The Aboriginal and Torres Strait Islander Health Performance Framework Report is used to inform policy development and monitor progress in Aboriginal and Torres Strait Islander peoples’ health.
An effective, efficient and equitable health system is an essential component for any whole-of-government effort to support the health of Indigenous Australians. In addition, action in areas such as education, employment, safety and housing is important to achieve sustainable health gains.
This section provides an overview of Australian and state and territory government policies and programs working to achieve sustainable health gains. Specific initiatives have been included where they directly or indirectly support Indigenous Australians through either tailored or mainstream programs. This list is not exhaustive and will be added to with future updates.
Closing the Gap is a framework aimed at reducing disadvantage experienced by Indigenous Australians.
In 2008, the Australian and state and territory governments approved the National Indigenous Reform Agreement which set out the Closing the Gap targets between Indigenous and non-Indigenous Australians in life expectancy, child mortality, education and employment. With a number of the targets expiring unmet in 2018, a new approach was needed.
The new National Agreement on Closing the Gap was endorsed in July 2020. This historic Agreement is the culmination of a significant amount of work undertaken by the Joint Council on Closing the Gap and developed in genuine partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations. This is the first time an Agreement designed to improve life outcomes for Indigenous Australians has been developed with Indigenous Australians. This new Agreement outlines a better way of working, with governments working in genuine partnership with Indigenous Australians to get better outcomes. The National Agreement sets out ambitious targets and new Priority Reforms that will change the way governments work to improve life outcomes experienced by Indigenous Australians. The new Agreement is available at Closing the Gap
As a first action, the Commonwealth has committed to provide a $46.5 million co-contribution over four years to build the capacity of the Aboriginal and Torres Strait Islander community‑controlled service delivery sector. In addition, state and territory governments have been asked to provide co‑contributions to further support these organisations. This new funding for the initial delivery of Priority Reform Two—Building the Community-Controlled Sector—will help deliver additional services to First Nations people.
The Commonwealth also provided an additional $33 million from the Indigenous Australians’ Health Programme (IAHP) to strengthen primary health care services for Indigenous Australians. Aboriginal Community Controlled Health Services and other eligible providers will be able to apply for grants, to improve health outcomes in the communities who need it most. The funding, to be provided over three years will help to ensure Indigenous Australians can access culturally appropriate primary health care, when and where they need it. These grants are part of the Commonwealth’s ongoing reforms to support the availability, clinical effectiveness and sustainability of Indigenous primary health care. This funding is in addition to the $90 million investment announced in November 2019 which is being provided through the new IAHP Primary Health Care Funding Model that commenced 1 July 2020.
Constitutional Recognition and the Voice
The Australian Government is working in partnership with Indigenous Australians across Australia to co-design a practical way for Indigenous voices to be heard at all levels.
Three groups are working together to develop options for an Indigenous voice: the Senior Advisory Group, National Co-design Group and Local & Regional Co-design Group. The groups are looking at ways to create local, regional and national elements of an Indigenous voice and how they would work together. They started by looking at what is already in place and working well around the country and internationally.
Once options for an Indigenous voice are developed, the co-design groups will provide recommendations to the Australian Government. Following this, there will be consultation across the country, which is expected to occur in early 2021.
Indigenous voice options will be refined based on the feedback and the refined options will go back to government for consideration. More information is available at voice.niaa.gov.au
National Aboriginal and Torres Strait Islander Health Plan
The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (Health Plan) is an evidence-based policy framework designed to guide all policies and programs related to Indigenous health. It provides linkages to other major Australian Government health activities and identifies areas of focus to guide future investment and effort to improve Indigenous health outcomes.
Work is currently underway to refresh the Health Plan—to embed the cultural determinants and social determinants of health and provide a single, overarching policy framework for the health and wellbeing of Indigenous Australians. This supports a vision that Indigenous Australians enjoy long, healthy lives that are centred in culture, with access to services that are prevention-focused, responsive, culturally safe, and free of racism and inequity.
While the current Health Plan is not due to expire until 2023, undertaking the refresh now provides an opportunity to align the Health Plan with the National Agreement on Closing the Gap and other whole-of-population health strategies under development, such as the National Preventive Health Strategy, the 10-Year Primary Health Care Plan and the various mental health, suicide prevention and social and emotional wellbeing strategies. It will also highlight the importance of ensuring that mainstream, or whole-of-population, services and programs are responsive to Aboriginal and Torres Strait Islander peoples.
The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Implementation Plan) outlines the actions to be taken by the Australian Government, the Aboriginal community controlled health sector, and other key stakeholders to give effect to the vision, principles, priorities and strategies of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023. The Implementation Plan identifies a set of 20 goals to measure progress towards achieving outcomes across governments, the health sector and community, and help promote accountability.
In 2017, the Australian Government released the My Life My Lead - Opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: Report on the national consultations (My Life, My Lead). These consultations provided an opportunity for Indigenous communities and leaders to share their voices and perspective on the factors necessary for Indigenous Australians’ wellbeing. Key themes identified during consultations include:
- Culture is central to Indigenous wellbeing and needs to be embraced and embedded across a range of Indigenous and mainstream services—both as a protector and enabler of health and wellbeing.
- Racism within health and other systems must be addressed to remove barriers to better outcomes in health, education and employment.
- The impacts of trauma across generations of Indigenous Australians must be acknowledged and addressed.
- Governments need to support long-term, coordinated, placed-based approaches that honour community priorities and embed participation.
It is anticipated that the refreshed Health Plan will be delivered mid-2021.
Indigenous Australians Health Programme
The Australian Government’s Indigenous Australians’ Health Programme (IAHP) provides grant funding to provide Aboriginal and Torres Strait Islander people with access to effective high quality, comprehensive, culturally appropriate, primary health care services in urban, regional, rural and remote locations across Australia. This includes through Aboriginal Community Controlled Health Services, wherever possible and appropriate, as well as services across the entire health system that deliver comprehensive, culturally appropriate primary health care. The IAHP funds comprehensive primary health care as well as targeted initiatives to improve the focus on local health needs, deliver the most effective outcomes, and better support efforts to achieve health equality between Indigenous and non‑Indigenous Australians.
An evaluation of the IAHP is being implemented over four years (2018–19 to 2021–22). The co-designed evaluation is taking a whole of system, person centred approach. It aims to support the health system to improve access to quality and effective primary health care services for Indigenous Australians.
Indigenous Advancement Strategy
The Australian Government funds and delivers a range of programs for Indigenous Australians through the Indigenous Advancement Strategy (IAS). The IAS is aimed at improving the lives and outcomes for Indigenous Australians in five key areas: jobs, land and economy; children and schooling; safety and wellbeing; culture and capability; and remote Australia strategies. The IAS supports the Government’s priority to work in partnership with Indigenous Australians. Communities will be at the centre of the design and delivery of local solutions to meet local needs.
State and Territory Governments have a number of overarching health plans and strategies relating to Aboriginal and Torres Strait Islander health:
- The New South Wales (NSW) Aboriginal Health Plan 2013–2023 focuses on strengthening the NSW public health system to improve the health and health care experiences of Indigenous Australians. Mid-term evaluation results are guiding ongoing plan implementation.
- In South Australia (SA), an Aboriginal Health Partnership Framework Agreement 2015–2020 has been signed, committing SA Health, the Commonwealth Department of Health and the Aboriginal Health Council of SA to cooperate and work collaboratively on Indigenous health issues such as cancer, diabetes and heart and stroke care.
- In Victoria, Korin Korin Balit-Djak: Aboriginal health, wellbeing and safety strategic plan 2017-2027, provides an overarching framework for action to improve the health, wellbeing and safety of Aboriginal Victorians. It has been developed alongside the Balit Murrup: Aboriginal social and emotional wellbeing framework; the Aboriginal Governance and Accountability Framework, and the Victorian Aboriginal Affairs Framework 2018–2023 (which is an overarching framework for working with Aboriginal Victorians, organisations and the wider community to drive action and improve outcomes).
- The Victorian Government is also committed to advancing the treaty process in partnership with the First Peoples’ Assembly of Victoria. The Assembly and the government are currently working to establish the elements necessary to support future treaty negotiations. This ongoing work will progress Aboriginal self-determination and is likely to inform future plans and strategies for Aboriginal Victorians, including in Aboriginal and Torres Strait Islander health.
- The WA Aboriginal Health and Wellbeing Framework 2015–2030 outlines a set of guiding principles, strategic directions, priority areas and strategic outcomes to improve the health and wellbeing of all Indigenous Australians living in Western Australia. It guides the approach that the Western Australian health system is adopting to improve Indigenous Australians’ health and wellbeing. The WA Aboriginal Health and Wellbeing Framework is supported by the Implementation Guide to inform its application and uses a Monitoring and Reporting Plan to support measurement and reporting.
- The Northern Territory (NT) Department of Health is currently progressing the renewal of the NT Aboriginal Health Plan. It sets out strategic directions that support actions to improve Indigenous health and wellbeing and reinforces an organisational commitment to increase cultural security of health services.
- The Queensland Government’s overarching policy for improving Indigenous Australian health is the Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033 - policy and accountability framework which was launched in 2010. Under this framework, Queensland Health has developed their fourth Investment Strategy 2018–2021 which seeks to operationalise the five key priority areas across the life-span and health service continuum to achieve sustainable gains in health outcomes.
- The Tasmanian Aboriginal and Torres Strait Islander Health Partnership Framework Agreement (2016–2021) provides the foundation for the work undertaken between the Australian Department of Health, Department of Health (Tasmania) and the Tasmanian Aboriginal Centre.
- The Australian Capital Territory’s (ACT) 10 year commitment to equity in health and wellbeing outcomes is set out in the ACT Aboriginal and Torres Strait Islander Agreement 2019 – 2028. The ACT Agreement commits to action over four phases of delivery in all areas of determinants of health. The ACT Agreement Focus Area—Health and Wellbeing Action Plan for Phase One outlines the priority actions the ACT will take from February 2019–December 2020.