statement of Intent commit 'to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Aboriginal and Torres Strait Islander Australians by the year 2030'.
On 26 August 2008, the Queensland Government launched Making Queenslanders Australia’s healthiest people – advancing health action which reiterates the commitment to close the health status gap between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Queenslanders.

On 16 February 2009, the former Queensland Premier and the former Prime Minister of Australia signed the Closing the Gap on Indigenous Health Outcomes National Partnership Agreement.

In June 2010, the Queensland Government published Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033 – policy and accountability framework.

Queensland Health calculates that to meet the life expectancy targets set by COAG, based on a straight line trajectory, Queensland would need to increase life expectancy by 0.66 years per year to close the gap in Aboriginal and Torres Strait Islander male life expectancy within a generation, and 0.60 years per year to close the gap in Aboriginal and Torres Strait Islander female life expectancy within a generation.  This represents a 16 year gain in life expectancy over the target period (Health Statistics Centre, 2009).

Evidence indicates that to make sustainable gains in achieving COAG close the gap targets the most effective interventions (or “best buys”) will be those that focus on:

• improved early diagnosis, treatment and management of the diseases and conditions that together contribute to 80% of the health gap;
• health promotion and health education to prevent risky health practices and target the risk factors for poor health outcomes that together contribute to one-third of the health gap;
• maternal and child health, early childhood development, parenting support, adolescent health;
• efforts across the whole health system to improve cultural capability and continuity of care;
• attention to the needs of urban populations and those living in discrete communities; and
• complementary action in other social policy areas (such as housing and education) to improve health outcomes. 

Making Tracks is comprised of two documents:

• Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033 – Policy and Accountability Framework providing the overarching policy directions to guide the Queensland Government’s efforts towards closing the health gap to 2033; and
• Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033 – Implementation Plan 2009-10 to 2011-12 intended to be the first in a series of triennial implementation plans detailing the specific initiatives to be implemented by the Queensland Government within the given period.

Making Tracks provides a comprehensive and evidence-based policy framework for the long-term effort required across the life-span and the health service continuum to achieve sustainable health gains for Aboriginal and Tores Strait Islander Queenslanders.  Identifying initiatives specifically aimed at meeting the close the gap targets, Making Tracks focuses on effort across the following areas:

• a healthy and safe start to life through maternal and child health services and programs that aim to establish positive and sustainable patterns of health behaviour that will impact heavily on adult physical and mental health outcomes;
• reducing the modifiable risk factors that contribute to chronic disease;
• improving the living environments of Aboriginal and Torres Strait Islander Australians through environmental health and housing improvement initiatives and efforts to improve community and personal safety;
• earlier diagnosis and appropriate treatment targeting the most prevalent disease groups;
• improving access to, and experience of, the health system by enhancing the cultural competence of the health workforce and participating in health service systems that encourage integration between programs and across all health service providers;
• working with the Aboriginal and Torres Strait Islander community controlled health sector to improve primary health care service coordination and to inform the design and delivery of funded programs and services for Aboriginal and Torres Strait Islander Queenslanders; and
• improve the quality and availability of research and data, accountability mechanisms and evaluation. 

The closing the gap targets and other health related performance indicators and initiatives are included in the following COAG Agreements, signed by the Queensland Governement:

• the National Indigenous Reform Agreement;
• the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes; and
• the National Partnership Agreement for Indigenous Early Childhood Development.

The Indigenous Health Outcomes National Partnership Agreement focuses on evidence-based priority areas within a scope that could be agreed by all jurisdictions:

• tackling smoking;
• healthy transition to adulthood;
• making Indigenous health everyone’s business;
• primary health care services that can deliver; and 
• fixing the gaps and improving the patient journey.

Expected outcomes include: reduced smoking rate; reduced burden of disease; increased uptake of Medical Benefits Scheme funded primary health care services; improved care coordination; and a reduction in the average length of hospital stay in re-admissions.

The COAG Indigenous Early Childhood Development National Partnership Agreement concentrates on priority areas (elements) where the evidence shows a high level of impact can be achieved to improve the outcomes for Indigenous children.  The National Partnership Agreement is based on facilitation payments and joint investment between the Commonwealth and States/Territories for elements one and two to correspond with bilaterally agreed work plans.