Closing the Gap ‘at risk’ without urgent focus on Indigenous health
Indigenous leaders and researchers have warned Closing the Gap targets will remain out of reach without immediate and targeted investment in Aboriginal and Torres Strait Islander health services in Australia’s cities.
Professor James Ward, Director of The University of Queensland’s Poche Centre for Indigenous Health, said newly launched national resources reveal a significant gap in Indigenous health policy and research focus on capital cities. He said policy and funding have not kept pace with demographic shifts that place a large share of Aboriginal and Torres Strait Islander people in urban areas.
Key Points
- Closing the Gap seen at risk without urgent urban health investment
- Three new national resources target urban Aboriginal health inequities
- 37 per cent of Aboriginal and Torres Strait Islander people live in capitals
- Median age at death 21 years lower in 5 of 8 capital cities
- Only 15 per cent of 2021 research focused on urban Indigenous health
- Urban Indigenous population grew 67 per cent over the past decade
- ACCHOs face capacity pressures as city populations outpace services
Almost four in 10 Aboriginal and Torres Strait Islander people, or 37 per cent, now live in capital cities. According to Professor Ward, urban communities receive “far less targeted research, planning and resourcing,” despite this population share. He said the median age at death for Aboriginal people is 21 years lower than for non-Indigenous people in 5 of Australia’s 8 capital cities, indicating city residence does not ensure access to better care.
“Urbanisation of our population is happening at lightning speed”
— Professor James Ward, The University of Queensland
Policy and research shortfalls
A 2021 review cited by the Poche Centre found that only 15 per cent of health research and policy focused exclusively on Aboriginal and Torres Strait Islander people in urban areas. This is despite the urban Indigenous population growing by 67 per cent over the past decade. The mismatch, Indigenous leaders argue, has created a persistent and consequential policy blind spot.
The inaugural State of Play Report concluded that Aboriginal and Torres Strait Islander people in major cities carry the largest share of the national burden of disease. The report identifies urban communities as the single greatest challenge to Closing the Gap, intensifying calls for a recalibration of investment and planning.
The University of Queensland’s Poche Centre, working with the Research Alliance for Urban Community Controlled Health Services, launched three national resources designed to strengthen the urban health evidence base and inform action:
- Urban Health and Wellbeing Framework
- State of Play Report
- Australia’s first Urban Aboriginal and Torres Strait Islander Health Equity Dashboard, developed with the Australian Institute of Health and Welfare (AIHW)
The resources are intended to give communities, services, and governments clearer visibility of local needs and service gaps. By consolidating data and analysis specific to major cities, the suite aims to guide targeted planning and track progress on equity initiatives over time.
Dr Fadwa Al‑Yaman of the Australian Institute of Health and Welfare said the new Health Equity Dashboard is designed to address longstanding gaps in urban Aboriginal and Torres Strait Islander health data. The dashboard focuses on access to regional information and aims to enable better decision-making at local and system levels.
The dashboard is positioned as a tool to identify inequities and monitor change, improving transparency around where investment is most urgently required. It complements the Urban Health and Wellbeing Framework and the State of Play Report by offering a practical platform to track indicators relevant to urban communities.
Leaders stress urgency
Professor Ward said the scale of health inequities in cities requires immediate and sustained attention. He emphasised that strengthening services in capital cities should not detract from efforts in regional and remote areas. Rather, he argued, resources should align with where the need is greatest, based on the evidence now available through the new resources.
The State of Play findings underscore the urgency of acting on the concentration of disease burden in urban settings. Leaders contend that the path to Closing the Gap runs directly through city-based services and infrastructure, where a significant share of Aboriginal and Torres Strait Islander people live and seek care.
Institute for Urban Indigenous Health CEO Wayne Ah Boo said the new resources highlight pressing capacity constraints across Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs). He said population growth in urban areas is outstripping ACCHO capacity, elevating the risk that demand will continue to exceed available services without targeted investment.
“we must fast track investment in urban ACCHOs,”
— Wayne Ah Boo, The University of Queensland
Mr Ah Boo linked timely investment to the goal of Closing the Gap by 2031. The call aligns with the evidence presented by the Poche Centre and AIHW collaboration, which points to under-resourced urban services relative to population growth.
According to the Poche Centre and its partners, the concentration of health need in cities means Closing the Gap will remain at risk unless urban communities receive proportionate attention in research, planning, and resourcing. The new framework, report, and dashboard are presented as a coordinated response aimed at addressing the policy blind spot identified by researchers and leaders.
Professor Ward said a “serious and sustained focus” is essential. He emphasised that the issue is not a zero-sum contest between regions, but an evidence-based recalibration to align investment with demonstrated need across all geographies where Aboriginal and Torres Strait Islander people live.
