So little to do so much in Indigenous communities

LESLEY RUSSELL assesses the Rudd government’s financial commitment to Indigenous Australians THIS WEEK marks the first anniversary of the Northern Territory Emergency Response. Responding to the Little Children are Sacred report into the protection of Indigenous children from child abuse in the Northern Territory, the Howard government implemented emergency measures that went well beyond ensuring the protection of Indigenous children from harm to encompass the acquisition of township leases, the abolition of the permit system and the introduction of market-based rents. Despite concerns about the welfare of children in communities in other states, the focus was solely on the Northern Territory, ignoring the huge unmet needs of Indigenous people of all ages in communities both remote and urban around Australia. Through legislation supported by the Labor opposition, the Howard government made a special appropriation to support the emergency response of $587.3 million for 2007-08. No funding commitments were made beyond June 2008. More than half this appropriation ($320.8 million) was for departmental expenditure and capital expenses to meet the costs of increased personnel, staff accommodation, infrastructure upgrades and improved IT capacity. The remainder was for administered expenses to implement welfare payment measures ($52.2 million), child-health check teams, follow-up medical teams and drug and alcohol teams ($72.7 million), improved childhood support services and alcohol diversionary programs ($91.2 million), improved teacher workforce capacity and increased classrooms ($16 million) and extra legal services and night patrols ($10.7 million). Despite the hype, the roll-out of the emergency response was slow. Questions in Senate Estimates in February revealed that only $168.6 million of the $587 million allocated for the emergency response had been spent in the six months since the appropriations legislation was passed. The Rudd government came to power in November having committed to continue the Emergency Response for at least twelve months. But the overall tone and focus was different, as exemplified when the prime minister apologised to the stolen generations and when the government pledged to “Close the Gap” on Indigenous disadvantage. So it is interesting to analyse the new government’s spending on Indigenous initiatives as a very concrete way to assess its commitment to addressing the needs of Indigenous people. In the 2007-08 Additional Estimates in February, the government committed $580.0 million over five years in new funding and $222.5 million over five years in redirected funding to Indigenous issues. Of this, $313.5 million was for the emergency response, and another $21.9 million was for an election commitment to boost hospital and community health in the Northern Territory. The 2008-09 Budget provides additional funding of $718.7 million over five years for 37 initiatives and programs across eight departments that are described as being about “closing the gap for Indigenous Australians.” Some of this funding was previously announced in February. The majority of the funding allocated in the budget ($426.6 million over five years) is provided for activities in the Northern Territory, including $320.9 million in 2008-09 for activities that are part of the emergency response. In total, new and directed funding for Indigenous measures following the 2007 election and the 2008-09 Budget is $1.2 billion over five years. Just over half this ($637.4 million) is specifically for the emergency response. There is $335.0 million over five years for health, nutrition, alcohol and drugs, and related programs, and $151.5 million of this is for specific programs within the response. Much of the attention - and the cynicism - has focused on children’s health checks. A recent report finds that these have been carried out for 63 per cent of the 17,182 children who are eligible. Only 0.5 per cent of children were referred to Family and Community Services on the basis of suspected instances of abuse, but physical health problems were very common and 67 per cent of children were referred for at least one type of follow-up service. As Dr Bill Glasson, a member of the emergency response taskforce, wrote: We already knew that the children in many of these communities had very high rates of chronic diseases, but have found that the situation is even worse than the official picture Probably 80% of the Indigenous children have middle-ear diseases. Intestinal parasites and skin infections are rife. An absence of water for washing - taps don’t run, toilets don’t flush, there is no soap - has led to skin hygiene so poor that pathogens thrive. This in turn contributes to the devastating levels of renal disease and heart disease, the latter particularly associated with rheumatic fever. Type 2 diabetes is also increasingly common in children. Most of the health checks thus far completed were done by volunteer medical professionals flown in for brief periods. The call has now gone out for health professionals, doctors, specialists and nurses to help out with the follow-up, but this type of approach to the delivery of needed health services is truly an emergency response and is not sustainable. Only 11 per cent of the Indigenous population lives in the Northern Territory, but new spending on national programs for Indigenous health in the 2008-09 Budget averages less than $40 million a year over the next five years. This is not sufficient to make any great inroads into the prime minister’s commitment to “close the gap.” The Centre for Aboriginal Economic Policy Research at ANU estimates that the funding required to achieve “normalisation” and sustainable improvements in outcomes in education, housing, health and employment for Indigenous people in the Northern Territory is $4 billion over five years. Gavin Mooney, Professor of Health Economics at Curtin University, says that if the government is prepared to pay up to $40,000 on pharmaceuticals to extend an Australian’s life by one year, then logic, fairness and justice would suggest that the government should be prepared to spend up to $340 billion to bridge the seventeen-year mortality gap for all Indigenous people. The fact is that a lot of money, manpower, effort and goodwill over a time-frame that spans more than one generation will be needed from all levels of government and from both black and white communities if we are to finally to close the gap and eliminate endemic Indigenous disadvantage. On that basis, the May Budget made a very small down-payment on a major debt. • Lesley Russell is the inaugural Menzies Foundation Fellow at the Menzies Centre for Health Policy which is co-located at the University of Sydney and the Australian National University and a senior adviser to Macroeconomics.com.au on health economics and policy including program analysis. • A detailed analysis of the 2008-09 Indigenous budget has been prepared by the Macroeconomics health team. Photo: Andrew Jeffre