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Advancing Aboriginal health

By Gavin Mooney - posted Tuesday, 9 October 2007

We need an open informed debate to determine both the desired outcomes of health services and the “principles” (such as equity) on which decisions about priorities should be set.

Ideally these principles would be set by the Australian community itself through, for example, “citizens’ juries”.

Citizens’ juries are a form of deliberative democracy. A random sample of the relevant population is brought together: they are asked to put their citizens’ hats on; given good information on the issues for debate; encouraged to question experts to clarify that information or seek more information; and then given time to reflect on some appropriate issues and make recommendations. These ideas formed the basis of the four conducted in health so far in Western Australia and one in South Australia, all facilitated by the author.


Priority setting normally embraces two ideas, efficiency and equity. Efficiency is about maximising benefit to society as a whole with the resources available. Equity is about fair distribution usually in terms of “equal access for equal need”, but the definition can be clarified by citizens’ juries. For example, in a 2001 Citizens’ Jury in Perth (PDF 91KB), citizens came up with the following highly sophisticated definition of equity.

Equal access for equal need, where equality of access means that two or more groups face barriers of the same height and where the judgement of the heights is made by each group for their own group; where need is defined as capacity to benefit; and where nominally equal benefits may be weighted according to social preferences such that the benefits to more disadvantaged groups may have a higher weight attached to them than those to the better off.

That definition would, for example, give high priority to investing in Aboriginal health since it allows higher weightings for benefits to disadvantaged groups.

Aboriginal health

There is an argument that I think many, including myself, would subscribe to and that is that one way to judge the decency of a society is by how well that society deals with its most disadvantaged. In Australia I think there would be agreement that Aboriginal people represent the most disadvantaged group.

How well do we treat them? Given their very poor health status and the fact that the gap between that and non-Aboriginal health status is increasing, then badly has to be the answer at best. If we then recognise that it has been known for a very long time that Aboriginal health is so poor and so little action has been taken to improve it, then the answer has to be that we treat them shockingly.

Why is there currently such a low priority for Aboriginal health in Australian health care? The answer is that vested interests are at stake - especially those of the medical profession and medical specialists. Explicit priority setting sheds light not only on the “good buys” but also on the “bad buys”. This might well expose that certain groups of doctors (“bad guys”) may be providing “bad buys”.


Competition for extra resources currently is on the basis of who can shout the loudest. To move the basis of competition to who can do most good is in everyone’s interests especially the population at large but with the exception, obviously, of the loud shouters. That of course may be why this simple change, which would promote both efficiency and equity, does not happen.

Symptomatic of the problems for Aboriginal health is the fact that for example the former DG for Health in WA (Mike Daube) has admitted to “1001 regrets” that he did so little during his tenure on Aboriginal health. His excuse? “You [as DG for health] don’t have time to focus on issues like indigenous health … You are focused on all the immediate issues, from budgets to EDs to whatever is running politically.” He also admitted to yet another regret: “when you’re in government, there are some things that you can’t say that you can say when you’re out of government.”

Again in WA, the AMA have issued over 350 media releases this century on hospital funding, smoking, GP clinics, etc., etc. Not one of them has been on Aboriginal health.

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About the Author

Gavin Mooney is a health economist and Honorary Professor at the Universities of Sydney and Cape Town. He is also the Co-convenor of the WA Social Justice Network . See

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