To the Editor: The Hon. Kevin Rudd, Prime Minister of Australia, addressed federal Parliament on 26 February 2009 regarding the Closing the gap on Indigenous disadvantage: the challenge for Australia report.1 In his speech, he asserted that government strategy to close the gap will focus on the treatment of Indigenous Australians’ illnesses “largely through the mainstream health system, because that is where 70% of Indigenous people are treated”.2

Unfortunately, the 70% figure is an urban myth based on one poorly worded question in the Australian Bureau of Statistics (ABS) National Aboriginal and Torres Strait Islander Health Survey 2004–05.3 At the National Aboriginal Community Controlled Health Organisation (NACCHO), we are concerned about the use of distorted evidence regarding the health of Aboriginal peoples, in particular the use of questionable data to formulate policies that undermine investment in Aboriginal community controlled health services (ACCHSs).

In the ABS survey, a small sample of the Indigenous population were asked “Where do you usually go when you have a problem with your health?” The respondent was permitted one answer from choices that included: an Aboriginal medical service (AMS); a hospital; a doctor or general practitioner (outside hospital or AMS); traditional healer; other; or nothing. Such a question is bound to elicit misleading answers when, for example, a patient who sees his or her regular GP at an AMS selects “GP” rather than “AMS”. The technical distinction between these options is not clear, and the degree of reproducibility and reliability with which surveyors clarify the options is untested.

Other Australian studies of primary care contradict the ABS findings. A recent study using 2007–08 data of the Bettering the Evaluation and Care of Health (BEACH) program found 0.9% of GP encounters are with Aboriginal and Torres Strait Islander patients.4 Over a 10-year period, this proportion has ranged from 0.7% to 1.6%.5 More than 70% of general practices do not see a single Indigenous Australian, and for the vast majority of those that do, less than 5% of their total encounters are with Indigenous Australian patients.6

In contrast, ACCHSs delivered 1 680 000 episodes of patient care to about 257 000 Aboriginal and Torres Strait Islander clients for the year 2005–06.7 Against an estimated national Indigenous population of 517 000, this indicates about 50% of Indigenous Australians use ACCHSs. ACCHSs also have more clients with complex disease than do private general practices,8,9 which supports our belief that ACCHSs target those who are “hard to reach”.

Closing the gap in Aboriginal disadvantage depends on supporting Aboriginal communities towards their greater participation in primary health care. The right of Aboriginal peoples to participate in decision making that affects their health and wellbeing is the principle at stake here. The ultimate expression of this principle is community control and governance. This makes ACCHSs different to general practices, and it’s that difference that can close the gap.