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Standing Committee on Health, Aged Care and Sport
Hearing health and wellbeing in Australia

GIBSON, Mr Brendan, Assistant Secretary, Health Branch, Indigenous Affairs Group, Department of the Prime Minister and Cabinet


CHAIR: I welcome the representative from the Department of the Prime Minister and Cabinet. Do you as a witness have any problems with the media recording anything that you say today?

Mr Gibson : No, not at all.

CHAIR: These hearings are formal proceedings of the parliament. The giving of false or misleading evidence is a serious matter and may be regarded as a contempt of the parliament. The evidence given today will be recorded by Hansard and attracts parliamentary privilege. Would you like to make an opening statement?

Mr Gibson : Yes, I would. The Department of the Prime Minister and Cabinet is acutely aware of the high incidence of ear disease and hearing loss amongst Aboriginal and Torres Strait Islander people, with a higher proportion of Indigenous Australians experiencing hearing problems than non-Indigenous Australians across most age groups and across remote, rural and metropolitan areas. The Commonwealth government recognises that Aboriginal and Torres Strait Islander ear and hearing health is a priority issue for closing the gap in health inequality.

Through the Department of Health, the Commonwealth invests a significant amount of funding into a range of activities to improve the ear and hearing health of Aboriginal and Torres Strait Islander children. The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 includes a requirement for an increased focus on ear health, particularly in the areas of prevention, early intervention and improved patient journeys.

We know that otitis media, middle ear infection, particularly among Indigenous children in remote areas, is a major contributing factor to the high rates of hearing loss in Indigenous Australians. Aboriginal and Torres Strait Islander babies and infants are affected by otitis media at a younger age, more frequently and with greater severity than non-Indigenous children.

Many of the programs funded by PM&C under the Indigenous Advancement Strategy positively impact on the social and cultural determinants of health, particularly as they relate to education, employment, housing and justice issues. The Commonwealth government's investment in the early years, including through the IAS, is twofold: improving integration of services across child and maternal health, childcare, early childhood education and schooling, resulting in better access to the services; and intensive support for the children and families who need it most.

More specifically, under the Indigenous Advancement Strategy Children and Schooling Program, PM&C funds a number of small-scale programs which support school- and preschool-aged children with hearing difficulties. This includes providing hearing and special needs support and screening for any health related issues identified upon enrolment. These projects are delivered within the following PM&C regions: eastern New South Wales, Far North Queensland, the Top End and the Tiwi Islands.

PM&C is currently in discussions with the Department of Health to identify possible approaches to address ear health, including through the department's regional network and working alongside communities. We also acknowledge the role of state and territory governments in the delivery of ear health programs in their jurisdictions, and their unique role in addressing environmental health challenges in communities.

The social and cultural determinants of health refer to the conditions in which people are born, grow, live, work and age. Life circumstances impact and are impacted by outcomes in health, education, employment, justice, income and housing. The impact of social determinants on the health of Aboriginal and Torres Strait Islander people is substantial, accounting for up to half the gap in life expectancy. Social determinants such as environmental health conditions, inadequate housing and overcrowding can be major causes of otitis media in remote areas.

Hearing loss in the early years can have a major impact on children's overall wellbeing and future potential. It can limit a child's ability to meet developmental milestones, it prevents participation in education, and over the long term it can subsequently limit employment opportunities into adulthood. The Indigenous Policy Committee of cabinet agreed late last year to establish a cross-agency working group led by the Department of Health to examine the social and cultural determinants of Indigenous health. This work will inform the revision of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan.

Mr TIM WILSON: Where do you see big gaps from the work that you do in terms of making sure there is access to appropriate services?

Mr Gibson : Sitting within PM&C, we do not have a really good line of sight about what you would call the care pathway for Aboriginal and Torres Strait Islander kids with hearing health issues. We would be dependent on our colleagues in the Department of Health, working with Aboriginal community-controlled health organisations and state and territory governments to put that picture together for us. We know, for example, from some of the reports that they produced in places like the Northern Territory, where there has been a huge effort over the last decade, since the start of the Northern Territory Emergency Response and Stronger Futures in the Northern Territory, that a lot of work has been done to try to piece together that care pathway from small kids, identification of hearing problems during the child health checks, getting the audiologists involved and if necessary getting the surgeons involved doing the follow-up care. We have a general idea of the complexity of that pathway, the need for it to be put together by the health authorities. If you said to me, can you pin where the system is working and is not working across the country, I would have to defer.

Mr TIM WILSON: In terms of managing the challenges of federation and the cooperative nature of different states and territories, without wanting to rank them in order of most cooperative to least cooperative, is there any state or territory in particular that you think is working successfully in dealing with these issues?

Mr Gibson : I could not really provide an evaluative comment on that. There are some jurisdictions that have more high profile programs—the Queensland Deadly Ears program; the Northern Territory one, because it has had such a strong effort; I know Western Australia has had some specific things, they have had some champions. It may relate more to the existence of champions for action in those jurisdictions than what is actually happening in practice.

Mr GEORGANAS: We have received some evidence that hearing health is not a priority in closing the gap. If that is the case, does it have an effect on funding for Indigenous communities hearing programs, hearing health?

Mr Gibson : There are the Closing the Gap targets and, you are right, there is not an ear health or ear disease Closing the Gap target. I guess ear disease or hearing health problems contribute to a number of other things that then later appear in Closing the Gap targets, but I guess there would be a line between things like year 12 attainment, for example, and what might be preventing kids participating early in life.

I suppose from a PM&C perspective we do not have a disease-specific way of looking at the world so much. It is very much looking through a holistic lens at Aboriginal people's lives and communities and how they progress through those major aspects of completing education and employment participation rather than kind of disaggregating the world into specific diseases that might be affecting those Closing the Gap priorities. It is not that we do not think that ear disease is important; it is just the way we would construct the Closing the Gap agenda is around those more holistic sorts of issues.

Dr FREELANDER: We are all aware of the social determinants of health. Sir Michael Marmot actually visited the Aboriginal health service in my electorate. There have been lots of working parties about hearing and Aboriginal health over the years. I think we pretty much know what to do. It is a matter of doing it. Do you see any way that we can improve our hearing services getting to Aboriginal communities, both urban and non-urban? Are you aware of any plan to improve hearing assessments?

Mr Gibson : I need to defer on issues that are more properly in the domain of the health portfolio about the delivery of hearing services into remote communities or into Indigenous communities anywhere. I am not sure—

Dr FREELANDER: You are not aware of any deficiency in hearing assessments in Aboriginal communities or any work that is being done?

Mr Gibson : I know there has been a substantial effort to improve the proportion of Aboriginal and Torres Strait Islander children, for example, who are having Aboriginal and Torres Strait Islander health checks, so item 715 under the Medicare Benefits Schedule. I know there have been concerted efforts over a number of years to drive those numbers up. There is a national key performance indicator around that—I may be wrong. I know there are concerted efforts to reach children a lot through those things.

Dr FREELANDER: Is there any move to increase funding to Aboriginal health centres around the country?

Mr Gibson : Again that would be a question for the health portfolio. My understanding is that Commonwealth government funding for Aboriginal community-controlled health services has been growing pretty steadily above CPI for 10 or 15 years now. There have been concerted efforts to increase funding generally. I think the trajectory in per capita expenditure on Aboriginal and Torres Strait Islander health has gone up over the last 10 or 15 years. I think the first time that was measured it was around $1.13 per capita for Aboriginal and Torres Strait Islander people for every dollar spent on non-Indigenous people. The last time it was measured it was up to about $1.47 per capita for Aboriginal and Torres Strait Islander people compared to non-Aboriginal people. There are resources going into the system. How well does that translate into adequate coverage of hearing assessments for Aboriginal and Torres Strait Islander children? I cannot draw that connection.

Dr FREELANDER: Thanks very much.

CHAIR: Thank you very much for your time today. If you have any additional comments that you think the committee should be aware of, you can forward those through to the secretariat. A Hansard transcript will be provided to you of your evidence today. We hope you enjoy estimates. Hopefully, we are a bit more pleasant than they are up there.

Mr Gibson : Thanks very much.