Academic journal article Australian Aboriginal Studies

What Constitutes Benefit from Health Care Interventions for Indigenous Australians?

Academic journal article Australian Aboriginal Studies

What Constitutes Benefit from Health Care Interventions for Indigenous Australians?

Article excerpt

Abstract: The health of Indigenous Australians is poor compared to that of their counterpart Australians. Further, their health is worse by international standards. The Australian Government recently made a commitment to improving the health status of Indigenous Australians through the 'closing the health gap' initiative. Achieving this requires an improvement in the priority setting process through the use of evidence. Central to this is the need for a concept of 'benefit' from services that reflects the needs and aspirations of Indigenous Australians. The purpose of this paper is to develop an Indigenous-specific health metric that captures individual and community benefits for improving the priority setting process.

A workshop-based approach identified four dimensions of benefit in Indigenous health: individual health gain, community health gain, equity and cultural security. The individual health gain dimension accounted for 42 per cent of the total perceived benefit from health care interventions, while the remaining three dimensions each weighted between 19 per cent and 21 per cent. The individual health gain had two sub-dimensions: a DALY consistent attribute and a non-DALY attribute. The DALY attributes were by far the most influential, but while the DALY as a measure of health gain in economic evaluation is desirable, alone it grossly underestimates the overall benefit from interventions in Indigenous health.

Purpose

In Australia the health of Indigenous peoples is poor by both Australian and international standards (ABS and AIHW 2010; CSDH 2008; Gracey and King 2009; Kunitz and Brady 1995; Marmot 2005; NHMRC 2010). About three per cent of Australia's population are Indigenous and more than half of them live in rural and remote areas. In 2006 Indigenous people comprised one per cent of the population in major cities, three per cent in inner regional areas, six per cent in outer regional areas, 15 per cent in remote areas and 49 per cent in very remote areas (Baxter et al. 2011). Like other Australians living in rural and remote areas, Indigenous Australians are generally disadvantaged in terms of access to and utilisation of health care services due to location and socio-cultural factors (AIHW 2008, 2014). Coupled with Indigenous-specific health disadvantage, such as higher levels of illness and disease risk factors, as well as historical and institutional factors, improving the health of Indigenous Australians becomes an urgent issue (COAG 2009; SCRGSP 2009).

The Australian Government has made a commitment to raising the health status of Indigenous Australians to a comparable level with non-Indigenous Australians through the 'closing the health gap' initiative (COAG 2009). Achieving this requires improved processes of priority setting in Indigenous health. Such a process requires the development of explicit guidelines that draw on knowledge from normative economics and social justice theory, as well as lessons from empirical studies and the literature (Otim, Jayasinha, Kelaher et al. 2015). This would likely improve the priority setting process in Indigenous communities in Australia and beyond. Such guidelines may be based on the size of the health burden, feasibility, sustainability, equity and acceptability of health interventions (Otim et al. 2014). These guidelines can be applied to assess a selection of priority setting frameworks such as Program Budgeting and Marginal Analysis (PBMA), Multi-Criteria Decision Analysis (MCDA) or the Quality-Adjusted Life Years (QALYs) for suitability for use in the Indigenous health sector.

There has been growing recognition in recent years of the PBMA framework as the most appropriate and acceptable framework for priority setting (Otim, Asante et al. 2015), largely because of its ability to uphold both economic and social justice principles. The due process aspect of PBMA, in particular, is consistent with Aboriginal values (AIATSIS 2000; Novak 2000; Synott 2003). …

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