Monday 19 May 2014

Budget 2014 - The Basics

If you were hoping to find one neat package of what Indigenous people can expect from the Budget 2014, you are not going to find it.

Because of the diversity of black lives, it would be easier to say look at the whole budget, because it all impacts on Indigenous individuals and communities.

A brief over view is here –  Budget Winners and Losers

As per the link, Indigenous spending is a ‘Loser’ which - at a loss of half a billion dollars over the life of the Budget 2014 measures - is somewhat of an understatement.

Commitments to reducing Indigenous disadvantage are summed up in strategies and targets around ‘Closing the Gap’, where improving Indigenous life expectancy spans inclusion of a a complex network of social determinants of health.

It has bipartisan agreement - all governments, all major parties - agree Indigenous life expectancy needs to be improved – and the long term expenses of not improving health make the current concerns about strains on the public purse the missed opportunity future governments will point to, in much the same way as this:

The history of Commonwealth policy for Indigenous Australians over the past 40 years is largely a story of good intentions, flawed policies, unrealistic assumptions, poor implementation, unintended consequences and dashed hopes.National Commission of Audit Report – released April 2014
The biggest threat to Indigenous health, where poverty is also a factor – without question – is the proposal to impose a $7 charge to see the doctor; to get a blood test; and for every health care transaction. [Update: news reports suggest the charge will be payable for a total of 7? doctor appointments/year, with no expense for any further appointments; and exemptions to the charge will include appointments as per a health care plan or a chronic disease management plan. 20 May 2014] 

There is a concern that people will look to avoid the GP charge and go to Accident and Emergency at the hospitals.
We don’t even have to speculate the likelihood that trips to the hospital will become the norm. In some country towns, Emergency is already the only health service some people access.
But this is a different kind of Emergency to one where big doors stand wide open, inviting the ill inside for triage before hours of television in the waiting room. The further from the city centres, the smaller the scope of services available. To infrequent locum GP services, add the lack of rehabilitation programs, mental health services and the effects of poverty, overcrowding and homelessness that exist, as for instance in outback New South Wales:
He had a bad habit of hitting himself in the head with empty beer bottles. Skoll – bam! That particular night, it had split his head open. He’d walked to the hospital and rang the bell, before slumping to the ground to wait for someone to come and see who was ringing the emergency buzzer. The pool of blood had reached his feet by the time a nurse came to the glass doors and peered out at him. She watched him for a while – needing to be sure there were no others around, who might jump out of the bushes as soon as she activated the electric doors. She recognized the seventeen year old. (Dramaticized account following feedback from the patient and the duty nurse. 2003)
A significant blow are the threats to what is an already inadequate dental health care.
Cuts to dental care in federal budget
Budget 2014: Dental health advocates slam budget cuts, say waiting lists will balloon
Oral health is not cosmetic. I’m not a health practitioner and if you aren’t either you may not realize how an infection in the mouth has potential to result in a lifelong weakness within the heart. But it does. Just as any compromised immune system at a young age will attack other organs – the kidneys in particular.
The economic impact of poor oral health is easy to understand – how much stigma is attached to people with ‘country teeth’, or no teeth? How would it impact your relationships, your chance of a job, if you do not have the teeth – that are only getting bigger and whiter with each passing year – that makes you 'fit' to be employed, regardless of your education, your skills or your desire to work?
They found the money somehow, and got her in to see a specialist. He said the mother needed to stop giving her daughter soft drink. But it wasn’t soft drink. It was much more serious than that. And with limited public funding available sufficient to fix the problem, and no money to pay for a specialist, the public health dentist with a waiting list of 1300 clients did the only thing he could do to manage the raging infection – he removed her front teeth.
 Not her baby teeth, her permanent teeth. Half an hour down the road you can get botox, spa treatments, million dollar views and tree changers protest about fracking. And a seven year old child had multiple extractions and a set of dentures fitted. If she was in the Northern Territory it’s unlikely she would get the dentures. (Rural dentist account, 2014)

Environmental issues are critical for this country – we’ll all starve if we don’t perish from lack of drinkable water first - but it is exceptionally difficult to get interest in understanding the dire consequences of inadequate oral health.
There is no national oral health advisory body – and with Budget 2014 announcements of intentions to amalgamate boards, councils, advisory committees and in some cases, entire agencies – it's unlikely the need for expert high level advocacy will be heard above the uproar in the future.

If there is a willingness to regard the unemployed as undeserving - spending their time surfing the couch and the waves -  then dental care is easily dismissed as cosmetic….’why don’t they just slip over to Thailand for a cut price tooth capping?’

Both of these examples highlight the gaps that exist now – before, and if the reduction in pensions and unemployment allowances get through the Senate. Imagine the ramifications on children, adults and pensioners with even less funding and supports.

The proposed Medical Research Fund – funded by $5 out of every $7 raised from the co-payment - would quite probably have a research focus on cancer, diabetes and heart disease. The effects of lifestyle, which for many is the effects of poverty would be part of the research agenda. Perhaps future researchers will examine the long term health problems – such as cancer, diabetes and heart disease - associated with the introduction of a co-payment, a reduction in existing health funding, the compromised functions of health advisory bodies and the overall impact on Aboriginal health services (staff retention and patient services) that never knew where it’s next dollar was coming from, a year at a time.

Young men, such as the boy in the above example, are unlikely to be working any time soon – without a suite of interventions that don’t currently exist  – and that primary school age child wont be smiling from ear to ear in a tourism commercial, or inclined to pose for a selfie on social media, or anywhere else. 

And what has been the most significant response from government on Indigenous health since the Budget 2014 announcement that half a billion dollars would be slashed from Indigenous spending?
Greg Inglis payments spark review on indigenous use of medical funds   
The Department of Health said Medicare income at grant-funded Aboriginal medical services could only be used for primary healthcare services.After investigating for less than a week, it determined the health promotion work Inglis did for the medical service fell within the scope of primary healthcare service provision. 
The contract was renewed in December last year at a reduced rate of $50,000.


National Congress of Australia First Nation's Peoples

Media Release: Australian Medical Association

Broome Regional Aboriginal Medical Service

Media Release: Rural Health Alliance

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