Unfair and Unhealthy

By Lesley Russell

In opposition, Prime Minister Tony Abbott said that he would be the “Prime Minister for Aboriginal Affairs” and he has consistently argued for a “focus on practical changes to improve the lives of Aboriginal people”. The 2014−15 Budget is his first substantive policy announcement in relation to Indigenous affairs; when evaluated in the light of his commitments, it is found to be failing. Short-term funding and statements about policy and program reviews have introduced considerable uncertainty and unease into the sector.

Already among the poorest, sickest and most marginalised, Indigenous Australians are hit twice by this budget: by cuts to specific programs totaling $603 million over five years and by cuts and changes to a wide swathe of general programs in health, education, welfare and legal services. Together, these will exacerbate Indigenous disadvantage and set back the already difficult task of “Closing the Gap”. This is aggravated by the December 2013 decision of the Council of Australian Governments not to proceed with the National Partnership Agreement on Closing the Gap on Indigenous Health. This decision and the fate of the $777 million allocated to joint Commonwealth/State and Territory efforts as part of the National Partnership Agreement has escaped public scrutiny.

Additional concerns are raised by the collapse of 150 Indigenous program areas to just five in the name of “rationalisation”. These changes flag a period of upheaval in Indigenous Affairs. A letter sent from the Minister for Indigenous Affairs to stakeholders says “There has also been far too much waste for far too long in Indigenous Affairs. More of the resources need to ‘hit the ground’.”But in taking this decision, the Abbott Government has reneged on its pre-election commitment to examine programs to make sure they are directly working to meet the Closing the Gap targets, with any savings identified to be reinvested in Closing the Gap activities. Instead, the health savings are to be invested in the Medical Research Future Fund and other savings will be going to the budget bottom line.

The new “Indigenous Advancement Strategy” within PM&C took effect on 1 July 2014. PM&C statements say communities will have opportunities to contribute to the design and delivery of local solutions to local issues. Programs will be implemented through the Remote Community Advancement Network in PM&C which will work with communities to produce long-term transformational change.

This sounds as if the focus will remain on remote communities. It also sounds disingenuous, given that the Budget initiatives were developed without input from Indigenous groups and there has been no modelling of the impact of initiatives like the $7 GP co-payment on Indigenous people and the health care providers who serve them.

Within the important Health portfolio, the Department of Health is also undertaking a process of rationalisation and consolidation and the development of a new funding allocation methodology, including a review to examine models to determine how much funding organisations will receive to deliver primary health care services. This could lead to funding being provided on the basis of need, which would be welcome, or it could be another means to cap expenditures.

Indigenous leaders have expressed concern that this Budget now has Australia heading towards two-tiered education and health systems, compounded by the withdrawal of welfare benefits. In particular, changes to youth welfare have been described as having a “devastating” impact on Indigenous communities, with the likelihood that they will further marginalise Indigenous youth. Young Indigenous people often do not have sufficient education, training and resources to look for work, and they may lack family support if they are unable to qualify for welfare. Indigenous youth are already over-represented in the prison population; the budget changes, which include cuts to Aboriginal Legal Services, can only exacerbate this.

At the same time, there are huge consequences for Indigenous people from a raft of other budget provisions, including the proposed co-payments for GP visits and associated pathology and diagnostic services and the proposed increased in co-payments for the Pharmaceutical Benefits Scheme (PBS). Prevention initiatives have been cut, including Indigenous tobacco programs, and this will result in increased health care costs in the future as the impact of smoking, obesity and chronic diseases – significant contributors to the health inequality gap – grow. Healthcare providers have spoken out expressing their concerns that Medicare and PBS co-payments will mean a continuation of poor health outcomes for Indigenous Australians. The Aboriginal Medical Services are worried about the considerable financial imposts they must bear to enable free access to services to continue.

The previous Labor Government released the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 in June 2013. On 24 June 2014, the Assistant Minister for Health Fiona Nash announced that the Abbott Government would begin work on developing a plan to implement the Plan. Her media release also announced that the Health Plan will be updated to “reflect the Coalition’s approach and priorities in Indigenous affairs”. It is not clear if this is being done in consultation with the Prime Minister’s new Indigenous Advisory Council and Indigenous stakeholders. No further information has been forthcoming, so it is not clear if this work has even commenced.

The broad message to Indigenous leaders and communities sent by the 2014–15 Budget is that the Government is more interested in saving money than in delivering more effective programs, it is reluctant to make the hard policy decisions, and its modus operandi is about increasing official controls rather than building personal and community responsibility. All the indications from this budget are that there are further changes in funding and management of Indigenous programs to come in the next twelve months. In the meantime, institutional memory and expertise will be lost, Indigenous people will continue to struggle to access needed services, many service providers are left in limbo, and the gap in disadvantage will continue to yawn.

My detailed analysis “Impact of the 2014-15 Federal Budget on Indigenous Programs and Services” is available here.

Dr Lesley Russell is Adjunct Associate Professor at the Menzies Centre for Health Policy. University of Sydney.