“ Hearing awareness week is a good time to reflect on the impact of poor hearing. Unfortunately we get so involved in social outcomes; we are often bombarded with information and misinformation.
I admit I am so intense with ears, to the point were I can have a conversation and lose my friend from talking too much “medicine”. I thought it might be nice to go back to basics to help the understanding for the community.”
Dr Kelvin Kong, an ear, nose and throat specialist gives us the score on Otitis Media and the importance on ear health for Hearing Awareness Week writing for IndigenousX see part 2 below
Kelvin hails from the Worimi people of Port Stephens, north of Newcastle, NSW, Australia. Being surrounded by health, he has always championed for the improvement of health and education.
Complementing his practice as a surgeon, he is kept grounded by his family, who are the strength and inspiration to him, remaining involved in numerous projects and committees to help give back to the community.
“Hearing is all about connection,’ Kristen said.‘Hearing enables us to connect and communicate – whether you’re in school, a family or a workplace.This Hearing Awareness Week please cherish your hearing and take steps to protect it.”
Apunipima audiologist Kristen Tregenza, works across eleven remote Cape York communities identifying hearing issues, has a message for all ages this Hearing Awareness Week (21-27 August 2016).
Cherish Hearing this Hearing Awareness Week
Littlies: Kids need to hear to learn how to talk, behave, learn and communicate. Kids are most susceptible to ear infections (which, if left untreated can cause permanent hearing loss) between the ages of nought – four.
Kristen’s advice for parents of littlies:
Never smoke around children as smoke damages the lining of little ears
Teach your children to wash their hands and blow their nose to minimise risk of infections
Whenever you take your child to the health centre, no matter what for, ask the them to check your child’s ears
Fill your child’s ears with stories, words, poetry and songs
Teenagers: Kristen is seeing many teenagers with first stage hearing loss due to playing music too loudly through headphones.
Kristen’s advice for teenagers:
If your ears ring after the music has stopped, your music was too loud.
Either turn the sound down a bit, or listen for a shorter period.
Experiment to see how loud you can have it without causing ringing in your ears
Adults: Adults can experience hearing issues for a range of reasons – from industrial noise to undiagnosed issues earlier in life.
Kristen’s advice for adults:
Take it seriously – we need to cherish the hearing. Look after the hearing you have and manage what you don’t
Head to your local health centre and ask for a hearing check
Dr Kelvin Kong, an ear, nose and throat specialist gives us the score on Otitis Media and the importance on ear health for Hearing Awareness Week.
Hearing awareness week is a good time to reflect on the impact of poor hearing. Unfortunately we get so involved in social outcomes; we are often bombarded with information and misinformation. I admit I am so intense with ears, to the point were I can have a conversation and lose my friend from talking too much “medicine”. I thought it might be nice to go back to basics to help the understanding for the community.
One of the things I did not want to do is create a non-readable document that we tend to do in medicine. So this is a straightforward guide to otitis media (ear infection), as I would explain to my patients.
The name itself is confusing. In medicine we forget that we have assumed another language, based on Greek and Latin words. Otitis comes from late 18th century: modern Latin, from Greek ous, ōt- ‘ear’ and itits, meaning inflammation. So Otitis, just means inflammation of the ear. Media, again Latin in origin, means middle layer. So, Otitis media is simply inflammation of the middle layer of the ear.
The ear is divided into 3 parts. An outer, middle and inner part.
Outer ear: The outer ear consists of the auricle or pinna, that is, the bit we can see. Yes some people have various names for them, some not so kind (wing nut, dumbo, Billy Big Muku’s etc), in my language, Gathang, it is known as the “Muku”. This is often decorated with piercings or multiple piercings in some cases.
The outer ear also has a tunnel that leads to the Ear Drum. This tunnel is known as the external auditory canal. This is where we find wax (which is normal) and may be traumatized with cotton buds (yes, stop using them in your ears).
Inner ear: The inner ear houses the important nervous structure of the ear. The wiring, if you like, that transmits a mechanical sound wave into an electrical one. I am continually amazed that we have the ability to change a mechanical energy into an impulse that our brain may translate for us. The intricate nature of this is not the scope of otitis media, but just to know it is important.
Middle Ear: So the ‘middle of the ear’ contains the vibratory component. A sound wave is channelled from the air via the pinna, to a special structure known as the external auditory canal (ear tunnel) to reach the tympanic membrane (ear drum). These make the ear drum ‘dance’ or wobble. The vibrations are then transmitted via 3 delicate ear bones to ensure the energy is not lost and converts the mechanical energy to and electrical impulse when it meets the inner ear.
So if the middle ear is full of fluid, or even worse infected fluid, then the eardrum and ear bones (ossicles) cannot function! I like to compare it to a real music drum (eg bongos) that you can tap (or bang). Imagine if you jumped into the ocean with the drum (bongos), and try to play them underwater, it wouldn’t work. That is, you cannot hear. We haven’t even started talking about the infections and complications.
So this beautifully designed apparatus and organ has the ability to help us communicate. Our rich culture has such a strong aural history and it is imperative for us to be able to pass on our culture. We need to be able to hear to pass on our stories, laughter and wisdom.
” In the Northern Territory, as elsewhere in Australia, Aboriginal and Torres Strait Islander people disproportionately experience poor health – much of which stems from SDoH factors. Concerted action must be taken by the incoming government to address these.
For instance, overcrowded housing for Indigenous people is a major problem in the Northern Territory and contributes to increased rates of infectious diseases. It is associated with the spread of ear and eye diseases, skin infections, respiratory infection, and streptococcal infections causing rheumatic fever and rheumatic heart disease.
Education and literacy are strongly associated with lifestyle choices and health literacy. The incoming government must prioritise strategies which improve access to education and increase educational participation for Aboriginal and Torres Strait Islander people across the Northern Territory, including early childhood education. “
The RACP’s Northern Territory Committee
#DondaleKids
“As in other Australian states and territories, Aboriginal and Torres Strait Islander youth and adolescents are hugely overrepresented in the Northern Territory justice system.
The special needs of these young people need to be considered. This should include the involvement of the Aboriginal Community Controlled Health sector in the provision of culturally specific and safe care. Culturally appropriate services and support programs are also needed post juvenile justice incarceration.
We welcome the Royal Commission into Child Protection and Youth Detention Systems of the Northern Territory; however we are calling for the Terms of Reference to be broadened to cover health. It is also crucial that all those who have been victims of any abuse receive immediate support and treatment for physical and mental health issues.
The disproportionate number of Indigenous young people in detention makes it essential that formal processes and mechanisms are put in place to facilitate the participation of Aboriginal and Torres Strait individuals and communities in the work of the Royal Commission and the overhaul of the Northern Territory’s incarceration culture.
The CLP abolished the Aboriginal Affairs portfolio, but reinstated it in 2015, has set public service Aboriginal employment targets and had pledged to invest more in remote housing, with a $1.65 billion program to build 240 houses a year for eight years in remote communities. Labor has pledged to give communities greater control over local government, education and training, health, childcare and justice, as well as promising a $1.1 billion 10-year remote housing program.
The Royal Australasian College of Physicians (RACP) is committed to working with all political parties to inform the development of health policies that are evidence-based and grounded in clinical expertise, that focus on ensuring the provision of high quality accessible healthcare. The Northern Territory Committee of the RACP utilises the knowledge and expertise of Northern Territory based members to develop policy positions and proposals which prioritise the health of all Territorians.
The RACP’s Northern Territory Committee has identified a number of policy priorities for the incoming government, accompanied by recommendations for action. These include:
Measures to address health inequity and the social determinants of health, as means to improve health outcomes and reduce rates of preventable diseases;
Improving access to specialist medical care for Aboriginal and Torres Strait Islander people and supporting the vital services of the Aboriginal Community Controlled Health sector;
Banning the use of lead shot for hunting;
Improving the provision of health, psychological and social services to adolescents in the juvenile justice system to facilitate rehabilitation and help detainees develop lifelong healthy behaviours;
Immediately ending the dangerous policy of open speed zones;
Implementing effective, community-led measures to reduce the harms of alcohol, including better utilisation of Alcohol Action Initiatives; and
Facilitating the provision of specialist medical services in community-based settings.
The RACP urges the incoming government to adopt strong policies which put the health of Territorians first, in line with the recommendations contained in this document.
Social Determinants of Health
Health is a matter that calls for a whole-of-government approach. The evidence is clear, an individual’s health is not only shaped by lifestyle choices but also by a range of socioeconomic factors which individuals often do not have direct control over. These are commonly referred to as the Social Determinants of Health (SDoH) and include housing, early childhood experience, economic status, transport, built and social environments and access to resources.
The evidence to date shows that:
Diseases and illness are exacerbated and disparately distributed in direct relationship to inequities in society.
Addressing the SDoH will reduce the burden of avoidable disease, resulting in savings to the health system as well as economic growth and development.
If action was taken to address the determinants of health at all levels of government, it is estimated that 500,000 Australians could avoid incurring a chronic disease.2
Governments can influence the SDoH by adopting an approach to policy-making that places health as a key decision-making factor in all areas of policy. This approach, referred to as Health in All Policies (HiAP), consists of systematically taking into account the health and health-system implications of all policy decisions, by seeking synergies between policy portfolios and avoiding harmful health impacts, in order to improve population health and health equity.3
In the Northern Territory, as elsewhere in Australia, Aboriginal and Torres Strait Islander people disproportionately experience poor health – much of which stems from SDoH factors. Concerted action must be taken by the incoming government to address these.
For instance, overcrowded housing for Indigenous people is a major problem in the Northern Territory and contributes to increased rates of infectious diseases. It is associated with the spread of ear and eye diseases, skin infections, respiratory infection, and streptococcal infections causing rheumatic fever and rheumatic heart disease. Education and literacy are strongly associated with lifestyle choices and health literacy. The incoming government must prioritise strategies which improve access to education and increase educational participation for Aboriginal and Torres Strait Islander people across the Northern Territory, including early childhood education.
In addition to adopting a Health in All Policies approach, a strong focus on health prevention is required. The absence of a clearly defined preventive health strategy in Australia is deeply concerning, especially with chronic conditions such as heart disease, kidney disease, cancer and type II diabetes, accounting for accounting for 83 per cent of premature deaths (deaths among people aged less than 75 years) and 66 per cent of the burden of disease in Australia. Investment in preventive health improves the population’s health and is critical to the long-term sustainability of the Northern Territory healthcare system.
Preventive health measures must address key contributing factors to chronic diseases in Australia, including alcohol consumption, obesity, poor nutrition and tobacco use. In order to effectively manage the preventive health risks posed by lifestyle factors and associated diseases, a coordinated approach is required.
The RACP calls on the incoming NT government to:
Adopt a ‘Health in All Policies’ approach to policy-making to place health as a key decision-making factor in all areas of policy which impact on individuals and communities’ health (i.e. housing, education, transport, built and social environments, etc.).
Develop a Northern Territory preventive health strategy which addresses and lowers the risk factors for preventable illnesses and diseases.
Support and contribute to the development and implementation of a national Australian Preventive Health Strategy.
Aboriginal and Torres Strait Islander Health
Data and experience shows that Aboriginal and Torres Strait Islander people access specialist services at a lower rate than needed, and they face many barriers in accessing specialist care – this is true whether they live in the city or in rural or remote areas.
For young Aboriginal and Torres Strait Islander people, access to sexual health information and services is critical. Concerted action is required to address the high levels of sexually transmitted infections (STIs) in Indigenous communities and to prevent increases in infection with blood borne viruses (BBVs). Aboriginal and Torres Strait Islander youth need to be empowered to promote and discuss good sexual health; supported to access timely, affordable and culturally appropriate sexual health services; with a target to reduce the incidence of STIs amongst Indigenous young people included in the Close the Gap objectives.
The RACP welcomed the launch of the Implementation Plan for The National Aboriginal and Torres Strait Islander Health Plan 2013-2023, with its recognition of the need for a national framework to improve access to specialist care that is needs-based, and initiated by and integrated with primary health care services. The RACP is committed to working with its partners to progress this work, including working with the NT government. It is vital that sufficient and sustained funding and resources are made available to drive this Implementation Plan, so that its aims become a reality.
Indigenous health leadership and authentic engagement of Aboriginal and Torres Strait Islander communities are crucial to achieving improved health outcomes. Service development and provision should be led by Aboriginal and Torres Strait Islander health organisations. The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, timely and culturally appropriate care to Aboriginal and Torres Strait Islander people, and must have long-term and secure funding to not only retain, but grow their capacity to do so.
The RACP calls on the incoming NT government to:
Allocate sufficient and secure long-term funding to progress the strategies and actions identified in the Implementation Plan that are the responsibility of the NT government.
Engage and consult with the RACP in order to utilise specialist expertise and clinical knowledge in overcoming barriers to accessing specialist care for Aboriginal and Torres Strait Islander people in the NT Time for Action on Health Policy: RACP Northern Territory Election Statement 2016 5
Implement specific strategies and initiatives to address the disproportionately high incidence of STIs and BBVs in Aboriginal and Torres Strait Islander communities.
Support the Aboriginal Community Controlled Health Sector to support the sector’s continued provision of Indigenous-led, culturally sensitive healthcare.
Build and support the Indigenous health workforce to grow their numbers and integration within multidisciplinary teams.
Banning use of lead shot for hunting
It is of significant concern that elevated lead levels have been found in over half of children tested in three Top End remote communities and in 20 per cent of adults. Updated guidelines from the National Health and Medical Research Council (NHMRC) of Australia recommend elevated levels be investigated and reduced. Inhalation or ingestion of lead can produce neurodevelopmental dysfunction in children, resulting in learning difficulties, and behavioural problems. Elevated lead levels can also contribute to dysfunction in cardiovascular, renal, neurological, and haematological systems in adults.
Lead shot used in guns remains a key source of lead exposure among populations where it is still commonly used; through directly ingesting game that has been hunted and therefore contaminated with lead shot, as well as handling lead ammunition (or playing with lead ammunition in the case of children), and consuming lead dust and particles.
For many Aboriginal and Torres Strait Islander populations, hunting and fishing yields continue to make up a considerable proportion of their diet. High consumption of game meat is also typical for many individual recreational and vocational hunters and their families.
Lead shot is banned for hunting waterfowl in the Northern Territory however Indigenous Australians hunting on Aboriginal-owned land are exempt from this legislation and therefore exempt from the protection it affords.
The RACP calls on the incoming NT government to:
Immediately ban lead shot for hunting in line with recommendations from the World Health Organisation and the National Health and Medical Research Council, and support appropriate access to alternatives.
Incarceration of adolescents
Significant improvements are needed within the juvenile justice system in the Northern Territory. The health and healthcare needs of young people in juvenile detention are rarely seen as a priority, despite the fact that these adolescents are among the most vulnerable in our community.
As in other Australian states and territories, Aboriginal and Torres Strait Islander youth and adolescents are hugely overrepresented in the Northern Territory justice system. The special needs of these young people need to be considered. This should include the involvement of the Aboriginal Community Controlled Health sector in the provision of culturally specific and safe care. Culturally appropriate services and support programs are also needed post juvenile justice incarceration.
We welcome the Royal Commission into Child Protection and Youth Detention Systems of the Northern Territory; however we are calling for the Terms of Reference to be broadened to cover health. It is also crucial that all those who have been victims of any abuse receive immediate support and treatment for physical and mental health issues.
The disproportionate number of Indigenous young people in detention makes it essential that formal processes and mechanisms are put in place to facilitate the participation of Aboriginal and Torres Strait individuals and communities in the work of the Royal Commission and the overhaul of the Northern Territory’s incarceration culture.
It is recognised that incarcerated adolescents are more likely to experience poorer health and life outcomes and disproportionately high levels of disadvantage over that of the general population, and it is increasingly recognised that their health needs are greater than adolescents in non-custodial settings.
Adolescence is a critical time in a person’s development, and it is imperative that juvenile detention provides opportunities for young offenders to rehabilitate and develop healthy behaviours for life. We acknowledge that the interactions between disadvantage, incarceration, poor health and well-being and life outcomes are complex, however this should not deter us from ensuring these young people are able to access the healthcare, support services and rehabilitation opportunities to support them to lead a healthy and productive future.
The RACP calls on the incoming NT government to:
Improve provision of health, psychological and social services to adolescents in the juvenile justice system, including a health screening within 24 hours of entry into detention.
Reduce reoffending and recidivism in the juvenile justice system and increase vocational productivity by addressing the social determinants of health through a “whole of Government” approach.
Improve the training of health professionals and others who work with adolescents in the juvenile justice system.
End Open Speed Zones
The open speed zone on the Stuart Highway puts hundreds of thousands of road users, tourists and local residents at risk each year. Northern Territory road users suffer a road safety record that is far worse than any other Australian state or territory. Its fatality rate is among the worst in the developed world – between February 2013 and March 2014, the fatality rate (17.79) was more than three times the national average of 5.11 deaths per 100,000 people.
These figures underscore a real and pressing need for the incoming government to commit to ending the policy of open speed zones in the interests of the health and safety of all Northern Territory road users and pedestrians. Road safety requires a comprehensive approach, and a vital element is missing when speed limits are not in place.
Since the reinstatement of open speed zones on the Stuart Highway in February 2014, the Northern Territory Committee of the RACP has consistently warned of the risks associated with open speed zones and advocated for an end to this dangerous policy. Speed is a relevant consideration in all road accidents. Higher speeds lead to a greater risk of a crash and a greater probability of serious injury if a crash occurs.
The RACP calls on the incoming NT government to:
Immediately abolish open speed zones on the Stuart Highway
Permanently end the policy of open speed zones across the Northern Territory
Show leadership and commit to road safety policies that focus on safeguarding the lives and health of all Northern Territory road users and pedestrians, in line with the principles of the National Road Safety Strategy 2011-2020.
Alcohol
The harms of alcohol are difficult to overstate. It is the world’s third largest risk factor for disease and eighth largest risk factor for deaths. It is a causal factor in more than 200 disease and injury conditions, and can lead to lifelong problems associated with Fetal Alcohol Spectrum Disorders (FASD).
The social and economic costs of alcohol to the Northern Territory are particularly high. National statistics have recorded the Northern Territory as having the highest per capita consumption of alcohol and the highest percentage of deaths attributable to alcohol. And while the epidemiology of FASD remains unclear due to a lack of standardised data, estimates suggest higher rates of FASD in the Northern Territory than the rest of Australia, particularly among Aboriginal and Torres Strait Islander children.
The RACP is particularly concerned about the harms of alcohol to children and young people, with the peak age for the onset of alcohol use disorders being only 18 years. The tendency of young people to combine drinking with high risk activities (such as drink driving) increases their risk of alcohol-related injury or illness, and in some cases can prove fatal. Risky drinking behaviours, combined with open speed limits (see above), creates conditions for further increases in the incidence of devastating road trauma and fatalities on Northern Territory roads.
The RACP calls on the incoming government to make better use of Alcohol Action Initiatives, as a potent tool for addressing the availability of alcohol while empowering local communities to restrict access to alcohol as they see fit. The previous Alcohol Management Plan (AMP) framework was shown to achieve stronger and more sustainable outcomes in reducing alcohol-related harms in communities where AMPs were locally driven and owned, and where supply measures were integrated with complementary demand and harm-reduction measures.
The RACP encourages the incoming government to prioritise the implementation of proposed new Alcohol Action Initiatives, as a means for the Northern Territory to partner with the Commonwealth to empower local communities to tailor a suite of initiatives covering alcohol restriction as well as better treatment facilities and community education to reduce local alcohol-related harms.
The RACP notes that development of a Northern Territory Alcohol Action Plan is currently underway, with a whole of government response to FASD to be included in the plan. The RACP encourages the incoming government to utilise the RACP’s evidence-based Alcohol Policy in developing the plan and to consult with RACP Fellows to ensure physician expertise underpins strategies to reduce alcohol-related harm in the Northern Territory
The RACP calls on the incoming NT government to:
Take full advantage of the new Alcohol Action Initiatives to partner with the Commonwealth to facilitate locally owned and managed initiatives to reduce alcohol related harm through a combination of alcohol restriction measures, education and better addiction treatment facilities.
Increase funding for alcohol treatment services in order to reduce the incidence of alcohol use disorders
Increase funding to facilitate workforce development to address unmet demand for alcohol treatment services.
Integrated Care
For the growing number of Australians living with multiple, chronic health conditions, navigating the health system has become increasingly complex. This problem also impacts people with disability and mental health issues. The care of individuals with multiple health problems is often disjointed, with the patient’s different health conditions managed by different health professionals.
Fragmented health services delivery not only impacts the quality of patient care, but leads to inefficiencies, duplication and wastage across the health system. An approach to healthcare which places the patient at the centre is required to not only improve the management of patients with complex care needs, but ensure the Northern Territory healthcare system operates efficiently and effectively.
Of particular priority for the RACP is the need to support increased provision of specialist services in community-based settings, such as primary healthcare centres, community clinics, Aboriginal Medical Services, residential aged care facilities and people’s homes. Community-based settings allow patients with multiple, chronic or complex conditions to be seen in convenient location, and facilitate greater collaboration and coordination between the different health professionals involved in patient care.
The RACP calls on the incoming NT government to:
Engage and consult with the RACP in order to utilise specialist expertise and knowledge when developing integrated models of care for the NT, including any involvement in the Health Care Homes trial, to ensure a multidisciplinary approach is taken.
Implement policies that promote and support health professionals and service providers to work collaboratively.
WHAT THE TWO MAJOR PARTIES ARE FOCUSING ON FOR THE NT ELECTION: AAP Summary
COST OF LIVING
The CLP says it has reduced the cost of housing and petrol over its term, and increased family subsidies. It says it will continue to do so with more land release, will offer $500 study vouchers, and will work to reduce the cost of food in remote areas. Labor has accused the CLP of planning to sell off public utility PowerWater Corporation. Labor is offering up to $26,000 in stamp duty relief for home buyers, and will issue seniors with a $700 debit card every two years.
LAW AND ORDER
The CLP made its legislation to presume against bail for young property offenders an election issue. It’s also promising more CCTV camera funding. Meanwhile, Labor is focusing on early intervention, prevention and rehabilitation of young people, as well as promising more police on the streets. Both parties have pledged to close down the Don Dale centre and both have promised a new police station for Palmerston.
JOBS AND THE ECONOMY
Chief Minister Adam Giles has promised to create 24,000 jobs next term, a third of which would be in the onshore gas industry, and the rest across marine infrastructure development, tourism, horticulture, indigenous housing, aquaculture, construction and defence. Labor says it will repurpose $100 million from the current budget for infrastructure stimulus to create jobs.
INDIGENOUS AFFAIRS
The CLP abolished the Aboriginal Affairs portfolio, but reinstated it in 2015, has set public service Aboriginal employment targets and had pledged to invest more in remote housing, with a $1.65 billion program to build 240 houses a year for eight years in remote communities. Labor has pledged to give communities greater control over local government, education and training, health, childcare and justice, as well as promising a $1.1 billion 10-year remote housing program.
MINING AND THE ENVIRONMENT
The CLP says developing the onshore gas industry is key to a stable future and job security in the NT, while Labor says if elected it will institute an indefinite moratorium on fracking until the process is proven to be safe. The CLP will institute world’s best practice regulations in relation to mining and energy projects. Labor will follow a science-based and transparent water license process, will support indigenous rangers and environment groups, and will move to a 50/50 renewable energy target by 2030.
The National Health and Medical Research Council is pleased to invite all eligible applicants to apply to the Indigenous Internship program.
The NHMRC’s Indigenous internship program provides a wide range of opportunities for Aboriginal and Torres Strait Islander students to gain insight into the work of the NHMRC, as well as to enhance their educational experience through practical work experience. An internship with the NHMRC provides:
exposure to government processes and requirements in relation to funding health and medical research,
experience in developing guidelines, identifying and promoting resolution of ethical issues,
exposure to mechanisms and challenges of disseminating and increasing uptake of knowledge, and
better understanding of the rationale for, and demands of, public administration and accountability.
A limited number of paid placements for internships are available in our Canberra and Melbourne offices from November 2016 to February 2017.
Eligibility
To be eligible you must be: enrolled in an Undergraduate or Masters degree in a health or medical research related field; able to work independently and as part of a team; and can provide evidence to confirm that you are of Aboriginal and/or Torres Strait Islander descent.
Applications for the 2016-17 Indigenous Internship Program close on 1 October 2016.
To find out more please see our Indigenous Internship Information, which details eligibility and selection, as well as the terms and conditions of the program
“Everything the government is talking about is in primary care, prevention and yet there’s not enough primary care training places in an ageing population and an increased morbid disease,
Because of years of lack of investment in general practice, there’s been considerable increase in the gap between specialist and GP remuneration, so that has to be a possible negative factor for some of the better and cleverer students.”
Australian Medical Association medical workforce committee chair Tony Bartone said the increase in specialists was needed, but the number of general practitioners remained too low especially in rural and remote areas
“Australia has long struggled to entice and retain medical workers to rural and remote regions.
The remote and rural regions of Australia have been under serviced by medical professionals,
There is a nation-wide undersupply of Indigenous doctors, and a great need in many areas like the Northern Territory, where Indigenous people make up almost a third of the population and have a higher burden of disease.”
The president of the Australian Medical Association’s NT branch, Robert Parker, said it was an ongoing challenge. SEE Previous article
The medical workforce has become skewed to specialist doctors while the number of general practitioners has barely changed in 10 years, in a trend that threatens to undermine the federal government’s push for better primary care.
The Australian Institute of Health and Welfare reported on Wednesday that the rate of general practitioners has remained steady around 114 per 100,000 people, while the number while the number of registered medical practitioners overall has increased by 3.4 per cent a year.
Health Workforce Australia, whose mission it was to manage the demand and supply of doctors, warned four years ago that Australia faced a massive shortfall of doctors by 2025, when a large number of them were due to retire.
But while there would be an undersupply of specialists in obstetrics and gynaecology, ophthalmology, anatomical pathology, psychiatry, diagnostics radiology and radiation oncology, there would be an oversupply of cardiologists, gastroenterologists and hepatologists and surgeons.
Prime Minister Malcolm Turnbull opened on Wednesday the first trial site for its “health care homes” program, which aims to co-ordinate the care and prevent the hospitalisation of people with chronic disease.
Australian Medical Association medical workforce committee chair Tony Bartone said the increase in specialists was needed, but the number of general practitioners remained too low especially in rural and remote areas.
There were currently 1600 training positions in general practice, which was about 100 short of what was needed.
“It’s got to come into your thinking when you could earn two or three times as much by being a specialist as in general practice.”
The colleges and the federal government would need to address the maldistribution of specialists by funding more training places in the regions and specialties where they were needed, he said.
Hornsby GP Elizabeth Marles, who is an advisor to the federal government on medical training, said if there were not enough GPs, health problems would be pushed into the sphere of specialists.
“It’s a significant problem in terms of health economics because we know that internationally the evidence is that the stronger the primary care workforce the better your health outcomes and the more cost effective it is,” Dr Marles said.
A spokesman for the Department of Health said GP numbers had increased substantially over time, from 16,601 full time equivalent positions in 2007-08 to 22,005 in 2014-15.
This was supported by an increase in the general practice training program from 600 in 2008 to 1500 in 2015.
“The Department closely monitors workforce supply trends over time, working with medical colleges, employers, states and territories and key stakeholders,” he said.
Rural Doctors press Release
The Rural Doctors Association of Australia (RDAA) has warned that the latest medical workforce data for Australia has shown a decline in the number of full-time equivalent (FTE) general practitioners in Remote, Very Remote and Outer Regional areas, and should be an alarm bell to governments and policy-makers that more must be done to entice and retain these doctors in the bush.
“RDAA is very concerned that in areas classified as Outer Regional and Remote/Very Remote, the number of General Practitioners (Full Time Equivalent) has decreased per 100,000 head of population in the previous 12 months”
RDAA Vice President, Dr John Hall, said.
“In Remote/Very Remote areas, the number of GPs (Full Time Equivalent) per 100,000 has decreased from 137 (in 2014) to 135.5 (in 2015). In Outer Regional areas, it has decreased from 116.8 (in 2014) to 116.3 (in 2015).
“This should be a real alarm bell for governments and policy-makers, and it reflects the urgent need for the role of National Rural Health Commissioner to be implemented sooner rather than later, in order to drive forward measures that will help reverse this decline.
“Policy-makers and governments need to understand that people in Remote/Very Remote and Outer Regional areas are often forced to travel vast distances to access a GP for even a basic appointment.
“Even the smallest reduction in GP numbers has a significant impact in these communities, where there is a higher prevalence of chronic disease and poorer health outcomes than for those living in the major cities or large regional centres.
“RDAA is also very concerned that while General Practitioner numbers per 100,000 population have improved in the Major Cities and RA2 (Inner Regional) classification areas, this may not be telling the complete story.
“While the Inner Regional classification includes some rural locations, it also includes very large regional centres such as Cairns, Townsville, Rockhampton and Mackay — if these centres are where the growth in GP numbers is occurring, as we suspect it is, then GP growth is clearly not meeting the needs of rural communities.
“This discrepancy in data underlines the fact that the Modified Monash Model classification system should be considered for this type of data collection and analysis going forward, rather than the outdated ASGC-RA classification system which the Government has already replaced for some medical workforce program purposes.
“The AIHW report has again underlined the fact that doctors working in Outer Regional, Remote and Very Remote communities continue to work longer hours than their city counterparts.
“In the Major Cities and Inner Regional classification areas, medical practitioners in the past 12 months have slightly reduced their average working hours, while the average hours for medical practitioners working in Outer Regional and Remote/Very Remote locations have remained the same.
“And with rural and remote locations across Australia continuing to struggle to attract specialists, RDAA cannot recommend strongly enough to the federal and state governments that there is an urgent need to progress a National Rural Generalist Framework in order to deliver more Rural Generalist doctors with advanced skills to rural areas.
“Rural Generalist doctors are able to provide a wide range of advanced medical and clinical services which integrate closely with rural general practices, and they can work closely with distant specialists to oversee the care of patients living in rural and remote communities.
“RDAA has welcomed the Federal Government’s election commitment that establishing a National Rural Generalist Framework will be a priority for the National Rural Health Commissioner when that position is itself established.
“We look forward to working with the Government to make both a reality.”
” The potential exists for HIV to escalate rapidly in the Aboriginal and Torres Strait Islander population – as has been the experience in other Indigenous populations globally. This potential is due to three main issues:
very high rates of other sexually transmissible infections (STIs) exist in many communities, and the presence of these increases the chances that HIV can be transmitted
increasing rates of injecting drug use – including increasing rates of methamphetamine (ice) use in Aboriginal communities, and
the close proximity of Papua New Guinea (PNG) to the Torres Strait Islands, and the mobility and interaction of PNG nationals and Torres Strait Islanders. PNG has the highest recorded rates of HIV in the Asia-Pacific”
Associate Professor James Ward is Head, Infectious Diseases Research Aboriginal and Torres Strait Islander Health at South Australian Health and Medical Research Institute (SAHMRI) and a guest editor of HIV Australia.U And Me Can Stop HIV
” Currently the lifetime cost of treating someone with HIV ranges from US $250,000 to US $500,000 (2006 figures).
Our Treatment as Prevention Strategy we have reduced new HIV cases in BC from 700 per year to less than 300 – which has provided savings of around $50 m per year.
We have also managed to nearly eliminate AIDS and there’s an important distinctions between AIDS and HIV – AIDS is the result of being infected with HIV for many years without treatment while HIV is an infection we can now treat and control the virus and prevent it from becoming AIDS.
In addition, people with AIDS can also be treated and become healthy and contribute to society like anyone else.”
Assistant Director, British Columbia Centre for Excellence in HIV/AIDS Dr Rolando Barrios
The Queensland HIV Treatment as Prevention (TasP) Roadshow took place over the last week of July and first week of August 2016.
The Roadshow, supported by the Queensland Aboriginal and Islander Health Council (QAIHC) and the HIV Foundation Queensland, engaged with health professionals working in Aboriginal and Torres Strait Islander and mainstream services across north –eastern Queensland.
Speakers included Assistant Director, British Columbia Centre for Excellence in HIV/AIDS Dr Rolando Barrios (also principal investigator of the Pharmacovigilance Program and Co-Chair of the Therapeutic Guidelines Committee), Director of Operations British Columbia Centre for Excellence in HIV/AIDS Ms Irene Day , Positive Living British Columbia Mr Glen Bradford and South Australia Health and Medical Research Institute Associate Head of Infectious Disease Research – Aboriginal and Torres Strait Islander Health Professor James Ward.
The Roadshow was aimed at educating health professionals and raising community awareness, a job made more urgent because of the spike in STI and HIV among Aboriginal and Torres Strait Islander people in Queensland over past 12 months.
The Queensland HIV TasP Roadshow included eight meetings with Aboriginal and Islander Community Controlled Health Services, and evening dinner meetings for health professionals in the same locations, starting in Brisbane on Monday, July 25.
The Roadshow brought together latest practice and evidence from around the globe in HIV prevention including the concept of treatment as a prevention and new medications such as pre-exposure prophylaxis (PrEP), both of which aim to significantly reduce the number of new HIV diagnoses.
Apunipima caught up with Irene Day and Dr Rolando Barrios at the Wuchopperen Health Service workshop on 1 August.
Apunipima: Tell me about the Roadshow
ID: The Roadshow is travelling throughout north – east Queensland talking about our concept of Treatment as Prevention (TasP) which was introduced by the British Columbia (BC) Centre for Excellence in HIV and AIDS in 2006. We’ve had a great deal of success with it in BC, in terms of driving down the rates of new cases of HIV. We’ve virtually eliminated AIDS, which is, of course different than HIV.
Apunipima: Is this both in the Aboriginal and mainstream populations?
ID: Both, but let me be clear we have not done as good a job in getting our Indigenous populations into care and treatment so that’s an area we are committed to working on more diligently. The good thing is that our provincial and federal government is very supportive and have made a commitment to working with the Indigenous population on HIV.
The virus is an issue not just in British Columbia but there is a significant increase in HIV in our Indigenous population in our prairie provinces, particularly Saskatchewan, as well so we definitely have more work to do there.
Apunipima: Break down Treatment as Prevention for me
So TasP means reaching out, engaging individuals (those who have been diagnosed and those who are at risk of contracting the condition) earlier into care and treatment. The key is getting people into testing, treatment and management early. Sustained treatment, that’s absolutely critical.
If you’re not being treated, the virus will replicate, your viral load will go up, your immune system will drop and you’ll become ill. Also, when you put good treatment in place you’re making spread of virus less likely.
The Treatment of Prevention strategy was introduced by us in 2006 and has been adopted in other countries including by the Queensland Government who signed an MOU with us in 2014.
We still have more work to do though, as BC is the only Canadian province that has adopted this Strategy.
Apunipima: Good treatments are available now – are they considered affordable?
RB: Currently the lifetime cost of treating someone with HIV ranges from US $250,000 to US $500,000 (2006 figures).
Our Treatment as Prevention Strategy we have reduced new HIV cases in BC from 700 per year to less than 300 – which has provided savings of around $50 m per year.
We have also managed to nearly eliminate AIDS and there’s an important distinctions between AIDS and HIV – AIDS is the result of being infected with HIV for many years without treatment while HIV is an infection we can now treat and control the virus and prevent it from becoming AIDS.
In addition, people with AIDS can also be treated and become healthy and contribute to society like anyone else.
Our Government has made the investment because, as our Director says, you make a decision now and pay it off or you mortgage your province and pay it off over many years. If we don’t do anything the infections will continue.
Apunipima: What are your key messages for Aboriginal and Torres Strait Islander populations when it comes to prevention, testing, treatment?
It’s no different than other parts of the world including BC, we experience the same issues in terms of marginalisation, low education, low income, drug use, mental health issues and so on. The key element, the message that we are giving to people is know your HIV status.
We know that when people know their HIV status they will immediately change their behaviour and there are studies in the US that show that 58 per cent of people who have been diagnosed immediately change their behaviour to lower risk behaviour.
Also, most people care about others so if you know that you are infected with HIV or you become aware you are HIV positive, you are going to try and prevent the transmission of the virus towards your loved ones.
And we know the importance of families for First Nations people, so it is an important area to consider and lastly, the earlier you are aware of your HIV status, the greater the benefits of the treatment so by starting treatment earlier, you prevent not only AIDS but other things as well as HIV may effect kidney, heart lungs and so on.
Apunipima: I’m old enough to remember what a big story this was in the 1980s , however things have changed since then and it is no longer a hot button issue or, in the West, a fatal disease. How hard is it to get HIV the attention it deserves?
ID: I think your comment is correct because people aren’t seeing the number of deaths related to AIDS. Unfortunately what people are missing is the issue HIV is having on particular populations. The Indigenous population, for sure, are on the cusp of a huge epidemic which needs to be addressed. Men who have sex with men, injecting drug users and sex workers also still experience have high rates of HIV.
RB: That said, what a wonderful situation we are in – in the late 80s, we had a condition we didn’t know the cause of. We now have extensive therapies and can extend the life of people with HIV so it’s not on top of the radar but things have improved and we are making a huge difference. We still have work to do but that is one of the reasons why we are here, the raise the profile and call people to action.
Apunipima: How did you link up with the Aussie mob?
ID: In 2014 we were in Melbourne for the International AIDS Conference but prior to that we were working with HIV Foundation for a strategy we could work collaboratively on and that was the treatment as prevention strategy.
So we signed an MOU with QLD who adopted the TasP strategy and as part of the MOU we committed to a knowledge exchange strategy. So we had a group that came from QLD to the BC Centre for Excellence in HIV and AIDS last year who stayed with us for about a week and a half and now we’re reciprocating and doing the roadshow with the HIV Foundation.
Apunipima: Is your goal to eliminate HIV?
ID: We will never eradicate it HIV because of human behaviour but what we want to do is to drive as many cases to undetectable levels as possible because if you are undetectable you don’t transmit.
Apunipima: And that’s doable now with the current treatments?
ID: I think it is doable now, yes.
RB: We have a toolkit of different interventions we can use and combined, this will help us control the HIV epidemic.
Apunipima: Do you think that because of things like PrEP, and effective treatments, people are taking condom use, not sharing needles and things like that less seriously as it’s not a deadly illness anymore?
RB: This was one of our early arguments in 2006 when we brought up the idea of treatment as prevention. If you think about on the back of decreasing HIV rates in BC, there was an outbreak of syphilis and other STIs and increasing rates of hepatitis C. This led us to believe that condom use and education alone are not effective when it comes to preventing HIV transmission. People who don’t want to use condoms and want to behave in certain ways will continue their trajectory in life.
Apunipima: Is this similar to the argument that if you put condoms in men’s jails you’re promoting homosexuality or if you provide safe injecting rooms you’re promoting drug use? But everyone knows that people will do these things anyway so you may as well do it safely? It’s not like if it’s not there it won’t happen.
RB: We know that condoms are highly effective in preventing HIV and STIs when used – the problem is if they are not used. Similarly what we would say, through using things like PrEP and Treatment as Prevention is that we are offering harm reduction. What we learn from sexual behaviour is that people don’t always carry that behaviour for the rest of their lives…
Apunipima: … so if you can just get them for that dangerous window?
ID: We look at the value of TasP in terms of four Ps.
Implementing TasP is good for public health policy, good for the public, good for politicians and good for the public purse because if you have people engaged in treatment, sustained on that treatment, and not transmitting, you are actually being cost averting to your healthcare system and I think there an opportunity when there’s limited healthcare dollars which have to be spread over a wide range of things, look at where we can have an impact in a short space of time – it’s like paying off a mortgage, you pay off a lump sum and then you’re able to move on to something else with that money down the road.
The other thing about TASP in BC, we’re applying that strategy to HIV but we’re also starting to apply it to Hepatitis C as well, and we think there’s an opportunity to expand that to addictions so we will be doing further work on that in the coming years.
RB: Treatment a Prevention is good for the person, good for public health in terms of avoiding transmission. Good for the purse because it saves cost for the healthcare system and good for the politicians, but in addition to that, antiretroviral therapy has shown to significantly decrease other medical conditions just because people are actually coming to treatment so we can diagnose diabetes earlier, we can diagnose high blood pressure earlier and several studies showing there is a decrease in co-morbidities particularly tuberculosis in Africa and actually there are a couple of studies in the US showing people with HIV are living longer than mainstream population because they are so engaged in care!
All our evidence points to TasP as a powerful preventative – people think that clients might not be adherent, they might not engage but we have proven this not to be the case with our program: people are highly adherent and committed to the program.
” This has never been more important, with one in two Australians living with a chronic condition and one in five managing two or more.
This coincides with 20 per cent of patients making up over 60 per cent of Medicare costs.
That’s why we’re investing nearly $120 million to roll out the first stage of Health Care Homes, including over $90 million in payments to support patient care and $21 million for infrastructure, training and evaluation.
The first stage will initially benefit up to 65,000 patients across 200 GP clinics and Aboriginal Medical Services Australia-wide and will be evaluated to enable refinements to the model prior to a national rollout.”
PRIME MINISTER THE HON. MALCOLM TURNBULL MP and MINISTER FOR HEALTH AND AGED CARE THE HON. SUSSAN LEY MP MEDIA RELEASE
Photo above file image meeting last month PM, Health Minister and AMA President
“ The reality is that GPs cannot afford to deliver enhanced care to patients with no extra support,
“There is no new funding for the Health Care Homes trial. Money has been shifted from other areas of the health budget.
“If the Health Care Homes funding model is not right, GPs will not engage with the trial, and the model will struggle to succeed.”
AMA President, Dr Michael Gannon
Chronic care finds new home in Medicare Federal Government Press Release
The Turnbull Government is strengthening Medicare to deliver better health outcomes for Australians.
As one of our first priorities this term, we are today announcing the ten regions across the country that will participate in stage one of our revolutionary Health Care Homes model.
Health Care Homes is a better way of delivering Medicare for Australians with chronic illness.
It will give Australians a local health care team – led by their GP – that they can trust to coordinate their health care needs throughout the year to ensure patients remain happy, healthy and out-of-hospital.
Health Care Homes is a better way to remunerate general practice that recognises the commitment and diligence they show every day in managing time-consuming chronic conditions.
It will allow doctors and their teams to focus on delivering quality improvements to patient care when they need it, no matter how often it’s needed, without the rigid constraints of Medicare’s current feefor- service model.
This has never been more important, with one in two Australians living with a chronic condition and one in five managing two or more.
This coincides with 20 per cent of patients making up over 60 per cent of Medicare costs.
That’s why we’re investing nearly $120 million to roll out the first stage of Health Care Homes, including over $90 million in payments to support patient care and $21 million for infrastructure, training and evaluation.
The first stage will initially benefit up to 65,000 patients across 200 GP clinics and Aboriginal Medical Services Australia-wide and will be evaluated to enable refinements to the model prior to a national rollout.
This will include the Primary Health Network regions of: Western Sydney (NSW), Perth North (WA), Tasmania (TAS), Hunter New England and Central Coast (NSW), Brisbane North (QLD), South Eastern Melbourne (VIC), Adelaide (SA), Northern Territory (NT), Nepean-Blue Mountains (NSW) and Country South Australia (SA).
Health Care Homes is a model of primary care designed by – and long-campaigned for – by doctors.
A model of care that could have already been benefiting Australians with chronic disease, had Labor not deliberately ignored the recommendations of their own health reform commission in 2009.
No Government has invested more in Medicare than the Turnbull Coalition to ensure access to universal health care for all Australians.
We are determined to ensure every dollar lands as close to the patient as possible.
Does Health Care Homes mean healthier patients and a healthier Medicare ?
GP SUPPORT KEY TO SUCCESS OF HEALTH CARE HOMES
Welcoming today’s announcement of the 10 Primary Health Network Regions to conduct the Government’s trial of the Government’s Health Care Homes initiative, AMA President, Dr Michael Gannon, said that GPs must be properly resourced and supported to make the trial – and the concept – a success.
Dr Gannon said the Health Care Home is potentially one of the biggest reforms to Medicare in decades.
“The AMA is delighted that the Government is using the Health Care Home trial to launch its renewed commitment to general practice and primary care,” Dr Gannon said.
“We especially welcome the Prime Minister’s role in actively promoting this key plank of the Coalition’s health platform for the new term of Parliament.
“The AMA shares the Government’s vision for the Health Care Home, and we have been actively engaged in its development.
“Under the model, patients have a continuing relationship with a particular GP to coordinate the care delivered by all members of the patient’s care team.
“We know from overseas experience that the model has the potential to support better patient outcomes, and can help to keep patients out of hospital. It aims to provide more support for patients, particularly those with more serious chronic and complex conditions.
“Importantly, it recognises the fundamental role of a patient’s family doctor who can provide holistic and longitudinal care and, in leading the multidisciplinary care team, safeguard the appropriateness and continuity of care.”
Dr Gannon said that GPs are managing more chronic disease, but in recent times their practices have faced substantial financial pressure due to the Medicare freeze and a range of other funding cuts.
“The reality is that GPs cannot afford to deliver enhanced care to patients with no extra support,” Dr Gannon said.
“There is no new funding for the Health Care Homes trial. Money has been shifted from other areas of the health budget.
“If the Health Care Homes funding model is not right, GPs will not engage with the trial, and the model will struggle to succeed.
“We urge the Government to provide new funding and resources for the trial, and lift the Medicare freeze and other burdens from GPs, in order to give this exciting primary care reform every chance of success,” Dr Gannon said.
The Australian Healthcare and Hospitals Association (AHHA) welcomes the Government’s commitment to Health
Care Homes and today’s unveiling of the program’s trial sites at Western Sydney Primary Health Network.
“The AHHA supports this reform aimed at providing better integrated care to Australians with chronic and complex conditions,” AHHA Chief Executive Alison Verhoeven said.
The AHHA urges the Government to ensure the Health Care Homes trial is provided with the funding and resources needed to succeed in delivering transformational change to the primary care system and to the care of all patients.
“The establishment of Health Care Homes across Australia was recommended by the Primary Healthcare Advisory Group to deliver continuity of care through coordinated services and a team-based approach according to the needs and wishes of the patients. It builds on the efforts of Primary Health Networks (PHNs) that are already implementing relevant services in their areas.”
“The establishment of Health Care Homes is a step in the right direction to resolving fragmented primary and acute care services for people with chronic conditions, but it will be important to get the funding balance right so that incentives promote value, not volume of services.
“However, the stated objectives cannot be achieved with inadequate funding and the investment proposed for this trial looks set to fall substantially short of requirements. Evidence from a number of sources suggests that funding of between $1300 and $2500 per person per annum would be required to truly deliver reform via a Health Care Home. There is much to be learned from previous coordinated care trials both in Australia and internationally about appropriate funding and incentives to promote quality care over volume.”
“The Health Care Homes package must be more than a one-size-fits-all approach. Chronic care reforms must be flexible, patient-centred and integrated with other reforms throughout the broader health sector, including the acute sector, and designed in partnership with the states and territories. Such initiatives have been shown to be most effective when primary care based population approaches are taken.
Ms Verhoeven said the trials would underscore the need for better primary health data and greater use of the My Health Record to support the design, implementation and evaluation of the reform. This requires the support of general practice, and national health statistics leadership to build a national minimum data set for primary care.
This must be shaped as a national data asset, not by commercial or niche sector interests.
“The data gathered by this trial must be used to launch Health Care Homes as a fully-resourced, integrated care program at the PHN level, aimed at improving the lives and health outcomes of Australians with chronic or complex conditions.”
Commitment to Health Care Homes welcomed – but more to do
The Royal Australian College of General Practitioners (RACGP) has welcomed the Federal Government’s progress in rolling out the first stage of the Health Care Homes pilot, with the announcement today of ten Primary Health Network (PHN) sites across Australia to take part in the trial.
The RACGP says commitment to the medical home model is a step in the right direction for the health of all Australians, however there remain particular concerns around the actual funding allocated to the Health Care Homes pilot.
Commenting on the announcement today, Dr Frank R Jones, President of the RACGP said that the announced $120 million in funding was not new money, and is actually being re-directed from other Medicare GP payments.
“The Prime Minister has today announced that nearly $120 million is being invested in the first stage of the Health Care Homes pilot. This is in reality $21 million from the Practice Incentive Program re-directed to infrastructure, training and evaluation, and $90 million of funding for some MBS chronic disease management items being cashed out of Medicare.
“This reallocation of funds does not represent genuine investment in the Health Care Home, and is instead a shuffling of existing expenditure,” said Dr Jones.
“In reality, the practices involved in the trial across Australia will be expected to provide more services, with the same amount of funding. In order to succeed, the trial must be properly resourced to support GPs and their teams to take on even more responsibility and to keep people out of hospital,” Dr Jones said.
According to the RACGP’s calculations, an appropriately funded trial will require $100,000 on average per practice per annum – in addition to current funding for chronic disease management items and other MBS items.
The RACGP has further recommended the Federal Government to extend the two year trial to five years, to allow proper implementation and evaluation.
“The overseas experience shows that outcomes from the medical home model improve over time. Extending the pilot to five years is crucial to fully test the model(s) in Australia and to understand what will and will not work for patients and the health system,” Dr Jones said.
The RACGP has developed the first set of Standards for the Medical Home, to align with the RACGP Vision for general practice and a sustainable healthcare system.
The Standards will be released at GP16, the RACGP conference for general practice in Perth, 29 September – 1 October 2016.
” Inequalities in health, Sir Michael says, are not confined to inequalities between Indigenous and non-Indigenous Australians: people in the middle of the social hierarchy will have fewer years of healthy life than those at the top, and those at the bottom have worse health than those in the middle.
‘There is a tendency to see health inequalities as confined to the shockingly poor health of Indigenous Australians,’ Sir Michael says.
‘There is a life expectancy gap of 14 years between Indigenous and non-Indigenous men and women. But in Australia’s general population, as elsewhere, the more years of education, or the higher the income, the better the health.
‘Health inequalities arise from inequalities in the conditions in which people are born, grow, live, work and age; and inequities in power, money and resources—the social determinants of health.”
The 2016 Boyer Lecture Series and Q and A turns a critical eye towards health policy. Epidemiologist Professor Sir Michael Marmot discusses how social determinants such as birthplace and income can have a greater effect on our lives than access to healthcare.
Q&A is hosting a special program off the back of the Boyer Lectures to discuss health inequality.
The ABC still has seats in the Sydney studio audience available and want to encourage your networks at NACCHO to join our discussion.
JOIN ABC TV’s Q&A live from Sydney with Professor Michael Marmot
This Monday 29th August, ABC TV’s Q&A will host a special program on ‘healthy inequality’ and we need you to join the debate!
The 2016 Boyer Lecture Series will be delivered by Professor Sir Michael Marmot, President of the World Medical Association, Director of the Institute of Health Equity and a leading researcher on health inequality issues for more than three decades.
This special Q&A will answer your questions about the challenges faced by communities in solving issues around inequality.
Professor Marmot will join the Q&A panel for the first time with:
The Chair of the Prime Minister’s Indigenous Advisory Council Warren Mundine
Sydney University Professor of Economics Deborah Cobb-Clark
Dean of Medicine at the University of Notre Dame Christine Bennett
CEO of the Australian Council of Social Service Cassandra Goldie
Would you like to join the debate? To join the live studio audience please register your details here and Q&A will be in touch with more information:
In the ‘how did you hear about us? section, please write: NACCHO
Who will deliver this year’s Boyer Lectures?
The 2016 Boyer Lecture Series will be delivered by Professor Sir Michael Marmot, the president of the World Medical Association, the director of the University College London’s Institute of Health Equity, and a leading researcher on health inequality issues for more than four decades.
Sir Michael’s lectures, the 57th Boyer Lecture Series, will explore the challenges faced by nations and communities in reducing health inequality.
Epidemiologist and former ABC Board member Fiona Stanley has called Sir Michael ‘the world’s most important social commentator and epidemiologist describing the social determinants of health’.
What will this lecture series cover?
Sir Michael’s lectures cast a critical, policy-minded eye over the social determinants on our health and well-being, ABC chairman James Spigelman says.
Sir Michael has said his key insight is that health is not simply a matter of lifestyle, or access to healthcare, but is instead related to the inequality of economic and social conditions that affect all of us.
About the Boyer Lectures
The Boyer Lecture series, named after former ABC chairman Sir Richard Boyer, is a series of radio lectures from a prominent Australian invited to express their thoughts on major social, cultural, scientific or political issues.
The first 2016 Boyer Lecture will be delivered in Sydney on Thursday 1 September 2016, and broadcast on RN over four consecutive Saturdays.
The Boyer Lectures are also podcast: you can subscribe on iTunes or on your podcast app.
“Rhetoric about closing the gap and advocacy for various Indigenous programs cannot paper over such a gaping hole in governance. It’s no surprise that public policy debates — not only in Indigenous affairs but also in areas such as health and education — are so impoverished.”
The Australia Editorial 24 August
“The CIS report contained “factual errors” in its analysis of projected federal government indigenous affairs spending, which he said was focused on delivering outcomes and ensures service providers are delivering results that meet the needs of local communities”.
The Australian government has built a better evidence base for the assessment and monitoring of grants,We are placing a strong focus on quantitative evidence
“If resources are being wasted or misspent, that needs to be challenged … there is no doubt that funds are not always being targeted to the community and to the areas of need, and that there have been drastic funding cuts to key frontline areas, such as legal services and early childhood education.”
Indigenous Affairs Minister Nigel Scullion
I’m willing to work with Minister Scullion to identify improvements on a co-operative basis, but let’s not pretend that the answer is to cut funding; the government needs to genuinely listen to indigenous people about what communities need.
“If resources are being wasted or misspent, that needs to be challenged … there is no doubt that funds are not always being targeted to the community and to the areas of need, and that there have been drastic funding cuts to key frontline areas, such as legal services and early childhood education.”
The criticism came as West Australian Labor senator Patrick Dodson called for “a clear emphasis on rigorous evaluation so money is being spent wisely
Almost $6 billion is spent each year on indigenous affairs but there is precious little evidence this money is doing any good. If you Google “closing the gap”, you’ll find hard data on, say, differences in longevity and literacy between black and white.
But there is no counterpart dataset on the successes and failures of the legion of spending programs aimed at indigenous welfare. It’s possible to say whether the gap is narrowing but not to distinguish between programs that represent a good investment and those that fail to achieve their goal.
Less than 10 per cent of 1082 such programs have ever been evaluated, according to a Centre for Independent Studies analysis that we reported yesterday. Of the 88 evaluations carried out, very few employed methods that could provide evidence of effectiveness.
Taking into account federal, state and territory government spending, as well as programs of the indigenous not-for-profit sector, the CIS verdict applies to annual expenditure of $5.9bn. That figure does not include the non-indigenous not-for-profit sector, such as universities. The cumulative total spent across the past several decades — a period in which some key indicators of indigenous welfare have gone backwards — represents a massive amount of money and a huge opportunity cost.
Rhetoric about closing the gap and advocacy for various Indigenous programs cannot paper over such a gaping hole in governance. It’s no surprise that public policy debates — not only in indigenous affairs but also in areas such as health and education — are so impoverished.
Too often the focus is on the amount being spent and whether it represents a cut or an increase, not an empirical analysis of outcomes attributable to particular programs. Duplication of programs also needs close attention. In the West Australian town of Roebourne, with a population of 1150, the CIS study documented 67 local service providers and more than 400 state and federal funded programs on offer.
Poor targeting of programs was another nagging problem. The CIS points out that most indigenous affairs policy fails to distinguish between markedly different sectors of indigenous Australia. Some 65 per cent of indigenous people had jobs and lives similar to other Australians; the obvious question is whether indigenous-specific spending on this sector amounts to middle-class welfare.
The neediest sector was those dependent on welfare and living on indigenous land where work and education opportunities were scarce. This profile represents only 13 per cent of indigenous Australia, or 70,000 people. There may be a case for diverting some funds to those in most need, assuming this is done through a program open to rigorous evaluation. The basic lesson is that spending itself is not a solution. With modest resources Noel Pearson’s Cape York Academy is achieving outcomes that state-run schooling could not.
The CIS report is a wake-up call. It makes sense to suggest that an evaluation be funded and built in as part of each and every program. It also makes sense for the commonwealth to show the way; it is the single biggest spender. Australia needs an indigenous affairs minister equal to the challenges of the portfolio. To date, Nigel Scullion has not inspired confidence as minister. It’s not just his clueless response to the Don Dale youth detention story. He gives no impression that he is seized of the serious subject matter of his ministry. What’s at stake is not only taxpayers’ money but also the chance to discover how to get good outcomes in indigenous affairs — which programs help people and which fail them.
The lack of accountability for indigenous program funding is “outrageous” and the awarding of contracts often appears politically motivated, prime ministerial adviser Warren Mundine says.
Mr Mundine, who chairs the Prime Minister’s Indigenous Advisory Council, said he had often been frustrated by a lack of detail and data since taking up to the role in 2014. “I asked for data when I first came into the job but it’s been very hard to get,” he said in response to a Centre for Independent Studies report that found a lack of proper evaluation in the $5.9 billion indigenous affairs sector.
“It’s a joke. I believe some programs are funded because of politics, others don’t have any evaluations. A lot of this stuff is politically motivated in the awarding of contracts.”
The criticism came as West Australian Labor senator Patrick Dodson called for “a clear emphasis on rigorous evaluation so money is being spent wisely. If resources are being wasted or misspent, that needs to be challenged … there is no doubt that funds are not always being targeted to the community and to the areas of need, and that there have been drastic funding cuts to key frontline areas, such as legal services and early childhood education.”
The CIS report, by researcher Sara Hudson, found that an inadequate focus on outcomes in indigenous affairs spending meant “too many programs are implemented because of their perceived benefit, rather than a rigorous assessment of a priori evidence”.
It examined 49 federal government programs, 236 state and territory programs and 797 programs delivered by non-government groups (though many of these were partly or fully funded by government). It found that just 8 per cent had been evaluated, and that even of these, “few used methods that actually provided evidence of the program’s effectiveness”.
Indigenous Affairs Minister Nigel Scullion last night claimed the CIS report contained “factual errors” in its analysis of projected federal government indigenous affairs spending, which he said was “focused on delivering outcomes and ensures service providers are delivering results that meet the needs of local communities”.
“The Australian government has built a better evidence base for the assessment and monitoring of grants,” Senator Scullion said through a spokesman. “We are placing a strong focus on quantitative evidence. An example of this is that we now analyse data on school attendance for Remote School Attendance Strategy schools every week.”
The government’s Indigenous Advancement Strategy, which accounts for $4.9bn in spending over four years, came in for criticism this year from a Senate committee which found its use of competitive tendering policies had disadvantaged some indigenous funding applicants, and short-term spending on programs had limited their effectiveness.
It has also been criticised for being a process which saw $500 million cut from the indigenous affairs budget although the government disputes this figure.
Senator Dodson said he was “willing to work with Minister Scullion to identify improvements on a co-operative basis, but let’s not pretend that the answer is to cut funding; the government needs to genuinely listen to indigenous people about what communities need.”
“Evidence from Indigenous health workers of “sly grogging” and “grog runs” is being used to argue alcohol restrictions should be eased in the Fitzroy Valley, where children suffer among the world’s highest rates of brain damage caused by maternal drinking.
Kids are being left hungry as parents spend all their money buying in alcohol as residents, mostly Centrelink recipients, were paying $150 a carton for beer.
“The ban, which still allows full-strength liquor in hotels, was extended to Halls Creek in 2009 amid an outcry over alcohol-fuelled violence, suicide and fetal alcohol syndrome.
Witness statements tendered by lawyers for hoteliers in the central Kimberley who are lobbying the West Australian Director of Liquor Licensing to ease the grog rules.
“After attending 50 funerals in 18 months, including a spate of 22 self-harm deaths over 13 months, many alcohol-related and 13 of them suicides, leaders from the Marninwarntikura Fitzroy Women’s Resource Centre (MFWRC) stepped up to fight for their futures.
Over a coffee, she explains that to stem the horrific effects of family violence, child abuse and suicide, they first had to stem the flow of alcohol. As CEO, Oscar led her corporation’s application to the State Government for alcohol restrictions.
“We had to stand up and say enough is enough,” she says. “Alcohol was destroying our community and it was affecting every aspect of life. It was being consumed to a level where everyone’s quality of life in Fitzroy Crossing was shocking. We had to stand up and fight for our future — our children’s future.
It was an Australian first — never before had alcohol been restricted to an entire community on such a scale. The women’s hardline stance was supported by a core group of men, but it also attracted criticism and fierce opposition. Members of their own families, some local councillors and the liquor companies felt the restrictions were too pervasive and too drastic.”
DRAPED in a splash of Kimberley colour, proud Bunuba woman June Oscar takes to the stage with some of WA’s big thinkers.
To her right is Chief Justice Wayne Martin and next to him is Perth-born polio-eradication campaigner Michael Sheldrick, a director of New York-based The Global Poverty Project. The rest of the line-up is impressive too, and Oscar, the only woman on the panel, admits she’s a little starstruck because the man asking the questions is academic, writer and TV host Waleed Aly.
“I’m pinching myself,” she says. “I can’t believe I’m here with you blokes. It’s a privilege, and it’s been so great to meet you Waleed. You’re one of my heroes.”
But Oscar, a social activist and community leader from the Fitzroy Valley in the state’s remote north, more than deserves her spot on the panel. She’s at the Disrupted Festival of Ideas in Northbridge — a gathering of mavericks for change — where Oscar has been invited to speak because for the past decade she’s been a lightning rod for sweeping social change in her home town of Fitzroy Crossing.
In May she was presented with the Desmond Tutu Reconciliation Fellowship Award by former governor-general Quentin Bryce, the same award won by Nobel Peace Prize laureate Aung San Suu Kyi. Her acceptance speech received a standing ovation.
After she steps off the stage, a stream of people waits to give her a hug or warmly grab her hand.
Oscar’s long fight to stamp out the ravages of excessive alcohol consumption in her community in the southern Kimberley has won her a swag of awards and a legion of supporters.
In July 2007 she spearheaded a female-led campaign to restrict the sale of full-strength takeaway alcohol across the Fitzroy Valley.
They are among 29 statements, including 10 by local indigenous people including health workers and child carers, to support claims that “sly grogging” and “grog runs” to other towns have thrived since a ban on the sale of full-strength and mid-strength takeaway alcohol in Fitzroy Crossing in 2007.
“There are some people who still don’t agree with the restrictions, but we had to take a stand,” she says. “Alcohol was playing a big part in the level of domestic violence, and it was tearing families apart.
“We could not tackle educating people about their violent behaviours and their emotional triggers until we had restricted their access to alcohol.”
Within six months, the results of the restrictions were undeniable — alcohol-related injuries in hospital presentations had fallen from 85 per cent down to below 20 per cent and alcohol-fuelled domestic violence incidents also fell by 43 per cent.
Children were going to school more often and doctors at the local hospital were staying for longer than three months to help the community rebuild its health and its future. Police reported that rapes, bashings and street drinking were also on the decline.
For Oscar, the fight was very personal. Among the 13 reported suicides in 2006 — which led to a coronial inquiry in 2008 — was her 39-year-old younger brother. Her grief, and the grief of those around her, pushed her to fight the grog head-on.
And then there was Hudson, the little boy from her extended family who was displaying developmental and intellectual deficits. They suspected it was a result of his mother drinking heavily right throughout her pregnancy.
“Everything I’m engaged in comes from a place of personal experience and lived reality,” Oscar says.
“There’s a really personal story for me in all of these issues, and it’s the same for most of the women in Fitzroy Crossing.”
Fitzroy Crossing where June Oscar decided to take action against the “rivers of grog”.
Hudson, and children like him, had facial irregularities, behavioural issues and learning problems. So the Marninwarntikura women held a bush meeting in 2008 and invited health researchers into the community to investigate.
They set up the Marulu: The Liliwan Project, working with researchers from the George Institute, the University of Sydney and the Telethon Kids Institute to study the incidence and prevalence of foetal alcohol spectrum disorder (FASD).
Initial studies of children aged seven and eight who had been born in 2002 and 2003 revealed Fitzroy Crossing had the highest incidence of the disorder in the country, and probably the world.
“When the women learnt that their drinking was harming their babies, they started to change,” Oscar says. “Now we are seeing more and more women who are pregnant abstaining from drinking. Some are finding it very difficult. It’s an ongoing battle.”
Dr James Fitzpatrick, head of FASD research at the Telethon Kids Institute, says Oscar’s intuition about the problems facing Fitzroy Crossing in 2008 has led to a huge drop in the number of women drinking during pregnancy. The rates fell from 65 per cent in 2010 to 18 per cent in 2015.
“June is incredibly courageous in her approach,” Fitzpatrick says. “After a long moment of community sobriety after the restrictions, she approached us to say they were ready to learn about FASD. She knows what she’s talking about and she’s steadfast in navigating what she often calls ‘a road out of hell’.”
Born in the heart of Bunuba country in the southern Kimberley, Oscar was the second of six children, brought up by her mother and mentor, Mona, now 82, a straight-talking domestic worker.
Her father was a white pastoralist, but three weeks after June was born she and Mona were forced to take refuge at the nearby United Aborigines Mission.
“His wife was not happy that he had fathered another child to an Aboriginal woman, so we were driven to the local police station and taken to the mission, where we stayed until I was three,” she says.
“I met him once when I was 19 and that was it.”
Despite this, she’s in regular contact with nieces and nephews from her four half-siblings on her father’s side.
“I’m a Bunuba woman, but I’m also a woman of European heritage and I have family from both sides,” she says. “I see people, I don’t see colour, or creed or ethnicity and I believe we are all connected.”
Mona later took a job at Leopold Downs Station and when Oscar was seven she was sent to boarding school at the nearby mission. Her family visited once a week and she would return to Leopold Downs to be with Mona during the school holidays.
“I don’t see myself as a member of the Stolen Generation,” she says. “I was never taken away from my mother in that sense, but I have lived through the massive impact it had on our people.”
She was sent to high school in Perth, staying at a hostel near John Forrest High School. It was the first time she heard the terms “boong” and “Abo”.
“I was a capable student, and I think I could have done better if I didn’t have to fight racism and taunts most the time I was there,” she says.
But it wasn’t until Oscar worked with Aboriginal activist and Yawuru man Peter Yu at the Aboriginal Legal Service in Derby that she had her own political awakening.
“I was working as a relief legal secretary and receptionist, typing up affidavits for the solicitors and the courts, when it hit home that what I had seen and experienced growing up was unacceptable and discriminatory,” she recalls.
“I reflected on my own life and understood that I could take action and change things for my whole community. Education and information were crucial.”
She was 29 when then Aboriginal Affairs Minister Robert Tickner rang her to invite her on to the first full board of the Aboriginal and Torres Strait Islander Commission. She even hung up on him the first time.
“I thought it was someone playing a prank — sometimes my mob did things like that, pretending to be someone important,” she says.
One of Oscar’s close allies in her work at Fitzroy Crossing is Emily Carter, another Bunuba leader and Oscar’s deputy at the MFWRC. The pair made a big impression on Kim Anderson, a former high school principal, who moved to Fitzroy Crossing five years ago after meeting them in Melbourne when they came to teach students about the languages of the Kimberley.
Anderson says that hearing of the pair’s efforts in teaching women about the effects of drinking during pregnancy impressed her and their “strong stance” in restricting the flow of alcohol was “phenomenal”.
Anderson has witnessed huge changes in the valley first-hand.
“I first went to Fitzroy Crossing in 2005, before the restrictions, and it was a very sad place,” she says. “When I went back in 2010 and the restrictions had been in place for some time — well, my goodness, what a difference. They never wavered in their decision to ban the sale of takeaway alcohol and that was incredibly courageous.”
Oscar and Carter are still working to promote the 28 surviving languages of the Kimberley region, signing up to a cross-cultural program with Melbourne’s Wesley College.
“Kids from Wesley come and stay with us and our kids visit them,” Oscar says. “It’s a chance for the Wesley students to be exposed to indigenous language and culture and issues.”
In 2009, the story of Fitzroy Crossing made it all the way to a commission on the status of indigenous women and children at the United Nations in New York. Oscar and Carter travelled with Labor MP Tanya Plibersek for the summit.
Their story struck such a chord when Yallijarra, a film about the Fitzroy Crossing and its children, aired, some delegates were in tears.
“Sometimes you have to get out of here to make a difference where it matters,” Oscar says. “I will go wherever I need to if it means that my community can grow and thrive from it.”
In the past two decades, Oscar has collected “many hats”, serving as a local councillor, language specialist and Bunuba Films director. She’s a member of the Lowitja Institute for Health Research and Bush Heritage Australia — and the list goes on. Three
Her quest to tell the stories of the valley have taken her all over the world, and she has lunched with the Queen and had drinks with Academy Award winners.
But Oscar is happiest by the Fitzroy River where the sights and smells of her childhood come flooding back.
“I love being ‘on country’,” she says. “Being down by the river just revives me. I love fishing in the spring with Mona. There’s a cave there, near the Geike Gorge, where we always retreat to. The Australian outback is the best part of the country and a big part of me.
“I suppose it’s true what they say,” she laughs. “You can take the girl out of the country, but you can’t take the country out of the girl.”
years ago she became an Officer of the Order of Australia.
The ban, which still allows full-strength liquor in hotels, was extended to Halls Creek in 2009 amid an outcry over alcohol-fuelled violence, suicide and fetal alcohol syndrome.
William Johnston, a night patrol worker in Halls Creek, says in the hoteliers’ written submission that “there is no less grog in town since the restrictions, maybe more”. “Every day someone is driving to another town like Kununurra to buy full-strength grog like beer and spirits,” he says.
Catherine Ridley, a registered carer with the Department for Child Protection, says in the submission that “kids are being left hungry” as parents spend all their money buying in alcohol.
One local health worker said in a statement that residents, mostly Centrelink recipients, were paying $150 a carton for beer.
Three businesses — Martin Peirson-Jones’s Kimberley Accommodation that owns the main Halls Creek hotel, the Leedal corporation that owns a Fitzroy Crossing pub and supermarket, and the Halls Creek Store — want permission to sell mid-strength takeaway beer.
They acknowledge in their submission, complied by law firm Dwyer Durack, that crime and alcohol-related hospital admissions in Halls Creek and Fitzroy Crossing have decreased since the ban. “While the situation has improved, an unintended consequence of the liquor restrictions is the thriving black market of full-strength liquor and the regular practice of grog runs,” it states, arguing a relaxation might deter this.
However, Fitzroy Crossing’s Women’s Resource Centre has applied to oppose any change. June Oscar, one of the indigenous women supported by West Australian Police Commissioner Karl O’Callaghan to secure the ban on full-strength takeaway alcohol, said the restrictions needed support and time rather than winding back.
When state coroner Alastair Hope examined the drug and alcohol-related deaths of 22 Aboriginal men and women in the region in 2007, he heard evidence that hungry children, neglected by alcoholic parents, had been sucking the teats of dogs.
June Oscar, who helped to bring in an alcohol ban at her home of Fitzroy Crossing. Picture: Richard Hatherly
“It is totally unacceptable that Aboriginal and Torres Strait Islanders are experiencing the highest rate of youth suicide in the world among young Indigenous men aged 25-29.
“Improving the health of Aboriginal and Torres Strait Islander peoples is one of Australia’s highest health priorities and a whole-of-system reflection is urgently needed.”
Dr Frank R Jones, president of The Royal Australian College of General Practitioners PRESS RELEASE
Aboriginal and Torres Strait Islander males are experiencing the highest rate of youth suicide in the world and health outcomes for all young Australians – particularly the disadvantaged – are falling. These disturbing results are revealed in a recent report Australian Youth Development Index 2016.
Commenting on the report, Dr Frank R Jones, president of The Royal Australian College of General Practitioners said that for GPs the report re-enforced the central concept that health risks not only affect a young person’s current state of health but also their health in years to come.
The other main health risk-related issues identified for youth between the ages of 15 and 29 years included alcohol, illicit drugs, sexually transmitted infections, obesity and mental illness.
“The report describes very worrying health trends among Australia’s youth and without urgent policy action to improve contextual social support systems and preventive healthcare services, it will get worse,” Dr Jones said.
The report, providing a snapshot of Australia’s 6.3 million young people aged between 10 and 29 years, reveals a significant decline in health and wellbeing since 2006, bucking the trend of other indicators which have seen positive increases such as educational attainment, employment opportunities and political engagement.
In addition to Indigenous disadvantage, marked disparities were found between urban and rural groups confirming inequities in health access and outcomes widening gaps for both groups.
“Whilst globally this report showed Australia had comparatively high youth development, it is clear there remains uneven results for our most disadvantaged young people confirming inequalities in social and health practices.
“We need to do more in terms of prevention and service responsiveness, particularly in areas of mental health care and drug abuse issues,” Dr Jones said.
“GPs play a crucial role in the provision of mental health services for all Australians but particularly so in rural and remote areas where there are less resources.”
RACGP Rural has been at the forefront in providing the necessary educational supports in the mental health arena, for our GP members who sometimes work in extremely challenging conditions.
Dr Jones said the RACGP is committed to raising awareness of the health needs for Aboriginal and Torres Strait Islander peoples and is a key signatory to the Close the Gap campaign.
The absence of an indicator around mental wellness limited the results in the report and needs capturing in future studies to help guide more supportive policy action in adolescent health interventions.
The RACGP believes in the equitable provision of health services and the discrepancy between health outcomes for youth in rural and urban areas, and youths of Indigenous and non-Indigenous communities is unacceptable.
“ Hearing awareness week is a good time to reflect on the impact of poor hearing. Unfortunately we get so involved in social outcomes; we are often bombarded with information and misinformation. 
