Last week, the Productivity Commission released the sixth annual report of performance assessments for the 'Closing the Gap' targets to address Indigenous disadvantage. These reports were previously produced by the COAG Reform Council, which was abolished by the Abbott government in 2014. However this lamentable decision has delivered an unexpected benefit: the Productivity Commission has produced a report for 2013-14 that is exemplary for its stark findings, forthright criticisms and thoughtful recommendations for future, more productive reporting and evaluations.
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The news is depressing. Little progress has been made in addressing the profound and persistent social and economic gaps experienced by Indigenous Australians. Few of the targets set by Australian governments in 2008 will be met and in some cases the gaps have widened. The data present national averages that hide substantial variations in achievements between the states and territories and situations that are worse in more remote areas.
The issues around life expectancy highlight the problems. The target, which will not be met, is to reduce the current gap of 10 years within a generation. Mortality rates are used as a proxy for life expectancy, but these do not take account of the high levels of disability experienced by Indigenous Australians. Mortality rates are not even available for Victoria, South Australia, Tasmania and the ACT due to problems with death registration data. Given that key risk factors like smoking, obesity and suicide remain unacceptably high, there is little likelihood that health outcomes and life expectancy will dramatically improve in the near future.
While infant mortality has improved, the mortality gap between Indigenous and non-Indigenous children aged 1-4 years has widened and Indigenous children face high levels of hearing and vision loss and rheumatic fever rates among the highest in the world. These health problems affect their ability to learn and future job prospects. Up to one half of the health gap is attributable to social determinants and so progress must be made on the full suite of targets, plus others such as housing, incarceration and social justice, in order to see real changes in any one target.
The Productivity Commission makes it clear that the thousands of pages of reports and data published annually by a variety of public and private agencies are too often duplicative and not very useful or informative. Surveys of health and social wellbeing targeted at Indigenous people are done sporadically, not regularly, and often lack future funding. Many of the recent improvements in health data sets are not included in the National Reform Agreement indicators.
The commission is very critical of the fact that current reports deliver little or no evidence about what works. It recommends that the future focus should be on ensuring independent reporting and especially on evaluation. Just 17 per cent of recently completed Indigenous-specific health programs had been evaluated to assess their effectiveness and the evaluation rate is even lower in non-health areas. The report finds that, in the absence of a strong evaluation culture with resources to facilitate this, policymakers will continue to flounder and programs will continue to fail to deliver the expected outcomes.
A system for building the evidence base about what works and does not work in Indigenous programs existed in the Closing the Gap Clearing House, but again, this is now defunded and defunct. The Clearing House had identified a number of key principles that are necessary for effective Indigenous programs and services. These include: flexibility in design and delivery to meet local needs; community involvement in design and decision making; trusting relationships; good governance on the part of all the organisations, communities and governments involved; retention of a well-trained and well-resourced workforce; and continuity and co-ordination of services and support.
There are difficulties in evaluating Indigenous programs but these are not insurmountable, they simply mean that more effort is needed. Too often Indigenous initiatives are time-limited pilots and trials that run their course and cease without any formal public evaluation, thus ensuring the loss of learning opportunities, regardless of the success or failure of the initiative.
Ultimately the responsibility for driving the Closing the Gap effort lies with the Prime Minister and his Department. Former Prime Minister Tony Abbott was correct to see tackling Indigenous disadvantage as requiring a whole-of-government approach. However the program disruptions and savage funding cuts simply sent the agenda backwards rather than forwards. While the impacts of these changes on progress in Closing the Gap have yet to flow through in the reporting, they will certainly contribute to yet another failing grade next year.
As the Productivity Commission makes very clear, Closing the Gap is not about making work for bureaucrats, collecting data and producing reports. It is about a long-term commitment to delivering programs and services in ways that are consultative, meaningful and productive for the very people they are meant to benefit. The report sums it up this way: "The answer to how to Close the Gap lies in knowing more about what works and why."
Dr Lesley Russell is an adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney.
