No excuses for this Indigenous eye health crisis

Most vision loss could be eradicated essentially overnight. Thousands of Aboriginal and Torres Strait Islander people needlessly have poor vision because of a lack of care and concern, writes Hugh Taylor.

Australia has some of the most advanced health technology in the world, yet our citizens are still going blind from simple, preventable conditions.

The situation is unacceptable. We have a moral obligation to make sure no-one loses their sight unnecessarily.

Aboriginal and Torres Strait Islander peoples should rightly expect the same eye care as non-Indigenous Australians. And yet, Indigenous adults are six times more likely to be blind.

It doesn’t have to be this way. Simple changes to our currently inadequate system can practically eradicate vision loss for our nation’s first people.

In 2010, around 15,000 Indigenous adults had poor vision, three times the rate of mainstream populations. This will increase to 34,000 in the next 10 years if we carry on slapping bandaids on the problem.

In fact, with proper care this number could be reduced to only 2,000.

A report released today by PwC shows that if the Government commits to a modestly increased investment to implement our recommendations, they could save $856 million over the next 10 years.

Eye care is one of many Indigenous health issues that needs to be addressed. But we know that most vision loss could be eradicated essentially overnight. Give a short-sighted person glasses and they will see in an instant. Give someone cataract surgery and they will see tomorrow. Eye care is different to most chronic diseases that require a lifetime of care and attention.

At the University of Melbourne we have looked at the provision of eye care to Aboriginal and Torres Strait Islander people in detail and have identified major issues in the pathway of care or the patient journey.

The current provision of care is a damaged pipe with lots of leaks. If you only fix one or two of the leaks, the pipe still leaks.

Our Roadmap has 42 specific recommendations, each addressing one of the leaks. So far at least some progress has been made on all of these recommendations and now seven have been fully implemented. This is a very good start.

With trachoma, for example, rates in children in outback communities have fallen from 14 per cent in 2009 to 4 per cent in 2013, but recently there has been an increase of trachoma in children in some communities. This reflects an urgent need for more intensive health promotion efforts that encourage personal hygiene by focusing on clean faces and safe bathrooms.

One of the major problems faced by Aboriginal and Torres Strait Islander people is the lack of basic eye care. Unbelievably, one in three Indigenous adults have never had even a basic eye exam and for those with diabetes, only 20 per cent get the annual eye exam that they need.

Although there has been an increase in Government spending on eye care for Indigenous Australians over the last few years, the PwC report released today shows that much of this expenditure is not being used efficiently and for each $1 spent, there is only a 90 cent return.

Over coming weeks, we will be making it very clear to policy makers and politicians that we have a clever and effective plan to close 11 per cent of the health gap for Indigenous people. As well as the immeasurable difference it will make to the quality of lives for people at risk of vision loss, it will ultimately save the Australian taxpayer money.

If our recommendations in The Roadmap were fully implemented, Aboriginal people would receive the treatment they need and no longer sit on long waiting lists or fall through the holes in the leaky pipe. So that for each additional dollar spent, there would be a huge return of $2.50.

We need good regional planning and co-ordination, particularly between the Aboriginal Medical Services, the Primary Health Networks and the local and visiting eye specialists. And this must coincide with monitoring and assessment of performance at local and national levels.

With this report as our proof, my colleagues and I call on the Commonwealth and State and Territory Governments to fully commit to the full implementation of the recommendations of The Roadmap. And in return, we can close the gap for vision.

With strong Commonwealth leadership we can make sure that in 10 years time, 32,000 Aboriginal and Torres Strait Islander people do not needlessly have poor vision for lack of care and concern.

Professor Hugh Taylor is Chair of Indigenous Eye Health at the University of Melbourne.