In this paper we explore the changing relationship between Aboriginal peoples and the Australian state within the context of Australian federalism. Our particular focus is on the relationship between the institutional organisation of Australian health systems and the equitable provision of health services to Aboriginal Australians. We examine the historical development of this relationship over three key periods. The period from Australian federation in 1901 to the 1967 referendum resulted in the deletion of race clauses from the Australian constitution. The Commonwealth’s racialised constitutional and legislative framework created a structural basis for racial rationing.
Incrementally, from 1967 to 1995, the Commonwealth developed a national Aboriginal health program but without a corresponding development of institutional links with national health financing and policy structures. Since 1995 there has been some success in the development of intergovernmental agreements in Aboriginal health (the Framework Agreements for Aboriginal and Torres Strait Islander Health) and a National Strategic Framework for Aboriginal and Torres Strait Islander Health which is linked to the Aboriginal and Torres Strait Islander health performance measurement framework. We argue that these developments provide a platform for the equitable provision of health services to Aboriginal Australians and we identify some of the key barriers to the realisation of this.