Closing the Gap Isn't Working: Billions of Dollars of Aid Hasn't Helped First Nations People

By Chris Gilford

In Closing the Gap isn't working, retired General Practitioner Chris Gilford takes a critical look at the campaign which started in about 2008 and was intended to close the gap between the health, education and employment of First Nations Peoples and the rest of the Australian population. Sadly despite the spending of billions of taxpayers' dollars very few of the indices have shown any improvement. The author concentrates on the health issues and goes right back in history to find the causes of the gap. The colonialists contributed to the mortality of First Nations people with weapons and the germs they brought with them, but there is now a more insidious factor which is continuing to disproportionately affect First Nations people. Life expectancy and childhood mortality rates improved substantially in the major towns and cities in Australia before the onset of Modern Medicine with its heart surgery, kidney dialysis and virtually all the pharmaceuticals that are available today, but the improvement in remote areas has been far less. The Closing the Gap campaign has many faults, including the way the Federal Government has funded it, the way the Agencies who implement it are managed, the selection of key indicators and the response by the First Nations people. Despite this there is optimism that solutions can be found.

• Language: English
• Publisher: Xlibris AU
• Release date: Dec 15, 2022
• ISBN: 9781669833512

Book preview

Closing the Gap

isn’t working

Billions of dollars of aid hasn’t

helped First Nations People

Chris Gilford

Copyright © 2023 by Chris Gilford.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Rev. date: 13/12/2022

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This book contains details of many medical conditions and is designed to show how many of them can be prevented or mitigated. The advice given is general in nature and may not apply to individual circumstances. The book contains data from reports from many sources including Australian government bodies, but this does not imply that it has been endorsed by any of them.

CONTENTS

List of Abbreviations

Notes to the Reader

Chapter 1 Introduction – The Closing the Gap Campaign

Chapter 2 Origin of the Gap

Chapter 3 First Nations Peoples

Chapter 4 Health Problems Commoner in First Nations People

Chapter 5 Childhood Health and Mortality

Chapter 6 Lifestyle and Risk Factors

Chapter 7 A Weighty Issue

Chapter 8 Injury, Violence, Crime, and Punishment

Chapter 9 Health Programmes

Chapter 10 First Nations Culture in an International Context

Chapter 11 Analysis of Closing the Gap

Chapter 12 A New Approach

Appendices

References and Further Reading

LIST OF FIGURES

Figure 1: Child mortality rates

Figure 1a: Child mortality rates – modified

Figure 2: School attendance by jurisdiction

Figure 3: Attendance gap, years 1–10

Figure 4: Mortality rate

Figure 4a: Mortality rate – modified

Figure 5: Life expectancy

Figure 6: Birthweight

Figure 7: Vavilov centres

Figure 8: Life Expectancy, Australia and UK

Figure 9: Vaccine-preventable deaths

Figure 10: Mornington liquor sign

Figure 11: Map of Outstations

Figure 12: Percentage of First Nations diabetics by BMI

Figure 13: Syphilis notifications

Figure 14: Remoteness map

Figure 15: Prevalence of obesity by age and ethnicity

Figure 16: Trend in obesity

Figure 17: BMI and mortality

Figure 18: Distribution of BMIs in Normanton

Figure 19: Medicare services by age

Figure 20: Hypothetical Medicare services by BMI

Figure 21: People dying by age group

Figure 22: Close the Gap Poster

Figure 22: Percentage of deaths below 35

All the figures, apart from the author’s photographs, have been obtained from websites and reports with a Creative Commons licence or are in the public domain, except for Figure 13, for which permission was obtained from the Department of Health and Aged Care, which owns the copyright.

LIST OF TABLES

Table 1: Year 12 attainment by remoteness

Table 2: Scores for the 2020 report

Table 3: Summary of the seventeen new outcomes

Table 4: Dates when new drugs were introduced

Table 5: Population of Australian states and territories

Table 6: BMI and weight categories

Table 7: Risk of diabetes for different ethnic groups

Table 8: Diabetic numbers in Normanton

Table 9: Treatments for type 2 diabetes

Table 10: Childhood mortality in certain countries

Table 11: Structural birth defects

Table 12: Deaths from SIDS and SUDI

Table 13: Deaths of young children from injury and poisoning

Table 14: Non-compliance with guidelines

Table 15: Alcohol and presentations at Mornington Island Hospital

Table 16: Proportion of people by remoteness

Table 17: Numbers of people by remoteness (thousands)

Table 6: BMI and weight categories

Table 18: WHR and weight categories

Table 19: Prevalence of obesity by country

Table 21: Size of T-shirts

Table 22: Percentage of deaths below 35

Table 23: Homicide rates in selected countries

Table 24: Ethnic background of victims and offenders

Table 25: Characteristics of assault victims

Table 26: Impact of colonialists on First Nations people

Table 27: Life expectancy of different races in the USA

Table 28: Life expectancy of different races in Canada

Table 29: Life expectancy of different races in New Zealand

Table 30: Life expectancy differences in five countries

Table 31: Life expectancy gaps over ten years

Table 32: Increase in number of First Nations people

Table 33: The health targets

LIST OF ABBREVIATIONS

NOTES TO THE READER

T HE TERM ‘INDIGENOUS’ has been used for most of the last forty years when referring to descendants of the original inhabitants of Australia. However, in the last few years, they have elected to call themselves ‘First Nations’ peoples, and so that is the way they will be referred to here, apart from where I am using quotations from other sources or when it is used in an international context.

I have used metric units throughout this book, but there are instances in everyday life when imperial units are used. The exception is for calories and joules, when I have given both. The other conversions are given here:

Heights

Weights of babies (chapter 6)

CHAPTER 1

Introduction – The Closing the Gap Campaign

I N THE LAST sixty years, there has been a huge change in society’s attitudes towards First Nations peoples. This has been a cultural shift, and it is impossible now not to be aware of their presence and the fact that they have been here for so long. Many meetings start with a ‘Welcome to Country’ or ‘Acknowledgement of Country’, an example being ‘I begin by acknowledging the traditional custodians of the land on which we meet today and pay my respects to their elders past, present, and emerging.’ Television programmes often provide a similar acknowledgement and identify the owners of the land where the programme was developed. The ‘Sorry’ speech was given in Parliament in 2008, there has been the Uluru Statement in 2017, and there is likely to be a referendum on a Voice to Parliament in 2023. First Nations peoples’ rights and interests in land are now formally recognised over more than 40 per cent of Australia’s land mass.

Many more people are identifying themselves as being First Nations, and we are seeing more and more First Nations people in prominent positions. The combined federal and state parliaments now have an estimated twenty-six members of Parliament who identify as First Nations (3.1 per cent of all federal, state, and territory parliamentarians). This percentage is almost the same as the proportion of people who identified as First Nations in the 2021 census (3.2 per cent).

However, well before now, before the end of the twentieth century, there was a realisation by governments that First Nations peoples were behind the rest of Australians in standards of health, education, and employment. The state governments had been putting extra resources into these areas, but the federal government started targeting First Nations people for increased funding early in the 2000s. After a few years, the term ‘Closing the Gap’ was coined as an umbrella term for this funding.

Closing the Gap now refers to a campaign that was formally established in 2008 and aims to reduce First Nations disadvantage in the areas of health, education, and employment and was under the direct supervision of the Department of the Prime Minister. Targets have been set to monitor the outcomes. The targets agreed to in November 2008 were to

• close the gap in life expectancy within a generation;

• halve the gap in mortality rates for Indigenous children under 5 within a decade;

• ensure all Indigenous 4-years-olds in remote communities have access to early childhood education within five years;

• halve the gap for Indigenous students in reading, writing, and numeracy within a decade;

• halve the gap for Indigenous students in year 12 attainment or equivalent attainment rates by 2020;

• halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade.

The targets have been modified since then, and an extra one (school attendance) was added in 2014, so they were then as follows:

1. Halve the gap in mortality rates for Indigenous children under 5 within a decade (by 2018)

2. Ensure 95 per cent of all Indigenous 4-year-olds are enrolled in early childhood education (by 2025)

3. Close the gap between Indigenous and non-Indigenous school attendance within five years (by 2018)

4. Halve the gap for Indigenous children in reading, writing, and numeracy within a decade (by 2018)

5. Halve the gap for Indigenous Australians aged 20–24 in year 12 attainment or equivalent (by 2020)

6. Halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018)

7. Close the life expectancy gap within a generation (by 2031)

Notice that life expectancy, which was originally top of the list in 2008, was relegated to the bottom in 2014.

Each year a report on progress with Closing the Gap was prepared for the prime minister and Parliament, and the reports are made available on the website www.closingthegap.gov.au; the latest one on that website is dated 2020 and was tabled in Parliament on 12 February 2020. After that report, extensive changes were made to the campaign, and there are now seventeen outcomes with associated targets. The report writing was transferred to the Productivity Commission, which produced their reports in July 2021 and 2022.

Additional reports have been prepared by the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research, funded by Oxfam. Their 2022 report, Transforming Power – Voices for Generational Change, is a ‘small collection of the hundreds of stories that catalogue the success of Aboriginal and Torres Strait Islander-led initiatives’.

The new reports by the Productivity Commission are somewhat deficient in hard data. There are now seventeen targets, and in many cases, there is little comparison with the previous indicators. I shall therefore discuss the 2020 report in detail and come back to the 2021 and 2022 reports at the end of this chapter.

The original inhabitants of Australia arrived about 65,000 years ago, and their descendants now number about 800,000 according to the 2021 census. Torres Strait Islanders (TSI) are ethnically distinct being of Melanesian origin and arrived in Cape York, the northern tip of Queensland, from the island of New Guinea. There is debate about when they first arrived in Australia, with no clear consensus. There are currently about 28,000 TSI people in Australia, most being in Cape York.

There is a third group of people that might satisfy the description of being Indigenous but probably not First Nations. These are now known as South Sea Islanders and are the Australian descendants of Pacific Islanders, mainly Melanesians but some Polynesians. They were kidnapped or recruited between the mid to late nineteenth century as labourers in the sugar cane fields of Queensland. At its height, the recruiting accounted for over half the adult male population of some islands. Their numbers are thought to be in the range of 10,000 to 20,000. Queensland Health published a report on their health in 2011, and this showed significantly poorer health than non-Indigenous people, but they are not covered by the Closing the Gap campaign.

1. Mortality Rates for Children

According to the 2020 report, the key points on childhood mortality were as follows:

• In 2018, the Indigenous child mortality rate was 141 per 100,000 – twice the rate for non-Indigenous children (67 per 100,000).

• Since the 2008 target baseline, the Indigenous child mortality rate has improved slightly, by around 7 per cent. However, the mortality rate for non-Indigenous children has improved at a faster rate; and as a result, the gap has widened.

• Some of the major health risk factors for Indigenous child mortality are improving. There is a need for further research to understand why these improvements have not translated into stronger improvements in Indigenous child mortality rates.

The report shows a graph showing the change in child mortality rates:

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Figure 1: Child mortality rates

The comment in the report is that ‘Indigenous child mortality rates have improved (by 7 per cent) between 2008 and 2018. However, this improvement was not as strong as prior to the 2008 baseline’. The report does attempt to explain the volatility of the data between 2012 and 2015, but no reason is given for its stagnation in subsequent years. It seems to me that there has been no improvement at all since 2009. Paradoxically, the improvement in non-Indigenous mortality was actually greater in 2008–2018 than in the previous ten years. This can be seen in my reinterpretation of the graph:

006_a_null.jpg

Figure 1a: Child mortality rates – modified

The Closing the Gap programme regarding child mortality can only be described as an abject failure as its achievement was to completely halt the improvement that had been made over the previous ten years.

2. Early Childhood Education

The target is for 95 per cent of all Indigenous 4-year-olds enrolled in early childhood education (by 2025). The key points in the 2020 report were the following:

• In 2018, 86.4 per cent of Indigenous 4-year-olds were enrolled in early childhood education compared with 91.3 per cent of non-Indigenous children.

• Between 2016 and 2018, the proportion of Indigenous children enrolled in early childhood education increased by almost 10 percentage points. There was a slight decline of less than 1 percentage point for non-Indigenous children.

• The attendance rate for Indigenous children was highest in inner regional areas (96.6 per cent), almost 17 percentage points higher than the lowest attendance rate in very remote areas (79.7 per cent).

The report only provides data for 2016, 2017, and 2018 and shows that there has been encouraging progress. It also shows that the gap between First Nations and non-Indigenous might have already closed. However, it is unlikely that the target of 95 per cent enrolment will be achieved by 2025, given that the figure for non-Indigenous is 91.3 per cent in 2018.

The change in target between 2008 and 2014 from ‘having access to early childhood education’ in 2008 to ‘enrolled in early childhood education’ in 2014 is interesting. Even the newer target should be fairly easy to attain. All it needs is for someone to get a list of all the 4-year-olds in a community and visit all their parents and sign them up on the spot. Surely, the target, and therefore the challenge, should be the percentage of who actually attend early childhood education.

3. School Attendance

The target is to close the gap between Indigenous and non-Indigenous school attendance within five years (by 2018). The key points from the 2020 report are as follows:

• The majority of Indigenous students attended school for an average of just over four days a week in 2019. These students largely lived in major cities and regional areas.

• School attendance rates for Indigenous students have not improved over the past five years. Attendance rates for Indigenous students remain lower than for non-Indigenous students (around 82 per cent compared with 92 per cent in 2019).

• Gaps in attendance are evident for Indigenous children as a group from the first year of schooling. The attendance gap widens during secondary school. In 2019, the attendance rate for Indigenous primary school students was 85 per cent – a gap of around 9 percentage points. By year 10, Indigenous students attend school 72 per cent of the time on average – a gap of around 17 percentage points.

Although the second key point above stated that the rate ‘had not improved’, the reality is far worse, particularly in the Northern Territory, where the rate actually declined by 7 percentage points. In every other jurisdiction, the rate also declined but ‘only’ by about 2 to 3 per cent, with most of the decline between 2017 and 2019. This is seen in the graph that the report supplied:

008_a_null.jpg

Figure 2: School attendance by jurisdiction

Remoteness is a major factor for the variation in attendance. Attendance was generally about 83–85 per cent for those in major cities and inner and outer regional centres. However, it was about 75 per cent in remote areas and 65 per cent in very remote areas. There was little comment on this in the report as it did not consider the difficulties for a child to attend a school. It may, in fact, be easier for a child to attend a school in a very remote First Nations community than in the leafy suburbs of a major city. In Mornington Island, the school is right in the middle of the township, so over 95 per cent of the population live less than one kilometre from the school, an easy ten- to fifteen-minute walk. I think that it is likely that the same is found in most remote communities. The exception, of course, is for those families who live on remote cattle stations, and they could well have an hour’s drive to get to school. However, many of these would be non-Indigenous, and the alternative is to enrol in the School of the Air, no doubt now using Zoom.

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Figure 3: Attendance gap, years 1–10

In contrast, those who live in large cities often have a long journey to school. They may take buses, either the normal community buses or dedicated school buses. Alternatively, their parents or carers may drive them to school, and the impact of this process is clearly visible to anyone who lives near a large school. A long queue of cars disgorging or collecting students clogs up the neighbouring streets for hundreds of metres twice a day.

What is worrying is that the attendance of First Nations students is virtually the same for years 1 to 6 at about 84 per cent, but after that, it drops at a steady rate of about 3 per cent a year, reaching about 72 per cent for year 10. This has implications for year 12 attainment.

4. Literacy and Numeracy

The target is to halve the gap for Indigenous children in reading, writing, and numeracy within a decade (by 2018). Here are the key points in the 2020 report:

• At the national level, the share of Indigenous students at or above national minimum standards in reading and numeracy has improved over the past decade to 2018. The gap has narrowed across all year levels by between 3 and 11 percentage points.

• Despite these improvements, in 2018, about one in four Indigenous students in years 5, 7, and 9 and one in five in year 3 remained below national minimum standards in reading. Between 17 and 19 per cent of Indigenous students were below the national minimum standards in numeracy.

• Looking at students exceeding national minimum standards provides a better understanding of how well Indigenous children are placed to successfully transition to further study or work. Between 2008 and 2018, for example, the share of year 3 students exceeding the national minimum standard in reading increased by around 20 percentage points.

The report gives data for reading and numeracy but not for writing. Surely, this is a serious omission. And although there is a wide year-to-year variation, the overall trend is a definite improvement.

Tasmania and the Australian Capital Territory (ACT) do the best, but they were also where attendance was best. Another reason is probably the lower population of First Nations people. There may only be a couple of First Nations children in each class, so they are more likely to socialise with non-Indigenous children, with peer pressure helping them. Queensland also does quite well without these advantages so should be congratulated.

However, remoteness is a major determinant of literacy and numeracy skills, which is hardly surprising – if the students’ attendance is poor, they are not going to learn much.

5. Year 12 Attainment

The target is to halve the gap for First Nations Australians aged 20–24 in year 12 attainment or equivalent (by 2020). The key points in the 2020 report were as follows:

• In 2018–19, around 66 per cent of First Nations Australians aged 20–24 years had attained year 12 or equivalent.

• Between 2008 and 2018–19, the proportion of First Nations Australians aged 20–24 years attaining year 12 or equivalent increased by around 21 percentage points. The gap has narrowed by around 15 percentage points as non-Indigenous attainment rates have improved at a slower pace.

• The biggest improvement in year 12 attainment rates was in major cities, where the gap narrowed by around 20 percentage points – from 26 percentage points in 2012–13 to 6 percentage points in 2018–19.

Further down in the report is the statement that ‘the target to halve the gap in year 12 or equivalent attainment rates by 2020 is on track’. The rates were 45 per cent for First Nations and 85 per cent for non-Indigenous in 2008 and 66 per cent and 91 per cent respectively in 2018–19. So the gap was reduced from 40 per cent to 25 per cent over this period, so it may achieve the target.

It is hardly surprising that remoteness is a major factor in year 12 attainment. For 2018–19, the attainment rate was as follows:

Table 1: Year 12 attainment by remoteness

High schools in remote areas are usually only available up to year 10. High schools that go to year 12 are only found in towns with a population of more than about 20,000, apart from those towns built around a mine, like Newman or Weipa. This therefore means that most students in years 11 and 12 who live in remote or very remote areas must attend a boarding school, which is usually located in a large city, sometimes many hundreds of kilometres away.

6. Employment Outcomes

The target is to halve the gap in employment outcomes between First Nations and non-Indigenous Australians within a decade (by 2018). The key points in the 2020 report were as follows:

• In 2018, the Indigenous employment rate was around 49 per cent compared with around 75 per cent for non-Indigenous Australians.

• Over the past decade (2008–2018), the employment rate for Indigenous Australians increased slightly (by 0.9 percentage points), while for non-Indigenous Australians, it fell by 0.4 percentage points. As a result, the gap has not changed markedly.

• The Indigenous employment rate varied by remoteness. Major cities had the highest employment rate at around 59 per cent compared with around 35 per cent in very remote areas. The gap in employment outcomes between Indigenous and non-Indigenous Australians was widest in remote and very remote Australia.

The chapter in the report on year 12 attainment points out