Ian Ring | Closing the Gap reports should focus on what's needed to achieve targets

Part of the problem is that the reports themselves, apart from some obvious measurement issues, don't tell politicians and the public what they really need to know.

This is because they focus on targets and outcomes and not on what actually needs to be done to achieve the targets, and in particular, the services required.

Take healthy birthweight one of the so-called successes. We are told that this "target shows good improvement and is on track to be met". No need for any action because what is happening now is doing the job.

Really? So, what has actually happened? Well, the percentage of live born singleton babies of healthy birthweight has gone from 89.0 per cent in 2014 to 89.5 per cent in 2019 which is nothing to write home about.

Healthy birthweight babies aren't really an issue though. The main driver for avoidable deaths in early life is low birthweight. Low birthweight babies have gone from 9.6 per cent in 2014 to 9.2 per cent in 2019 but there is a lot of year-to-year variation. For example, the rate in 2018 was 9.8 per cent.

That does not really seem OK. Worryingly, despite increasing antenatal attendance, almost a third of women are not attending antenatal services in the first trimester.

What policymakers and communities really need to know is whether there is adequate and appropriate, access to dedicated services for mothers and babies, run by and for Aboriginal and Torres Strait Islander people.

There is clear evidence that such services reduce the proportion of low birthweight babies and reduce deaths in early childhood.

So, if you were a politician or a policymaker, the key information you would want to get your hands on, is where are the areas that lack such services?

Then they could set about filling the service gaps and do something positive to ensure Aboriginal and Torres Strait Islander kids get a good start in life.

But the report tells us nothing about this key driver of birthweight. Instead, it provides a misleading picture that everything is OK when that is far from the case.

One target looms over the rest - life expectancy. This is because it reflects the sum total of the effects of so many other factors. We are told "between 2005-2007 and 2015-2017, the gap in life expectancy narrowed for males (from 11.4 years to 8.6 years) and for females (from 9.6 years to 7.8 years).

Nationally, based on progress from the baseline, the target shows improvement but is not on track to be met for males or females.

The report is probably right on one point - the target is not on track. The rest of the commentary is dubious and based on techniques which other national agencies no longer use and advise against.

The problem is that these conclusions are based on census data and the apparent improvements in life expectancy are influenced in no small part by increasing identification of Aboriginal and Torres Strait Islander people in cities and towns in successive censuses.

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More than anything, life expectancy is driven by changes in chronic diseases and this, in turn, is significantly driven by access to primary health care services, ideally run by and for Aboriginal and Torres Strait islander people.

But the report doesn't tell us, for example, that access to such services is grossly inequitable within and between the jurisdictions and that, overall, funding for such services may be, at best, little over 50 per cent of the needs-based requirements.

Worse, access to specialists and use of life-saving medications through the Pharmaceutical Benefits Scheme is a fraction of what is needed.

Misrepresenting statistical artifact as real progress, and not showing progress or otherwise in the main drivers of change is unlikely to turn the tide.

But, on the positive side, we know that relatively large improvements, at least in health, and almost certainly in other areas as well, are possible in short periods of time from adequately resourced and well-run programs.

This is certainly true for chronic diseases and the health of babies.

Crucially, huge strides have been made in the formal ways for Aboriginal and Torres Strait Islander people to engage with and support developments across all the Australian governments.

Hopefully, in the future, the Voice will become a reality with groundbreaking consequences.

So, how could the Closing the Gap reports play a more use and productive role? Firstly, focusing just on targets and outcomes is not really all that helpful.

Simply hoping next year's numbers will look better is not really exemplary public administration. What is needed is a major shift to also measure the funding and services required to achieve those targets.

Equally importantly, it is essential to have a clear idea about the expected timing in terms of programs and services. It may take five to 10 years for the effects of new funding for, say, services for mothers and babies, to be reflected in measured outcomes for babies.

This is all laid out in various government reports but is not reflected in the Closing the Gap reports, which in the future should include a clear trajectory timeline showing what can and should be expected, and when - assuming, of course, that there is a clear understanding of the services required to achieve the targets.

And finally, the concept of needs-based funding has to be entrenched and measured. If people have twice the disease burden, they will need more health services. This is what happens with the elderly.

Australia, like most other countries, spends a large part of its health budget on the elderly because their need is greater.

No-one should assume that the gaps are going to close miraculously by spending relatively less on those with the most need - and expenditure relative to need should become a key measure for future Closing the Gap reports.