NACCHO NEWS ALERT: Why health experts are asking governments to consider the health impacts of all policies

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The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan, but I  acknowledge it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

Martin Laverty, the chairman of the Social Determinants of Health Alliance

ABC Health & Wellbeing By Bianca Nogrady

‘An ounce of prevention is worth a pound of cure’, Benjamin Franklin is quoted as saying.

But as bang-for-your-buck as prevention may be when it comes to your health, adopting a healthy lifestyle is not as simple as it may sound.

It’s easy enough to say, “don’t smoke and you’re less likely to get cancer”, or “eat healthy food and exercise regularly and you’re less likely to become overweight”. But what if you grew up in a smoking household? What if you don’t have enough money to buy fresh vegetables and don’t have the know-how or time to prepare meals with them? What if your job pays so little, you have to work double shifts just to make ends meet and don’t have time to do any exercise?

Preventive health goes way beyond individual choices, because our health – particularly when it comes to chronic diseases such as type 2 diabetes and heart disease – is influenced by factors that are often far beyond our individual control. These factors are known as the social determinants of health.

Social determinants of health


Social determinants of health are the social and economic factors that contribute to our state of health and wellbeing, such as:

  • how much money we earn
  • what level of education we have
  • where we live and whether we have access to transport
  • our ethnicity.

Addressing these drivers of health is challenging, says Associate Professor Lyndall Strazdins, senior fellow at the National Centre for Epidemiology and Population Health, at the Australian National University.

“Once you move beyond giving people flu shots and that sort thing, then what is it that you have to engage with?” says Strazdins.

“That’s what makes social determinants of health such a difficult policy field because it steps out of what’s considered to be health, which is health care, and moves into the drivers of health, the systems that will move health up or down in a society.”

This means just about any policy or law is likely to have an impact on health; whether it’s paid parental leave, minimum wage, working hours, education, etc. Recognition of this has given rise to a global movement for ‘health in all policies’.

Strazdins says the movement emphasises the importance of policy-makers taking health into account.

One example is the knock-on health impacts of workforce participation policies. Policies that push back the retirement age and keep us in the workforce for longer, reduce the amount of time we have for leisure activity and exercise as we age. As well, some of us are going to be caring for our partners. All this means we’re less able to give any emerging health issues the attention they may need.

Despite this, health is rarely even mentioned in such policies, Strazdins says.

“So here we have health at the heart of [whether] this policy is going to succeed or not, and it’s not mentioned, so the very first step is putting health in,” she said.

“If you come back to even economic analysis, we know these things are costing the country; what we don’t realise is how the way we’re structuring the country could make a huge difference.”

Health in all policies – how does it work?

In 1997, the Swedish Road and Traffic Safety Agency contributed to the introduction of a bill that has had a hugely positive impact on the health of the Swedish population.

The bill aimed for zero fatalities and serious injuries on Swedish roads by 2020, by bringing together transport, justice, environment, health and education sectors to promote, enforce and assist with road safety. So far, this initiative has reduced Sweden’s road fatalities by more than two-thirds.

Thailand has introduced a policy requiring the use of health impact assessments in an effort to reduce the health consequences of environmental hazards such as air pollution. The approach has been taken for developments such as coal mines, biomass power plants, waste management systems and water conservation initiatives.

It is even bringing this into consideration of patent protection laws for pharmaceuticals.

Improving health for all

Martin Laverty, the chairman of the Social Determinants of Health Alliance, says Australia is well-placed to address some of the most important social determinants of health, such as education.

“We’ve got universal access to education, social safety to provide access to income support, social housing scheme, universal access to health care, but despite these levers, people fall through the cracks,” says Laverty, also CEO of the Royal Flying Doctor Service.

“The universal access to health care, education, social safety net of income and housing support is not providing optimal support for those most vulnerable within the community.”

One major Australian initiative attempting to deal with social determinants of health is the Federal Government’s Closing The Gap program.

“In Indigenous affairs we see a social determinants action plan that is informing how we are acting to improve Indigenous life expectancy and improve chronic illness,” Laverty says.

The program has had some wins, particularly in child mortality, but Laverty says the next areas for improvement are in stopping people smoking and boosting Indigenous people’s level of education.

He would also like to see this approach taken to improving the health of all Australians.

“The next challenge is nationally, for all Australians, the Australian Government adopting the WHO framework to drive improvements across communities and populations, remote and metropolitan,” he says, but he acknowledges it’s not a politically attractive target.

“Action on social determinants requires long-term commitment that goes beyond the three-year cycles of elected governments.”

You might also like to read other stories from our Social Determinants of Health series:

NACCHO Hearing Awareness Week : Is Hearing loss the missing piece of the puzzle in why Aboriginal disadvantage is so hard to address

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“At school, hearing difficulties increase the likelihood of delayed speech, problems learning to read, and isolation from other children. All this contributes to Aboriginal children leaving education early, finding it difficult to find a job, and, ultimately, ending up in trouble with the law”

Samantha Harkus is the Manager of Aboriginal Services at Australian Hearing. (see New Matilda article below )

“Widespread ear disease may be the missing piece of the puzzle in why Aboriginal people are over-represented in Australia’s criminal justice system.”

Jacqueline Krynda reports

Thirty-five per cent of school children in Cape York do not hear normally.Hearing health among Aboriginal and Torres Strait Islander people is poor compared to hearing health in non-indigenous communities”

Apunipima’s audiologist Kristen Wallin knows all too well the challenges faced by people in remote communities.

Hearing Awareness Week (August 23-29) is recognised Australia-wide and organisers of the Deafness Forum Australia, aim to highlight the issues faced by people with hearing impairments.

Hearing

GET YOUR HEARING TESTED THIS WEEK : For nearest Location

Ms Wallin provides hearing health services to Mossman Gorge, Laura, Wujal Wujal, Hopevale, Coen, Lockhart River, Pormpuraaw, Kowanyama, Mapoon, Napranum and Aurukun to educate young children about the importance of healthy ears for a healthy body.

Ms Wallin also works with Apunipima’s Maternal and Child Health Team to train and mentor health workers and nurses to identify early signs of ear disease. Part of this work is to educate health workers to teach families in community about the impact of passive smoking, poor nutrition and hygiene, insufficient sleep on ear and hearing health.

“Apunipima’s goal is to empower families to make positive parenting choices, such as breastfeeding and healthy eating, immunisations, regular handwashing, and nose-blowing, which all have protective affects against chronic ear disease. In addition, families that take time to talk a lot with their kids – to read stories and sing songs every day – those families are growing the strongest children.

“Having good speech and language is the most important foundation for a positive education, and having a positive education is the best foundation for improving health outcomes and employment opportunities.

“Sadly, middle ear infections are one of the biggest reasons that Cape York children fall behind on their speech and language during the early years. One easy thing that families can do is to ask health staff to check their child’s ears every time they visit their local clinic, and to ask for a full test if they are worried about their child’s ears.”

High Aboriginal Prison Rates Linked To Hearing Loss By Jacqueline Jane Krynda –NEW MATILDA

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Widespread ear disease may be the missing piece of the puzzle in why Aboriginal people are over-represented in Australia’s criminal justice system. Jacqueline Krynda reports.

When lawyers from the North Australian Aboriginal Justice Agency (NAAJA) come to Darwin Correctional Centre to see an Aboriginal man charged with serious driving offences, they cannot find a way to communicate with him.

The man is profoundly deaf, from a remote Aboriginal community, and does not use a sign language they can recognise. When this man is asked a question, he nods and seems to agree, even though it is not always clear that he understands.

He does not seem to understand his charges and at times becomes quite distressed. The lawyers cannot communicate with him enough to enter a plea of guilty or not guilty. He continues to be remanded in prison.

Unfortunately, according to NAAJA, this man’s story is not uncommon. Principal Legal Officer Jonathon Hunyor says that hearing loss is widespread among their clients. A 2010 study of prisons in Darwin and Alice Springs found that 94 per cent of Aboriginal inmates had moderate to severe hearing loss.

This reveals one important link between deafness and the over-representation of Aboriginal people in the criminal justice system. Aboriginal defendants like this man at Darwin Correctional often begin to lose their hearing as a child, because of repeated ear infections.

According to data gathered by Darwin-based psychologist Damien Howard, Aboriginal children are 50 times more likely to contract middle ear infections during infancy than non-Aboriginal children.

Most have had their first experience of a burst eardrum by only five and a half months old. Chronic ear disease (middle ear infections, ‘glue ear’ and ‘runny ear’) is what Howard calls a “disease of poverty”.

It is not particular to Aboriginal people, but occurs wherever there is poor nutrition, overcrowded housing, and limited access to medical care. Ear disease was prevalent in poor urban areas like the Fitzroy slums last century.

“It’s common around the world for people in disadvantaged conditions,” he says. After spending an average of two and half years with ear diseases, an estimated 74 per cent of Aboriginal children go on to develop a permanent hearing loss in adolescence and adulthood.

At school, hearing difficulties increase the likelihood of delayed speech, problems learning to read, and isolation from other children. Samantha Harkus is the Manager of Aboriginal Services at Australian Hearing, and explains that all this contributes to Aboriginal children leaving education early, finding it difficult to find a job, and, ultimately, ending up in trouble with the law.

A typical case is that of a 16-year-old Aboriginal boy from the Northern Territory who was diagnosed with hearing loss during childhood, but did not have access to hearing treatment, speech therapy, or special education.

He left school and was convicted shortly after for seven offences including car theft and arson. “If you have difficulty in schooling you’re more likely to disengage,” says Harkus. “Disengaged kids are more likely to engage in risk-taking behaviour that would bring them into contact with the criminal justice system.”

She says that if hearing loss is not detected early it is more likely to go untreated, because of the difficulty in self-diagnosing hearing loss and the sense of shame attached to it.

If hearing loss does go undetected, the first time it usually becomes an issue is in interactions with police.

A common problem that NAAJA encounters is that a deaf offender has misunderstood and reacted incorrectly to a police instruction when they are being stopped or searched. “Police are often unsure if the person is being uncooperative, or if language is an issue, or if there is a cognitive impairment, and so they often just bulldoze through,” says Hunyor.

If this offender is arrested, their hearing loss is also likely to crop up as an issue during interrogation. Although there are procedures (the Anunga Rules) for respecting the linguistic and cultural differences of Aboriginal people, hearing experts say that they do not think police are generally aware that some of the defendant’s confusion may be down to hearing loss.

“It’s a common problem because in the transcripts of cases that I’ve been involved in, I know there’s a hearing loss before I even see the person,” says Howard.

“They’ve either not answered or answered in a way that doesn’t respond to the question.” These problems are often repeated again in court, especially in noisy and fast-paced criminal trials in the Local and District Courts, where even lawyers like Hunyor admit to sometimes getting lost.

In some instances, hearing-impaired defendants will act oddly during court proceedings, speaking too loudly and at the wrong time.

In a 2001 Supreme Court case in NSW, for example, a deaf Aboriginal defendant was removed from the court after alternatively swearing at the judge, singing, sleeping, and threatening the prosecutor. According to his doctor, all this was driven by a mental impairment, hearing loss, and frustration at being “unable to make full sense of [the] proceedings, and… adequately engage in them.”

In the majority of cases, however, the hearing-impaired defendant will appear to withdraw into themselves.

This is so prevalent that Howard says that it has become known over time as the ‘Aboriginal demeanour’ in court. “The most frequent response is to withdraw from the situation, mentally, emotionally, and visually,” Dorothy Parker observed as far back as 1987, in an anthropological study of criminal trials in the Northern Territory.

“One magistrate in a country town complained to me that ‘Aborigines in the dock are always gazing out of the window, or looking down and either ignoring questions or mumbling inaudible answers.’” For lawyers, much of the difficulty is in teasing out whether this disengagement is caused by hearing loss, cultural misunderstanding, or mental impairment.

Some of the clients that Hunyor sees at NAAJA have troubles with all three. If a client is found to be profoundly deaf, they are often treated as if they have a mental impairment anyway.

“There’s a whole strand of law and a number of cases which have considered the position of deaf people under the law, and they are actually treated as if they have a mental incapacity, which I think is kind of bizarre, and, for a deaf person, a bit outrageous,” he says.

If a deaf defendant is sent to prison, being unable to hear adds another layer of isolation. Common complaints from prisoners documented in the 2010 Darwin and Alice Springs prison study included;

“I can’t hear what my family says”, “I can’t hear them officers and I get in trouble”, “I don’t understand that court fella and I can’t hear what them said”, and “hard for me in prison”.

Harkus, however, points out that these complaints can be remedied so long as the prisoner is tested for hearing loss and given treatment.

She tells the story of a 36-year-old female inmate at Mulawa (now Silverwater) Detention Centre who she diagnosed as having severe hearing loss in one ear, and moderate to severe hearing loss in the other.

This woman had entered prison 18 times before this, but this was the first entry in which her hearing had been tested. Harkus arranged to have her fitted with a hearing aid.

As a consequence, the woman was able to talk to her mother over the phone without shouting, and hear what was being said at her weekly Narcotics Anonymous meetings.

When she was downgraded to a lower security prison some years later, she became the Aboriginal Women’s Delegate. “Just providing one hearing aid made a massive difference in what she got out of life,” says Harkus.

However, there is currently no comprehensive hearing screening for Aboriginal defendants at court or Aboriginal inmates entering prison anywhere in Australia. Australian Hearing has considered pre-trial programs where court support staff would be on hand to test an Aboriginal defendant’s hearing if they or their lawyers requested it.

Hunyor says that he thinks that these sorts of programs would be very helpful. “It would be great where you could go into court and say ‘Your Honour, I’ve got this client in the cells, and I think they might have a hearing issue, could we get that tested?’” he says. “It would be really useful because you have the client there at court.”

Australian Hearing and Justice Health are also considering hearing screening programs in prison reception centres for inmates who have already been registered as having another chronic disease. Hearing services could also be involved in the rehabilitation process.

Howard says that screening defendants and fitting hearing aids is only the start of a solution. He says that police, solicitors, and court officers all need to be trained to better recognise hearing loss and deal with it through visual communication strategies.

This might include using pictures and gestures or taking the defendant along to a court before trial so that they can observe what is going on. “Aboriginal people have very good and astute visual communication strategies, and they watch what’s going on to help understand what is being said,” he says. However, the big barriers are time and cost.

Within the ever-shrinking legal aid budgets of organisations like NAAJA, lawyers like Hunyor have to prioritise suspected disabilities by seriousness, and are usually only alerted to deafness if it is raised in the medical records given to them. “One of the real shortcomings in the approach that we’re forced to take is that we’re not able to be proactive about a lot of things, and we know that these things contribute to people offending,” he says.

The organisation is also in high demand and does not have the time to thoroughly implement visual communication regimes. “We do what we can to understand and explain, but when you’ve got 30 clients on a bush circuit you don’t really have the time to then say ‘wait outside for five minutes and I’ll talk you through what happened.’”

Howard has found that time and cost is also why governments are not providing more screening, treatment, or visual communication programs. The major governmental response to his lobbying on the issue in 2010 was the Commonwealth transferring the funding responsibility for these services to the States and Territories.

He says that because the issue is complex and multi-disciplinary it is easy for government to evade responsibility. “Police said ‘Oh look, that’s a health issue’, and Health said ‘Oh look, that’s a Justice issue’. It’s a multi-disciplinary problem and so it’s very easily duck-shoved into some else’s basket,” he says. But, as he points out, concerns about the cost of hearing programs do not make sense if they are compared to the cost of keeping people in prison.

A report released by the Productivity Commission this February estimated the total cost keeping a person in prison at $292 per day.

The issue is also not simply about criminal justice but also about Aboriginal health care more generally. Rates of ear disease seem to be on the rise, and have been recently labelled “a massive public health problem… needing urgent attention” by the World Health Organisation.

“Hearing loss is the missing piece of the puzzle in why Aboriginal disadvantage is so hard to address,” Howard says. “While it remains missing the rest of the picture won’t make sense.” –

See more at: https://newmatilda.com/2015/08/21/high-aboriginal-prison-rates-linked-hearing-loss#sthash.EGzgX4Fy.dpuf

NACCHO Suicide Prevention News: Do we need to move beyond the medical model to address Indigenous suicide

 

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“Australian Aboriginal suicide is essentially a post-1960 phenomenon, one of incredibly quick and alarming growth. Some scholars insist there must have been high rates before then, but they are unable to find the data to support that view.

So what happened to the Aboriginal self after 1960? How did we get from an almost nil rate to among the highest rates on the planet — right up there with the World Health Organization “rankings” of Guyana, South Korea and Sri Lanka — in fifty years?”

We should acknowledge that the only sovereignty many youth of all kinds and classes have in life is sovereignty over their own lives and bodies. It is, all too often, their only form of empowerment. They can suffer it, as so many do, or they can end it, as so many do. A decision to conclude that sovereignty cannot be treated with a pill or on the phone or by a booked appointment.

A holistic team approach involving a number of professions – doctors, nurses, health workers, psychologists, counsellors, and particularly grief counsellors – and community members — is essential if there is to be any progress. That group must also include sports people and sports organisers.”

Colin Tatz writes for the Conversation

Despite efforts to prevent suicide among Indigenous Australians, especially the young, the Aboriginal and Torres Strait Islander suicide rate is at least twice as high as – and in some instances, such as at Mowanjum near Derby, 100 times – the national rate.

We have an array of prevention agencies, lifeline programs and public mantras about “being in life”. So why don’t they seem to work in rural and remote communities?

The obvious – but always avoided – response is that we don’t know why people, particularly young people, take their lives. We can’t get to the soul of the suicide. And prevention is a somewhat pretentious term: suicide isn’t measles or smallpox and there are neither overt symptoms nor vaccinations to hand.

The medicalised model of suicide asserts that all suicide must be the result of some form of mental illness and is therefore treatable – even curable – if only we could find the right pill or talk therapy.

I have yet to find a medical student in Australia who has been taught, or even been asked to read, the history of the bad, sad, and mad suicide eras. Bad, as in the Middle Ages when suicide precluded one’s burial in a “proper” cemetery. Sad, as in the Age of Reason when discoloured bile or urine were deemed to cause an unsettling of the temperament. Mad, as in the modern nineteenth century when lawyers, not doctors, devised “insanity” as ways out of forfeiting one’s asset to the Crown, which was the case if one suicided.

Tradition dies slowly: we decriminalised suicide in various Australian jurisdictions only between ten and fifty years ago; since then, we have simply medicalised it.

The biomedical model goes further, even promoting a likely suicide “gene” or some chemical imbalance in the brain, with the quest to locate it so as to eliminate it, somehow.

An increasing number of respected scholars now condemn the pathologisation of distress and unhappiness and advocate considering the social contexts of suicide. I believe we need to take on board an entirely new, anthropological view.

European scholars Ludek Broz and Daniel Münster have studied mainly native communities in several lands and are soon to publish a major book arguing that suicidal ideas and actions reside within one’s persona: they are the agents and agency of suicide, not some external illness or cause that somehow invades.

These scholars don’t start from the premise that nobody wants to end their lives. They don’t assert that if such “victims” do so, or want to do so, there must be something other than the self that is responsible, such as an acquired black dog depression. In short, they don’t subscribe to our medical mantra that you must be out of your mind if you suicide.

Australian Aboriginal suicide is essentially a post-1960 phenomenon, one of incredibly quick and alarming growth. Some scholars insist there must have been high rates before then, but they are unable to find the data to support that view.

So what happened to the Aboriginal self after 1960? How did we get from an almost nil rate to among the highest rates on the planet — right up there with the World Health Organization “rankings” of Guyana, South Korea and Sri Lanka — in fifty years?

Logically that answer must lie in the political, legal, social, and economic environment. As I’ve previously outlined, the hasty “decolinisation” processes – in Australia and Canada, among other places – caused governmental and mission-structured administrations, however harsh and authoritarian, to disappear overnight. The vacuum they left caused several communities to implode and become disordered societies.

Something on those lines has to explain the radical shift from nil suicide rate to a catastrophic one.

So, what can we do about it?

The medical and helping professions are trained to look for illness and disease rather than fix social problems. Even Aboriginal health organisations and personnel are caught up in the medical pathology approach.

Those who administer medical treatment to essentially white Anglo and non-Aboriginal urban populaces have no guidelines for approaching cluster suicides in Broome, Yirrkala, Kempsey, Swan Hill or Walgett, let alone suicides among eight- and ten-year olds.

A focus on community, rather than isolated problems, is essential. yaruman5/flickr, CC BY-NC-ND

We should acknowledge that the only sovereignty many youth of all kinds and classes have in life is sovereignty over their own lives and bodies. It is, all too often, their only form of empowerment. They can suffer it, as so many do, or they can end it, as so many do. A decision to conclude that sovereignty cannot be treated with a pill or on the phone or by a booked appointment.

A holistic team approach involving a number of professions – doctors, nurses, health workers, psychologists, counsellors, and particularly grief counsellors – and community members — is essential if there is to be any progress. That group must also include sports people and sports organisers.

We need a “total community” project, a focus on restoring or recreating community rules rather than focusing on one specific problem, such as suicide, as if it can be dealt with in isolation.

NACCHO Aboriginal Health News: Get over historical Indigenous wrongs says Noel Pearson

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it was a “policy and leadership convenience’’ to blame the wrongs of the past — such as removing Aboriginal children from their parents — for the poverty, violence and disadvantage now rife in indigenous communities.

“I just see too much acquiescence and submission to history and the loss of agency in the present,’’ he said. “It is the ­trauma of the present … that most engages me. The challenge we now face is 20 years of brutal trauma caused by an untrammelled ­alcohol binge.’’

Noel Pearson speaking at the  Royal Australian and New Zealand College of Psychiatrists annual congress in Brisbane.

This is not a matter of blame…but it is a matter of responsibility (2001)

“Of course most Aboriginal people we know in the Peninsula – our cousins, our friends, our uncles, our brothers – who are involved in the pathologies of drinking and gambling, are caught in an economic and social system not of their choosing.

They do not set out to create misery for their people. They do not set out to destroy the prospects of their children.

The suction hole of these drinking and gambling coteries, and all of the social and cultural pressure that it brings to bear on people is almost impossible to avoid. Even where people remain sober their resources are drawn upon by these activities. People who manage to get over grog and try to set out in a new direction after spending time in prison end up being sucked back.

This is not a matter of blame. People are caught in an economic and social system which precipitated this misery. But it is a matter of responsibility. Our people as individuals must face their responsibility for the state of our society – for respect and upholding our true values and relationships.

Our own laws and customs.”

Noel Pearson July 2001 From notes have been produced as a contribution to the work of Cape York Partnerships and Apunipima Cape York Health Council in the development of strategies to attack the grog and drug problem in Cape York Peninsula.

DOWNLOAD this 2001 report here : Noel Pearson outline-of-grog-and-drugs-strategy Cape York 2001

 Get over historical indigenous wrongs: Noel Pearson

 From the Australian by: Natasha Bita

Aboriginal leader Noel Pearson has challenged indigenous Australians to get over their traumatic history in the same way that Jews survived the Holocaust.

Mr Pearson yesterday declared that alcohol was damaging indigenous communities far more than the past wrongs inflicted on Aborigines.

“I honestly believe people can rise above historic trauma, otherwise we’ll lose agency and we’re defeated by history,” he told the Royal Australian and New Zealand College of Psychiatrists annual congress in Brisbane.

“I have to push back against too much attribution to past, to people’s present troubles. Whatever the scars and the burdens that people coming out of the Holocaust suffered, they nevertheless endured, and they laid foundations for their families.’’

Mr Pearson said it was a “policy and leadership convenience’’ to blame the wrongs of the past — such as removing Aboriginal children from their parents — for the poverty, violence and disadvantage now rife in indigenous communities.

“I just see too much acquiescence and submission to history and the loss of agency in the present,’’ he said. “It is the ­trauma of the present … that most engages me. The challenge we now face is 20 years of brutal trauma caused by an untrammelled ­alcohol binge.’’

Mr Pearson, a lawyer and academic who founded the Cape York Institute for Policy and Leadership, said alcohol and drugs had left a generation of “very damaged’’ parents who threatened the “beautiful green shoots’’ of indigenous children.

“The parents of the children at school now are very damaged,’’ he said. “We have cycles of offending and abuse of children and it’s hard to see how we are going to break the cycles.’’

Mr Pearson condemned the decision 30 years ago by Queensland’s Bjelke-Petersen government to open an alcohol canteen in the remote Cape York community of Aurukun, against the protests of the community’s women and elders.

“The community received millions of dollars worth of unemployment benefits and the canteen was the means to convert those benefits into local government (revenue),’’ he said. “Literally the kidneys and livers and bodies of the Wik people ­became a means of laundering commonwealth funds into operational funds for local government.’’

Mr Pearson said indigenous people needed jobs and ambition to lift themselves out of poverty and disadvantage. However, he added, “ the minute a black person shows a sign of accumulating wealth, there’ll be more controversy over that than anyone else owning a Mercedes”.

“It makes it very hard for people to progress and we end up in a situation where our young people are equivocal about whether they should be materialistic and whether they should work and be paid for it, or be consultants, or pursue professions,’’ he said.

Mr Pearson said “lower-class people’’ were told it was somehow selfish to act in self-interest. “Yet the rest of us wake up every morning with self-interest right under our noses,’’ he said.

“It is the liberal idea of self-interest … and the jealous pursuit of something better for themselves and their children that is the engine of development. We want something better for ourselves and our children, but when it comes to the disadvantaged we think the right policy is charity and that we have to save them.’’

Mr Pearson said welfare dependence had created an industry of white workers to service indigenous people trapped on the dole. “We now have multinational corporations that deliver work-for-the-dole programs in remote communities, painting rocks,’’ he said. “We’ve constructed a major industry out of indigenous disadvantage. Australia spent $33 billion last year in the name of indigenous people … yet the results are the poorest you can imagine.’’

Mr Pearson said white Australia believed indigenous people had a “right to welfare’’.

“All of the middle-class people on good salaries with good homes and their children in good schools are telling my mob we have a right to live at the bottom,’’ he said.

“Don’t tell me we have a right to $15,000 a year down at the bottom. What kind of a right is that? We have a right to a job.

“But too many white Australians think the door opens to opportunity from the outside, when you’ve got to be let into the door from the inside.’’

Mr Pearson said constitutional recognition of Aboriginal and Torres Strait Islanders as Australia’s first inhabitants would be “psychologically liberating’’.

“You know, this is our country too,’’ he said.

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NACCHO Aboriginal Health News: Overview of Australian Indigenous health status released

WADEYE ABORIGINAL CLINIC NT

The Overview of Australian Indigenous health status 2014 (Overview) has been released providing a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people.

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DOWNLOAD the REPORT HERE overview_of_indigenous_health_2014

The Overview shows that the health of Aboriginal and Torres Strait Islander people continues to improve slowly.

The Overview confirms that there have been declines in infant mortality rates and an increase in life expectancy. There have also been improvements in a number of areas contributing to health status such as increased immunisation coverage and a slight decrease in the prevalence of tobacco use among Indigenous people.

The Overview is an important part of the HealthInfoNet‘s translation research, which contributes to ‘closing the gap’ in health between Indigenous and other Australians by making research and other knowledge available in a form that is easily understood and readily accessible to both practitioners and policy makers.

View Website for report info

HealthInfoNet Director, Professor Neil Drew, said ‘The Overview is our flagship publication and has proved to be a valuable resource for a very wide range of health professionals, policy makers and others working in the Aboriginal and Torres Strait Islander health sector.

The Overview provides an accurate, evidence based summary of many health conditions in a form that makes it easy for time poor professionals to keep up to date with the current health status of Aboriginal and Torres Strait Islander people throughout Australia.

This year, as part of our ongoing commitment to quality improvement we have made some important changes, including a statement on the appropriate use of terminology and a commitment to enhancing a strengths based approach to understanding health issues

Key facts

Population

  • At 30 June 2014, the estimated Australian Indigenous population was 713,600 people.
  • For 2014, it was estimated that NSW had the highest number of Indigenous people (220,902 people, 31% of the total Indigenous population).
  • For 2014, it was estimated that the NT had the highest proportion of Indigenous people in its population (30% of the NT population were Indigenous).
  • In 2011, around 33% of Indigenous people lived in a capital city.
  • There was a 21% increase in the number of Indigenous people counted in the 2011 Census compared with the 2006 Census.
  • The Indigenous population is much younger than the non-Indigenous population.

Births and pregnancy outcome

  • In 2013, there were 18,368 births registered in Australia with one or both parents identified as Indigenous (6% of all births registered).
  • In 2013, Indigenous mothers were younger than non-Indigenous mothers; the median age was 24.9 years for Indigenous mothers and 30.8 years for all mothers.
  • In 2013, total fertility rates were 2,344 births per 1,000 for Indigenous women and 1,882 per 1,000 for all women.
  • In 2012, the average birthweight of babies born to Indigenous mothers was 3,211 grams compared with 3,373 grams for babies born to non-Indigenous mothers.
  • In 2012, the proportion of low birthweight babies born to Indigenous women was twice that of non-Indigenous women (11.8% compared with 6.2%).

Mortality

  • In 2006-2010, the age-standardised death rate for Indigenous people was 1.9 times the rate for non-Indigenous people.
  • Between 1991 and 2010, there was a 33% reduction in the death rates for Indigenous people in WA, SA and the NT.
  • For Indigenous people born 2010-2012, life expectancy was estimated to be 69.1 years for males and 73.7 years for females, around 10-11 years less than the estimates for non-Indigenous males and females.
  • In 2008-2012, age-specific death rates were higher for Indigenous people than for non-Indigenous people across all age-groups, and were much higher in the young and middle adult years.
  • For 2010-2012, the infant mortality rate was higher for Indigenous infants than for non-Indigenous infants; the rate for Indigenous infants was highest in the NT.
  • From 1998 to 2012, there were significant declines in infant mortality rates for Indigenous infants.
  • For 2012, the leading causes of death among Indigenous people were cardiovascular disease, neoplasms (almost entirely cancers), and injury.
  • In 2006-2010, for direct maternal deaths the rate ratio was almost 4 times higher for Indigenous women than for non-Indigenous women.

Hospitalisation

  • In 2012-13, 4.0% of all hospitalisations were of Indigenous people.
  • In 2012-13, the age-standardised separation rate for Indigenous people was 2.7 times higher than for other Australians.
  • In 2012-13, the main cause of hospitalisation for Indigenous people was for care involving dialysis, responsible for 48% of Indigenous separations.

Selected health conditions

Cardiovascular disease

  • In 2012-2013, 13% of Indigenous people reported having a long-term heart or related condition; after age-adjustment, these conditions were around 1.2 times more common for Indigenous people than for non-Indigenous people.
  • In 2012, hospitalisation rates for circulatory disease were 1.6 times higher for Indigenous people than for non-Indigenous people.
  • In 2012, cardiovascular disease was the leading cause of death for Indigenous people, accounting for 25% of Indigenous deaths.
  • In 2012, the age-adjusted death rate for Indigenous people was 1.6 times the rate for non-Indigenous people.

Cancer

  • In 2005-2009, age-adjusted cancer incidence rates were slightly lower for Indigenous people than for non-Indigenous people.
  • In 2004-2008, the most common cancers diagnosed among Indigenous people were lung and breast cancer.
  • In 2012-13, age-standardised hospitalisation rates for cancer were lower for Indigenous people than for non-Indigenous people.
  • In 2012, the age-standardised death rate for cancer for Indigenous people was 1.5 times higher than for non-Indigenous people.

Diabetes

  • In 2012-2013, 8% of Indigenous people reported having diabetes; after age-adjustment, Indigenous people were 3.3 times more likely to report having some form of diabetes than were non-Indigenous people.
  • In 2013-14, age-adjusted hospitalisation rates for diabetes for Indigenous males and females were 3 and 5 times the rates for other males and females.
  • In 2012, Indigenous people died from diabetes at 7 times the rate of non-Indigenous people.

Social and emotional wellbeing

  • In 2012-13, 69% of Indigenous adults experienced at least one significant stressor in the previous 12 months.
  • In 2012-13, after age-adjustment, Indigenous people were 2.7 times as likely as non-Indigenous people to feel high or very high levels of psychological distress.
  • In 2008, 90% of Indigenous people reported feeling happy either some, most, or all of the time.
  • In 2011-12, after age-adjustment, Indigenous people were hospitalised for ICD ‘Mental and behavioural disorders’ at 2.1 times the rate for non-Indigenous people.
  • In 2012-13, there were 16,393 hospital separations with a principal diagnosis of ICD ‘Mental and behavioural disorders’ identified as Indigenous.
  • In 2012, the death rate for ICD ‘Intentional self-harm’ (suicide) for Indigenous people was 2.0 times the rate reported for non-Indigenous people.

Kidney health

  • In 2009-2013, after age-adjustment, the notification rate of end stage renal disease was 6.2 times higher for Indigenous people than for non-Indigenous people.
  • In 2012-13, care involving dialysis was the most common reason for hospitalisation among Indigenous people.
  • In 2008-2012, the age-standardised death rate from kidney disease was 2.6 times higher for Indigenous people than for non-Indigenous people.

Injury

  • In 2012-13, after age-adjustment, Indigenous people were hospitalised for injury at nearly twice the rate for other Australians.
  • In 2012-13, the hospitalisation rate for assault was 34 times higher for Indigenous women than for other women.
  • In 2012, injury was the third most common cause of death among Indigenous people, accounting for 15% of Indigenous deaths.

Respiratory disease

  • In 2012-2013, 31% of Indigenous people reported having a respiratory condition. After age-adjustment, the level of respiratory disease was 1.2 times higher for Indigenous than non-Indigenous people.
  • In 2012-2013, 18% of Indigenous people reported having asthma.
  • In 2012-13, after age-adjustment, rates for Indigenous people were 4.4 times higher for chronic obstructive pulmonary disease, 3.3 times higher for influenza and pneumonia, 1.8 times higher for asthma, 1.8 times higher for acute upper respiratory infections and 1.4 times higher for whooping cough, than for their non-Indigenous counterparts.
  • In 2012, after age-adjustment, the death rate for respiratory disease for Indigenous people was 2.2 times that for non-Indigenous people.

Eye health

  • In 2012-2013, eye and sight problems were reported by 33% of Indigenous people.
  • In 2008, the rate of low vision for Indigenous adults aged 40 years and older was 2.8 times higher than for their non-Indigenous counterparts.
  • In 2008, the rate of blindness for Indigenous adults aged 40 years and older was 6.2 times higher than for their non-Indigenous counterparts.

Ear health and hearing

  • In 2012-2013, ear/hearing problems were reported by 12% of Indigenous people.
  • In 2012-13, the hospitalisation rate for ear/hearing problems for Indigenous children aged 0-3 years was 0.8 times lower the rate for non-Indigenous children and the rate for Indigenous children aged 4-14 years was 1.6 times higher than the rate for non-Indigenous children.

Oral health

  • In 2007-2008 in NSW, SA, Tas and the NT, Indigenous children had more dental problems than non-Indigenous children.
  • In 2004-2006, caries and periodontal diseases were more prevalent among Indigenous adults than among non-Indigenous adults.

Disability

  • In 2008, after age-adjustment, Indigenous people were 2.2 times as likely as non-Indigenous people to have a profound/core activity restriction.

Communicable diseases

  • In 2006-2010, after age-adjustment, the notification rate for tuberculosis was 12.5 times higher for Indigenous people than for Australian-born non-Indigenous people.
  • In 2011-2013, the crude notification rate for hepatitis B was 5 times higher for Indigenous people than non-Indigenous people.
  • In 2011-2013, the crude notification rate for hepatitis C for Indigenous people was 3.7 times higher for Indigenous people than for non-Indigenous people.
  • In 2007-2010, notification rates for Haemophilus influenza type b were 12.9 times higher for Indigenous people than for non-Indigenous people.
  • In 2011, the age-standardised rate of invasive pneumococcal disease was 8 times higher for Indigenous people than for other Australians.
  • In 2007-2010, the age-standardised notification rate of meningococcal disease was 2.7 times higher for Indigenous people than for other Australians; the rate for Indigenous children aged 0-4 years was 3.8 times higher than for their non-Indigenous counterparts.
  • In 2013, Indigenous people had higher crude notification rates for gonorrhoea, syphilis and chlamydia than non-Indigenous people.
  • In 2013, age-standardised rates of human immunodeficiency virus (HIV) diagnosis were 1.3 times higher for Indigenous than non-Indigenous people.
  • In some remote communities, more than 70% of young children had scabies and pyoderma.

Factors contributing to Indigenous health

Nutrition

  • In 2012-2013, less than one half of Indigenous people reported eating an adequate amount of fruit (42%) and only one-in-twenty ate enough vegetables (5%) on a daily basis.

Physical activity

  • In 2012-13, 46% of Indigenous adults met the target of 30 minutes of moderate intensity physical activity on most days.
  • In 2012-2013, after age-adjustment, 62% of Indigenous people in non-remote areas reported that they were physically inactive, a similar level to that of non-Indigenous people.

Bodyweight

  • In 2012-2013, 66% of Indigenous adults were classified as overweight or obese; after age-adjustment, the level of obesity/overweight was 1.2 times higher for Indigenous people than for non-Indigenous people.

Immunisation

  • In 2013, 93% of Indigenous children aged 5 years were fully immunised against the recommended vaccine-preventable diseases.

Breastfeeding

  • In 2010, breastfeeding initiation levels were similar among Indigenous and non-Indigenous mothers (87% and 90% respectively).

Tobacco use

  • In 2012-13, 44% of Indigenous adults were current smokers; after age-adjustment, this proportion was 2.5 times higher than the proportion among non-Indigenous adults.
  • Between 2002 and 2013, there has been a decline in the number of cigarettes smoked daily among Indigenous people.
  • In 2011, 50% of Indigenous mothers reported smoking during pregnancy.

Alcohol use

  • In 2012-13, 23% of Indigenous adults abstained from alcohol; this level was 1.6 times higher than among the non-Indigenous population.
  • In 2012-2013, after age-adjustment, lifetime drinking risk was similar for both the Indigenous and non-Indigenous population. In 2008-10, after age-adjustment, Indigenous males were hospitalised at 5 times and Indigenous females at 4 times the rates of their non-Indigenous counterparts for a principal diagnosis related to alcohol use.
  • In 2006-2010, the age-standardised death rates for alcohol-related deaths for Indigenous males and females were 5 and 8 times higher respectively, than those for their non-counterparts.

Illicit drug use

  • In 2012-13, 22% of Indigenous adults reported that they had used an illicit substance in the previous 12 months.
  • In 2005-2009, the rate of drug-induced deaths was 1.5 times higher for Indigenous people than for non-Indigenous people.

 

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NACCHO Aboriginal Health News : Patrick Tjungurrayi: Bringing the gift of better health to community

 

purple

The entwined nature of health and homeland is a strong subtext inBeyond Borders. Promoting the need for properly resourced remote communities is a provocative sentiment as the West Australian government is planning to close hundreds of small settlements and outstations. Tony Abbott even described living in such places as a “lifestyle choice”.

The rate of kidney failure in remote desert communities is “at epidemic proportions, between 15 and 30 times the national average”.

The causes are varied, from being born prematurely with small kidneys to constant infections, high blood pressure and diabetes. “Poor access to good food, substandard housing and limited education also has a part to play. It is, ultimately, an illness born of poverty and dispossession.

“It’s a national health crisis, but it’s also much more than that,”

Sarah Brown, chief executive of the Purple House

As published online in the Australian

When artist Patrick Tjungurrayi got sick with kidney disease, he said he would rather die in his own country than be sick in someone else’s.

“I’m not f.. kin’ stopping here (Alice Springs Hospital)!” he declared. “That’s not my country. I’m painting for Western Desert here, not painting for the town. I’m going.”

“At the peak of his powers,” writes historian John Carty, who will launch a book about Tjungurrayi’s life in Melbourne today, “one of our great artists became another statistic in the tragic calculus of Aboriginal health in remote Australia.”

The respected Western Desert artist had spent several years working with Carty and a team of art curators on Yiwarra Kuju: The Canning Stock Route, a seminal collection of paintings, oral histories and memorabilia that brought to life the history of the 1800km cattle track through country that Tjungurrayi was born in and knew well.

His painting career has been only the latest chapter in an extraordinary life: two decades as a desert nomad with no white contact, another two as mission resident, then pioneer of the homelands movement that saw Western Desert peoples return to their country.

That reconnection nurtured an explosion of creativity on canvas. Tjungurrayi’s breathtakingly com­plex and beautiful canvases have won many awards, including the painting prize at the 2001 National Aboriginal and Torres Strait Islander Art Awards and the $50,000 Western Australian Indigenous Art Award in 2008.

But by 2010, when dignitaries gathered at the National Museum of Australia for the opening of the Canning Stock Route show, Tjungurrayi’s kidneys were failing and he couldn’t attend.

As it happened, sales of Tjungurrayi’s art had already helped establish a pioneering dialysis program called the Purple House, based in Alice Springs but dedic­ated to establishing dialysis ser­vices for residents of desert communities. When his own health problems emerged, Tjungurrayi was living in Kiwirrkurra in Western Australia, just 150km away from a dialysis machine that he had helped fund in Kintore, in the Northern Territory.

But the Territory authorities refused him access across the border, and he was bewildered to be told he would be flown 2600km to Perth for treatment.

The absurdity was self-evident; unlike many other regional populations across Australia, his people had come together to fund their own vital health service, yet bur­eaucracy was preventing one of its founding members from using it.

It made no sense to Tjungurrayi. “There is no road between Kiwirrkurra and Perth. I will be lost. No one will find me.”

Writes Carty: “The media murmured, governments rumbled, rules changed and borders briefly opened. Eventually, as he knew it should, dialysis came to Patrick in Kiwirrkurra.”

He will need dialysis three times a week for the rest of his life to survive.

Carty’s book is titled Beyond Borders, referring to Tjungurrayi’s peripatetic life and artistic vision, and the lifesaving reach of the Purple House, which operates 20 dialysis machines in 10 communities, an Alice Springs clinic and a mobile van service.

An eye-catching photograph in the book shows one of Tjungurrayi’s vivid purple, orange and white masterpieces adorning the length of the Purple Truck, the mobile dialysis unit that brings on-country treatment to people in far-flung places.

“On this truck his painting roars across the desert like the Tingarri hoards depicted in them, enormous and improbable, keeping the story alive by keeping people in their country,” says Carty, who is contributing all book sales to funding Purple House services.

The entwined nature of health and homeland is a strong subtext inBeyond Borders. Promoting the need for properly resourced remote communities is a provocative sentiment as the West Australian government is planning to close hundreds of small settlements and outstations. Tony Abbott even described living in such places as a “lifestyle choice”.

Sarah Brown, chief executive of the Purple House, notes the rate of kidney failure in remote desert communities is “at epidemic proportions, between 15 and 30 times the national average”.

The causes are varied, from being born prematurely with small kidneys to constant infections, high blood pressure and diabetes. “Poor access to good food, substandard housing and limited education also has a part to play. It is, ultimately, an illness born of poverty and dispossession.

“It’s a national health crisis, but it’s also much more than that,” adds Brown.

“Traditionally, kidneys hold the spirit. If you have sick kidneys, you have a sick spirit.”

She says moving away from home to be close to a dialysis machine can lead to a downward spiral for the patient, their family and community.

On every level, community-based dialysis makes sense, she argues. “And when you see Patrick, home in his community, painting at his art centre and watching his grandkids grow, there can be no doubt that what we are doing is right.”

The Purple House has won accolades at the Human Rights and Indigenous Governance awards, a national disability award and an ethical enterprise award.

Jennifer Westacott, chief executive of the Business Council of Australia, will host the launch of the book and the Purple House Fund, which it is hoped will raise money to support ongoing dialysis services.

“The day I spent at the Purple House was one of the best days of my life,” says Westacott.

“This organisation is a model service provider: innovative, creative and … a lesson in the management of chronic disease and the preservation of cultural dignity.”

Carty says Tjungurrayi is an inspiration to wider Australia. “Patrick’s career as an artist, and his illness, returns us to the epic quality of his life,” he says.

“Whether blown up on the side of a dialysis truck, or hanging in an exhibition about Australian history, or as a chapter in Australian art history, Patrick’s paintings are … extensions of his character, his life, his ongoing journey.

“His art mobilises big ideas, and continues to do difficult work in the world.”

Patrick Tjungurrayi: Beyond Borders (UWAP, $59.99).

NACCHO Health News: AMA speech “Social Determinants and Aboriginal Health”

Brian

Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people. Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.”

AMA PRESIDENT A/PROF BRIAN OWLER (pictured above with Matthew Cooke NACCHO chair at recent Parliamentary event )

SPEECH TO BMA SYMPOSIUM The Role of Physicians and National Medical Associations in Addressing the Social Determinants of Health and Increasing Health Equity LONDON 24 MARCH 2015

The Social Determinants of Health: the Australian Perspective

The Australian connotation of the words ‘social determinants’ in relation to health immediately conjure images of the issues faced by Australia’s first people, our Australian Aborigines and Torres Strait Islanders.

And this is rightly so. The social determinants of health are major issues for Australia as a nation in its attempts to ‘close the gap’ for disadvantage of Indigenous people in relation to a range of outcomes, including health.

The implications of the social determinants are not bound by race, although race might be thought of as a social determinant in itself. Social determinants are important to health outcomes for all Australians.

The issues are much more complex than whether someone has a roof over the head, whether they have access to clean water and nutritious food. What I want to talk about, from the Australian perspective, are two issues.

First, there are deeper issues that underlay the social determinants of health. This comes from a sense of physical, social, and emotional wellbeing, the origins of which have deep spiritual roots for Australia’s Indigenous people.

The second is that the term ‘social determinants of health’ is somewhat misleading. While I know many here understand this, we must not forget that health is a determinant of social and other outcomes.

Australian Indigenous peoples represent about 3 per cent of the Australian population. Indigenous Australians experience poor health outcomes. We have a gap between Indigenous and non-Indigenous Australians in terms of health, but also in many other aspects of life. Indeed, the health outcomes are poorer compared to the Indigenous populations of other nations.

Life expectancy of Indigenous Australians is 10.6 years less for men, and 9.5 years for women. This gap in life expectancy is a serious blight on our nation, and remains unacceptable.

The AMA sees that addressing this issue is a core responsibility of the AMA and the medical profession.

While the gap in life expectancy remains unacceptable, there have been gains in Indigenous health. Life expectancy has increased by 1.6 years and 0.6 years for men and women respectively over the past five years. Mortality rates for Indigenous Australians declined by 9 per cent between 2001 and 2012.

So, what are the main contributors to the gap in life expectancy?  Chronic diseases are the main contributors to the mortality ‘gap’ between Indigenous and non-Indigenous Australians.

Four groups of chronic conditions account for about two-thirds of the gap in mortality: circulatory disease, endocrine, metabolic and nutritional disorders, cancer, and respiratory diseases.

Another major contributor to the gap in life expectancy is the Indigenous infant and child mortality rate. These rates remain well above that of the non-Indigenous population.

The infant mortality rate remains high at around five deaths per 1000 live births, compared to 3.3 per 1000 for non-Indigenous children.

External causes, such as injury and poisoning, account for around half of all deaths of children aged 1–4 years. External causes, mainly injury, are also the most common cause of death among Indigenous children aged 5–14, and account for half of the deaths in that age group.

The trend data for most States show a 57 per cent decline in the Indigenous infant mortality rate between 2001 and 2012, and a 26 per cent decline in the non-Indigenous rate.

There has been progress here, but clearly there is much more to do.

Suicide was the third leading cause of death among Indigenous males, at six per cent.

The rate of suicide is about two times higher for males and 1.9 for females, compared to non-Indigenous Australians. Suicide also occurs at a younger age. This is not consistent with Aboriginal culture, in which suicide was thought to be rare.

These sorts of reports highlight several important issues.

First, as is already known, non-communicable diseases, in particular circulatory disease and diabetes, remain very significant issues for the Australian Indigenous people.

Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people.

Second, the rate of suicide, particularly among young Indigenous males, is unacceptably high. This speaks to something much more difficult to address.

It is an issue of how we address mental health, the need to focus on drug and alcohol problems, but it also raises questions about why so many Indigenous people take their own lives.

Third, our child and infant mortality rates are too high, but are improving. What is disturbing is that many of the deaths remain preventable. That is, they are caused by trauma or injury. Some of these injuries will be non-accidental.

While those with chronic disease need to be cared for, prevention, particularly in the early part of life, is the key if we are going to see a generational change in health outcomes.

As a nation, Australia is conscious of the need to improve the health of Indigenous Australians – to Close the Gap.

Each year, the Prime Minister, in the first week that Federal Parliament sits, delivers a report on Closing the Gap.

In 2008, the Council of Australian Governments, or COAG, set six targets aimed at reducing Indigenous disadvantage in relation to health and education.

The Closing the Gap targets are to:

  • close the life expectancy gap within a generation (by 2031);
  • halve the gap in mortality rates for Indigenous children under five within a decade (by 2018);
  • ensure access to early childhood education for all Indigenous four year olds in remote communities within five years (by 2013);
  • halve the gap in reading, writing and numeracy achievements for children within a decade (by 2018);
  • halve the gap for Indigenous students in year 12 attainment rates (by 2020); and
  • halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018).

Despite good intention and considerable investment by successive Governments, the disparity in outcomes remains.

As expressed in this year’s Closing the Gap statement by the Prime Minister: ‘It is profoundly disappointing that most Closing the Gap targets are not on track to be met’.

Closing the Gap is an incredibly difficult task, and it is fair to say that Australia and Australians have learnt much about how to Close the Gap over a number of decades.

There were many mistakes, not only in Closing the Gap, but also in how modern Australia has treated Indigenous Australians. These issues have had to be confronted in order to advance efforts to Close the Gap.

For example, from 1910 to 1970, it is estimated that 100,000 Indigenous children were taken from their families and raised in institutions or fostered to non-Indigenous families.

The ‘Stolen Generation’, as they are termed, was disastrous in its outcome, however well-intentioned it may have been – separating families, but also alienating individuals from their own culture and families.

There have been many examples of Governments trying to address the social determinants of health – but often they have failed. For example, the Australian Government attempted to improve the living conditions of Indigenous people by building houses.

The houses were often inappropriate for the location. The plumbing would block because of the hardness of the water. They would fall into disrepair, and they did not serve the needs of the communities. These initiatives were well meaning, but improvements in health outcomes were somewhat marginal.

We have learnt, unfortunately by mistake, but also through partnership with Indigenous Australians. When it comes to health, there is much more to improving Indigenous health than building houses and sending people to school.

The concept of health for Indigenous Australians is very different from that of Western culture. There is no word for health in many Aboriginal languages. Rather, health is more of a concept of social and emotional wellbeing than of physical health.

Even that statement is a generalisation.

Before the arrival of Europeans, Australia was inhabited not by a uniform nation of Aboriginal people, but rather hundreds of ‘Indigenous nations’, whose language varied tremendously, along with their culture and beliefs.

Despite this variation, a unifying theme in terms of that ‘social and emotional wellbeing’ is the connection of Indigenous people with their land.

Australia’s first peoples have been continuously sustained, both physically and spiritually, by their land for 50,000 years of more. They have a deep connection with the land, and it is an important component of maintaining their spiritual wellbeing.

The close connection with the land also means that Indigenous people often live in remote regions. These remote communities present challenges in delivering health care as well as infrastructure and services that improve the social determinants of health.

For Indigenous Australians, their very existence, let alone their lifestyle, was threatened by European settlement as late as 1788. For Indigenous Australians, the arrival of Captain Cook in 1770, and subsequently the First Fleet in 1788, is not seen as European settlement, but rather as a modern invasion.

It signified displacement, imprisonment, forced adoption and much worse. It has left both emotional and spiritual wounds open and unable to heal. Modern economic solutions will continue to fail until these much more deeply seated issues are confronted.

There have been important steps in our young nation’s history that have attempted to approach these issues.

As I mentioned, the attachment to land is an important part of Indigenous culture. For each Indigenous ‘nation’, certain places hold spiritual importance.

From the land stemmed the basis of Aboriginal ‘dreamtime’, the spiritual conceptualisation of the universe and the basis of human existence for Aboriginal peoples. One might say that their landscape was their religion.

Recognition of the longstanding connection to the land came through a series of legislative changes that largely started under the Whitlam Government in 1972. Whitlam established the Aboriginal Land Rights (or Woodward) Commission to examine the possibility of establishing land rights in the Northern Territory.

In 1975, the Whitlam Government purchased traditional land and handed it back to the Gurindji people. In a now famous gesture, Whitlam poured sand into the hands of Vincent Lingiari, an Elder of the Gurindji people.

The Aboriginal Land Rights Act was passed by the Fraser Government in 1976, and established land rights for traditional Aboriginal landowners in the Northern Territory.

In 1992, the doctrine of terra nullius was overruled by the High Court of Australia in Mabo v Queensland, which recognised the Meriam People of Murray Island in the Torres Strait as native title holders over part of their traditional lands.

The Native Title Act was legislated the following year, 1993, by the Keating Government.

Not only did this provide the legal acknowledgement that Indigenous Australians sought, it also provided a source of revenue. The use of land for mining purposes, for example, provided significant funding to Aboriginal people through regional land councils.

More has been done since, but these are important issues to address that underlay social and emotional wellbeing and, therefore, the health of Indigenous people.

In 2008, Prime Minister Kevin Rudd issued a formal apology to Indigenous people for the stolen generation. It had enormous symbolism for Indigenous Australians.

The next likely step is to recognise Australia’s first people in our Constitution.

Constitutional recognition is a vital step towards making Aboriginal and Torres Strait Islander people feel historically and integrally part of the modern Australian nation.

Recognising Indigenous people in the Constitution will improve their self-esteem, their wellbeing, and their physical and mental health.

The AMA is a proud supporter of the Recognise campaign, and is a Foundation Signatory of the campaign.

In 2013, the Abbott Government was elected. Prime Minister Abbott had spent significant amounts of time with Indigenous people, often living for a week at a time in Indigenous communities.

In Government, he ‘ran the country’ for a week from a remote Indigenous community in Arnhem Land of the Northern Territory.

Prime Minister Abbott also took over the responsibilities for many Indigenous policy areas. The coalescence of these responsibilities into the Department of Prime Minister and Cabinet coincided with the reduction of the number of Indigenous programs into five main areas.

The Indigenous Advancement Strategy, or IAS, that began on 1 July 2014 now embodies these aims. The IAS outlines a number of priority areas – getting children to school, adults to work, and making communities safer.

The IAS replaced more than 150 individual programs with five broad programs – Jobs, Land and Economy; Children and Schooling; Safety and Wellbeing; Culture and Capability; and Remote Australia Strategies.

These are all worthy aims. They remain important.

But what is missing from the core of the IAS is a focus on health.

Health, in a modern sense, underpins many of these outcomes. We need to get the balance right and we, the AMA, need to ensure that health is seen as a foundation to these outcomes.

So, what is our role as a national medical association? Our role is to guide politicians and their policies; to shape the national narrative and debate.

The AMA’s Indigenous Health Taskforce, which I chair, draws experts in Indigenous Health together. It highlights the AMA’s commitment to working, in partnership with Indigenous Australians, to improve the health of Indigenous Australians.

Not only do we highlight the problems, but the AMA works on solutions and to highlight the successes as well.

The AMA regularly publishes the AMA Indigenous Report Card.

Last year, we highlighted the importance of a healthy early start to life.

My predecessor, Dr Steve Hambleton stated that: “Robust and properly targeted and sustained investment in healthy early childhood development is one of the keys to breaking the cycle of ill health and premature death among Aboriginal peoples and Torres Strait Islanders.”

Gains can be made by focusing on antenatal care.

In the Pitinjarra lands of north western South Australia there have been major gains in antenatal care, with 75 per cent of all pregnant women seen in the first trimester.

The proportion of children under three years of age with significant growth failure has fallen from 25 per cent in the 1990s to less than 3 per cent today. Immunisation rates approach 100 per cent.

This year, the AMA Report Card will focus on the bigger picture of the importance of health in underpinning the outcomes of education, training, and employment.

We will also focus on the issues of Indigenous incarceration rates, which have continued to escalate.

Law and order policies and health policies are often interlinked. Incarceration leads to a multitude of poorer physical and emotional health outcomes.

Poor health, and a poor start to life, is likely to increase the chances of incarceration. The AMA will be working with the Law Council of Australia on this issue.

To change the health of an entire population is an enormously difficult task. It is too easy for Governments to ignore health, to focus on the economics. Education and economics alone are not sufficient. Health is the cornerstone on which education and economics are built.

If you can’t go to school because you or your family are sick, truancy officers won’t work. If you can’t hear because of otitis media, you won’t learn. If you miss training opportunities because of depression or ill health, you won’t progress to employment. You can’t hold down a job if you keep having sick days.

Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.

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NACCHO Chair Justin Mohamed speech – NACCHO Health Summit 2014

justin_speech

As a Goorang Goorang man from Bundaberg QLD I would like to commence by formally acknowledging the traditional owners and custodians of land upon which we meet today and pay my respects to elders both past and present. 

Today my topic is ‘investing in community controlled health makes economic sense.

I don’t need to tell most of you in the room here today that putting resources into community controlled health can have a great impact: not only in closing the health gap between Aboriginal and mainstream Australia, but also in providing employment and training opportunities and  giving an economic boost to Aboriginal and mainstream communities.

Indeed we heard many great examples of this in the presentations and workshops yesterday. There is some amazing work being done across many critical areas within local Communities and I am looking forward to hearing more success stories as the Summit continues over the next two days.

We have all known that Aboriginal Community Controlled Health Services have a flow effect into their communities – indeed most people in this room would have seen it in action.

But at times it has had its challenges for us to provide the definitive proof when asked by policy makers or funders.

Which is why last year NACCHO commissioned research into the economic benefits of Community Controlled Health Services.

We wanted to have something tangible, something that clearly articulated what we were seeing in individual services every day, was a reality across all our services and across the Nation.

So we bought in respected health economist Dr Katrina Alford, where she spent time analysing the statistics that are publicly available, reviewing the data, talking to our services and compiling a comprehensive report which we were fortunate to have been invited to launch earlier this year at the National Press Club.

Of course the report showed just what we had thought it would – that the multiplier effect of our services in terms of employment, training and improving participation of our people is significant.

Our services are large-scale employers of Aboriginal people and in fact the main source of employment in many of our communities.

Lets take a look at a service, one used as a case study in the report – Mulungu.

Mulungi is in Mareeba in far north Queensland, on the Atherton Tablelands about an hour west of Cairns. Mareeba has a population of around 10,000 people and about thirteen per cent of those are Australia’s First Peoples.

Mulungi provides employment for 41 people in this small town, thirty being Aboriginal and Torres Strait Islander people from the local community. Aboriginal employment at Mulngu accounts for more than 12 per cent of all the Aboriginal employment in the area and wages and salaries in excess of $2.6 million a year

That’s a huge economic contribution, not just to the local Aboriginal community, but to the broader community of Mareeba.

Mulngu is not alone. Our 150 Aboriginal Community Controlled Health Services employ more than 5,500 people across the country and more than 3,500 of those are Aboriginal and Torres Strait Islanders.

That’s a very high number of people who have meaningful, secure jobs – participating in the labour market and in many cases effectively breaking the welfare cycle that can persist in some of our communities.

Further, these jobs are predominantly skilled occupations – Aboriginal Health Workers, doctors, nurses, health professionals, finance, IT, medical transport and administrative staff.

They provide wages and salaries that are much higher than the average Aboriginal Australian income which is use to support their families, take into their communities and boost regional economies.

The ripple effect of this employment cannot be underestimated and so our services are providing a solution to one of the key challenges we need to address if we are to reduce the chronic unemployment rates of our people.

Dr Alford’s report also found that alongside employment, Aboriginal Community Controlled health services provide extensive education and training opportunities for Aboriginal people.

Many of us here today, including myself can testify of the opportunities and experiences that were made available to many of us as younger Aboriginal & Torres Strait Islander men and women starting out our careers were given through our local Aboriginal Community Controlled Health Organisations.

This includes being mentored by inspiring, incredible and visionary Aboriginal people  – that taught us the importance of “Aboriginal health in Aboriginal hands”.

Learning on the job, raising educational levels and earning our stripes along the way. I doubt whether we could have achieved so much if it hadn’t been for opportunities and privileges to learn and be developed in such a nurturing and culturally sensitive environment.

Sadly however, although we are slowly seeing some improvements, many of the Aboriginal and Torres Strait Islander health workforce suffer institutionalized racism in the mainstream system and many have their career paths stunted.

Yet, in an Aboriginal Community Controlled Health environment, the Aboriginal and Torres Strait Islander health workforce employees in the main flourish.

And as they do so they provide culturally appropriate, culturally safe, holistic health care which our people want to use.

They combine clinical know-how with culturally enriched local knowledge and wisdom.

We are seeing demand for our services rising at a rate of six per cent a year as more and more of our people seek our the care of the local services where they know they will be treated without judgment, but with respect and dignity.

People come to use our Services from far and wide – there are many examples of /Community members traveling many kilometres and considerable time to access our member services and in some cases by-passing mainstream health services on the way to our “culture centres of Comprehensive Primary Health Care”

 

Aboriginal Community Controlled Health Organisations

The trend toward Aboriginal people seeking check ups at their local Aboriginal Community Controlled Health service means we are starting to diagnose earlier, make real inroads into reducing risk taking behavior’s like smoking, and putting preventative health measures in place.

And as a result it is our services that are reducing child mortality by 66 per cent, and reducing overall Aboriginal and Torres Strait Islander mortality rates by 33 per cent.

This in turn is slowly reducing the pressure and costs at the chronic end of the scale, reducing the need for hospitalisation and acute care.

And so again we see that our services are ticking numerous boxes in the struggle to close the gap between Aboriginal and white Australia:

Health – tick
Employment – tick
Training – tick.

Indeed, a single investment in Aboriginal Community Control Health Organisations deals with all three of the main challenges in Aboriginal communities:

  • High unemployment
  • Low education levels
  • And poor health

It is hard, then, to argue against the proposition that investing in Aboriginal community controlled health makes economic sense.

And yet we are still fighting for that investment.

It’s true that ACCHOs funding was renewed for 12 months just prior to the Federal Budget and that was welcome given the climate of spending cuts in all areas and particularly across the board in Aboriginal affairs.

But let’s face it – this is a long way short of what is needed – long term surety and security for our services and the large numbers of people they employ.

Plus many of the programs we run outside of the core funding are still up in the air. Indigenous health spending was cut by millions in the Budget and we are still waiting to see what that will mean for us on the ground.

The introduction of the medicare co-payment will hurt our services and given most will absorb the cost rather than pass it on to their clients, it will effectively result in a cut to their operating budget.

The next twelve months will be telling.

At NACCHO we will be fighting for five-year funding agreements, such as are given to the pharmacy guild, alongside a reduction in the masses of administrative red tape which divert many of services from providing care.

We will also continue to argue at the national level for ACCHOs to be exempt from any co-payments. We simply can’t afford for there to be any barriers to Aboriginal people seeking medical advice and seeking it early.

Introducing the co-payment will take us one step backwards and in Aboriginal health we need to keep moving forward or our gains will be lost.

We have worked hard over the years to develop our multi-partisan relationships with key decision makers at the highest levels and I believe we are getting some traction.

I take it as a positive sign that the Assistant Minister for Health Fiona Nash took up the invitation to speak at the Summit yesterday. She also said on the public record in a recent press release, and I quote:

“The Government recognises that while some improvements in Indigenous health outcomes have been achieved over recent years, there is still a long way to go to close the gap between the health and life expectancy of Aboriginal and Torres Strait Islander people and non-Indigenous Australians.”

“The role that Aboriginal Community Controlled Health Organisations continue to play in the delivery of health services to Aboriginal and Torres Strait Islander people is therefore vital.”

She may be convinced, but we are yet to see how this may be realised by other politicians, our collective job is to make sure every other Member of Parliament is also convinced, so when it comes down to a decision by the Treasurer on where he puts his funding, every Member of Parliament is an advocate for our movement of Aboriginal Community Controlled Health Organisations Programs, run by our member services for diabetes, chronic disease, smoking, maternal health and there is more,  we need local, state and federal decision makers to physically see our best practice models.

We have a goal over the next 8-10 months to have every MP visit their local ACCHO – see first hand what goes on in our services, to get a better sense of the great work that is being done in electorates across the country, and to see for themselves the real social and economic benefit of community controlled health.

Together we are a strong and powerful entity unmatched by any group or sector in this Nation. We as Aboriginal Community Controlled Health Organisations is the door for MP’s to gain first hand experience, so in this NACCHO has created an MP kit to assist in guideing on how to engage with local MP’s. Many already have long-standing relationships, but there are a number of newly elected MP’s and many more who may never have stepped inside an ACCHO.

If there is ever a time for our us to think and act strategically “with one voice” it is now.

We have the structure across local, State and National levels, we have great support from other State and National health bodies.  The next 3-6 months will prove to be nothing short of extreme importance not only for our member services today but into future years.

Aboriginal Controlled Health has proven over 4 decades that we are the vehicle in addressing Aboriginal Health and the cultural connection between clinical and traditional healing of the physical, emotional and spiritual wellbeing our our people.

 

 

 

 

NACCHO Aboriginal health and racism : What are the impacts of racism on Aboriginal health ?

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“On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.”

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research (and a former chair of NACCHO) see her opinion article below

“If you (Indigenous patient) go to a health service and you’re made to feel unwelcome, or uncomfortable or not deserving or prejudged and there are lots of scenarios of Aborginal people being considered to be perhaps being seriously intoxicated when in fact they’ve been seriously ill.”

Romlie Mokak CEO Australian Indigenous Doctors Association

JUST ADDED 3 March VACCHO POSITION PAPER Health and Racism

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It’s well known that Indigenous Australians have much lower life expectancy than other Australians, and have disproportionately high rates of diseases and other health problems.

Could that in part be due to racism?

Would cultural awareness training for health professionals would reduce the incidence of racism ?

Should governments acknowledge and address the impact of factors such as racism on health outcomes?

These are some of the question being asked in the health and community sectors, amid reports of a rise in racist incidents.

How racism affects health

The impact of racism on the health of Aboriginal and Torres Strait Islander people can be seen in:

  •   inequitable and reduced access to the resources required for health (employment, education, housing, medical care, etc)
  •   inequitable exposure to risk factors associated with ill-health (junk food, toxic substances, dangerous goods)
  •   stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems
  •  engagement in unhealthy activities (smoking, alcohol and drug use)
  •  disengagement from healthy activities (sleep, exercise, taking medications)
  •  physical injury via racially motivated assault

HOW DO WE BUILD A HEALTH SYSTEM THAT IS NOT

World news radio Santilla Chingaipe recently interviewed a number of health organisations

It’s well known that Indigenous Australians have much lower life expectancy than other Australians, and have disproportionately high rates of diseases and other health problems.

Could that in part be due to racism?

The Social Determinants of Health Alliance is a group of Australian health, social services and public policy organisations.

It lobbies for action to reduce inequalities in the outcomes from health service delivery.

Chair of the Alliance, Martin Laverty, has no doubt racism sometimes comes into play when Indigenous Australians seek medical attention.

“When an Indigenous person is admitted to hospital, they face twice the risk of death through a coronary event than a non-Indigenous person and concerningly, Indigenous people when having a coronary event in hospital are 40 percent less likely to receive a stent* or a coronary angiplasty. The reason for this is that good intentions, institutional racism is resulting in Indigenous people not always receiving the care that they need from Australia’s hospital system.”

Romlie Mokak is the chief executive of the Australian Indigenous Doctors’ Association.

Mr Mokak says the burden of ill health is already greater amongst Indigenous people – but this isn’t recognised when they go to access health services.

“Whereas Aboriginal people may present to hospitals often later and sicker, the sort of treatment they might get once in hospital, is not necessarily reflect that higher level of ill health. We’ve got to ask some questions there and why is it that the sickest people are not necessary getting the equitable access to healthcare.”

Mr Mokak says many Indigenous people are victims of prejudice when seeking medical services.

“If you (Indigenous patient) go to a health service and you’re made to feel unwelcome, or uncomfortable or not deserving or prejudged and there are lots of scenarios of Aboriginal people being considered to be perhaps being seriously intoxicated when in fact they’ve been seriously ill.”

But Romlie Mokak from the Australian Indigenous Doctors Association says the onus shouldn’t be on the federal government alone to improve the situation.

He suggests cultural awareness training for health professionals would reduce the incidence of racism.

“Not only is it at the point of the practitioner, but it’s the point of the institution that Aboriginal people must feel that they are in a safe environment. In order to do this, it’s not simply that Aboriginal people should feel resilient and be able to survive these wider systems, but those services really need to have staff that have a strong understanding of Aboriginal people’s culture, history, lived experience and the sorts of health concerns they might have and ways of working competently with Aboriginal people.”

Martin Laverty says at a recent conference, data was presented suggesting an increase in the number of Australians experiencing racism.

And he says one of the results is an increase in psychological illnesses.

“We saw evidence that said about 10 percent of the Australian population in 2004 was reporting regular occurences of individual acts of racism and that that has now double to being close to 20 percent of the Australian population reporting regular occurences of racism. We then saw evidence that the consequences of this are increased psychological illnesses. Psychological illnesses tied directly to a person’s exposure to racism and discrimination and that this is having direct cost impacts of the Australian mental health and broader acute health system.”

Mr Laverty says it’s time governments acknowledged and addressed the impact of factors such as racism on health outcomes.

He says a good start would be to implement the findings of a Senate inquiry into the social determinants of health, released last year.

“In the country of the fair go, we should be seeing Australian governments, Australian communities acting and indentifying these triggers of racism that are causing ill health and recognising that this is not just something the health system that needs to respond to, but the Australian government can respond by implementing the Senate inquiry of March 2013 that outlines the set of steps that can be taken to overcome these detriments of poor social determinants of health.”

Racism a driver of Aboriginal ill health

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On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research (and a former chair of NACCHO)

As published in The Australian OPINION originally published in NACCHO July 2013

 In July 2013, the former federal government launched its new National Aboriginal and Torres Strait Islander Health Plan.

As with all such plans, much depends on how it is implemented. With the details of how it is to be turned into meaningful action yet to be worked out, many Aboriginal and Torres Strait Islander people, communities and organisations and others will be reserving their judgment.

Nevertheless, there is one area in which this plan breaks new ground, and that is its identification of racism as a key driver of ill-health.

This may be surprising to many Australians. The common perception seems to be that racism directed towards Aboriginal and Torres Strait Islander people is regrettable, but that such incidents are isolated, trivial and essentially harmless.

Such views were commonly expressed, for example, following the racial abuse of Sydney Swans footballer Adam Goodes earlier this year.

However, the new health plan has got it right on this point, and it is worth looking in more detail at how and why.

So how common are racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people?

A key study in Victoria in 2010-11, funded by the Lowitja Institute, documented very high levels of racism experienced by Aboriginal Victorians.

It found that of the 755 Aboriginal Victorians surveyed, almost all (97 per cent) reported experiencing racism in the previous year. This included a range of behaviours from being called racist names, teased or hearing jokes or comments that stereotyped Aboriginal people (92 per cent); being sworn at, verbally abused or subjected to offensive gestures because of their race (84 per cent); being spat at, hit or threatened because of their race (67 per cent); to having their property vandalised because of race (54 per cent).

Significantly, more than 70 per cent of those surveyed experienced eight or more such incidents in the previous 12 months.

Other studies have found high levels of exposure to racist behaviours and language.

Such statistics describe the reality of the lived experience of Aboriginal and Torres Strait Islander people. Most Australians would no doubt agree this level of racist abuse and violence is unwarranted and objectionable. It infringes upon our rights – not just our rights as indigenous people but also our legal rights as Australian citizens.

But is it actually harmful? Is it a health issue? Studies in Australia echo findings from around the world that show the experience of racism is significantly related to poor physical and mental health.

There are several ways in which racism has a negative effect on Aboriginal and Torres Strait Islander people’s health.

First, on an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Second, Aboriginal and Torres Strait Islander people may be reluctant to seek much-needed health, housing, welfare or other services from providers they perceive to be unwelcoming or who they feel may hold negative stereotypes about them.

Last, there is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health or behaviour of people belonging to a particular group.

What the research tells us, then, is that racism is not rare and it is not harmless: it is a deeply embedded pattern of events and behaviours that significantly contribute to the ill-health suffered by all Aboriginal and Torres Strait Islander Australians.

Tackling these issues is not easy. The first step is for governments to understand racism does have an impact on our health and to take action accordingly. Tackling racism provides governments with an opportunity to make better progress on their commitments to Close the Gap, as the campaign is known, in Aboriginal and Torres Strait Islander health. The new plan has begun this process, but it needs to be backed up with evidence-based action.

Second, as a nation we need to open up the debate about racism and its effects.

The recognition of Aboriginal and Torres Strait Islander peoples in the Constitution is important for many reasons, not least because it could lead to improved stewardship and governance for Aboriginal and Torres Strait Islander health (as explored in a recent Lowitja Institute paper, “Legally Invisible”).

However, the process around constitutional recognition provides us with an opportunity to have this difficult but necessary conversation about racism and the relationship between Australia’s First Peoples and those who have arrived in this country more recently. Needless to say, this conversation needs to be conducted respectfully, in a way that is based on the evidence and on respect for the diverse experiences of all Australians.

Last, we need to educate all Australians, especially young people, that discriminatory remarks, however casual or apparently light-hearted or off-the-cuff, have implications for other people’s health.

Whatever approaches we adopt, they must be based on the recognition that people cannot thrive if they are not connected.

Aboriginal and Torres Strait Islander people need to be connected with their own families, communities and cultures. We must also feel connected to the rest of society. Racism cuts that connection.

At the same time, racism cuts off all Australians from the unique insights and experiences that we, the nation’s First Peoples, have to offer.

Seen this way, recognising and tackling racism is about creating a healthier, happier and better nation in which all can thrive.

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research.

NACCHO Healthy Futures Summit Melbourne 24-26 June 2014 : Invitation to submit abstracts

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On behalf of the NACCHO Board and Secretariat it is my pleasure to invite you to submit an abstract to the NACCHO Healthy Futures Summit at the Melbourne Convention and Exhibition Centre 24-26 June 2014.

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ALL ABSTRACTS MUST BE SUBMITTED VIA THE ABSTRACT PORTAL

The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

SUMMIT WEBSITE FOR MORE INFO REGISTER

NACCHO would like to demonstrate to the government at this summit how investing more in ACCHS is the best way of promoting better health more employment, more jobs and greater community economic benefits.

ABSTRACT SUBMISSIONS ONLINE

NACCHO Healthy futures Summit-Melbourne 24-26 June 2014

NACCHO invites abstracts submission from its members the Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholder organisations to showcase policy frameworks, best practice and investment in Aboriginal Health.

The delegates will be a representation from all over Australia in clinical practice, policy and research.

IMPORTANT DATES

Call for Abstracts open 25 February
All Abstracts Due 21 Mar 2014
Abstract Notifications 4 April 2014
Presenter Registration Due 18 April 2014
Early bird registrations open 25 February 2014
Early-Bird registrations Closes 18 April 2014
Program released 4 April 2014
Exhibition and sponsorship 16 May 2014
NACCHO 2014 Summit 24 -26 June 2014

Program Streams

1.Economic Development

  • Economic models of investment  into Aboriginal Community Controlled Health Organisation
  • Economic models of investment through partnership
  • Income generation through Aboriginal Community Controlled Health Organisations
  • Brokerage Modelling with Aboriginal Community Controlled Health Organisation

2.Health Reform

2.1 Workforce

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • National, State, Regional and Local Workforce Needs Analysis
  • Models of success
  • Recruitment and Retention Strategies
  • Mentoring Programs
  • Workforce Innovation Partnership
  • Career pathways that incorporate Scope of Practice within ACCHO’s

2.2 Continuous Quality Improvement

  • Affiliate Registered Training Organisations Capacity Building of ACCHO’s through scope of practice
  • Accreditation
  • Clinical Standards

3.Healthy Futures

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Clinic Practice/frontline servicing
  • Mental Health
  • Social Emotional Wellbeing
  • Drug & Alcohol
  • Mums & Babies
  • Women’s Health
  • Men’s Health
  • Oral Health
  • Aged Care
  • Disabilities
  • Adolescent
  • Sexual Health

4.Youth

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Investment in Youth by Aboriginal Community Controlled Health Organisations
  • Career pathways within an ACCHO, Affiliates and key stakeholders
  • Youth Leadership
  • Mentoring
  • Healthy Lifestyles and Youth
  • Health Promotion Strategies

5.Research & Data

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Population Health
  • Best practice models
  • Gap and Needs analysis
  • Research within Aboriginal Community Controlled Health Organisations
  • Research Partnerships
  • Health Information
  • Importance of Data
  • Cultural protocols into practice
  • What’s the Aboriginal Community Controlled Health Data telling us?

General guidelines for submissions

  • Abstracts will only be accepted by submitting through the online process below .
  • Abstracts must be a maximum of 300 words .
  • All abstracts must be original work.
  • The abstract will contain text only; no diagrams, illustrations, tables or graphics.
  • All presenting authors must register and pay for their registration for the conference by 18 April 2014 otherwise the presentation will be removed from the program.
  • The NACCHO advisory group reserves the right to accept and reject abstracts for inclusion in the program and allocate to a format that may not have been initially specified by the author/presenter.
  • The conference organisers will not be held responsible for submission errors caused by internet service outages, hardware or software delays, power outages or unforeseen events.
  • It is the responsibility of the presenting author to ensure that the abstract is submitted correctly. After an author has submitted their abstract, they should check their abstract was uploaded successfully.
  • All authors will receive notification of the outcome of their submission on 4 April 2014.
  • Responsibility for the accuracy of abstracts rests with the author.
  • Where there are co-authors, only one abstract is to be submitted. The presenting author is responsible for ensuring the co-authors agree with and are aware of the content before submitting the abstract.
  • An abstract which does not adhere to these requirements will not be accepted

ALL ABSTRACTS MUST BE SUBMITTED VIA THE ABSTRACT PORTAL

For further information contact the NACCHO SUMMIT TEAM 02 6246 9300 or EMAIL