Report Cards

• Article 24: Children have a right to access the highest attainable standard, facilities and treatment of health. Governments should ensure that no child can be deprived of this right
• Article 3(3): Institutions involved in the care and protection of children shall conform to the standards established by competent authorities, particularly in the area of health

Positive Developments

NATIONAL: Launch of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) was launched on 23 July 2013 by the Hon Minister Snowdon MP, Minister for Indigenous Health, and replaces the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013. This ten year plan sees an estimated $12 billion projected funding for health programs specifically targeted at Aboriginal and Torres Strait Islander people. [1] The aim of NATSIHP is to provide a long-term framework that continues the work of the ‘Close the Gap’ campaign that was launched in 2006, as well as the commitment of the 2008 ‘Close the Gap Statement of Intent’ toward the goal of closing the gap in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians within a generation (by 2018).

Jody Broun, Co-Chair of the National Congress of Australia’s First Peoples, has identified one of the major obstacles that people often face in accessing a health service, “there might be a hospital or there might be a health service in town; people won’t use it if they have had a negative experience and what they perceive as a racist experience in that place.” [2] NATSIHP attempts to address this issue by emphasising the centrality of culture in the health of Aboriginal and Torres Strait Islander people [3] and providing a, “health system so that people feel comfortable.” [4]

On 15 November 2013, the Australian Bureau of Statistics released data on the life expectancy of Aboriginal and Torres Strait Islander Australians for the 2010-2012 period. The data has revealed some positives, with the life expectancy of Indigenous men increasing by about one-and-a-half years compared to the one year increase of non-Indigenous men, as well as a one year increase in life expectancy for Indigenous women. [5] Overall, the gap between the life expectancies of non-Indigenous and Indigenous people has reduced by 0.8 years for men, and 0.3 years for women over the last five years. [6] Whilst “the ABS data shows a small but very welcome improvement in Aboriginal and Torres Strait Islander life expectancy,” [7] Mick Gooda, a Close the Gap campaign co-chair and the Aboriginal and Torres Strait Islander Social Justice Commissioner, has expressed concern at the “significant gap [that] remains.” [8] Kirstie Parker, a co-chair of the Close the Gap campaign and of the National Congress of Australia’s First Peoples, has acknowledged the support the Close the Gap campaign has received. She described, “closing the gap as a national priority and an area of bipartisan support that the Government can build on.” [9]

NATIONAL: Expanded Medicare Healthy Kids Check

In March 2013, the Department of Health announced the Expanded Medicare Healthy Kids Check (Expanded Check). This Expanded Check sees an additional $11 million being committed over five years, [10] and rides on the back of the current Medicare Healthy Kids Check which was initiated in 2008. The Royal Australasian College of Physicians (RACP) and its Paediatric and Child Health Division have thrown their support [11] behind this expansion that will now include assessment of a child’s social and emotional wellbeing, in addition to the physical health, general wellbeing and development aspects that form part of the current health check. It also lowers the age bracket to children three-and-a-half to five years.

The Expanded Check will be implemented in stages, the first having already been brought in earlier this year, and will be rolled out nationally in 2014 subject to an evaluation of this first stage. [12] The RACP has highlighted the importance, “that all children, especially vulnerable children exposed to other risks, are able to access this check.” [13] During this first stage, eight Medicare Locals are involved although GPs in all states and territories still offer the current voluntary check. The Australian Medicare Local Alliance has been contracted to undertake the project.

NATIONAL: The Australian Medical Association releases the Aboriginal and Torres Strait Islander Health Report Card for 2012-2013, The Healthy Early Years – Getting the Right Start in Life

On 10 December 2013, the Australian Medical Association (AMA) released their Indigenous Health Report Card for 2012-2013 at Parliament House, Canberra. In his introduction, AMA’s president, Steve Hambleton, emphasised the disparity between Indigenous and non-Indigenous children in the enjoyment of the right to the best start in life, [14] the tone also adopted by the rest of the report card. The report card focuses on the importance of remedying early childhood adversity to ensure a smooth transition into adult life and improvement to longer-term health and wellbeing. [15] Included with the report card is a list of best practice evidence-based programs operating throughout Australia. The Abecedarian Approach to Early Childhood Development is one of these programs, providing a suite of teaching and learning strategies targeted at children from at-risk and under-resourced families which are implemented in various services such as family child care homes and child care centres. [16] Despite some of these positive outcomes, the AMA recommended for the renewal of another COAG National Partnership Agreement on Indigenous Health, and National Partnership Agreement on Early Childhood Development. [17] The AMA also advised for the development of a national plan, to be implemented within five years, to expand existing child and maternal services, and that these services, where possible, should be provided through the Aboriginal community-controlled health sector, or otherwise, for medical staff to receive cultural safety training. [18]

NSW: Publication of the Health Assessment of Children and Young People in Out-of-Home-Care (Clinical Practice Guidelines)

NSW Health published the Health Assessment of Children and Young People in Out-of-Home-Care (Clinical Practice Guidelines) on 10 October 2013. This publication reflects the state’s implementation of the Commonwealth Department of Health and Ageing’s National Clinical Assessment Framework for Children and Young People in OOHC (2011). [19] The Clinical Practice Guidelines aim to improve consistency of the health assessments performed on all children and young people entering out-of-home-care. NSW Health has also collaborated with the Community Services Division of the Department of Family and Community Services to develop a Model Pathway for the Comprehensive Health and Developmental Assessments for All Children and Young People Entering OOHC, with further training and support to be provided as implementation continues.

VIC: New dental package for children, Healthy Families, Healthy Smiles

On 22 February 2013, the Victorian Government launched a new dental package for children and pregnant women. The Healthy Families, Healthy Smiles program will receive $2 million funding [20] until June 2015 [21] and is being run as a partnership between the Victorian Department of Health and Dental Health Services Victoria. The program will work towards improving the skills of health professionals, including Aboriginal health workers, and early childhood workers to better promote oral health. [22] Healthy Families, Healthy Smiles targets children aged between 0-3 years as research shows that a large concentration of families experiencing socio-economic disadvantage have children who have not received a dental check-up before they start primary school. [23] It has also been found that Aboriginal people, those living in rural or remote areas, and those experiencing socio-economic disadvantage are more vulnerable to poor oral health. [24] Currently, some of the initiatives being piloted are the Tooth Packs project, which distributes tooth packs to families in six trial sites, and the Midwifery Initiated Oral Health e-learning program, which delivers content regarding oral health knowledge, advice, and assessments to midwives. [25]

Developments Requiring Attention

NATIONAL: Dental health reform package

In August 2012, the then Health Minister, Tanya Plibersek, announced a six year, $4 billion dental health reform package that will see $2.7 billion provided towards subsidised or free dental visits for children between 2 and 18 years whose families are eligible for Family Tax Benefit A and $1.3 billion for early intervention care for 5 million low-income Australians and those in remote rural areas. [26] The reform package also includes more than $225 million being allocated to improving rural and regional dental services [27] and comes on top of the $515.3 million in dental funding announced in the 2012-13 federal budget. [28]

Although the Child Dental Benefits Scheme provides a $1000 total benefit entitlement for an eligible child over a two year period, national welfare group Brotherhood of St Laurence has been pushing for the transformation of dental care into a universal system like Medicare. [29] According to their Executive Director, Tony Nicholson, “For too long oral health has been neglected – with dire consequences for the most disadvantaged in the community”. [30] Nicholson also recommended “Access to healthcare should be determined on the basis of need, not ability to pay”. [31] The Scheme replaces the existing Medicare Teen Dental Plan and is due to commence on 1 January 2014, The current government is yet to announce their plans for the dental health reform package.

Negative Developments

NATIONAL: Absence of mandatory training in child rights for all health professionals

The collaborative development in 2011 of the Charter on the Rights of Children and Young People in Health Care Services in Australia (the Charter) by Children’s Hospitals Australasia and Association for the Wellbeing of Children in Healthcare aims to ensure a child’s rights are upheld when they are receiving care from all Australian health facilities. Despite this, there has not yet been implementation of a mandatory requirement to train all health professionals in child rights. The preamble of the Charter does however enounce a healthcare provider’s obligation to provide care that takes into account the rights of children and young people. [32] A child-friendly version of the Charter has also been developed. [33] In 2010 the Sydney Children’s Hospital also trialled a pilot program of the Self Evaluation Model and Tool developed by the Taskforce on Health Promotion for Children and Adolescents in and by Hospitals and Health Services. The pilot was part of an international project that aimed to evaluate, enhance and progress the application of the CRC across developed countries. [34]

NT: Lack of Indigenous consultation regarding Stronger Futures in the Northern Territory

In the Close the Gap, Prime Minister’s Report 2013, the Northern Territory was identified as the locality where the ‘gap’ is currently the widest. [35] The Stronger Futures in the Northern Territory package (Stronger Futures package) was announced in August 2012 as part of the Indigenous Specific National Partnership Agreements, with the legislative support for the initiative coming into effect on 16 July 2012. [36] As part of the ten year $3.4 billion investment, $754.4 million has been allocated to health, which includes continued funding of the Mobile Outreach Service Plus, and the Remote Area Health Corps, [37] as well as an integrated oral health program. Some 80 clinics across the Northern Territory and short-term placements of health professionals will also receive support as part of the package. [38]

Under the Stronger Futures package, two new Personal Helpers and Mentors Remote Services and two new Family Mental Health Support Services will be implemented between 2012 and 2014. [39] Although the Stronger Futures package will provide the NT with more health resources, the passing of the legislation has not been received well by residents of the Northern Territory and human rights organisations have condemned the laws for their lack of consultation with the Indigenous community. This particular frustration at the consultation process was summed up by Northern Land Council chief executive as, “meeting with Aboriginal peoples and then doing all the talking is not consultation…We feel there needed to be a lot more listening”. [40] Djiniyini Gondarra, spokesman for the Yolungu National Assembly criticised the Government for making a terrible mistake. [41]

• Consider upholding child rights in healthcare more stringently by requiring all health professionals to undertake mandatory child rights training.
• Continue working on the Close the Gap campaign to ensure the targeted gap in life expectancy reduction is achieved by 2030.

1. http://www.indigenous.gov.au/new-health-plan-to-help-close-the-gap/ (accessed 28 October 2013).
2. http://www.abc.net.au/news/2013-07-23/government-announces-indigenous-health-framework/4838414 (accessed 13 November 2013).
3. National Aboriginal and Torres Strait Islander Health Plan 2013-2023, 4.
4. http://www.abc.net.au/news/2013-07-23/government-announces-indigenous-health-framework/4838414 (accessed 13 November 2013).
5. http://nacchocommunique.com/category/national-aboriginal-torres-strait-islander-health-plan-natsihp/(accessed 27 November 2013).
6. http://www.naccho.org.au/download/aboriginal-health/abs%20life%20expectancy%20fact%20sheet(2).pdf (accessed 27 November 2013).
7. http://nacchocommunique.com/category/national-aboriginal-torres-strait-islander-health-plan-natsihp/ (accessed 27 November 2013).
8. http://nacchocommunique.com/category/national-aboriginal-torres-strait-islander-health-plan-natsihp/ (accessed 27 November 2013).
9. http://nacchocommunique.com/category/national-aboriginal-torres-strait-islander-health-plan-natsihp/ (accessed 27 November 2013).
10. http://www.health.gov.au/internet/main/publishing.nsf/Content/healthy-kidschk (accessed 13 November 2013).
11. The Royal Australasian College of Physicians, Paediatricians Support Healthy Check (accessed 13 November 2013).
12. http://www.health.gov.au/internet/main/publishing.nsf/Content/healthy-kidschk (accessed 13 November 2013).
13. The Royal Australasian College of Physicians, Paediatricians Support Healthy Check (accessed 13 November 2013).
14. Australian Medical Association, ‘Aboriginal and Torres Strait Islander Health Report Card 2012-2013 – The Early Years – Getting the Right Start in Life’ (December 2013) 1.
15. Australian Medical Association, ‘Action needed to give Indigenous children a healthier start to life’ (media release, 10 December 2013) 1 < http://searcha.beta.capmon.com/pdfdisplay/data/repository/pressrel/p131210565.pdf> (accessed 23 January 2014).
16. Australian Medical Association, ‘Best Practice and Good News Stories 2012-13 AMA Indigenous Health Report Card – “The Healthy Early Years – Getting the Right Start in Life”’ (website, 10 December 2013) <https://ama.com.au/2013-ama-indigenous-health-report-card-good-news-stories> (accessed 23 January 2014).
17. Australian Medical Association, ‘Aboriginal and Torres Strait Islander Health Report Card 2012-2013 – The Early Years – Getting the Right Start in Life’ (December 2013) 10.
18. Ibid.
19. http://www0.health.nsw.gov.au/policies/gl/2013/pdf/GL2013_010.pdf, p1 (accessed 27 November 2013).
20. The Hon Wendy Lovell MLC, Victorian Government, ‘Coalition delivers on pledge to boost healthy smiles for children’ (media release, 22 February 2013) 1 <http://searcha.beta.capmon.com/pdfdisplay/data/repository/vic/v130222563.pdf> (accessed 23 January 2014).
21. Dental Health Services Victoria, ‘connected’ (website) <https://www.dhsv.org.au/about-us/oral-health-promotion/hfhs> (accessed 23 January 2014).
22. The Hon Wendy Lovell MLC, Victorian Government, ‘Coalition delivers on pledge to boost healthy smiles for children’ (media release, 22 February 2013) 1 <http://searcha.beta.capmon.com/pdfdisplay/data/repository/vic/v130222563.pdf> (accessed 23 January 2014).
23. Dental Health Services Victoria, ‘Healthy Families, Healthy Smiles Issue No. 4 December 2013’ (newsletter, December 2013) 1 < https://www.dhsv.org.au/__data/assets/pdf_file/0011/26489/2013-12_HFHS-Newsletter.pdf> (accessed 23 January 2014).
24. Cited in Department of Health, Victoria, ‘Your Health: The Chief Health Officer’s Report 2012’ (August 2013) 47 < http://docs.health.vic.gov.au/docs/doc/11410F08BC2FC9A0CA257C050001CF96/$FILE/1212017%20Your_health_2012_WEB.pdf> (accessed 23 January 2014).
25. Dental Health Services Victoria, ‘connected’ (website) <https://www.dhsv.org.au/about-us/oral-health-promotion/hfhs> (accessed 23 January 2014).
26. http://www.abc.net.au/news/2012-08-29/plibersek-unveils-4b-dental-reform-package/4230196 (accessed 13 November 2013).
27. http://www.news.com.au/money/cost-of-living/government-announces-13b-boost-to-public-dental-schemes/story-fnagkbpv-1226460559009 (accessed 13 November 2013).
28. Close the Gap, Prime Minister’s Report 2013, p73 (accessed 28 October 2013).
29. http://www.bsl.org.au/mediareleases.aspx?id=977 (accessed 13 November 2013).
30. http://www.bsl.org.au/mediareleases.aspx?id=977 (accessed 13 November 2013).
31. http://www.bsl.org.au/mediareleases.aspx?id=977 (accessed 13 November 2013).
32. Charter of Children’s and Young People’s Rights in Healthcare Services in Australia, 5. <http://children.wcha.asn.au/system/files/australian_version__final_210911web.pdf>.
33. See Children’s Hospitals Australasia, ‘Report on CHA Project on the Rights of Children and Young People in Healthcare Services’ (August 2011) Appendix 1 and 4 < http://children.wcha.asn.au/system/files/cha_childrens_rights_forum_report__final.pdf> (accessed 21 January 2014).
34. http://www.sch.edu.au/health/ (accessed 27 November 2013).
35. Close the Gap, Prime Minister’s Report 2013, p10 (accessed 28 October 2013).
36. Close the Gap, Prime Minister’s Report 2013, p10 (accessed 28 October 2013).
37. http://www.health.gov.au/internet/main/publishing.nsf/Content/oatsih-strongfutures-nt (accessed 13 November 2013).
38. Close the Gap, Prime Minister’s Report 2013, p70 (accessed 28 October 2013).
39. Close the Gap, Prime Minister’s Report 2013, p77 (accessed 28 October 2013).
40. http://www.abc.net.au/news/2012-06-29/stronger-futures-laws-rushed-through-senate/4100288 (accessed 27 November 2013).
41. http://www.abc.net.au/news/2012-06-29/stronger-futures-laws-rushed-through-senate/4100288 (accessed 27 November 2013).