Exposing the Ideas, Discourses, and Limitations of the Council of Australian Governments’ Closing the Gap Agenda for Health

This thesis explores how neoliberal ideas and values have shaped policy settings and outcomes in Indigenous health, focusing on the Council of Australian Governments’ closing the gap policy launched in 2007. Indigenous health is often considered to be an intractable, “wicked” policy problem. Despite the implementation of various national reforms by successive Commonwealth governments, Indigenous peoples continue to experience significant disparities in health and social outcomes. The Rudd Labor Commonwealth government declared that the closing the gap reforms marked a watershed in Indigenous affairs, transforming how national policy sought to overcome Indigenous disadvantage. It argued that the reforms would be based upon an objective, thorough assessment of evidence, rather than political ideology.
   
   This thesis challenges the view that the closing the gap reforms supported an innovative, ideologically neutral policy approach. Rather, the policy settings and institutional arrangements structuring the reforms promoted neoliberal ideas and practices, which have exemplified and accentuated recent policy trends in Indigenous health.
   
   Research undertaken for this thesis shows that neoliberal values have interfaced with other influential discourses, specifically that of a biomedical model of health, to shape policies in Indigenous health. There is significant congruence between the values and assumptions that underpin biomedicine and neoliberal ideology. As a consequence, the political shift towards neoliberalism in recent decades has elevated an individualised, biomedical approach to health service and program delivery and a behavioural approach to health promotion in Indigenous health.
   
   This thesis further explores how the neoliberal framework for reform has created a number of problems in addressing Indigenous health disadvantage, and frustrated the implementation of more efficacious policy approaches. There is little evidence to suggest that an individualised, biomedical approach can support substantive improvements in Indigenous peoples’ health and social outcomes. Health policies that promote a broader, social approach to health have proved to be relatively successful. Reflective of neoliberal ideas and practices, the closing the gap reforms understated the benefits of these potentially more effective policy approaches. Moreover, the technical, “evidence-based” framework of the reforms worked only to obscure from view, rather than promote, these alternative policy options. The conclusion drawn from this research is that the closing the gap reforms were a missed opportunity to redress the chronic failings of past policies and the longstanding crisis in Indigenous health.