Bree Parker

Student Number: 220152029

OORA200
Case Study Report 50%
Unit Coordinator: Darin Gorry

Due Date: 10th October 2019

Word Count: 2250
Abstract
The Close the gap program is a campaign developed to reduce the disadvantages to Aboriginal and
Torres Strait Islander people over a period of 25 years, this is achievable by many programs and
projects designed by both national and state governments. Focusing on the gap in the health sector
this case study highlights the positives and negatives of three programs, Housing for health, a state
wide Victorian Government agreement and the #youcantalk campaign. Using a variety of online
resources, this case study focuses on improving the health of the ATSI (Aboriginal and Torres Strait
Island) communities around Australia and how to make closing the gap and achievable task. The
current targets are discussed as to whether these are on track and further recommendations made
to improve the work already being done.
Table of Contents

Introduction

Identify Successes of Program’s

- Housing for health
- Victorian Government Agreement
- The #youcantalk campaign

Identification of Problems of Programs

- Housing for health
- Victorian Government Agreement
- The #youcantalk campaign

Solutions to identified Problems

- Housing for health
- Victorian Government Agreement
- The #youcantalk campaign

Conclusion

Recommendations
Introduction
Closing the Gap is a program run by the Australian government which aims to reduce the
disadvantages which affect the Aboriginal and Torres Strait Islander people. These
disadvantages include, life expectancy, access to early childhood, employment outcomes
and opportunities. All Australian Governments have made it a commitment to achieve
equality in Aboriginal and Torres Strait Islander health within 25 years of the program
beginning in 2005. Closing the Gap can only be achieved with the use of strategies and
policies which are sustained over a period of time. Within this case study there will be a
focus on the projects which have attempted to close the gap between health inequalities for
Aboriginal and Torres Strait Islander people. The programs discussed are only a few of the
many state and national projects which have been put in place to assist with closing the gap.
Housing for Health is a program which aims to make housing safe and allows Aboriginal and
Torres Strait Islander people to live healthily by repairing and maintaining homes making
them safe and liveable. The Victorian Department of health also implemented a state wide
agreement to assist with closing the gap in Aboriginal and Torres Strait Islander (ATSI)
people’s health, this has been done by focusing on the main five priority areas which affect
the ATSI population as defined by the Council of Australian Governments (COAG). A number
of Australian Mental health and suicide prevention organisations have also been working
together to form the #YouCanTalk campaign which focuses on giving ATSI people the
confidence and support for themselves and others when discussing suicide, this incudes
teaching the signs of others thinking of suicide and educating them on where to seek help.

Identify Successes of Program’s

Housing for health was originally implemented in the 1980’s and it has been evidentially
beneficial that by fixing and maintaining homes, the risk of injury, infection and diseases are
decreased. The program is targeted at areas within the home and prioritised by projects
which will have the highest benefit the health of the occupants. The health benefits of this
program are presented both directly and directly. There has been evidence to show that by
the use of this program there has been a decrease in chronic disease and infectious
diseases, diseases are commonly caused by environmental factors including respiratory
conditions and skin infections. The World Health Organisation (WHO) has reported that 80%
of diseases are caused by environmental factors, the report also states that many of these
factors are modifiable (Who.int, 2019). By establishing and enabling the correct facilities
(such as hot water) the program promotes cleanliness within the home, minimising the
spread of infection. During the most recent ten years, the housing for health program has
run in over 2000 homes over NSW, a survey done by housing to health fund that the
projects completed were sustained from when projects were completed to two and a half
years later when the survey was completed (Closing the gap: 10 Years of Housing for Health
in NSW An evaluation of a healthy housing intervention, 2019).
The Victorian Department of health has implemented a plan focusing on five key areas
which are deemed a priority in ATSI health, these areas are tackling smoking, primary health
care services, fixing the gaps and improving the patient journey, healthy transition to
adulthood and lastly, making indigenous health everyone’s business. The Victorian
government has formed eight committees to focus on their own particular health region in
the state. The plan also focuses on specific projects such as ‘improving pathways to hospital
care – North West Metropolitan regions’, this plan focuses on the patient’s journey from the
hospital to primary care services and has been run at St Vincent’s hospital. It was found that
by partnering with Aboriginal communities, providing Aboriginals in the workforce and
providing resource supports, ATSI people benefitted and had an improvement in health for
themselves and their families. Aboriginal personnel have developed support structures with
in the hospitals for patients to provide additional support to the Aboriginal community.
(Reference pages 18-21). Studies done by improving pathways to hospital care project
resulted in an increases in ATSI community engagement, a greater understanding of
Aboriginals healthcare staff roles as well as providing the health care sector with an
increased knowledge about the Aboriginal health care issues.
The #YouCanTalk campaign was formed by beyond blue, headspace, lifeline and other
mental health awareness groups to break down the worries of talking about suicide and
empower people to check on others welfare and knowing the signs that something is not
okay. The campaign promotes that every single person has the ability to talk to a friend or
family member and gives people the tools to discuss suicide. There are also tips on how to
voice concerns and where to seek help for a person if they are in need. Lifeline CEO, Bob
Gilkes stated "Australia has world-leading suicide prevention services and we want to ensure
people who need them access them. However, the reality is, not everyone will seek help
themselves – they may firstly disclose their need to family and friends." This makes the
#YouCanTalk campaign vital in preventing suicide amongst communities as friends and
family members of a person suffering from mental health are the first point of help.

Identification of Problems of Programs

Although the housing for health program is promoting safety and health within homes, it is
evident that the homes will need repairs and upgrades as the years go on and may not be
maintained. A community in Western NSW was chosen to be surveyed 2.5 years after the
initial program ran in this community and it was found that some items previously fixed
were in need of repair again. This will continue to be an area of concern for the program.
Housing for health also is not capable of carrying out all repairs on houses as this would be
unachievable and vastly time consuming for all involved, the program consults with the
community to agree on expectations of the program which will directly impact on resident’s
health. Other items within the home which impact on health such as the temperature of
fridges and freezes are considered ‘tenants responsibility’ and is not up to the program to
fix, therefore although maintenance items will be repaired, other concerns such as expired
food will continue to be an area of health concern.
The Victorian Government has found challenges within the program ‘improving pathways to
Hospital care’ as the change needed to make a substantial difference in ATSI health will take
time to overcome and improve the overall care provided. The evaluation of the program has
found that many aspects of the hospitals planning and improvement structures have not yet
been integrated. There has been a lack of organisation support from ‘middle-management’
in this program as they have not been corresponding with their authority. Other programs
run within the Victorian government project has also faced challenges with tackling ATSI
health and closing the gap, other problems found include unplanned leave by trainers
causing lack of training to others. Not maintaining effective partnerships and loosing
leadership from elders.
The #youcantalk program is not well known in many communities as unfortunately there is a
stigma around mental health causing many young ATSI children and adults to not seek the
help when necessary. This campaign is well known through many of the suicide prevention
organisations such as headspace, the black dog institute and lifeline. Being a part of these
organisations makes it easier to share experiences regarding suicide were as people who are
not members of these communities may not be as comfortable speaking about these
concerns with suicide. A study done by the University of Melbourne found that 40% of
participants think suicide happens without warning, this reinforces that these participants
have not heard or know of the #youcantalk campaign.

Solutions to identified Problems

It is known that although repairs can be done in homes it is guaranteed that homes need to
be constantly maintained. To minimise the frequency of repairs, housing to health insures
they use quality items that will be able to last and reduce the risk of further work. Whilst the
survey team inspect the house for repairs they also offer education to residents on small
areas of concern which need to be addressed such as thermostats on appliances etc. this
allows residents to quickly fix these items and make a larger benefit to their health.
Although housing to health is unable to address all levels of health concerns, other
programs have been linked to the housing for heath program including Community clean-
ups, smoke free homes and rodent and best control. By using a variety of programs
together, the housing to health program will be able to continue to see results and a
decrease in diseases and infections caused by poor living conditions.
Within the projects provided by the Victorian governments efforts to the close the gap in
ATSI health there are many identified concerns which are causing challenges in the
programs. Although it has been discussed that it will take time to make a substantial
difference, the time is necessary to make an impact, hence why the closing the gap program
I ran over 25 years. It is not expected to have a noticeable impact straight away. There has
also been noticeable lack of organisational support provided by the middle management of
the program, this can be fixed by providing appropriate and stricter working practices for
employees, these practices can also than be forwarded onto the trainers who have been
taking extra unplanned leave causing further internal issues.
#youcantalk campaign has information and links online allowing people to access the
information on suicide prevention in their own time and own homes. This prevents the
stigma associated with suicide to affect a peoples personal choices in the matter. "Suicide is
an issue that many find difficult to talk about, but it is an issue that is having major impacts
on communities across Australia. #YouCanTalk is about giving people the confidence to have
the conversation by connecting them to the tools that can support them."
(Everymind Director, Jaele). There has been an increased use of the hashtag #youcantalk
which means it will hopefully be further recognised and known to the wider ATSI
community and help make more of a difference to suicide prevention as social media is very
prominent in the current day and age.

Conclusion
The close the gap program can be seen as a very unachievable project as it takes time and a variety
of programs to begin to see the impact that it is making to the health of Aboriginal and Torres Strait
Islander people. However over the course of many years a report was done in 2019 by Close the gap
and found that since 2008, Indigenous child mortality rates have declined by 10%, however this gap
has not narrowed as the non-indigenous rates for child mortality has declined at a faster rate.
Differing to this, the target to close the gap in life expectancy by 2031 is not on track to be met,
there has only been a small reduction in the gap over the years 2012-2017. Overall there has been
small and large improvements in ATSI health and whether or not all targets are met by their deadline
it will have a significant improvement to the overall health of Aboriginal and Torres Strait Islander
people.

Recommendations
Housing for health program needs to be an ongoing solution to improving the quality of homes as
the deterioration of houses will be a permanent problem. It was found that some homes have been
found to deteriorate over time and with this it is necessary to do further reviews on the homes. The
Victorian government agreement program has advised that they have had concerns with their staff,
this should be targeted as a problem and stricter working practices need to be introduced and
targets need to be met and addressed by the workers. The #youcantalk campaign has had little
acknowledgment by the community and should further more be recognised as this is a vital and
necessary way to combat suicide in both ATSI and non-indigenous communities. Further online use
of the hashtag will make it more prominent and known and spread vastly throughout the
community.
References
Closing the gap: 10 Years of Housing for Health in NSW An evaluation of a healthy housing
intervention. (2019). [ebook] Sydney: Aboriginal Environmental Health Unit. Available at:
https://www.health.nsw.gov.au/environment/Publications/housing-health.pdf [Accessed 19
Sep. 2019].
Life in Mind Australia. (2019). #YouCanTalk - Life in Mind Australia. [online] Available at:
https://www.lifeinmindaustralia.com.au/youcantalk [Accessed 11 Oct. 2019].
Lifeline.org.au. (2019). #YouCanTalk about suicide… and save lives. [online] Available at:
https://www.lifeline.org.au/about-lifeline/media-centre/media-releases/2018-articles/you-
can-talk-about-suicide-and-save-lives [Accessed 11 Oct. 2019].
Victoria State Government. (2014). Closing the Gap in Aboriginal health outcomes initiative -
health.vic. (2019). [ebook] Available at:
https://www2.health.vic.gov.au/Api/downloadmedia/%7B81EBD167-5104-4523-8A2C-
DA6C4E6B85A7%7D [Accessed 11 Oct. 2019].
Who.int. (2019). WHO | Almost a quarter of all disease caused by environmental exposure.
[online] Available at: https://www.who.int/mediacentre/news/releases/2006/pr32/en/
[Accessed 19 Sep. 2019].