As a sponsor of a scholarship for the University of NSW indigenous medical student programme we were invited to attend a donors lunch last week. There was lively discussion around the table on the state of funding for such programmes, and consensus that all Australian state and federal governments could do more to provide funds.
UNSW Medical School relies heavily on philanthropic donations from individuals and private sector companies. Funding is the single largest obstacle to success and a leg up from government would be a massive boost.
There is no lack of money being thrown at indigenous health. The much publicised Closing the Gap initiative has been pledged $3.6 billion over 10 years to reduce the stark disparity, between indigenous and non-indigenous Australians, on just about any health metric you care to measure.
A quick glance at the Closing the Gap initiatives suggests that they are mostly geared around early wins. Understandable, as there is pressing need for urgency on many indigenous health issues, but what of the long-term future?
There is little doubt that, if you want to achieve sustainable improvement in any form of social inequity then workforce empowerment through education is your best long-term bet. It would therefore make sense that some Closing the Gap funding goes towards scholarships that facilitate indigenous doctors entering the medical workforce.
If you are looking for a yardstick then one clear objective is to achieve parity of numbers of indigenous doctors in the medical workforce. Here are some statistics from 2010:
Number of indigenous doctors in Australia - 153
Percentage of Australian doctors that are indigenous - 0.2%
Percentage of Australians that are indigenous - 2.5%
Increase required to achieve parity - 12-fold
Compare this to New Zealand where 3.1% of doctors are Maori or Pacific Islander in origin, against a general population figure of 10%. New Zealand only needs a three-fold increase in numbers to achieve parity. New Zealand, it seems, has a lot to teach Australia about running indigenous medical student programmes and government support seems to be a key component of their success.
So why should governments care about training indigenous medical students? Purely appealing to the moral imperative is not enough. Governments are generally motivated by arguments that either clearly win votes or demonstrate a return on investment. It is unlikely that there are many votes in this issue so some financial modeling to show that money invested will deliver cost-benefit down the track is probably the strategy of choice.
I can immediately think of a number of benefits that might flow from indigenous doctors serving in their own communities. Better health outcomes and lower costs of remote service provision immediately spring to mind. I dare say that our New Zealand cousins have spent some time looking into this and may be able to provide some encouraging evidence.
Ultimately the challenge is the length of time it will take for this initiative to bear fruit. It is hard to persuade government to think in terms of time horizons over decades, when election cycles turn over in as little as three years.
In the meantime, programmes such as the one that the UNSW has set up, and similar programmes around Australia, are making significant progress in terms of 'closing the gap' in the medical workforce. The current cohort of UNSW indigenous medical students alone will increase the number of indigenous doctors by 20% when they have all graduated – a spectacular step in the right direction.