NSW State of Play 2023: governments being 'city-centric' has consequences that follow remote & outer regional populations to their graves

 

The Australia Institute, media release, 14 February 2023:

New analysis reveals residents born in Far West NSW are suffering substantially worse health outcomes than residents in Sydney.

People in Far West NSW are dying earlier than they should, from avoidable causes, and while suicide rates have steadied in Sydney, they are on the rise in the most remote parts of the state.

The report warns of serious and growing inequality in health outcomes between city and country residents and recommends immediate investment in the sector.

Key points:

• Life expectancy: People born in the Far West have a life expectancy 5.7 years less than those in Sydney, with the divide worsening

• Premature death: Residents in Far Western NSW are 2x more likely to die prematurely than those in Sydney

• Avoidable death: ‘Potentially avoidable deaths’ are 2.5x more likely in the Far West than in Sydney

• Suicide: Residents in the NSW Far West are 2x as likely to commit suicide than those in Sydney, with a clear upwards trend in suicide rates

“Far West NSW is in serious need of medical attention. Where you live shouldn’t dictate how long you’ll live, but unfortunately in NSW it does” said Kate McBride, Researcher at The Australia Institute.

“Those in the Far West have significantly poorer health outcomes, inferior access to health services and face substantial financial challenges to access services.

“Life expectancy, premature deaths, and ‘potentially avoidable’ deaths are key statistical indicators of whether our health system is working. It is clear from the analysis in this report, sirens should be sounding from the Far West of the state.

“There’s a compelling case for significant investment across the continuum of care, from disease prevention to rehabilitation and ongoing care, in regional NSW.

“The first release in a series, this report reflects a wider national trend: That the health system is failing those living in regional and remote Australia” said Kate McBride.

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RELATED RESEARCH

Kate McBride, The Unlucky Country: Life expectancy and health in regional and remote Australia. Part 1: NSW, February 2023.

FULL REPORT

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Excerpts from the McBride report:

“Australia has the world’s third highest life expectancy at 84.3 years. However, this national average masks the fact that the ‘lucky country’ has some rather less lucky residents. In every state and territory, those in regional and remote areas have life expectancies several years lower than in the city.

New South Wales (NSW) is a stark example of this divide. Life expectancy in Far West NSW is 79.1 years compared to 84.5 years in Sydney. This more than five-year gap has grown from relative parity at the turn of the millennium to the current gap. Today, a person in far west NSW is more than twice as likely to die prematurely (under 75) than someone in Sydney.

While there are many possible reasons for this discrepancy, overall, people die of the same causes in urban and remote parts of NSW; a comparison of the top causes of death in each area reveals that the top 10 are almost identical. However, regional and remote people are dying younger and from preventable causes at much higher rates than those in Sydney. Deaths considered ‘potentially avoidable’ are more than two and a half times as common in the far west than in the state’s capital.

It has been known for years that there is a suicide issue in regional Australia. Suicide rates in far west NSW—already more than twice as high than those in Sydney—are continuing to rise, while those in urban areas remain steady. But while suicide is a significant problem, it is only the tenth leading cause of death in the region. Suicide tends to take people at a younger age than other causes and as a result can disproportionally skew life expectancy, having said this there are other factors likely at play.

In 2022, a NSW Parliamentary Inquiry into health outcomes and access to services in rural, regional, and remote NSW found that people outside urban areas had significantly poorer health outcomes, inferior access to health services, and faced substantial financial challenges to access services.

This divide between life expectancy in the cities and in the country is a problem that extends beyond far western NSW. The city/country divide exists across Australia, and it is growing. Inequity between Australians living in capitals and remote areas is a significant problem that demands government intervention, particularly concerning overwhelmed and under resourced health systems.”

NOTE: I draw to the attention of "North Coast Voices" readers, living in what is the Australian Bureau of Statistics' Coffs Harbour-Grafton Level 4 Statistical Area, the fact that the combined populations of Clarence Valley and Coffs Harbour City have a projected life expectancy at birth which is 3.9 years lower than that of the population of the Greater Sydney metropolitan area. Only the projected life expectancy at birth for the Far West and Orana region has a worse comparative figure.

The only differences are dehydration and suicide (more below) in the Far West being replaced by heart failure and breast cancer in Greater Sydney. The similarity in causes of death suggests that the factors driving lower life expectancy in the far west are not due to different physical conditions or different lifestyles, but to how causes of death are prevented and managed. [my yellow highlighting]

Sadly, what the preceding paragraph is politely hinting at is that there is a culture within governments which tolerates and, perhaps even relies upon, inequality of access to health care along with an acceptance of delivery of poorer quality health care to those living in remote areas of New South Wales, as one of the tools which allows the provision of a much higher quality of health care to those living in metropolitan centres and inner regional areas on the fringes of major cities. 

That is where the bulk of the state's electorates and voter numbers are concentrated and, it will come as no surprise that ahead of the March 2023 state election little electoral growth was expected in the western half of New South Wales [Report of the Electoral Districts Redistribution Panel on the draft determination of the names and boundaries of electoral districts of New South Wales, 9 Nov 2020].

Response to the 12th Annual Closing The Gap Report: "We die silently under these statistics"

The Monthly, 12 February 2020:

Northern Territory Labor senator Malarndirri McCarthy gave a devastating interview this morning, ahead of today’s annual Closing the Gap address, drawing a direct connection between the ongoing failure to meet targets to reduce Indigenous disadvantage and the policies of the Coalition government. 

Starting with the Abbott government’s decision to cut the Aboriginal affairs budget by half a billion dollars, McCarthy then cited the disastrous Aboriginal work-for-the-dole scheme (the Community Development Program), the cashless welfare card that “entrenches First Nations people in poverty in this country”, and the out-of-hand rejection by the Turnbull and Morrison governments of the First Nations voice to parliament requested in the Uluru Statement from the Heart. “All of these things are connected to Closing the Gap and improving the lives for First Nations people,” said McCarthy, who went on to slam as an “absolute disgrace” the abandonment of any referendum on constitutional recognition of Indigenous Australians after a backlash [$] in the Coalition party room yesterday. 

The key findings of the 12th annual Closing the Gap report, tabled in parliament today, received blanket coverage this morning: only two out of seven targets have been met, on early education and Year 12 attainment, while the other five targets on child mortality, school attendance, literacy and numeracy, employment and life expectancy are all off track. The government has responded by seeking to adopt new targets expected in April, drawn up after a year’s consultation by the Coalition of Peaks representative body chaired by Pat Turner, from the National Aboriginal Community Controlled Health Organisation, under a new national agreement to be signed by COAG. Both PM Scott Morrison and Opposition Leader Anthony Albanese gave set-piece addresses, and the debate continued into Question Time, with no real progress. Fine words every Closing the Gap day achieve nothing – as Crikey’s Bernard Keane writes [$], the sentiments are often the same, from PM to PM, from year to year. 

In a debate this afternoon, shadow Indigenous Australians minister Linda Burney gave a moving speech citing former social justice commissioner Mick Dodson, who said Australians suffered from an “industrial deafness” to the statistics of Indigenous disadvantage, accepting them as almost inevitable. “We die silently under these statistics,” Burney said, flagging that Labor looked forward to supporting new and ambitious Closing the Gap targets. Failure was not inevitable, she said, adding that “once again we offer bipartisanship from this side of the house”. In reply, Minister for Indigenous Australians Ken Wyatt also stressed the need for bipartisanship, saying: “All of us have failed in the Closing the Gap journey over the last 10 years. The intent has been good … but the model has been broken.” Then he veered into unconvincing management speak: a different paradigm, turning the dial, joint and shared decision making, better ownership at local level, and the engagement of mainstream Australia. 

While nobody is doubting that Wyatt is genuine about his portfolio, it will amount to little if his government colleagues are not behind him. It will be a tragedy if it turns out the first Indigenous minister for Indigenous Australians was appointed for cynical political purposes, and was nobbled from the start....

Read the full article here.

Closing The Gap Report 2020, exerpt:

Progress against the Closing the Gap targets has been mixed over the past decade. 

As four targets expire, we can see improvements in key areas, but also areas of concern that require more progress. 

• The target to halve the gap in child mortality rates by 2018 has seen progress in maternal and child health, although improvements in mortality rates have not been strong enough to meet the target. 

• The target to halve the gap for Indigenous children in reading, writing and numeracy within a decade (by 2018) has driven improvements in these foundational skills, but more progress is required. 

• There has not been improvement in school attendance rates to close the gap between Indigenous and non-Indigenous school attendance within five years (by 2018). 

• The national Indigenous employment rate has remained stable against the target to halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018). 

Two of the continuing targets are on track. 

• The target to have 95 per cent of Indigenous four year-olds enrolled in early childhood education by 2025. 

• The target to halve the gap for Indigenous Australians aged 20–24 in Year 12 attainment or equivalent by 2020. 

However, the target to close the gap in life expectancy by 2031 is not on track. 

Jurisdictions agreed to measure progress towards the targets using a trajectory, or pathway, to the target end point. The trajectories indicate the level of change required to meet the target and illustrate whether the current trends are on track.

BACKGROUND

According to the Australian Bureau of Statistics; The final estimated resident Aboriginal and Torres Strait Islander population of Australia as at 30 June 2016 was 798,400 people, or 3.3% of the total Australian population.

It has been estimated that the pre-1788 resident Aboriginal population could have been as high as over one million people, or 100% of the total Australian population.

“Shit Life Syndrome” is sending Britons and Americans to an early grave…..

With Scott Morrison as the new prime minister, the Abbott-Turnbull era persistent attacks on the social fabric of the nation are bound to continue. Thus ensuring that Australians follow down the same path as Britain and America?

The Guardian, 18 August 2018:

Britain and America are in the midst of a barely reported public health crisis. They are experiencing not merely a slowdown in life expectancy, which in many other rich countries is continuing to lengthen, but the start of an alarming increase in death rates across all our populations, men and women alike. We are needlessly allowing our people to die early.

In Britain, life expectancy, which increased steadily for a century, slowed dramatically between 2010 and 2016. The rate of increase dropped by 90% for women and 76% for men, to 82.8 years and 79.1 years respectively. Now, death rates among older people have so much increased over the last two years – with expectations that this will continue – that two major insurance companies, Aviva and Legal and General, are releasing hundreds of millions of pounds they had been holding as reserves to pay annuities to pay to shareholders instead. Society, once again, affecting the citadels of high finance.

Trends in the US are more serious and foretell what is likely to happen in Britain without an urgent change in course. Death rates of people in midlife (between 25 and 64) are increasing across the racial and ethnic divide. It has long been known that the mortality rates of midlife American black and Hispanic people have been worse than the non-Hispanic white population, but last week the British Medical Journal 

published an important study re-examining the trends for all racial groups between 1999 and 2016.

The malaises that have plagued the black population are extending to the non-Hispanic, midlife white population. As the report states: “All cause mortality increased… among non-Hispanic whites.” Why? “Drug overdoses were the leading cause of increased mortality in midlife, but mortality also increased for alcohol-related conditions, suicides and organ diseases involving multiple body systems” (notably liver, heart diseases and cancers).

US doctors coined a phrase for this condition: “shit-life syndrome”. Poor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighbourhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare.

Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological

side-effects, that is the killer.

Shit-life syndrome captures the truth that the bald medical statistics have economic and social roots. Patients so depressed they are prescribed or seek opioids – or resort to alcohol – are suffering not so much from their demons but from the circumstances of their lives. They have a lot to be depressed about. They, and tens of millions like them teetering on the edge of the same condition, constitute Donald Trump’s electoral base, easily tempted by rhetoric that pins the blame on dark foreigners, while castigating countries such as Finland or Denmark, where the trends are so much better, as communist. In Britain, they were heavily represented among the swing voters who delivered Brexit.

Read the full article here.

NOTE: The last time the United States saw a prolonged life expectancy decrease due to natural causes was during the Spanish Influenza pandemic of 1917-1919 when life expectancy fell by twelve years.