Closing the Gap

Page last updated: 06 April 2018

The Australian Government is committed to closing the gap in life expectancy between Indigenous and non Indigenous Australians and halving the gap in child mortality by 2018.

As detailed in the Prime Minister’s 2018 Closing the Gap Report, we are on track to halve the rate of child mortality by 2018. Since 1998, the mortality rate for Indigenous children under five years has declined by 35 per cent. While we are not on track to close the life expectancy gap by 2031, the Government has invested in targeted activities to improve health outcomes over the life course, that have reduced the burden of disease:

  • Fewer Indigenous people are dying from chronic conditions –
    o Indigenous mortality rates from circulatory disease reduced by about 45 per cent (from 1998 to 2016)
    o respiratory disease death rates reduced by 24 per cent (from 1998 to 2015)
    o kidney disease death rates reduced by 47 per cent (from 2006 to 2015).
  • The proportion of Indigenous people aged 18 years and over who smoke has decreased significantly, from 55 per cent to 45 per cent (between 1994 and 2014-15).
  • Australia is on track to eliminate trachoma as a public health problem by 2020. The prevalence of active trachoma in Indigenous children aged 5–9 years in at-risk communities fell from 14 per cent in 2009 to 4.7 per cent in 2016.
  • The rate of vision impairment and blindness in Indigenous Australians has reduced from six times that of non-Indigenous Australians in 2008 to three times that of non-Indigenous Australians in 2016.

Funding for Indigenous health


The Australian Government will invest $3.6 billion over four years through the Indigenous Australians’ Health Programme, an increase of more than $724 million over the previous four years.

Key areas of investment are child and maternal health; and chronic disease prevention and management.

Mental health is another priority area. From July 2017, funding of $85 million over three years will improve access to culturally sensitive, integrated mental health services for Aboriginal and Torres Strait Islander people. These will be commissioned locally by Primary Health Networks, working closely with Aboriginal Community Controlled Health Services.

The scourge of ice in many Indigenous communities is being tackled head-on. The Australian Government is spending $241.5 million over four years for local alcohol and drug treatment services, including $78.6 million for Aboriginal and Torres Strait Islander people.

Smoking is the leading risk factor for disease and early death among Aboriginal and Torres Strait Islander people. The Government has allocated $183.7 million over 2018-19 to 2021-22 to continue the Tackling Indigenous Smoking program.

Funding of $135 million over two years from 2016-17 will better integrate and coordinate care for Aboriginal and Torres Strait Islander people with chronic disease, and help them to more easily navigate what can be a complex system.

Improving health outcomes for mothers and babies


The Australian Government is committed to halving the gap in child mortality for children aged less than five years.

Improved health and wellbeing in childhood helps to improve health, education and employment outcomes across the lifespan [1] .

Funding of $94 million for Better Start to Life will increase access to Aboriginal and Torres Strait Islander antenatal and postnatal care. Better Start to Life expands two established maternal, child and family health activities: the Australian Nurse-Family Partnership Program (ANFPP) and New Directions: Mothers and Babies Services (NDMBS). ANFPP is implemented in 13 sites across Australia and NDMBS is implemented in 124 locations across Australia and will be expanded to 136 locations by 30 June 2018.

Service integration


The Australian Government is working to strengthen the links between child and family health services for Aboriginal and Torres Strait Islander families.

The Department of Health is working in partnership with the Department of Education and Training to implement the Connected Beginnings program.

The Connected Beginnings program will help Indigenous children to be healthy and ready for school, by integrating early childhood services in up to 16 sites (with 14 sites to be funded by Health) across Australia in response to recommendation 1 of the Forrest Review, Creating Parity.

Two other programs that seek to improve service integration are:

  • the Abecedarian Day Care Centre in Alice Springs, trialling alternative methods to support developmentally delayed children in their early years; and
  • the Trauma Assessment, Response and Referral Outreach Teams project, focusing on vulnerable Indigenous children.

Access to primary health care services


The Government funds a national network of approximately 140 Aboriginal Community Controlled Health Services and around 40 other services to deliver culturally competent, comprehensive primary health care. In 2015-16, these services delivered over 3.9 million episodes of care.

Access to primary health care services for Aboriginal and Torres Strait Islander people is being improved. Aboriginal and Torres Strait Islander people received 8.9 million Medicare rebated services in 2015-16, nearly half (4.2 million) for GP services. The rate of GP Medicare services claimed has almost doubled over the past 10 years.

Tackling Indigenous Smoking


Indigenous smoking rates are down to the lowest recorded. In 2014–15, the proportion of Aboriginal and Torres Strait Islander people aged 15 years and over who were daily smokers was 38.9 per cent, down from 44.6 per cent in 2008 and 48.6 per cent in 2002. [2]

An Australian Bureau of Statistics analysis on trends in Indigenous smoking [3] reported significant progress has been made since targeted investments in Indigenous tobacco control commenced in 2010. The Australian Bureau of Statistics compared the time period 1994-2004/05 'pre-investment in tobacco control' to 2008- 2014/15 'post investment in Indigenous tobacco control' and found declines in smoking rates in Aboriginal and Torres Strait Islander people aged 18 years and over (2.1 percentage point decline per year) in the investment period, compared to the 0.7 percentage point per year upward trend in smoking rates in the pre-investment period. There were also declines in smoking initiation in the investment period (1.9 percentage points per year), compared to no decline in the pre-investment period.

An October 2017 Australian National University study [4] reported that smoking rates have fallen in urban/regional areas. The study also noted that a lag time between declining smoking rates and declines in smoking-related deaths is to be expected. This means the number of deaths due to smoking related lung cancer will continue to increase for some years, despite an overall reduction in smoking rates in the Indigenous population. However, there have been declines in cardiovascular diseases (heart attacks, heart disease) due to declines in smoking in the Indigenous population.

The majority of Tackling Indigenous Smoking program funds go to 37 regional grants to reduce smoking. The Preliminary Evaluation of the program found that grant recipients are operating effectively, using proven approaches to change smoking behaviours, and delivering evidence based local tobacco health promotion activities. Tackling Indigenous Smoking funding also supports the Tackling Indigenous Smoking National Best Practice Unit; the National Coordinator; a national program evaluation; enhanced data collection; enhanced activities for priority groups; Indigenous Quitline enhancement; and Quitskills brief intervention training.

Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013–2023)


The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (the Implementation Plan), launched in October 2015, outlines the actions to be taken by the Australian Government, the Aboriginal Community Controlled Health Sector, and other key stakeholders to give effect to the vision, principles, priorities and strategies of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

The Implementation Plan is the Commonwealth’s key health portfolio framework to drive and coordinate our efforts in Closing the Gap. It was developed in close partnership with the National Health Leadership Forum and has multi-partisan support.

The Implementation Plan is being progressed in two stages. The first stage (2015-2018) is to strengthen the health system to:
  • respond flexibly to identified needs and service gaps;
  • support Aboriginal and Torres Strait Islander people to make healthy choices; and
  • provide culturally safe access to quality early intervention and treatment services.

The next iteration of the Implementation Plan presents us with an opportunity to challenge our current approach and consider new ways of working.

A key priority will be addressing the social determinants and cultural determinants of health for Aboriginal and Torres Strait Islander peoples. These issues contribute to at least 34 per cent of the gap in life expectancy, and require whole of Government action and collaboration across sectors.

Between March and May 2017, the Department of Health, in conjunction with the Implementation Plan Advisory Group, led an extensive national consultation process (My Life My Lead) with over 600 people in attendance across 13 face-to-face fora, with written 102 submissions provided through an online portal.

The My Life My Lead - Opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: Report on the national consultations was released by the Minister for Indigenous Health, the Hon Ken Wyatt AM, MP, on behalf of the Australian Government on 21 December 2017. This report will help inform the whole-of-government approach to better Indigenous health including the updated Implementation Plan.

Network Funding Agreement


From July 2017, the Government has supported the Aboriginal Community Controlled Health (ACCH) sector through a new Network Funding Agreement with National Aboriginal Community Controlled Health Organisation and Aboriginal and Torres Strait Islander Sector Support Organisations in each state and territory. The Agreement was developed in consultation with the ACCH sector to inform national policy and support ACCH services on the ground. In 2017-18, the Government provided around $20 million (GST exclusive) to the Aboriginal Community Controlled Health Sector Support Network to ensure our commitment to working with Indigenous Australians is a reality.

[1] Karoly, L, Kilburn, R Cannon, J (2005) Early childhood interventions : proven results, future promise Rand Corporation.
[2] National Aboriginal and Torres Strait Islander Social Survey, 2014-15, available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0
[3] Aboriginal and Torres Strait Islander Peoples: Smoking Trends, Australia, 1994 to 2014-15, available at: abs.gov.au/ausstats/abs@.nsf/Lookup/4714.0main+features122014-15.
[4] Lovett R., Thurber K., & Maddox R. 2017. ‘The Aboriginal and Torres Strait Islander smoking epidemic: what stage are we at, and what does it mean?’, Public Health Research and Practice, Vol. 27(4), October 2017.