AMA 15th National Conference 2003 - Media Conference Dr Kerryn Phelps, AMA President - AMA's Public Report Card on Indigenous Health 2003, Aboriginal and Torres Strait Islander Health, Time for Action


Policy Discussion Panel: Dr Paul Bauert, Past President of AMA Northern Territory; Dr Henry Councillor, Chair, NACCHO; Professor Ian Ring, ANU; Dee Delaney, CEO, NACCHO; Nye Brown, President, Australian Indigenous Medical Association

PHELPS: Thank you all for being so patient with our timing this morning but this was a very important project for us to launch this morning. As you know, the Public Report Card 2003, Aboriginal and Torres Strait Islander Health, Time For Action was launched today.

QUESTION: In your speech, Dr Phelps, you said that time was running out if nothing was done on Aboriginal health. The statistics you provided are pretty appalling. Do you think it could get even worse?

PHELPS: I hope that it can only get better from here. Certainly this is as much as anything a consciousness raising exercise and what we're trying to do is to motivate governments to continue the progress that they are making.

We're pleased to see that there has been progress made in terms of policy direction and in terms of some of the coordination but certainly there is a great deal more that needs to be done and you can't make that sort of progress without putting adequate levels of funding.

You really just need to travel a little to some of these remote communities where the need is so great. I mean, these people are asking for things that everyone else just takes for granted, if you live in a less remote location. I mean, things like roads and decent sewerage systems and water systems and educational opportunities for their children, fresh food and water. These are not a big ask but they do, because of remoteness, in many cases, take more money to provide these things.

There's also a need for more health workers working in Aboriginal communities and with Aboriginal people and certainly what we need to do is to build on the success of projects like Professor Wendy Hoy's.

There are a number of successful projects that have been outlined the report card this year and these are the things that need, once they've been piloted, been found to be successful in one community, to be funded and funded in the long term, not just have people scratching around for funds every 12 months and having things that get up and running and get a momentum and get people behind them, only to be disappointed 12 months later when the funding falls down.

So there has to be consistent funding, there has to be a commitment by governments to coordinate, not only with each other but with departments within levels of government so at state level to have all of the departments responsible have some form of mechanism where they can appropriately untangle the wires and get things happening.

QUESTION: The remoteness and the concomitant cost, is that an intractable situation when it comes to providing services?

PHELPS: I'd like to ask Henry to answer that one.

COUNCILLOR: Really, yes and no. It's a two-bladed sword in terms of that. There are ways, particularly, say, for cost of freight, in relation to that, that doesn't stop the retailers to bump things up. And nine times out of 10, the retailers upmark it 100% in terms of freight charges. And that's the difficult thing about it. And when you look at it, the last study done in 1990, talking about where is the highest cost of living in Australia, was at Fitzroy Crossing where the Great Northern Highway runs straight through it. That's the issue.

QUESTION: Don't the councils have some control over that?

COUNCILLOR: They do but in regards to the Commonwealth and the states, there's no big stick so irrespective of whether local shires or state and territory governments are not responsible, they've given a cap of what it may be and if it's about 10% or 15% it doesn't stop the retailers from upmarking it to generate a profit.

RING: On the remoteness issue, 20% of Aboriginal people live in remote areas. We manage to provide adequate services for non-Aboriginal people in remote areas and we just accept that that costs more and the issue really isn't any different.

Just on the earlier question, the choice is really, if we keep on doing what we're doing then the health will remain pretty much the same as it is now and the gap between Aboriginal people and non-Aboriginal will continue to increase whereas if Australia were to do the things which are recommended in this action plan, then it's reasonable to talk about a 30% improvement in health in the next 10 years, just from doing the simple basics: having a properly funded set of services, having a training plan to produce the trained staff to deliver the services and to fix the issues of the environment.

This is a doable proposition. Most of the rest of the world has done it. It happens as a matter of course for the population as a whole and it's now time it happened for Aboriginal people.

QUESTION: The trials that have been implemented now, what's the level of investment of those?

BAUERT: The coordinated care trials?

There's a couple of things from that, from the coordinated care trials in the Northern Territory, for instance, there's a plan to roll out, eventually, 21 zones and they would follow along the lines of the coordinated care trials. Initial funding has been approved for, I think, five zones and the concept is that the community themselves receive - the funding goes to the community and the community itself decides how those funds should be spent and the concept is that if they see a particular issue as a major problem then they'll focus on that and it's hoped that that will break down a lot of the problems in coordination between different departments and subsections of departments.

The problem is that for them to get going, particularly in the more remote areas, they really do need a lot of support. The people involved need training on how to run these things and the Northern Territory government has made the commitment to be a trainer and a supporter as these roll out but I don't think they appreciate the full extent of that help that's going to be needed to get these off the ground and a big fear that the Northern Territory branch of the AMA has is that this will be yet another scheme that goes flat on its face. We hope it doesn't and we hope that the government will provide the support and training necessary to get them off the ground.

The concept is great but the support needed is huge and the government really has to commit to that.

COUNCILLOR: Just to follow on from Paul, I think in respect from where NACCHO comes from in relation to the coordinated care trials and PHCAP, which is interlinked, but also the current trials, is that we're strongly looking for support from the Australian Medical Association, AMA, in maintaining that there's no cost shifting in these particular areas from the states and territories to the Commonwealth. That has been one of the issues so far in the last 12 to 24 months of in terms of pooling those resources but maintaining the level of resources that need to be inputted or that has been inputted into these particular regions.

And there's been a lot of cost shifting which we feel is breaking down not just the relationship but also putting up barriers in terms of allowing these things to actually be coordinated in a way that's approachable and also ensuring that the community participation and ownership in relation to these programs be maintained and be sustainable.


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