Closing the Gap in Queensland (Aboriginal and Torres Strait Islander Health Branch)
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 in Queensland
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 10.8 years for males and 8.6 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 70% of the health gap:
- Cardiovascular disease – an estimated 20% of the health gap
- Diabetes – an estimated 16% of the health gap
- Mental disorders – an estimated 16% of the health gap
- Chronic respiratory disease – an estimated 9% of the health gap
- Intentional injuries – an estimated 7% of the health gap
- Cancers – an estimated 6% of the health gap.
Cardiovascular disease and diabetes and mental disorders are the leading contributors to the health gap in major cities, regional centres and remote areas, together accounting for 52% of the health gap in Queensland.
11 risk factors explain 40% 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, obesity and smoking was the largest cause of health loss, contributing 18% and 12% respectively to the health gap.
Queensland Government policy mandate
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 16 February 2009, the former Queensland Premier and the former Prime Minister of Australia signed the National Partnership Agreement on Closing the Gap on Indigenous Health Outcomes. This agreement expired in June 2013.
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.
What is required to close the gap?
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 0.80 years per year to close the gap in Aboriginal and Torres Strait Islander male life expectancy within a generation, and 0.59 years per year to close the gap in Aboriginal and Torres Strait Islander female life expectancy within a generation. (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:
- Target areas where evidence indicates potential for greatest health gains – chronic disease mortality in the middle years (30-60 years).
- Early diagnosis and intervention by primary health care services to detect, treat and manage chronic conditions.
- Interventions that target the leading causes of infant and child mortality.
- Take a life-course approach to prenatal and antenatal education from an early age.
- Address the broader determinants of health – particularly education, housing and employment.
- Appropriate management of mental illness to avoid hospitalisation.
- Focus attention on the modifiable risk factors – smoking, nutrition and physical activity.
- Target the cultural factors impacting on health.
- Target smoking and passive smoking in pregnancy.
- Ensure the focus on timeliness of immunisation is maintained.
Progress towards closing the health gap is monitored and reported through Closing the Gap performance reports developed and published annually by Queensland Health's Aboriginal and Torres Strait Islander Health Branch.
Closing the Gap performance report 2016 (PDF, 1.78MB) charts the progress in achieving health gains and improving system access for Aboriginal and Torres Strait Islander Queenslanders against a comprehensive suite of key performance indicators, including progress towards closing the gap in life expectancy and halving the gap in child mortality.
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 – Investment Strategy 2015-2018, the second 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 Torres 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.
Previous investment strategies