Australia – Health inequities persist among Aboriginals #indigenous


Aboriginal heroes betrayed by buck-passing

Date
June 3, 2013 

Chronic renal disease has taken another Aboriginal hero.

Yolgnu warrior Yunupingu was an activist to the end. Why his family, our country and the world should lose him 25 years younger than our national average life expectancy to kidney failure is a tragic reminder of the deep health inequities which persist in Aboriginal Australia.

Northern and central Australia is one of the world’s hardest places to deliver first-world healthcare. Sparse and dispersed populations struggle with a traditional life riven with the worst the First World has to offer. It has led to an avalanche of kidney failure, where senior men and women are trucked away to distant dialysis, too many elders never return home.

Yunupingu led the way for a solution. Early last month he convened a two-day summit to devise a regional solution to a disease that so cruelly rips elders from their families. Despite his own struggles with the disease, he stayed for the entire event.

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Tragically, since healthcare workers raised the alarm a decade ago, state and federal governments have been in pitched battle, not to deliver dialysis chairs remotely, but rather to avoid taking responsibility.

In 2011, the federal government was “so passionate about expanding medical services out of the big cities” according to then Health Minister Nicola Roxon, they were “helping to provide better care, closer to home” with 22 dialysis chairs across remote Western Australia. Treasurer Wayne Swan committed to “greatly improve access to quality healthcare.”

How soon the party ended. Less than a year later, the Commonwealth was suddenly “not responsible for renal service delivery.”

The origins of this story can be traced to Chief Medical Officer John Horvath, who noted that Alice Springs dialysis patients had jumped from 74 to 200 in the decade since 2000, threatening “to overwhelm the capacity of staff and facilities.”

At the time, Northern Territory refused to continue dialysing non-resident Aboriginal Australians, demanding those who crossed the border to Alice Springs for care, to fly back to their own capital cities.

The federal government then commissioned Alan Cass’s Central Australian Renal Study in 2010. Stunned by the findings, they returned his first version for re-writing. Next they sat on the revised version for six months, before pressure from this newspaper compelled minister Warren Snowdon to release it.

Only with the magnitude of the problem laid bare in Cass’s report did the federal government suddenly develop cold feet. The official federal line changed from Roxon’s “better care closer to home” to building flats for patients and their families. There is nothing wrong with flats, but it won’t treat chronic renal failure.

With a population of 233,000 administered by a city barely the size of Geelong, the Northern Territory simply lacks the size and tax base to fund its share of expanded health services. It struggles with twice as many admissions per head, who stay far longer due to complex disease and lack of discharge options. On top of that, surgery costs are around 25 per cent higher and death rates are double. The relative size of the task in the Northern Territory demands more flexible approaches from the Commonwealth than those it applies to the larger states around it.

NT figures indicate the Commonwealth currently funds less than a quarter of the their hospital bill, compared to 36 per cent of other states’ hospitals. For health overall, Canberra funds 43 per cent of the Territory’s costs, compared to an average 62 per cent elsewhere.

These inequities are most apparent when acute and intensive health care like renal dialysis must be expanded. Governments of all persuasions have been slow to respond. Commonwealth money has been waved in front of the Northern Territory on the condition it isn’t spent on recurrent health costs. That sticking point has cost senior Aboriginal men and women time they don’t have. Being uprooted from land and kin to squat in major towns for second-daily dialysis imposes massive social costs. Apart from a new mobile service in the Western Desert, their hope for outreach dialysis remains unfulfilled, two years after Cass laid out the solutions.

Last week was national Kidney Week, which passed without good news. Then came devastating private communication late Friday, when Snowdon’s office informed central Australian stakeholders that the $10 million for central Australian renal care was no longer on the table; presumably returned to consolidated revenue.

Yes governing can be tough. But governments are appointed to grind out the deals and “get to yes.” The vanishing chronic renal dollars which never found a home caring for kidney disease represents one of the emerging health tragedies of 2013. Governments need to return to the table this week and restart the Northern Territory talks with Darwin. Only a solution-first approach to chronic renal disease in the Northern Territory will ensure that Yunupingu’s final vision for kidney care is realised.

Andrew Laming is the federal Coalition’s spokesman on indigenous health.

Read more: http://www.smh.com.au/comment/aboriginal-heroes-betrayed-by-buckpassing-20130603-2nlfw.html#ixzz2V8xrGNod

 

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