Indigenous Health Policy and 'Closing the Gap': Policy Failure or Success?

Cameron Smith (43171214)
Has Indigenous health policy since 1967 been a story of policy failure? With
reference to the indicators of life expectancy and child mortality, in what ways has
‘Closing the Gap’ rectified this failure, or further consolidated it, in your view?

 
It would be an understatement to state that Indigenous policy constitutes a
controversial and complex policy domain. After years of di#ering policy initiatives and
approaches, a cursory glance across many issues of Indigenous policy reveal a range of
problems that seem to remain as intractable as ever. The factors underpinning these
problems are undoubtedly as numerous as there are academics and policy-makers
purveying solutions to them; the recent election of a conservative Liberal government in
Australia being particularly notable in this regard for the promises of the newly-elected
Prime Minister to be a ‘Prime Minister for Indigenous A#airs’. Furthermore, it would seem
that media reports and rhetoric from both major political parties in Australia have largely
relayed stories of continuous, entrenched disadvantage; yielding a discernible tendency
within broader Australian society to perceive Indigenous a#airs more generally as a
province of continual desperation and discouragement. 

In this context of perceptible desperation and discouragement regarding Indigenous
a#airs, successive Australian governments have undertaken to address Indigenous
disadvantage through various ambitious policy initiatives. It could be argued that two of
the most notable, and perhaps controversial of these initiatives in recent years are
embodied in the Northern Territory Emergency Response (NTER) introduced by the
Howard government in 2007 and re-badged as ‘Stronger Futures’ by the Gillard
government in 2012, and the ‘Closing the Gap’ initiative committed to by the Rudd
government in March 2008 and operationalised by the Council of Australian Governments
in the form of the National Indigenous Reform Agenda (COAG, 2008).
1
Though both
initiatives have occurred in the same timeframe, and are still operational at the time of
writing, both are shaped by the political demands and priorities of the contexts in which
they were formulated. Thus, in seeking to address di#erent manifestations of Indigenous
disadvantage, each contains varying normative assumptions about the nature and causes
of Indigenous disadvantage. 

Examining both initiatives is beyond the scope of this paper. Ergo, this paper will
examine the Closing the Gap initiative with particular reference to its impact on
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Indigenous health policy through deploying particular methods of measuring and
evaluating Indigenous health policy outcomes. Beginning with a brief discussion of the
concept of ‘policy failure’, this essay will first explore whether Indigenous health policy
since 1967 has indeed been characterised by a protracted failure of government policy to
improve health outcomes for Indigenous peoples in terms of the two Closing the Gap
health indicators: estimated life expectancy at birth, and mortality rates for children under
five. Subsequently, issues of measuring and evaluating the two above health indicators
will be considered in discussing whether the Closing the Gap framework is working to
rectify or consolidate policy failure in Indigenous health policy. In considering whether the
Closing the Gap initiative is rectifying or consolidating policy failure, this discussion will be
conducted with special reference to the problematic of ‘evidence-based’ policy, as well as
the ontological and epistemological assumptions inherent in the Closing the Gap
framework. 

Indigenous health and policy failure since 1967

Defining policy failure

The concept of ‘policy failure’ requires further explanation before one delves into its
relationship to Indigenous health policy and the Closing the Gap framework. Taken at face
value, the concept of ‘policy failure’ in the context of Indigenous health policy seems to
imply a failure of a particular government policy or program to engender meaningful
improvements in health outcomes for Indigenous peoples. However, the very notion of
being able to objectively evaluate whether a particular policy or program has failed is
highly contestable, as this presupposes that policy evaluation represents a value-free
pursuit in which the context of evaluation is one of neutrality and objectivity. Instead, the
process and outcomes of policy evaluation owes much to a set of power relations that
‘shape and determine the scope, and thus also the impact of evaluation’ (Perche, 2011:
406-407).  

As a consequence, policy evaluation is inevitably a process that is characterised by
‘ambiguity, interpretation and contestation’ (Ibid). In an inherently oppositional political
system governed by the need for the elected government to demonstrate progress and
improvement, policy evaluation can serve as a means to engender a sense of policy
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e#ectiveness. On the other hand, should the circumstances demand ’scapegoats and
targets for blame’, policy evaluation can be serve to emphasise the role of past policy
formulation in causing policy failure (Ibid). In short, particularly given that Indigenous
health policy and Indigenous policy more generally has historically been a domain of
much contention, it is important to acknowledge that the a$xation of ‘policy failure’ to
particular government initiatives in Indigenous health policy represents a normative
judgement, and not an objective one. 

Policy failure and Indigenous health statistics since 1967

Having established that normative judgments are inevitably involved in a$xing labels
of ‘failure’ or even ‘success’ to Indigenous health policies and programs, we now turn to a
discussion of the trajectory since 1967 of the two indicators of Indigenous health
outcomes in the Closing the Gap framework, as cited in the National Indigenous Reform
Agreement: Closing the Gap (COAG, 2008). The first indicator we will discuss is life
expectancy at birth; an indicator accompanied in the above agreement by a commitment
to close the gap in life expectancy between Indigenous and non-Indigenous peoples by
2031. In this regard, the pursuit of evaluating the success or failure of Indigenous health
policy using statistics from the Censuses of Population and Housing undertaken by the
Australian Bureau of Statistics in 1971, 1981, 1991 and 2001 is shown by Altman et al.
(2004, 2008b) to be an incredibly di$cult exercise. With little reliable statistics available to
compare Indigenous and non-Indigenous life expectancy at birth in both 1971 and 1981
census data, along with a change in o$cial method for estimating Indigenous life
expectancy in 2004 (Altman et al., 2008b: 9), the comparative measurement of Indigenous
and non-Indigenous health status using census data has been largely dependent on a
‘rough proxy’: the proportion of the population aged over 55 years (Ibid). However, this
method of measuring health status is also somewhat imperfect, as it is subject to
changes in the fertility rate (Ibid). 

Despite the di$culties mentioned above in regards to measuring life expectancy,
Altman et al. provide an assessment of long-run absolute trends in male and female
Indigenous life expectancy from 1971 to 2001: male Indigenous life expectancy at birth
has increased from 49.6 to 56.0 years, and female Indigenous life expectancy at birth has
also increased from 50.0 to 63.0 years in the same period (Ibid: 23). Relative to the non-
Indigenous population, life expectancy has increased; the ratio of Indigenous to non-
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Cameron Smith (43171214)
Indigenous male life expectancy at birth has increased slightly from 0.73 to 0.74, also
increasing from 0.67 to 0.77 for female life expectancy at birth (Ibid: 25). The Overcoming
Indigenous Disadvantage (OID) 2011 report collates the most recent estimate of
Indigenous life expectancy from Australian Bureau of Statistics data, estimating
Indigenous life expectancy at birth in 2005-2007 to be 67.2 years for males, 11.5 years
less than non-Indigenous males (78.7 years), and 75.0 for Indigenous females, 9.7 years
less than for non-Indigenous females (82.6 years) (SCRGSP, 2011: 4.7). 

The di$culties alluded to above in measuring life expectancy at birth also extend to
the second indicator: the measurement of mortality rates for children under five years.
With the Closing the Gap target of halving child mortality rates within a decade in mind,
the OID Report discusses the five primary measures that comprise this indicator: child
under five mortality rates, and mortality rates by leading causes (perinatal, infant, 1-4
years and 0-4 years) (Ibid: 4.14). The availability of long-range trend data since 1967 for
these indicators is fragmentary at best, with small Indigenous populations in Victoria,
Tasmania and the ACT along with di$culties inherent in the process of identifying
Indigenous people in deaths registrations causing data on Indigenous mortality to only be
available for NSW, Queensland, WA, SA and the NT (Ibid: 4.15). Even in these states, the
earliest data available for perinatal mortality is 2005-2009, while a longer-time series of
data for infant and child mortality is available back to 1991 for WA, SA and the NT and
1997 for NSW and Queensland (Ibid: 4.17-4.24).  

It is thus di$cult to perceive whether progress was made in child mortality rates
before 1991; however, notwithstanding the relatively short time series of the data sets
mentioned above, it is important to note that progress has been made in the time range
covered on the majority of indicators associated with child mortality. Given the
aggregation of perinatal death statistics over five-year periods, it is di$cult to observe
meaningful trends; however, Indigenous perinatal death rates dropped relative to non-
Indigenous perinatal deaths from 2007-2009 (Ibid: 4.19). Infant mortality rates in NSW,
Queensland, WA and the NT fell between 1997-99 and 2007-09, also dropping faster than
those of non-Indigenous infants. A longer time-series was available for WA, SA and the
NT, showing also a steep decline of 48 per cent from 1991-2009 (Ibid: 4.21). Mortality
rates for Indigenous children aged 0-4 and 1-4 remained relatively constant from 1997-99
to 2007-09, though the longer time-series of data between 1991 and 2009 for WA, SA
and the NT shows a decline of 45 per cent for children aged 0-4 years (Ibid: 4.24). 
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Cameron Smith (43171214)

The above figures highlight the di$culties involved in accessing comprehensive,
reliable data that can be used to estimate national long-run trends in Indigenous health
status in terms of the two Closing the Gap health indicators. With the discussion of the
role of normative judgements in a$xing ‘success’ or ‘failure’ to Indigenous health policies
and programs in mind, it thus becomes more di$cult to argue whether Indigenous health
policy has failed or succeeded in terms of bringing about meaningful change to life
expectancy and child mortality rates. Thus, answering the question ‘has Indigenous
health policy since 1967 been a story of policy failure?’ in terms of life expectancy and
child mortality requires a value judgment regarding what constitutes success and failure.
Here, I contend that the trend of discernible, if limited progress in increasing Indigenous
life expectancy and decreasing rates of child mortality is welcome, though represents
neither success nor failure. This can best be described as a position of ambivalence; a
posture that maintains that progress is welcome, but further improvement to the current
policy framework should be sought if disparities between Indigenous and non-Indigenous
health status are to close (Altman et al. 2008a: 10). 

Issues of ‘evidence-based’ policy

In answering the second part of the question: ‘in what ways has ‘Closing the Gap’
rectified or consolidated this failure?’, one should first consider how the policies and
programs that address the COAG Closing the Gap targets are formulated, evaluated and
constantly re-adjusted in response to changes in the indicators of life expectancy and
child mortality. There exists a wide, almost innumerable range of factors contributing to
changes in both indicators; examples of which include disparities in income and
education levels, lack of or limited access to health, social and support services, as well
as social and environmental factors like lack of clean water and sanitation (SCRGSP,
2011: 4.5). It would thus seem that formulating policy to address the Closing the Gap
targets of reducing disparities in life expectancy and child mortality is a complex, multi-
faceted endeavour, demanding high levels of cooperation across government agencies
and third-sector organisations, along with a significant investment of resources. 



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Cameron Smith (43171214)
Framing the problem and solution

With the complex and demanding nature of the process of making Indigenous health
policy established, it is unsurprising to find an emphasis on pursuing ‘what works’ within
the governmental discourses that typify the Closing the Gap approach to Indigenous
health (Donato & Segal, 2013: 235). This approach places the evaluation of policy
progress or failure within the bounds of a context in which specific programs and
interventions are viewed as the key catalysts for change, and little emphasis is placed on
what Donato and Segal call the ‘linkage between health system model approaches and
health outcomes’ (Ibid). The various disparities in Indigenous and non-Indigenous health
are framed exclusively in terms of quantitative data in the case of life expectancy and
child mortality, with little consideration for the societal factors that underpin them beyond
those covered in other Closing the Gap indicators. Thus, the framing of the ‘problem’ in
the Closing the Gap approach to Indigenous health outcomes, rather than taking into
account broader systemic and societal issues, seems to revolve exclusively around an
identification of statistical disparity between Indigenous and non-Indigenous health
status, often accompanied by an a$xation of ‘success’ or ‘failure’ to particular policies
and programs that have or have not yielded progress in reducing this disparity. This is an
evidence-based policy approach par excellence. 

The logical corollary of this evidence-based policy approach to framing the
‘problem’ of Indigenous health policy inevitably e#ects how ‘solutions’ are devised to
address them - as argued by Jordan et al. (2010: 337), the choice of indicators and the
way in which they are chosen necessarily influence the means used to achieve policy
goals. A rough content analysis of the COAG OID Report (SCRGSP, 2011) and the AIHW’s
‘What works to overcome Indigenous disadvantage’ report (Closing the Gap
Clearinghouse, 2013) reveals evidence of this in a number of references to various
perceived ‘success factors’ and ‘things that work’. These ostensible ‘success factors’, or
‘high level principles and practices that underpin successful programs for Indigenous
Australians’ include: ‘flexibility in design and delivery so that local needs and contexts can
be taken into account’; ‘community involvement and engagement in both the
development and delivery of programs’; ‘continuity and coordination of services’ amongst
others (Ibid: 1). As pointed out by Sanders in the context of the NTER, this emphasis on
the ‘hard, quantitative data that advocates of evidence-based policy seek’ betrays a
dependence on ‘practical implementation knowledge’ rather than ‘knowledge generated
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Cameron Smith (43171214)
by research processes’ (2010: 323-325), an approach that presents evidence as standing
alone, devoid of context, interpretability and ideology (Sanders, 2010: 328). 

Problems of representation

This point regarding the negation of the influence of context, interpretation and
ideology in the Closing the Gap evidence-based policy approach is particularly salient
when considering the major problem of Indigenous under-identification in the collection of
data that influences the formulation of Indigenous health policy. As acknowledged by the
AIHW, the process of identifying the Indigenous status of patients and clients is an
important one; as it can determine whether targeted health services can be delivered to
Indigenous peoples, and can hinder responses to the disease and death burden amongst
Indigenous peoples (Closing the Gap Clearinghouse, 2013: 1). Particularly with regard to
the Closing the Gap indicators, it is crucial to be able to determine Indigenous status in
order to determine whether progress is being made on the Closing the Gap targets (Ibid).
Unfortunately, best-practice AIHW recommendations for methods of ascertaining
Indigenous status are almost laughably simplistic, and show no evidence of consultation
with Indigenous peoples in development and/or implementation, recommending a
‘national standard Indigenous question’ that is composed of three possible tick-box
responses (Ibid: 1-2). This approach, in understandably trying to institute a simple, easy-
to-adopt method of ascertaining Indigenous status on a national level, essentialises the
identity of the plurality of Indigenous peoples in Australia who identify themselves in a
multiplicity of ways. 

Similarly, the Closing the Gap evidence-based policy approach is underpinned by a
particular definition of what it means to have good health and/or wellbeing. Though the
Closing the Gap goals of halving life expectancy by 2031 and halving child mortality
within a decade are desirable goals, they operate under an implied definition of physical
and mental health that centres around the elimination of disparities in both indicators
between Indigenous and non-Indigenous peoples. Biddle points out that this definition
contrasts with that of the World Health Organisation, which defines health as ‘not only the
absence of infirmity and disease but also a state of physical, mental and social
wellbeing’ (WHO, 2006 cited in Biddle, 2012: 65). Similarly, the National Health and
Medical Research Council argues that health does not simply mean the ‘physical
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wellbeing of the individual’, but also ‘the social, emotional, spiritual and cultural wellbeing
of the whole community’ (NHMRC, 1996 cited in Ibid).  

Following these definitions of health and wellbeing, measures of the subjective
wellbeing of Indigenous people do exist; an example of this is the National Aboriginal and
Torres Strait Islander Survey (NATSISS) conducted by the ABS (2010). This survey collates
data on various measures of health not covered by the Closing the Gap measures: the
measure of self-assessed health status of Indigenous peoples presenting a key example
of in this regard. Though imperfect in themselves, measures of self-assessed health
status or similarly subjective indicators are jarringly absent in the peak-body literature that
governs the formulation, implementation and evaluation of Indigenous health policy,
particularly with regard to the Closing the Gaps framework. As argued by Biddle (2012:
66), this lack of focus on subjective factors in the Closing the Gaps indicators and
Indigenous health policy more generally betrays a ‘reasonably narrow’ definition of health,
and circumscribes narrowly the range of possible factors that are counted as
determinants of Indigenous health.  

This narrowness in the definition and determinants of health is ostensibly a function
of the inherently comparative nature of Closing the Gap indicators, as the focus is entirely
on explaining and addressing the disparities in health status between Indigenous and
non-Indigenous peoples in the terms of life expectancy and child mortality (Ibid). In this
regard, it is easy to see the need for parsimony and generalisability in implementing a
national approach to Indigenous health, along with the demands of electoral expediency.
Despite this, as argued by Maddison, the deployment of an evidence-based policy
approach foments an approach to Indigenous health that fails to problematise the
‘dominant ways of thinking about the world’ underpinning the Closing the Gaps
framework; the methods of knowing that produce and reproduce unequal power
relationships (2012: 275). With this in mind, the final section of this essay will examine this
evidence-based policy approach in terms of the ontological and epistemological
assumptions that underpin the emphasis on comparative health indicators in the Closing
the Gap framework.  


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Cameron Smith (43171214)
Unravelling the ontological and epistemological
underpinnings of the Closing the Gap framework

The opening section of this essay outlined how discourses of ‘policy failure’ are
deployed normatively, and not objectively. In the same way, the formulation,
implementation and evaluation of Closing the Gap goals, along with the collating of data
in developing indicators of life expectancy and child mortality, are underpinned by
assumptions about the nature of being (ontology) and the acceptability of certain modes
of knowing over others (epistemology). Thus, the use of indicators of life expectancy and
child mortality in the Closing the Gap framework for ameliorating the disparities in health
status between Indigenous and non-Indigenous do not simply represent an evidence-
based policy approach; they are also underpinned by certain understandings of how
Indigenous peoples relate to and are placed within the world-at-large, and what ways of
knowing are valuable in measuring and evaluating the health status of Indigenous
peoples. 

Rowse’s ‘peoples and populations’

Tim Rowse has written extensively on the ontological assumptions that underpin
Indigenous health policy in Australia, particularly in an article published in the Journal of
Cultural Economy called ‘The Ontological Politics of Closing the Gaps’ (2009) and in his
book ‘Rethinking Social Justice: From ‘Peoples’ to ‘Populations’ (2012). Deconstructing
the binary between Indigenous and non-Indigenous Australians as deployed in the
Closing the Gap framework and in Indigenous a#airs more generally, he asserts that
current perspectives on how to enact social justice with particular regard to Indigenous
disadvantage are largely underpinned by two competing idioms of how to represent
Indigenous people: ‘peoples’ and ‘populations’. The former conceives social justice as
originating within e#orts to enact a ‘resolution of di#erences between political entities’,
exemplified in struggles for the ‘recognition of status and rights as a people’ (Rowse,
2012: 7). The latter envisions ‘many individuals and households within an Australian
population categorised by self-assigned ‘race’ or ‘ethnic identity’’, and endeavours to
bring social justice include e#orts to ‘ensure that the inequalities among these individuals
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Cameron Smith (43171214)
and households do not correspond to such characteristics as their self-identified
‘ethnicity’’ (Ibid).  

The Closing the Gap framework, of course, constitutes an exemplar of social justice
in terms of the ‘population’ idiom. To Rowse, this emphasis on the population idiom can
be problematised through using John Law’s concept of the ‘method assemblage’ to
deconstruct the nation-wide standardised processes of data collection and interpretation
exemplified in the indicators of life expectancy and child mortality (Law, 2004, cited in
Rowse, 2009: 42). The concept of a method assemblage describes how procedures of
rational investigation both ‘construct or perform realities’ and emblematise ‘entrenched
habits of thought and practice that enables us to forget such processes of construction
and performance’ (Ibid: 34). Thus, in the case of the Closing the Gap framework, we can
use the concept of the method assemblage to perceive the normative assumptions that
underpin said framework; what realities are performed and constructed, and what
entrenched habits of thought and practice enable us to forget the inherent normativity of
such habits? 

Conventions of interpretation and forms of action 

First of all, the normative underpinnings of the Closing the Gap framework spring
from what Rowse calls a ‘neo-liberal or contractualist ontology’ which envisions society
as amoral; an ‘aggregate of individuals who contract with one another to give e#ect to
their common purposes’ (2009: 40). Thoughts and practice regarding social justice are
thus referred to only in the context of society as an ensemble of contracting individuals,
leaving questions of collective being aside (Ibid). Given the obvious influence of the
Enlightenment and experiences of Western modernity in this approach, it seems logical
that such perceptions of ontology should be accompanied by an epistemological
approach in which the ‘western intellectual subjects’ that make up the policy machinery
of government have been ‘trained to see our ordained products as secular, rational
actions’ and the intentions of organisations involved are presented as ‘prosaic, logical
and evidence-based’ (Lea, 2008: 20) 

Though other conceptions of both certainly figure in the various debates, this
particular notion of an individualistic political ontology and rationalistic epistemology has
clear implications for the ability of the two Indigenous health targets in the Closing the
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Cameron Smith (43171214)
Gap framework to address issues of Indigenous health beyond the ‘population’ idiom.
Indeed, in addressing a population binary made up of individuals aggregated according to
self-identified ethnicity, the indicators of life expectancy and child mortality and the goals
associated with them deploy certain ‘conventions of interpretation’ and make possible
specific ‘forms of action’ (Rowse, 2009: 45). In deploying the conventions of interpretation
embodied in the ‘population’ idiom and its accompanying tick-box approach to
ascertaining Indigeneity, the ability of the Closing the Gap framework to address
Indigenous ‘peoples’ is e#ectively negated. Conceptions of Indigenous peoples as a
‘complex political artifact’ and ‘a dense texture of kinship’ are ignored, as any possibility
of the ‘Gap’ containing a trace of Indigenous ‘peoples’ would ‘sabotage the work of
remedial di#erence’ embodied in the Closing the Gap framework through exposing the
individualist/rationalist state to the ‘dilemma of social improvement’ (Kowal, 2008: 345). 

In terms of ‘forms of action’, a direct corollary of avoiding exposure to the dilemma
of social improvement is thus a one-eyed emphasis on a remedial approach to
Indigenous health embodied in Closing the Gap notions of statistical equality. This
approach to Indigenous health, unwittingly or otherwise, designates the heterogenous
and varying aspirations of Indigenous peoples as irrelevant and inconsequential to the
pursuit of social justice in Indigenous health. The reliance on indicators of life expectancy
and child mortality in Closing the Gap, while creating an illusion of evidence-based value
neutrality, in fact neglect to take into account the complexity and diversity of the
development aspirations of Indigenous peoples, while simultaneously reinforcing the idea
that these aspirations are homogenous (Jordan et al., 2010: 352). Furthermore, questions
of the standing of Indigenous peoples vis-a-vis the colonial state are left either
uninterrogated or are given token recognition. As Rowse argues, ‘it is not possible to
pose the question that confronts many Indigenous people: on what terms are peoples
within a nation-state to live together?’ (2009: 41). 


Conclusion

In conclusion, this essay has aimed to discuss two main questions: firstly, has
Indigenous health in terms of life expectancy and child mortality been an area of policy
failure since 1967? After arguing that normative judgements of what constitutes ‘progress’
are inevitable in any a$xation of ‘failure’ to Indigenous health, the available health data for
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both indicators was briefly discussed. Despite problems with the availability and
applicability of data concerning both, it was argued that there has been gradual progress
in both indicators. Given the normative character of policy failure already described, a
position of ambivalence was adopted in regard to the first question. Progress is welcome,
but further improvement should be sought. 

Secondly, this essay considered whether the Closing the Gap framework has
rectified or consolidated policy failure in Indigenous health, particularly in its identification
of life expectancy and child mortality as two indicators in which statistical equality
between Indigenous and non-Indigenous people was codified as its goal. Beginning with
a discussion of the evidence-based policy approach adopted in the formulation,
implementation and evaluation of the Closing the Gap framework, I argued that this
approach, while presenting itself as dealing in the currency of objective, practical
knowledge, contains normative assumptions regarding the problems that need
addressing in Indigenous health, and the solutions devised to fix them. Problems of
under-identification of Indigeneity and definitions of health and wellbeing were considered
as exemplars of the normativity of evidence-based policy approaches. 

Lastly, in considering the second question, I argued that the formulation,
implementation and evaluation of Closing the Gap indicators and goals are primarily
characterised by an approach to Indigenous policy-making more broadly that deploys
what Rowse (2012) describes as the ‘population’ idiom. I argued, again using Rowse
(2009), that this approach to Indigenous policy-making is underpinned by an individualist,
contractualist ontology and rationalist epistemology. These were further unpacked in
terms of the conventions of interpretation they deploy and the forms of action they allow;
in the case of the former, social justice is interpreted as the elimination of statistical
inequality; in terms of the latter, a remedial approach to Indigenous health is deployed
that negates the complexity and diversity of Indigenous development aspirations and fails
to problematise the standing of Indigenous peoples vis-a-vis the colonial state.  

In terms of policy failure, it is important to note that the Closing the Gap framework
is relatively new, and any a$xation of failure would be premature (and normative). Any
progress is welcome; though as Altman et al. (2008b) point out, the timeframe for the
elimination of disparities across most indicators span multiple generations. Thus, though
the Closing the Gap framework in terms of life expectancy and child mortality may
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succeed to a small degree in progressing toward its goals, I argue that the reconstruction
of Indigenous health policy to better consider the heterogeneity of Indigenous peoples
and the primacy of issues of ‘people-hood’ would expedite the pursuit of social justice in
Indigenous health. 


Reference List

Altman, J.C. Biddle, N. & Hunter, B.H. 2008a. ‘The Challenge of ‘Closing the Gaps’ in
Indigenous Socioeconomic Outcomes’. Centre for Aboriginal Economic Policy Research:
Topical Issue No. 8. Canberra: Australian National University. 

Altman, J.C. Biddle, N. & Hunter, B.H. 2008b. ‘How Realistic are the Prospects for
‘Closing the Gaps in Socioeconomic Outcomes for Indigenous Australians?’ Centre for
Aboriginal Economic Policy Research: Discussion Paper No. 287. Canberra: Australian
National University. 

Altman, J. Biddle, N. & Hunter, B.H. 2004. ‘Indigenous Socioeconomic Change
1971-2001: A Historical Perspective’. Centre for Aboriginal Economic Policy Research:
Discussion Paper No. 266. Canberra: Australian National University. 

Australian Bureau of Statistics (ABS). 2010. National Aboriginal and Torres Strait Islander
Social Survey, 2008. cat. no. 4704.0, Canberra: Australian Bureau of Statistics. 

Australian Institute of Health and Welfare (AIHW). 2013. Towards better Indigenous health
data. Cat. no. IHW 93. Canberra: AIHW. 

Biddle, N. 2012. ‘Improving Indigenous health: Are mainstream determinants su$cient?’
in B. Hunter & N. Biddle (eds.) Survey Analysis for Indigenous Policy in Australia: Social
Science Perspectives. Canberra: Centre for Aboriginal Economic Policy Research,
Australian National University. pp. 65-78. 

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Closing the Gap Clearinghouse. 2013. What works to overcome Indigenous disadvantage:
key learnings and gaps in the evidence 2011-12. Canberra: Australian Institute for Health
and Welfare. 

Council of Australian Governments (COAG). 2008. National Indigenous Reform Agreement
(Closing the Gap). available at http://www.federalfinancialrelations.gov.au/content/
national_agreements.aspx, accessed 15 Nov 2013. 

Donato, R. & Segal, L. 2013. ‘Does Australia have the appropriate health reform agenda
to close the gap in Indigenous health?’ Australian Health Review. 37, pp. 232-238. 

Jordan, K. Bulloch, H. & Buchanan, G. 2010. ‘Statistical equality and cultural di#erence in
Indigenous wellbeing frameworks: A new expression of an enduring debate’. Australian
Journal of Social Issues. 45:3, pp. 333-362. 

Kowal, E. 2008. ‘The Politics of the Gap: Indigenous Australians, Liberal Multiculturalism,
and the End of the Self-Determination Era’. American Anthropologist. 110:3, pp. 338-348. 

Lea, T. 2008. Bureaucrats and Bleeding Hearts: Indigenous Health in Northern Australia.
Sydney: University of New South Wales Press. 

Maddison, S. 2012. ‘Evidence and Contestation in the Indigenous Policy Domain: Voice,
Ideology and Institutional Inequality’. Australian Journal of Public Administration. 71:3. pp.
269-277. 

Perche, D. 2011. ‘Dialogue Between Past and Present: Policy Evaluation and History’.
Australian Journal of Politics and History. 57:3, pp. 403-419. 

Rowse, T. 2009. ‘The Ontological Politics of ‘Closing the Gaps’. Journal of Cultural
Economy. 2:1-2. pp. 33-48. 

Rowse, T. 2012. Rethinking Social Justice: From ‘Peoples’ to ‘Populations’. Canberra:
Aboriginal Studies Press. 

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Sanders, W. 2010. ‘Ideology, Evidence and Competing Principles in Australian Indigenous
A#airs: From Brough to Rudd via Pearson and the NTER’. Australian Journal of Social
Issues. 45:3, pp. 307-331. 

SCRGSP (Steering Committee for the Review of Government Service Provision). 2011.
Overcoming Indigenous Disadvantage: Key Indicators 2011. Canberra: Productivity
Commission.


1
COAG had already devised and commissioned the Overcoming Indigenous Disadvantage framework in
2002, and had been the subject of biennial reports since 2003. The Closing the Gap targets represent a
dramatic revision of the original OID indicators (Jordan et al., 2010: 337)
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