The Parliament of the Commonwealth of Australia +HDOWKLV/LIH Report on the Inquiry into Indigenous Health House of Representatives Standing Committee on Family and Community Affairs May 2000 Canberra © Commonwealth of Australia 2000 ISBN 0 642 43672 X Cover Art: Bush Medicine by Gloria Petyarre Reprinted with permission &RQWHQWV Foreword..............................................................................................................................................vii Membership of the Committee..............................................................................................................ix Terms of reference ...............................................................................................................................xi List of abbreviations............................................................................................................................ xiii List of recommendations......................................................................................................................xv 1 Introduction...........................................................................................................1 The Indigenous population .......................................................................................................3 Experiences in other countries................................................................................................. 5 Earlier reports............................................................................................................................. 7 Commonwealth coordination.................................................................................................... 9 Community control................................................................................................................... 13 Other important issues ............................................................................................................ 14 2 Improving the coordination, planning and delivery of health services.........17 Current arrangements for planning and delivery of health and related services.............. 17 Access to Medicare Benefits and the PBS ............................................................................ 18 Funding ..................................................................................................................................... 20 Commonwealth coordination.................................................................................................. 24 Coordinating Indigenous health services.............................................................................. 25 Revised funding arrangements............................................................................................... 29 Determining revised funding levels........................................................................................ 30 iv 3 Indigenous health services and community control.......................................35 Health services for Indigenous Australians .......................................................................... 35 Community control................................................................................................................... 41 Building community capacity ................................................................................................. 44 4 Improving housing and Infrastructure services ..............................................47 Other health related services.................................................................................................. 47 Focus on sustainable services ............................................................................................... 49 Other housing matters............................................................................................................. 54 Training issues ......................................................................................................................... 56 Water.......................................................................................................................................... 58 Roads and other access issues.............................................................................................. 60 Some other barriers to access................................................................................................ 61 Infrastructure funding and service delivery issues.............................................................. 63 5 Cultural, educational and employment issues as they relate to health ........67 Cultural issues.......................................................................................................................... 69 Education .................................................................................................................................. 72 Employment.............................................................................................................................. 76 A role for the health sector...................................................................................................... 79 6 Other important health issues...........................................................................81 Nutrition..................................................................................................................................... 81 Substance misuse.................................................................................................................... 88 Impact of the welfare system .................................................................................................. 92 7 Health professional issues ................................................................................95 Aboriginal Health Workers ...................................................................................................... 95 Other health professionals.................................................................................................... 100 General training issues.......................................................................................................... 104 Doctors.................................................................................................................................... 106 Nurses ..................................................................................................................................... 110 Indigenous health professionals .......................................................................................... 112 Support for Indigenous students.......................................................................................... 113 v 8 Research and data collection..........................................................................117 Link between data and funding............................................................................................. 119 Research ................................................................................................................................. 122 Appendix A...............................................................................................................125 List of Submissions ............................................................................................................... 125 Appendix B...............................................................................................................129 List of Public Hearings and Witnesses ................................................................................ 129 Appendix C...............................................................................................................149 Communities and Organisations consulted by the Committee......................................... 149 Appendix D...............................................................................................................153 The Indigenous population ................................................................................................... 153 Levels of disadvantage.......................................................................................................... 155 Changing patterns of ill-health ............................................................................................. 157 Appendix E ...............................................................................................................161 Overseas experiences ........................................................................................................... 161 Appendix F ...............................................................................................................165 Some previous reports on Indigenous health matters....................................................... 165 vi )RUHZRUG In selecting the title for this report the Committee was very mindful of the comments by the National Aboriginal Health Strategy Working Party that: In Aboriginal society there is no word, term or expression for ‘health’ as it is understood in western society. ….The word as it is used in Western society almost defies translation but the nearest translation in an Aboriginal context would probably be a term such as ‘life is health is life’. 1 The continuing poor state of Indigenous health, and the many efforts of successive governments to address the issue, has seemingly left a nation at a loss to know what to do for the best on this issue. The Committee believes that many