Health Equality

HEALTH EQUALITY:

A COMPARATIVE ANALYSIS OF

AUSTRALIAN ABORIGINALS , TORRES STRAIT ISLANDERS AND

THE FIRST NATIONS OF CANADA

INTRODUCTION

Equality in health implies that ideally everyone should have a fair opportunity to attain his or her full health potential and, more reasonably, that no one should be disadvantaged from achieving this potential. Based on this definition, the aim of policy for equity and health is not to eliminate all health differences so that everyone has the same level and quality of health, but rather to reduce or eliminate those which result from factors which are considered to be avoidable and unfair. To appreciate the importance of striving for equity in relation to health, it is necessary to be aware of just how extensive are the differences in health found in the world today. In every part of the region, and in every type of political and social system, differences in health have been noted between different social groups and between different geographical areas in the same country (Whitehead 2000). There is consistent evidence that inequalities in health result in disadvantaged groups having poorer survival chances, suffering a heavier burden of illness, and sharing a similar pattern of low quality of life

The poor health of the Australian Aboriginals and Torres Strait Islanders is well known. Since the 1970s, mortality rates have been declining, but life expectancy has not changed and the gap between the Aboriginal population and the total Australian population has widened. This pattern contrasts with that of the Indigenous population of Canada where marked improvements in health have occurred. From that standpoint, this paper will discuss the important issues of health care inequalities that exist with the Aboriginals in Australia and compare them to those which subsist in the First Nations of Canada.

POPULATION OF AUSTRALIA

Australians have among the highest life expectancy in the world and most have ready access to comprehensive health care of high quality. In the 1995 National Health Survey, 83% of Australians aged 15 or over reported their overall health as excellent, very good or good (ABS 1997). The average life expectancy in 2000 was high for both men and women being 76 years and 82 years respectively. In terms of disability-adjusted life expectancy (DALE), Australia ranks in 2nd place after 191 countries (WHO 2000). In 1998, males at birth could expect to live for 63.3 years without experiencing major disability and women could live for 57.5 years free of disability (OECD 2000).

Despite high measures of health among Australians, health disparities in service quality and access continue to exist between urban Australians and the Aboriginal Australians. Although, incomplete recordings in routine health data collection of Indigenous people remain barriers to a complete picture of their health, the available evidence suggests that they continue to suffer a greater burden of illness than the rest of the population. In a total population of approximately 19 million in 2001, Australian Aboriginals make up 2.7% (500,000). Of this total, 34% live in metropolitan areas, 32% live in rural areas and 34% live in remote areas (ABS 2001). The general picture is identified as closer to a "third-world" health profile compared to the good health measures for the rest of the population. Life expectancy and age-specific mortality rates are much worse than for the general population with life-expectancy being 56 years for indigenous men at birth and 63 years for women. Thus, they live on average 15-20 years less than the rest of the Australian population (AIHW 2001). The report, Mortality of Indigenous Australians, suggests that while death rates have dropped slightly among Indigenous males, there has been no corresponding decline for Indigenous females (AIHW 1996). Mortality rates are higher in all age groups, particularly in infancy with the IMR being 14.1, 2-4 times higher than the national average of 5.0 (WHO 2000).

Figure 1: INDIGENOUS AND TOTAL POPULATIONS BY AGE, 2001

(Source: ABS 2001)

Aboriginals and Torres Strait Islanders are the most disadvantaged group of Australians. In many communities Aboriginals do not have adequate access to health care services, safe water, housing, power, or roads contributing to the burden of ill health. Social disadvantage and cultural disruption results in excess illness and premature deaths, injury and disability. The health statistics for Aboriginals are the worst of any group in Australia, and worse than those for comparable Indigenous populations in other countries (AIHW 2001). At times groups of Aboriginals have been removed from their lands, moved onto reserves and lived in overcrowded conditions, with poor diet, contact with infectious diseases and lack of adequate health care: "In some cases Aboriginal and Torres Strait Islander family groups were broken up and communities were formed that bore little relationship to traditional kinship structures" (NATSIHC 2001).

HEALTH CARE SYSTEM IN AUSTRALIA

Australia has a complex health care system with all levels of the government involved and both public and private sectors funding and providing health care. A key principle underlying Australia's health system is universal access to most health care regardless of ability to pay. Australia is committed to public financing and public involvement in health care with revenue stemming mainly from general taxation (Healy et al., 2001). The following figure shows the main organizations involved in the health sector:

Figure 2: Organizational chart of health care system

(Source: Healy, et al. 2001)

The universal health insurance system, Medicare, is financed mainly through general taxation. There is a health tariff equivalent to 1.5% of taxable income above certain income threshold upon individual taxpayers. Revenue raised by the Medicare levy has been equal to about 20% of total Commonwealth health expenditure and about 8.5% of total