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NACCHO Alert: Win Tickets to the NRL All stars

Tackling Indigenous Smoking Flyer for competitions

Would you like to see the NRL Indigenous All Stars Games from the luxury of a corporate box at Suncorp?

Maybe an exclusive dinner with the Indigenous Women’s Team is more your thing?

Or perhaps you would prefer an autographed and framed picture of the team?

Tackling Indigenous Smoking at Aboriginal Hostels Limited (AHL) have recently partnered with the NRL Indigenous All Stars, and as such we have a range of exciting giveaways on offer.

To be in the running to win such all you have to do is enter one of our exciting competitions:

  • The 4 Ds Art Competition (open to Aboriginal and Torres Strait Islander children and young people between 8-18);
  •  the Healthy Hostels Talent Contest (open to all AHL staff and residents of our hostels;) and
  •  the Share Your Story raffle.

Full details of all competions attached

Entries must be submitted by mail and received in Canberra by 2 February 2013. Any entry received after this date will be deemed invalid

For more information please email Samara on samara.rahman@ahl.gov.au or call 02 6212 2063.

Given the tight time frames surrounding this competition, I would really appreciate it if you could please promote and circulate the competitions to your friends, family members, and everyone else in your networks.

Smoke Free

NACCHO affiliate news alert:Plea for Aboriginal health funds

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WA’s peak Aboriginal health group says almost 100 services and more than 300 jobs are under threat because the State Government is dragging its feet to sign up to a new $150 million funding agreement.

Picture above and more info

Cathy O’Leary, Medical Editor, The West Australian

The Aboriginal Health Council of WA, which oversees the Aboriginal Medical Service, wants the Government to commit in writing to the next four-year Council of Australian Governments funding agreement for Closing the Gap in Aboriginal Health Outcomes before it goes into caretaker mode.

Chairwoman Vicki O’Donnell said the current funding ended in June, and the May Budget was too late to find out how much would be provided in the future, particularly for staff who did not know if there would be cutbacks and whether they would still have a job.

Health Minister Kim Hames said the Liberal-Nationals Government had given $117.4 million in 2009 towards closing the gap in Aboriginal health. Dr Hames said future funding for the program would be considered as part of the Budget process.

“The significant improvements we’ve made to date to the health outcomes of Aboriginal people in WA now face an uncertain future due to the lack of clarity over the program’s ongoing funding,” Mrs O’Donnell said.

“Since the four-year COAG funding agreement commenced, we have seen healthcare services delivered to both Aboriginal and non-Aboriginal people in rural, remote and metropolitan regions we’ve never been able to reach before.”

Mrs O’Donnell said the national partnership agreement had helped set up and expand 98 Statewide services, including 23 programs addressing chronic disease and specialist mental health services.

“Without the Government’s continued support and its investment in the health … of Aboriginal people in this State, 98 critical health services will cease and over 300 jobs will be lost in the workforce, 70 per cent of which are held by Aboriginal people,” she said.

“Not having made a commitment at this late stage to continuing this approach and renewing the COAG funding agreement is bordering on recklessness. The situation is critical.”

Real “good news” stories from NACCHO:Starting out in Aboriginal Health: Richard Weston CEO-Healing Foundation

NACCHO:Real stories of real people who are working to deliver better health outcomes for Aboriginal people.

Richard weston

This is Richard’s first blog on his new site

You can follow Richard’s BLOG HERE

or TWITTER Richard Weston‏@RichJWeston

In work I am CEO of the Aboriginal and Torres Strait Islander Healing Foundation and have been a CEO in Aboriginal & Torres Strait Islander organisations since August 2000.

I was CEO of Maari Ma Health based in Broken Hill NSW for 8 years; I went from there to Brisbane to take up the CEO role with the Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) for 14 months and then to my current role with the Healing Foundation where I have been since September 2010.

I moved to Broken Hill in 1996 with my partner and our two sons (who were 2yrs & 6 months old respectively). I had no job there and set about looking for work on arrival. I soon had the choice of taking a job with a fledgling Aboriginal Health Service (I would be their third employee) or a much safer job with Social Security which was later to become Centrelink under the Howard government

I chose the former which was a Project Officer gig with the Far West Ward Aboriginal Health Service (later to become Maari Ma) on a CES TAP* scheme for 2 years.

It’s been a great ride and I have experienced much of the good and bad sides of human nature along the way. I have helped build success in organisations. I have been on the blunt end of black politics and I have gained insight into what makes Indigenous organisations successful. I don’t hold grudges towards anyone across this journey, you get bruised along the way; it’s the nature of the space.

I have to say though that I have had more uplifting experiences on my journey than low points. On the whole I have enjoyed the ride. I have had the opportunity to work with good people both black and white who wanted to bring tangible improvement to the lives of Aboriginal and Torres Strait Islander people.

It’s the journey I want to share on this blog. I want to provide you with a firsthand account of working at the coal face of Aboriginal and Torres Strait Islander affairs from a management and leadership perspective.

It’s a challenging space to work in because it is so political. On the other hand it has been very satisfying because of the people relationships that I’ve developed and the things that we’ve achieved. One outstanding element of my journey has been the sense of humour that exists in our Aboriginal and Torres Strait Islander communities. How our people maintain a positive and humorous take on life in spite of high death rates, high levels of trauma, grief and loss in our communities, violence, alcohol abuse, chronic disease – the list seems endless – is a wonder. It never ceases to amaze.

The Aboriginal Health Service was small (it commenced life with $35k in the bank). The inaugural CEO was William ‘Smiley’ Johnstone, who had been a railway fettler and who had tried his hand at becoming a teacher, gone into the politics of ATSIC and became CEO of the new Aboriginal health service. I had little knowledge of the health system but I had solid administration experience and had worked in HR in WA as an employment and development officer and cross cultural trainer. These jobs were in federal and state bureaucracies.

Those early days of the mid-1990s were challenging. We were confronted with a health system that employed few Aboriginal people, and those that were in the system worked at the margins and had little training. The public health system in NSW had undergone a restructure to create 17 Area Health Services and Boards, including the Far West Area Health Service, which mirrored the Murdi Paaki ATSIC region boundary. Aboriginal health was a poorly grasped concept to the health system and even more foreign was the concept of actually involving Aboriginal people in planning, designing and delivering health services that affected them.

In addition to this the Murdi Paaki Region of NSW had the poorest health outcomes in NSW. The whitefellas were worse off than their counterparts in the rest of NSW, but when we looked at data for Aboriginal people, the story was much worse. On almost every indicator of health (and for that matter education, employment, housing and economic development) Aboriginal people fared far worse than Aboriginal people in the rest of the state.

Even more alarming than the actual health status of the region was that the data told us that most Aboriginal people were hospitalised from complications arising from chronic diseases, like diabetes and respiratory conditions. These are preventable diseases. Many people were being diagnosed with their chronic illness on presentation to hospital, which often meant the disease was well advanced with little chance of cure. That’s the problem with chronic illness, you can have a problem but not feel sick, and by the time you are aware you have an issue it may be too late.

The health system needed to change to engage with Aboriginal people more effectively to catch chronic conditions earlier in their onset and Aboriginal people needed to be involved in how this reform would occur, to better meet the needs of their own people. The unrelenting nature of a number of socio-economic factors makes it difficult for our people to prioritise health above other pressing day to day issues, like surviving on welfare or CDEP**.

The next challenge was that our communities (9 in all) were spread out over an area that geographically was one sixth the total area of NSW. This made service delivery, particularly continuity and quality of care, very challenging.

Along with our organisation and the public health system the other key players were the Flying Doctors (South East Section) and the Rural Health Training Unit. The Flying Doctors did a great job of providing emergency care but did little on the primary health care (prevention / early intervention) front for Aboriginal people, other than GP clinics in communities that were not well coordinated with the rest of the system. The Rural Health Training Unit was another fledgling organisation that would play a key role in improving the system for Aboriginal people.

So here I was living in Barkantji country with a young family, working for an organisation that was to deliver better access to health in a challenging landscape, with no experience working in the health system.

In my next blog I’ll share with you the vision that was developed by Aboriginal people that captured our imaginations and the partnership that developed between whitefellas and blackfellas to reform the health system in the Murdi Paaki Region.

You can find out more about Maari Ma and what it is currently doing by visiting: www.maarima.com.au

Richard

* CES TAP scheme – Commonwealth Employment Service Training for Aboriginal People

**CDEP – Community Development Employment Program, work for the dole scheme that was in place for Aboriginal people long before it was mandated for long term unemployed.

Know a Real stories of real people who is working to deliver better health outcomes for Aboriginal people.

Send details to media@naccho.org.au

Aboriginal kids belong in classrooms, not courtrooms

NACCHO  supporting the Generation One campaign for generation change

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Yet a series of media reports regarding the incarceration rates of Indigenous youth shows the appalling rate of young people who are entering, and being trapped in, the justice system.

As a nation, we need to take action.

Like many Australians, at GenerationOne we believe that diversionary programs focussing on education and employment are crucial to reversing the statistics.

Through a Vocational Training and Employment Centre (VTEC) a holistic approach can be used to ensure our young people don’t enter the criminal justice system.

The VTEC model works for Indigenous people who have been long term unemployed – we can replicate this for Indigenous youth who are at risk of falling through the cracks.

The facts are:

  • On an average day in 2011-12 Indigenous youth were 31 times as likely to be in juvenile detention as non-Indigenous youth.
  • Aboriginal people are returned to prison at a higher rate than they are retained in either high school or university.
  • 35.9 per cent of the Indigenous population is under the age of 15 – the time for action is now.
  • 90 per cent of young Indigenous people that appear before the Children’s Court go on to appear before the adult criminal court. Young Indigenous offenders are repeat offenders; small crimes turn into big crimes and the whole community loses. We can change that.

Actions you can take:

  1. Make a submission to the Value of a Justice Reinvestment Approach to Criminal Justice in Australia. It is not everyday that politicians listen, but they are listening now.
  2. Share your knowledge; send us information you have about existing diversionary programs and projects that focus on education and employment that are working.
  3. Here is one example: White Lion
  4. Make some (useful) noise. Share this information with your friends and ask them to be part of the generation for change then hit social media using #Gen1 #justreinvest

There are huge disparities in employment, participation and economic outcomes for Indigenous people in Australia.

Criminal records are a major barrier to many Indigenous people finding work.

The Closing the Gap Clearinghouse identified that criminal history adds a layer of complexity to employment in addition to the socioeconomic disadvantage Indigenous ex-offenders experience.

Please join us in this important campaign.

Warren Mundine

Press Release:National Aboriginal health movement calls on all politicians to consider inflammatory impacts before making public comments

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Justin Mohamed (pictured above) the Chair of the peak body, National Aboriginal Community Controlled Health Organisation (NACCHO), said today that politicians from both sides of politics should be more responsible when making comments in the public arena about Aboriginal and other national issues.

You can download the NACCHO press release

 Mr Mohamed was commenting on the standard of this weeks public debate by a wide range of politicians questioning the “welfare on tap” tweet gaffe by Opposition Indigenous health spokesperson Andrew Laming, whose social media comment became a bigger local and national story than the actual underlying issues  that ignited the clash of families in the south Brisbane suburb of Logan.

 “The whole political and media landscape has changed with social media channels such as Twitter’s two million users in Australia replacing the traditional press release for news comment, public engagement and social policy debate.

 In this high profile media case we have both Aboriginal and Pacific Islander leaders trying desperately to inject calm into a long running feud and their efforts are not helped by politicians making “off the cuff”, random, inflammatory and irresponsible social media comments, rather than making high level positive contributions to the national policy debate about the underlying social determinants that often fuel these types of incidents” Mr Mohamed said.

Media contact: Colin Cowell 0401 331 251

Invitation to attend National Stakeholder Consultations 2013-Mental illness

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ATAPS Increasing Efficiency National Stakeholder Consultations 2013

April 2008 a review of the Access to Allied Psychological Services (ATAPS) program identified four key areas for the program to focus on to better meet the needs of consumers experiencing mental illness.  

These four areas were better addressing service gaps, increasing efficiency, encouraging innovation and improving quality.

Initial implementation of review recommendations involved ATAPS moving to a new population-based funding model in which funding is allocated on an equitable basis according to relative need.  

The review also foreshadowed that the Department would move towards improving the efficiency of ATAPS service provision in a form that would complement the population-based funding model.

The Department is planning to complement the population-based funding formula with the introduction of increasing efficiency measures to ATAPS Tier 1 services in stages.  

Healthcare Management Advisors (HMA)—an independent organisation that provides specialised management consulting services to the Australian health industry—has been engaged to explore feasible options for enhancing the efficiency of the ATAPS program, specifically through the introduction and implementation of an efficiency model for Tier 1 activity; taking into consideration the whole cost of delivering ATAPS Tier 1 services, and the development of efficient business models for ATAPS fund holders.  

The work undertaken by HMA to date has included a review and analysis of ATAPS financial and activity data for the 2010-11 financial year; and initial stakeholder consultations with a cross-section of ATAPS fund holders, peak bodies for mental health professionals and the Department—all of which has informed the development of a consultation paper, which will be available in mid January 2013.

The Department is now seeking involvement from stakeholders to participate in the national stakeholder consultations.

The purpose of the national stakeholder consultations is to:
·        explain the initial findings of the analysis of ATAPS Tier 1 financial and activity data for the 2010-11 financial year;
·        present the methodology for choosing a suitable efficiency product;
·        present options for introducing efficiencies for ATAPS Tier 1 services, focusing on the strengths and weaknesses of each option; and
·        seeking input from the stakeholders around the issues and questions posed at the end of the consultation paper.

Stakeholders interested in contributing to the consultations are encouraged to register for one of the following consultations:  

Brisbane        Wednesday 30 January 2013                http://www.eventbrite.com.au/event/4646991276
Sydney                Thursday 31 January 2013                http://www.eventbrite.com.au/event/4682584737
Melbourne        Tuesday 5 February 2013                http://www.eventbrite.com.au/event/4690606731
Adelaide        Wednesday 6 February 2013                http://www.eventbrite.com.au/event/4690881553
Perth                Thursday 7 February 2013                http://www.eventbrite.com.au/event/4690985865

Please click on one of the links above to register your attendance.  The consultation paper will be distributed prior to the consultations.

Please note: attendance at the national consultations is limited to a maximum of three representatives per Medicare Local.

Should you require additional representation, please email your request listing all of your required attendees, their title/position and relationship to the ATAPS program to ATAPS@health.gov.au for consideration by the Department.

Written Submissions

Stakeholders who are unable to attend the consultations but wish to provide feedback, or those who will attend the consultations but wish to provide additional feedback may do so by making a written submission on the consultation paper which will be forwarded to you. Guidelines to assist stakeholders in making a written submission are attached.

Dr Ngaire Brown:Real stories of real people who are working to deliver better health outcomes for Aboriginal people.

Ngiare Brown has always wanted to be a doctor.

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Dr Ngiare Brown pictured above is currently a NACCHO Public Health Medical Officer

Download Ngiare’s poster

Do you know an Aboriginal person employed in an Aboriginal Community Controlled Health organisation working to deliver better health outcomes for Aboriginal people. NACCHO would like to share thier “real” story.Send details to media@naccho.org.au

This story is reproduced from  Real stories of real people

“From a very young age – seven or eight years old – I really wanted to be a doctor,” she says. “My parents said ‘we don’t mind what you do, as long as you do your best, do what you love, and love what you do.’ I have always seen myself working in health. Lucky for me, my family agreed.”

And lucky for Australia, too, because Ngiare has gone on to become one of the first Aboriginal doctors in the nation – as well as a vibrant, committed and passionate advocate for quality patient care and Aboriginal and Torres Strait Islander health policy, research, workforce and education.

Two things drive Dr Ngiare Brown – pride and commitment: pride in being an Aboriginal woman which, along with the importance of education, was instilled in her by her parents; and commitment to making a difference to the lives of Aboriginal and Torres Strait Islander people through improved health.

“I am incredibly proud to be an Aboriginal woman,” she says. “I want my children – I have two daughters – to be incredibly proud to be Aboriginal women. And I want every Aboriginal and Torres Strait Island person to feel that pride in themselves and their culture.

“I want to be able to contribute to raising tens of thousands of beautiful Aboriginal and Torres Strait Islander children in an environment where they will feel safe and proud.

“There is a lot to be done and I just hope I am doing enough and doing it right.”

Ngiare graduated from the University of Newcastle, obtained a Masters of Public Health and Tropical Medicine, and has held a range of positions including Indigenous Health Advisor to the Australian Medical Association (AMA), Senior Lecturer at the University of New South Wales and the Australian National University, Manager of Preventative Indigenous Health Programs for World Vision Australia, and foundation Chief Executive Officer for the Australian Indigenous Doctors Association in 2002-2003. In 2005, she was awarded the AMA’s Woman in Medicine for her major contribution to the medical profession. She has recently commenced as Medical Officer for the Australian Indigenous Doctors’ Association.

Having followed her destiny with energy and conviction, she’s now encouraging others to get involved with Aboriginal health, either as a change in career direction, or as a brand new career. Do so, she says, and you could be making the most personally and professionally rewarding decision of your life.

Ngiare’s vision is for her people to achieve equity, justice, respect and acknowledgment – and one of the pivotal ways to do this is through better health.

This is why she is an enthusiastic advocate of the Australian Government’s campaign to attract more people into careers in Aboriginal and Torres Strait Islander health. She knows that improvement in Aboriginal and Torres Strait Islander health cannot happen without having in place an appropriately resourced and trained health workforce. It’s a two-fold challenge. Over time, the challenge is to attract more Aboriginal and Torres Strait Islander people into health careers. In the short term, the need is to increase the number of experienced professionals working with Aboriginal and Torres Strait Islander people.

“Aboriginal and Torres Strait Islander health is everybody’s business,” Ngiare says. “We need to create an environment where people are aware of the issues in attracting people, both Aboriginal and Torres Strait Islander and non-Indigenous, into health careers. We need to support and promote the aspirations of young Aboriginal people, acknowledge the role of people currently in the workforce, and provide incentives and rewards for those who choose to work in Aboriginal health.

“For experienced professionals, there are many options in Indigenous health. It might mean working as a locum with an Aboriginal Medical Service, doing a short term clinical placement, or relocating to a regional or remote area.

“To my Aboriginal and Torres Strait Islander brothers and sisters who are working in health related roles, I say: we come from a long and proud tradition of storytelling. By sharing our stories, we can encourage more of our mob to join our ranks. We can also help current and future generations of health care providers to get to know us and better understand what it is like for our families and communities.”

With her diversity of training and experience, there’s not much Ngiare doesn’t know about Aboriginal health. “I guess I’m a Jack of all trades, master of none,” she says. “There are many things that I don’t know or am yet to learn, but I think I do have a real diversity of experience. That has been really important for me in terms of developing a broad perspective and understanding of Aboriginal and Torres Strait Islander health.”

Ngiare has seen first-hand both the challenges involved in Aboriginal health, and some of the triumphs in meeting those challenges. And, she believes, things are getting better.

“In terms of Aboriginal health and our desire for participation, the fact that we have been able to establish community-controlled health organisations, establish peak bodies for doctors, dentists, physiotherapists, psychologists and other allied health professionals – we have about 150 Aboriginal doctors and the same number of students – that kind of progress has been amazing,” she says. “These sorts of achievements have been made in the last 30, 40 or 50 years – that’s not bad given the historical context in this country, but we can do so much better.

“Some of the most significant barriers remain in the system itself. We need to get that long-term and sustainable commitment to changing the political, electoral and funding cycles.”

For all her own accomplishments, Ngiare doesn’t really see herself as a role model. But if others choose to, that’s not a problem. “I don’t stand up and say I am a role model,” she says. But I do know that it is important to lead by example, to be positive – and I do know that my actions should reflect what I am trying to achieve. If that encourages someone else to be involved in Aboriginal health, that would be wonderful.”

So what sort of people should we be looking to attract into Aboriginal health? “There will be a lot of people who will self-select,” Ngiare says. “There are a great many students and qualified practitioners in a range of disciplines who would be really interested in engaging – some may just not know how to make that first contact.

“To engage other people who may be less interested is more of a challenge – I think they need to have the right attributes and attitude: have an open mind with no pre-conceived notions. Be respectful in any role or relationship. Be able to acknowledge the contribution of others. Have an understanding of the cultural and social aspects that exist through Aboriginal and Torres Strait Islander communities. And have clinical confidence, because often you are it 24/7.

“I can tell you – the experience you have in Aboriginal and Torres Strait Islander health will certainly be among the most rewarding and enriching that you could possible envisage, both in a professional sense and in your personal growth and cultural understanding.

“There are plenty of opportunities in Aboriginal and Torres Strait Islander health. You just need to start the conversation.”

Download Ngiare’s poster

Dedicated to pursuit of social justice:GAVIN MOONEY, 1943-2012

Image of guest columnist Gavin MooneyGavin Mooney.JPG

Further to the Chair of NACCHO tribute: “Aboriginal health movement mourns the loss of the founding father of health economics Gavin Mooney.”

 Press Release tribute December 2013

If you would like to leave a tribute on the NACCHO communique to Gavin please enter on the comments box blow

The following article is;

Republished from the Sydney Morning Herald 11 January 2013

Gavin Mooney believed passionately in social justice and taught thousands of students in the ”caring discipline” of health economics. The real power of health economics, he said, was to be found in asking the right questions: ”What does the community want from their health system?”, ”How can we improve health unless we achieve greater equity?” and ”What does equity mean anyway?”

Not one for convention, Mooney instilled in all of his many PhD students the obligation to question the status quo and to propel new ideas and methods into the discipline of health economics.

Gavin Hunter Mooney was born on October 30, 1943, son of Hendry Mooney and his wife, Mary (nee Hunter), who inculcated the ideas of social justice into their children. He grew up in Glasgow, graduated from Edinburgh University in economics and became a trainee actuary. He did a short stint in the civil service but his true calling was to the academic world.

In 1977, despite not having a PhD, Mooney was appointed Professor of Health Economics at the University of Aberdeen and founded the Health Economics Research Unit (HERU). To this day HERU remains one of the leading health economics teaching and research centres in the world.

Mooney moved to Denmark in the mid-1980s, married Anita Alban and was Professor of Health Economics at Copenhagen University. He made a valiant attempt to learn Danish and his students made a valiant attempt to understand his Danish delivered with a strong Glaswegian accent. He also took up a part-time position at the University of Tromso in Norway, the world’s northern most university, and developed an influential correspondence course there for health professionals.

In 1987 Mooney made his first visit to Sydney, as a keynote speaker at the annual conference of the Australian and New Zealand Public Health Association. In his opening lines, he said that Australians were a kind and friendly bunch. Then came the challenge – if we are concerned about equality in our society, particularly in relation to health, then we had better consider what we mean by equality and do something about it.

And in time Australia did so. In 1993, the University of Sydney appointed Mooney as the Foundation Professor of Health Economics and it wasn’t long before he helped to establish the Centre for Health Economics Research and Evaluation, based at Westmead Hospital, where he met and later married Jackie Dettman.

He later also established the Social and Public Health Economics Group (SPHERe) in the School of Public Health at the University of Sydney and it was here that he pursued his communitarian ideology and abiding passion for Aboriginal health.

In 2000, Mooney moved to Western Australia and led the SPHERe group at Curtin University and established the WA social justice network. An outspoken critic of institutions, governments and some professional bodies, Mooney ruffled feathers and mobilised action for social justice. He also met and fell in love with Del Weston.

During his time at Curtin, Mooney trained five Aboriginal health economists – a remarkable achievement and a reflection of his commitment to Aboriginal health.

His life was run in the pursuit of social justice for people everywhere. He forged an enduring relationship with the health economics group at Capetown University and was a regular visitor to South Africa. At 67, he ran a marathon to raise money to support education for orphaned African kids. His friends and colleagues supported him with sponsorship and he raised a considerable sum of money. He was delighted when, in 2009, the University of Capetown awarded him an Honorary Doctorate as ”one of the founding fathers of health economics”.

No matter what the language, the culture or country, Mooney had what his colleague Steve Leeder described as a ”challenging, clarifying and provocative style”. He also wrote more than 20 books and more than 200 publications and held honorary positions at Aarhus University in Denmark, Victoria University in New Zealand and the University of NSW.

Gavin Mooney is survived by his family in Scotland: sister Helen, brother Grant and four nieces. Del died with him.

Glenn Salkeld

Read more: http://www.smh.com.au/national/obituaries/dedicated-to-pursuit-of-social-justice-20130110-2civ7.html#ixzz2HcvIMZZX

Increased support for Aboriginal people to ‘get healthy’ in 2013

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The NSW Aboriginal Get Healthy Service builds on the success of the Get Healthy Service, which has helped tackle chronic disease and the risk factors for chronic disease in the general population since its implementation in 2009.

Download: The story of the NSW Get Healthy Information and Coaching Service/ Over 400 Aboriginal particants coached: see research

Research :An effective service with population health impact and reach

Increased support for Aboriginal people to ‘get healthy’

Aboriginal people across NSW will have increased access to information and support about healthy eating, physical activity and weight management through a new telephone service launched today by the Minister for Healthy Lifestyles, Kevin Humphries.

Mr Humphries said the NSW Aboriginal Get Healthy Service is a free, confidential telephone service that will assist Aboriginal people to make healthy lifestyle changes and close the health gap between Aboriginal and non-Aboriginal people.

“This Aboriginal-specific telephone service provides Aboriginal people with free one-on-one coaching and goal setting from qualified health professionals to help set healthy lifestyle goals, overcome barriers and setbacks, maintain motivation and achieve long-term lifestyle changes,” Mr Humphries said.

“The start of the New Year is the perfect time for people to take up the challenge to get healthy, and I would encourage Aboriginal people across the State to give the service a call and discuss ways in which they can make 2013 the year in which they improve their physical health and wellbeing.”

Mr Humphries said the NSW Government has developed this service to further address the inequitable health outcomes of Aboriginal people within NSW and ensure that programs are better designed to meet the needs of Aboriginal people across the State.

“Just knowing that on the end of the phone there is someone willing to help will be a big support to people as they take the important first steps towards a healthier life,” Mr Humphries said.

“The service will help combat chronic disease risk factors that are more common in Aboriginal people than the rest of the population, such as smoking, overweight and obesity and not eating recommended serves of fruit and vegetables.

“Aboriginal people are far more likely to experience poorer health outcomes and to die younger than non-Aboriginal people mostly because of these risk factors and the chronic conditions that they can cause, like cardiovascular disease, kidney disease and diabetes.

“This new service is an important step towards reversing this trend and reflects the NSW Government’s commitment to implementing changes that will make a real difference to the lives of the State’s Aboriginal people.”

The NSW Aboriginal Get Healthy Service builds on the success of the Get Healthy Service, which has helped tackle chronic disease and the risk factors for chronic disease in the general population since its implementation in 2009.

For further information about

the Aboriginal Get Healthy Service please call 1300 806 258

or visit http://www.gethealthynsw.com.au.

Building better systems of care for Aboriginal and Torres Strait Islander people:findings from the kanyini health systems assessment

thumbs_waynequilliamphotographywannik913

“Consistent with our theoretical understandings of kanyini, staff frequently commented on the obligations they felt to reach people and act in their best interests.

This need to hold and nurture people was most profoundly felt by Aboriginal Health Workers (AHWs).”

You can download the full report here

Background

Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment.

Methods

Two theories informed the study: (1) „candidacy‟, which explores “the ways in which people‟s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or holding‟, a Central Australian philosophy which describes the principle andobligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed.

Results

Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, andcommitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld.

Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is„tractable‟ and „navigable‟ to its users. Staff also described entrenched patient discriminationin hospitals and the need to expend considerable effort to reinstate care.

Conclusions

Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs „hold‟ their users and enhance their candidacy to health care.

Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.

Theme 1: AMSs are different from private general practice

At all sites staff emphasised the unique aspects of AMS service delivery when compared with private general practice. In particular, engagement with local Aboriginal and Torres Strait Islander communities was repeatedly affirmed as the main difference. Staff viewed the typeof care they provided to be comprehensive, responsive to community expectations and patient rather than business oriented. By contrast, private general practice was viewed as focussing on maximising business revenue and providing reactive rather than preventive health care. It was also felt to inadequately acknowledge the particular needs of Aboriginal and Torres Strait Islander people.

I suppose, as an Indigenous doctor, you often get (patients saying) “I‟m happy to talk to you about this, but I wouldn‟t really want to talk to the GP down the road about it…..If it’s something to do with emotional, cultural, spiritual stuff, then that really does need to be addressed. But, you know, mainstream practices might not see it as „true‟ medicine. (GP1, regional AMS2)

Although community linkages are known to be an important component to chronic care, the depth of community connection in AMSs goes beyond this. Even for the only noncommunity governed health service, staff stressed the importance of ensuring community input and that this is usually not appreciated in mainstream services.

Even though we’re a mainstream health service we do work really strongly with the community. There‟s nothing more important than having local people (on staff)…that liaise between the community and us…We still have that strong contact, especially with the elders… Normally mainstream health services never venture out in Indigenous health to actually work with thecommunity and not many (patients) come to them. (Clinical director, urban AMS1)

Consistent with our theoretical understandings of kanyini, staff frequently commented on the obligations they felt to reach people and act in their best interests. This need to hold and nurture people was most profoundly felt by Aboriginal Health Workers (AHWs). One AHW stated that her work „doesn‟t just stop when we finish work‟. These obligations constitute a powerful mechanism for enhancing the candidacy of Aboriginal and Torres Strait Islander communities to health care. For AHWs there was an unconditional quality to the care provided, subtly blending the more demarcated work responsibilities with diffuse personal obligations in the community. Whilst these obligations may manifest quite differently for non-Indigenous staff a similar dedication beyond the ordinary was apparent. This duty to reach people also helps explain why health promotion constitutes a key part of service activity. Bridging clinical services with activities that develop community capacity wereviewed as central to health service function.

Daniel (pseudonym), an Aboriginal project officer, works on a shared responsibility agreement with the football club.…I think that is a really good example of delivering health in a very different way and engaging thecommunity‟s strengths. Rugby league is a huge factor for a man and it shows in figures that men attending the clinic are still under represented….So this work has seen an investment of infrastructure in the community sector as well as furthering this clinic. (AHW project officer 1, urban AMS1

In order for an AMS t o „hold‟ and nurture its community, this engagement is needed at all levels of the organisation, not just with the governing board. The employment of local Aboriginal and Torres Strait Islander staff across a variety of positions allows this holding to be adequately enacted. It affirms community linkages and the consequent legitimacy of the organisation.

Being a community controlled service you not only have it (community control) at the board level but it should be reflected in the organisational structure right through to even the groundsmen…it gives the staff themselves a sense of belonging and knowing that it is owned by the community. We all live in this community so we’re a part of the organisation and we‟re working for it, showing to the wider community that we are able to work at all these different levels..(AHW1, regional AMS3)

A key component to enhancing candidacy to health care is that services are easily navigated by their users. Staff from all professional backgrounds particularly commented on the availability of transport services as a key component to a navigable health service. Rather than merely an ancillary support, transport was viewed as an integral part of health care itself.

Staff commented that health care standards were heavily influenced by the availability of transport and that its absence „ defeats the purpose of us being here‟. For the two remote services, transport was critically important. One service provided daily visits to homelands and transport to the major referral centre for acute or specialist care. This consumedsubstantial monetary and human resources. For the other remote site airplane transportservices were especially dire with long wait times and patients having to travel alone toattend appointments. This left many fe eling vulnerable when „stuck‟ without family in the referral centre. For some people this impacted greatly on future decisions to seek specialistcare.

Thus transport is a key mechanism by which people are supported to navigate the system

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