Health Policy and Advocacy

Introduction to Health Policy and Advocacy

Health policy applies to initiatives, approaches, and actions taken within the same society to accomplish particular health-care objectives. A consistent health policy will do many things: it sets a plan for the future and in turn order to establish priorities and targets for the short to medium term. Healthcare policy is important as it sets out a broad implementation plan for guiding expected outcomes and is a fundamental mechanism for strategic planning. Healthcare policies and procedures are structured to convey the best outcomes by the nation to people (Davy et al., 2016). The Australian health care system is a dynamic combination of support and accountability from the states and the federal government that makes it difficult for patients to manage. Given its difficulties, the universal health care system in Australia achieves positive outcomes that are reasonably successful. Health spending in Australia is about 8.8 percent of GDP (Dittmann & Stephens, 2017). Australia's Government has implemented many health policies to improve its people's health, Aboriginal and Torres Strait Islander health policy, closing the gap is among one of them. In this essay, closing the gap health policy is discussed along with the problem that it addresses, its targets, stakeholders, and representations. The essay also discusses the policy process, solutions, and implementation.

The Problem and Context

Aboriginal people are Australia's first inhabitants, who have deep traditions and societies. Aboriginal resilience provides the framework on which more attempts to enhance Aboriginal health can be developed. Numerous interlinked factors lead to Indigenous people's poorer health outcomes. An understanding of Aboriginal health's social determinants, including dispossession, community dissolution, intergenerational trauma, schooling, jobs, housing, environmental factors, social and cultural capital, and racism, is fundamentally relevant to bridging the health divide between Indigenous and non-Aboriginal (The Lancet, 2019). Closing the Gap is a government initiative which aims at reducing the weakness of Aboriginal and Torres Strait Islanders over lifespan, infant mortality, early childhood care and education access, academic attainment, and job outcomes (Gracey, 2019). It is a collective pledge on the part of all government agencies to achieve health equality between Aboriginal and Torres Strait Islanders within 25 years. Aboriginal resilience provides the framework on which more attempts to strengthen Aboriginal health policies can be developed.

The policy seeks to assist health agencies and workers in enhancing Aboriginal people's health and well-being by consistently applying an 'Aboriginal Health Lens' to all policies, services, and strategies. The goal is to recognize Aboriginal people's health needs in the process of revising or implementing policies, services, and strategies at an early stage. The strategy has contributed to a comprehensive analysis and evaluation of obstacles, facilitators, and interconnections to the health system concerning Aboriginal health to identify opportunities for increasing access to healthcare as well as possible negative impacts to be mitigated (Bourke et al., 2018). There is little clarification about the desires of the Aboriginal and Torres Strait Islander communities, how to identify the expectations as priorities and objectives, and how to plan and execute programs to attain the goals. Most notably, the government has failed to communicate with the Aboriginal and Torres Strait Islander communities, and thus the multiple government agencies (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).

Frame of Reference/Dominant Discourse

'Deficit discourse' refers to a discussion that reflects the absence, loss, or inability of individuals or groups in terms of deficiency. This signifies discourse that places blame for concerns with the impacted individuals or groups narrowly, ignoring the broader socio-economic systems they are situated within. This is fraught with race-based assumptions, and there is evidence that better health outcomes are an obstacle to that. Therefore, in policy, it discusses different facets of the deficit debate (Koon et al., 2016). The deficit metrics assessed the homogenization and comparative contrast of Aboriginal and Torres Strait Islander Australians with the Australians who are non-Indigenous approaches depending on abilities. These methods aim to step away from the conventional problem-based model, and offer a new vocabulary and collection of solutions to solve a problem. Deficit discourses arise when debates and strategies helping to alleviate inequality are so entangled in reductionist narratives of failure and incompetence that Aboriginal and Torres Strait Islanders they are seen as barrier to the success of the health policy.

Key Stakeholders

The key message from the policy was that it was seen as a roadmap at the beginning of Closing the Gap and set out how to move towards equality. The policy had the framework for achieving the equality between indigenous or the aboriginals and non-indigenous Australians by working together with indigenous people, especially within the Closing the Gap initiative. The Policy engages actively with various stakeholder groups: Health services managed by Aboriginal and Torres Strait Island groups and their elected bodies; Public Health and Aboriginal Affairs agencies; Non-governmental organizations; Technical Federations; Workforce health programs (including Indigenous and Torres Strait Islander Social professionals, doctors, nurses and other health professionals); Research institutes; Academic institutions which include tertiary and technical institutions; and Organizations offering training.

Development of The Policy and Motivation

The evidence suggests that Closing the Gap is based on a specific theoretical framework that draws on previous public health policy that reflects on scientific and socio-economic indicators and more broadly describes existing trends in social policy and public health (Biddle & Taylor, 2012). The literature suggests that the program does not necessarily meet the complex requirements of the indigenous and Torres Strait Islander populations (Pholi et al., 2009). Although this evidence is ten years old, its condemnations point to the need for a personal and group / culture-based approach that assesses real results rather than metrics. Such critiques are still at the center of much input from today (Altman, 2018). In the year, 2017 the Close the Gap progress and goals study suggested that ' the constantly changing strategies of the Aboriginal and Torres Strait Islander have undermined efforts to establish a nationally coordinated solution (Wright & Lewis, 2017). They agreed that closing the gap was a modern way of communicating with Indigenous Australia but did not specifically differentiate it as a different mechanism from other social initiatives. People knew about the overall goals and it was an attempt by COAG to close the gap.

Policy Progress

The Closing the Gap report is released by the Australian prime minister every year into the parliament detailing the progress of the plan and on the priorities of the strategy. The Close the Gap Steering Committee also gives a report annually outlining the progress on the dual health-related priorities and presenting policy suggestions. Achieving substantial changes in health and well-being among Aboriginal and Torres Strait Islanders is largely dependent on the successful execution of these goals, as they reflect some of the significant problems faced by the population of the Aboriginal and Torres Strait Islanders (Calma, Dudgeon & Bray 2017). The timelines for the goals of closing the gap recognize the nature of the problems facing authorities and the country in that long-term sustainable, coordinated, systematic programs and practices will have to be sustained – short-term progress does not occur to the extent set out from the different goals.

While improvements have occurred in the areas of employment, health, and educational achievement of Aboriginal and Torres Strait Islanders in the 10 years since the beginning of Closing the Gap, only two of the seven Closing the Gap targets were on target to be achieved in 2018. In December 2016, COAG agreed to update the Closing the Gap Strategy in acknowledgment of this slow progress and, in 2018, four of the seven goals will expire. COAG agreed in June 2017, about the refreshed Closing the Gap Strategy would be adopted and it will be based on a strength-based approach. This will eventually ensure Aboriginal and Torres Strait Islander communities were central to the development and implementation of the program (Council of Australian Governments, 2017).

Solution Emerged

The Council of Australian Governments (COAG) has set clear targets for monitoring the changes in Aboriginal and Torres Strait Islander population health and wellbeing. The health policy goals were to close the gap of life expectancy gap by 2031, the maternity mortality difference should be halved by 2018 (Council of Australian Governments, 2018). The policy will also ensure that 95% of Aboriginal and Torres Strait Islanders children get to reach early childhood education by 2025. The other goals were to half the writing, reading, and numeracy gap by 2018, to reduce the job gap by half by 2018, and also Close the gap in attendance at the school by 2018 (this goal was introduced in May 2014) (Council of Australian Governments, 2018).

The Close the Gap Movement is extremely difficult as that the goal of closing the gap in life expectancy between Aboriginal and Torres Strait Islanders and non-Indigenous people by 2031 is to increase rather than close in 2019. In the Closing the Gap Report 2019, the country’s prime minister acknowledged to parliament that this goal is not achieved as per the plan. The Movement is adopting a new strategy for its 2019 report. It is believed that after identifying it, the immediate priority themes for closing the health gap will be centered first. The study addresses the following three main themes: First, help should be provided to indigenous people with focused primary health care based on needs, responsive health care system, and good housing facility which can eventually help in being healthy (Coombs, 2018).

Effectiveness of The Policy

The policy goals like child mortality, school attendance, literacy and numeracy (where there is improvement), education (which is stable), and life expectancy are among the current seven goals not achieved or not on track. Many that are "on course" are in the fields of early education and success in year 12 (Council of Australian Governments, 2017). A main message from the policy review was that the Closing the Gap mechanism involves trust between governments, societies, service providers, and individuals to work together, but partnerships have not improved (Deravin, Francis, & Anderson, 2018). In reality, the early optimism decreased significantly about three to four years after its formation due to a range of actions taken by the Commonwealth government, particularly redirecting grants from the Aboriginal communities' protected sector and introducing the Indigenous Advancement Strategy. Most of the stakeholders assessed raised concerns that anecdotal evidence seemed to indicate that a large amount of IAS funds had been redirected to non-Indigenous organizations to provide resources to indigenous citizens. Several factors impact government-indigenous Australia partnerships, and several of them are potentially beyond the scope of this initiative because they are not specifically about the Close the Gap Mechanism. However, if the feedback from the discussions suggests that they have a profound impact on the capacity of the government to meet the targets and ignore them, it will be counterproductive to the efforts to close the gap (Murawin et al., 2018).

Conclusion on Health Policy and Advocacy

The indigenous peoples still face difficulties to get access to the health care facilities. Securing the access of the indigenous people to the health care facilities will require a little more than readily available policies. It can be impossible to maintain the standard of health care for Aboriginal populations who often face a wide variety of social obstacles like perceptions of discrimination and racism. This closing the gap health policy was aimed at identifying problems that make things difficult for indigenous populations from accessing the basic health care services, and then exploring whether, if any, indigenous health care programs handled these problems. The integration of the policy framework makes several contributions to the information about the scope and quality of health care. The plan of policy also helped to know about the determinants of social and cultural wellbeing and how it influences the degree to which aboriginal communities can access health services. Importantly, indigenous health systems and policy are better suited to solve these problems.

References for Health Policy and Advocacy

Aboriginal and Torres Strait Islander Social Justice Commissioner. (2005). Social Justice Report 2005. Sydney: Human Rights & Equal Opportunity Commission.

Koon, A. D., Hawkins, B & Mayhew, S. H. (2016). Framing and the health policy process: A scoping review. Health Policy and Planning, 31(6), 801–816, https://doi.org/10.1093/heapol/czv128

Altman, J. (2018). Beyond closing the gap: Valuing diversity in Indigenous Australia. Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian National University.

Biddle, N., & Taylor, J. (2012). Demographic consequences of the ‘Closing the gap’indigenous policy in Australia. Population Research and Policy Review31(4), 571-585.

Bourke, S., Wright, A., Guthrie, J., Russell, L., Dunbar, T., & Lovett, R. (2018). Evidence review of indigenous culture for health and wellbeing. International Journal of Health, Wellness & Society8(4).

Calma, T., Dudgeon, P., & Bray, A. (2017). Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health. Australian Psychologist52(4), 255-260.

Coombs, D. (2018). Primary health networks’ impact on Aboriginal community controlled health services. Australian Journal of Public Administration77(S1), S37-S46.


Council of Australian Governments. (2017). Closing the gap: the next phase - a public discussion paper. Canberra: Department of the Prime Minister and Cabinet.

Council of Australian Governments. (2018). COAG statement on the Closing the Gap Refresh. Canberra: Council of Australian Governments.

Davy, C., Harfield, S., McArthur, A. et al. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal of Equity Health 15, 163. https://doi.org/10.1186/s12939-016-0450-5

Deravin, L., Francis, K., & Anderson, J. (2018). Closing the gap in Indigenous health inequity - Is it making a difference?. International Nursing Review65(4), 477–483. https://doi.org/10.1111/inr.12436

Dittmann, A. G., & Stephens, N. M. (2017). Interventions aimed at closing the social class achievement gap: Changing individuals, structures, and construals. Current Opinion in Psychology18, 111–116. https://doi.org/10.1016/j.copsyc.2017.07.044

Gracey M. (2019). Closing the Aboriginal health gap. Lancet (London, England)394(10194), 218. https://doi.org/10.1016/S0140-6736(19)31247-4

HealthInfoNet. (2008). Stakeholders. https://healthinfonet.ecu.edu.au/about/engagement/stakeholders/

Murawin and Associates. (2018). Cultural and Indigenous research centre Australia (CIRCA). Closing the Gap: Retrospective review. Retrieved from https://www.voced.edu.au/content/ngv:84619

Pholi, K. (2009). Is' Close the Gap' a useful approach to improving the health and wellbeing of Indigenous Australians?. Australian Review of Public Affairs: Journal9(2).

The Lancet (2019). Closing the gap for Aboriginal health. Lancet (London, England)393(10173), 718. https://doi.org/10.1016/S0140-6736(19)30405-2

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