Report 1 : Indigenous health checks and follow-ups
Through Medicare (MBS item 715), Aboriginal and Torres Strait Islander people can receive Indigenous-specific health checks from their doctor, as well as referrals for Indigenous-specific follow-up services.
In 2017–18, 230,000 Indigenous Australians had one of these health checks (29%).
The proportion of Indigenous health check patients who had an Indigenous-specific follow-up service within 12 months of their check increased from 12% to 40% between 2010–11 and 2016–17.
Report 2 : Regional variation in uptake of Indigenous health checks and in preventable hospitalisations and deaths
Potentially preventable hospitalisations (PPH) and potentially avoidable deaths (PAD) are hospitalisations and deaths that are considered potentially preventable through timely access to appropriate health care.
While the risk of these health outcomes depends on population characteristics to some degree, relatively high rates indicate a lack of access to effective health care.
In Australia, Aboriginal and Torres Strait Islander people have PPH and PAD rates that are more than 3 times as high as those for non-Indigenous people.
All Indigenous Australians are eligible for Indigenous-specific health checks, which are a part of the Australian Government’s efforts to improve Indigenous health outcomes. The health checks are conducted by GPs and are listed as item 715 on the Medicare Benefits Schedule.
In this report, we contrast the geographical variation in Indigenous PPH and PAD with the variation in uptake of Indigenous-specific health checks at the local-area level (Statistical Area Level 3), by Primary Health Network and by state or territory.
Overall, areas with large Indigenous populations tend to have high rates of PPH and PAD and high uptake rates of Indigenous health checks. That areas with high rates of health checks also tend to have high rates of PPH and PAD may seem counterintuitive. However, any effects of the health checks on the rates of PPH and PAD are likely to become more apparent over time as there has recently been a dramatic increase in the rates of Indigenous health checks in many parts of Australia. It is reasonable to expect that there will be some lag time between an increase in the uptake of health checks and when positive effects on health outcomes can be seen.
We use a regression model to identify areas with unexpectedly high or low rates of PPH given the demographic composition of their populations and other characteristics of the areas (such as remoteness). Cape York, Tasmania and the northern parts of the Northern Territory stand out as regions with unexpectedly low rates of PPH. Regions with unexpectedly high rates include Central Australia, the Kimberley and some inner parts of Darwin, Perth and Brisbane.
Unexpectedly high or low rates of PPH can be due to a number of factors including:
performance of the local health-care services, including past performance affecting the health of local people
accessibility of hospitals and relative use of hospitals or other health-care services
people with poor health moving from areas without services to areas with services (for high rates)
unaccounted factors that influence the risk of PPH
These factors are all potentially important. How they influence reported health outcomes needs to be better understood to ensure that policy and management decisions are based on the best available information.
Aboriginal and Torres Strait Islander people can receive an annual health check, designed specifically for Indigenous Australians and funded through Medicare (Department of Health 2016).
This Indigenous-specific health check was introduced in recognition that Indigenous Australians, as a group, experience some particular health risks.
The aim of the Indigenous-specific health check is to encourage early detection and treatment of common conditions that cause ill health and early death—for example, diabetes and heart disease.
NACCHO note : Many of ACCHO’s throughout Australia offer incentives like Deadly Choices shirts to have a 715 Health Check
During the health check, a doctor—or a multidisciplinary team led by a doctor—will assess a person’s physical, psychological and social wellbeing (Department of Health 2016). The doctor can then provide the person with information, advice, and care to maintain and improve their health.
The doctor may also refer the person to other health care professionals for follow-up care as needed—for example, physiotherapists, podiatrists or dieticians.
This report presents information on the use of:
health checks provided under the Indigenous-specific Medicare Benefits Schedule (MBS) item 715; and
follow-up services provided under Indigenous-specific MBS items 10987 and 81300 to 81360.
The data include all Indigenous-specific health checks and follow-ups billed to Medicare by Aboriginal Community Controlled Health services or other Indigenous health services, as well as by mainstream GPs and other health professionals.
Note that the data are limited to Indigenous-specific MBS items, so do not provide a complete picture of health checks and follow-ups provided to Indigenous Australians.
For example, Indigenous Australians may receive similar care through other MBS items (that is, items that are not specific to Indigenous Australians), or through a health care provider who is not eligible to bill Medicare (see also Data sources and notes).
Throughout the report, ‘Indigenous-specific health checks’ is used interchangeably with ‘health checks’ to assist readability. Similarly, ‘Indigenous-specific follow-ups’ is used interchangeably with ‘follow-ups’.
Indigenous-specific health checks and follow-ups: data summary
Number of health checks
In 2017–18, there were about 236,000 Indigenous-specific health checks provided to about 230,000 Aboriginal and Torres Strait Islander people. The minimum time allowed between checks is 9 months, and so people can receive more than 1 health check in a year.
Between 2010–11 and 2017–18, the number of Indigenous Australians receiving a health check more than tripled—from about 71,000 to 230,000 patients.
Figure 3 shows the rate of Indigenous-specific health checks by four different geographic classifications—state/territory, remoteness area, Primary Health Network (PHN), and Statistical Areas Level 3 (SA3s).
This analysis is based on the postcode of the patient’s given mailing address. As a result, the data may not reflect where the person actually lived—particularly for people who use PO Boxes. This is likely to impact some areas more than others, and will also have a greater impact on the SA3 data than the larger geographic classifications. See Data sources and notes for information on areas most likely to be affected.
across states and territories, the Northern Territory had the highest rate of Indigenous-specific health checks (with 38% of the Aboriginal and Torres Strait Islander population receiving an Indigenous health check), followed by Queensland (37%). Tasmania had the lowest rate (13%).
across PHNs, the rate of Indigenous-specific health checks ranged from 4% (in Northern Sydney) to 42% (in Western Queensland).
Based on needs identified during a health check, Aboriginal and Torres Strait Islander people can access Indigenous-specific follow-up services—from allied health workers, practice nurses, or Aboriginal and Torres Strait Islander Health practitioners—through MBS items 10987, and 81300–81360 (see also Box 2).
Indigenous Australians may receive follow-up care through other MBS items that are also available to non-Indigenous patients. For example, if a person is diagnosed with a chronic health condition, the GP might prepare a GP Management Plan, or refer the person to a specialist. Data in this report relate to Indigenous-specific items only.
In 2017–18, there were about 324,000 Indigenous-specific follow-up services provided to 133,000 Indigenous Australians. This was an increase from around 18,500 follow-ups provided to 9,900 patients in 2010–11 (Figure 7).
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Feature article this week
1.1 National : Relationships key to better Indigenous Health – and the 715 health check is paving the way says Dr Mark Wenitong
“You really have to engage with the local Aboriginal community, so they feel comfortable to come in and get their 715.
You need to understand cultural sensitivities to get a proper medical history – you can’t diagnose if you don’t know what’s really going on with a patient, so building that trust is really critical.
Aboriginal and Torres Strait Islander people have the worst health outcomes of any community in Australia.
We have a responsibility as health professionals to take care of this community, the same way that we take care of any part of our community.
Our people can actually take care of themselves if they have the education and the information in their hands.”
Dr Mark Wenitong Apunipima Health Service
Mark is one of a kind. Descending from the Kabi Kabi tribal group of South Queensland, Mark is one of the first Aboriginal men to graduate as a Doctor and is now a powerful advocate for improving Indigenous health outcomes.
Mark says he was inspired to become a Doctor by his mother who was one of the first Aboriginal Health Workers to be trained in Queensland. Her work with the Cape York community, in particular tackling the surge of sexually transmitted diseases in the region at the time, inspired a passion for better health within the family.
“Mum’s legacy was what really made me want to become a Doctor. I wanted to be able to help our mob to look after their own health, to provide a cultural lens. For me, that’s why it’s so important that Aboriginal Doctors are part of our service system, we can translate research, evidence and even program work into real practice” says Mark.
“With more Aboriginal Doctors, we can relate to our people, overcome barriers and build cultural resonance.”
After studying and graduating from the University of Newcastle in 1995, Mark is now based in Cairns at Apunipima Health Service, working with the local Aboriginal and Torres Strait communities up north, both in the clinic and out in communities.
Mark says, the annual health check for Aboriginal and Torres Strait Islander people, item 715 under the Medicare Benefits Schedule, provides enormous opportunities for GPs to engage with Indigenous communities about their health needs.
“The importance of 715s can’t be overstated – it’s one of the most important innovations that Medicare, and the Government, has brought in. We needed to do it, because we needed to get an understanding of what people’s health profile was before they were unwell. Why wait until patients come to us with a chronic disease? Let’s start screening early,” says Mark.
With Aboriginal and Torres Strait Islander people 2.3 times more likely to suffer a chronic condition, the annual health check is designed to provide early detection and prevention. Mark says the assessment is critically important in improving Indigenous health outcomes.
“There’s a couple of aspects to a 715 that are really important. The first is the screening – there are lots of people that are asymptomatic – meaning they aren’t showing symptoms yet – that could have early disease like diabetes, hypertension. These patients may not come in until they get symptoms because people still think they have to be sick to come to a clinic. It’s an important way to engage the community, so they know they can come to a clinic whenever they need do,” says Mark.
“The other important aspect is that it’s a comprehensive assessment – a complete head to toe. By screening a broad array of physical, social and emotional factors, we get a really good picture of individual and community level health. Because we can identify problems early, we can also start early treatment.
“At a community level, we get really great data from undertaking the 715. We work with the local Elders groups to deliver 715 health check days out in the community, and screen people that otherwise wouldn’t come to the clinic. It gives us an idea of what the issues are at a really local level. We can then look at broader issues that affect the whole community, like immunisation, dementia, mental health and social wellbeing and can work to develop appropriate programs that tackle the specific issue a community might be experiencing.”
The annual health check is available for Aboriginal and Torres Strait Islander people of all ages, however nationally less than 30 per cent of patients are accessing the check.
Mark says it’s important to engage young patients with getting a 715 early as part of educating people about how to stay healthy.
“I see young people come in for their 715 and they’re very well. But I talk to them about health maintenance, talk to them about what they could end up like. Their uncle whose overweight, with no teeth and smoking outside. Our young people want to look deadly and fit, so we can help them with information and tips to stay in good health.
But with Aboriginal and Torres Strait Islander Doctors representing less than 1% of the general practitioner workforce it’s important that all GPs understand the benefits of a 715 for Aboriginal and Torres Strait Islander patients.
Mark says the key to improving mainstream health services for Aboriginal and Torres Strait Islander patients is to encourage practices to engage with their local community to build cultural competency.
“If Aboriginal people walk into a service and don’t feel welcome, they won’t come back. Access is a big issue – creating a safe space for people to feel welcome is important,” says Mark.
“You really have to engage with the local Aboriginal community, so they feel comfortable to come in and get their715. You need to understand cultural sensitivities to get a proper medical history – you can’t diagnose if you don’t know what’s really going on with a patient, so building that trust is really critical.
“Most GPs can do this fairly well with most people, so it’s just a matter of then learning a little bit more about Aboriginal social and cultural issues to be able to relate to these patients in the right way. If you do, you’ll make a big difference.
“Some mainstream practices I’ve worked with have done really simple things, like putting Aboriginal health posters up in the waiting room or hiring and Aboriginal Health Worker or Aboriginal receptionist to help people feel welcome.”
Mark’s message to health professionals is simple – help your Aboriginal and Torres Strait Islander patients in the same way you help any others.
“Aboriginal and Torres Strait Islander people have the worst health outcomes of any community in Australia. We have a responsibility as health professionals to take care of this community, the same way that we take care of any part of our community. Our people can actually take care of themselves if they have the education and the information in their hands.”
The 715 health check is available annually to Aboriginal and Torres Strait Islander people of all ages. Further information, including resources for patients and health practitioners is available at www.health.gov.au/715-health-check.
1.2 National : Donnella Mills Acting @NACCHOChair broadcast interview at Lowitja Conference in Darwin
1.3 National : Donnella Mills Acting @NACCHOChair and John Paterson CEO AMSANT presents at Lowitja the Coalition of ACCO Peaks on #ClosingtheGap
2. NSW : Katungul ACCHO newly appointed CEO for the next 12 months, Joanne Grant talks about what motivates her to get out of bed every day
What motivates you to get out of bed every day to come and work at Katungul and why?
I firstly want to pay my respects to the Walbunja peoples, some of whom are family, of the Yuin nation and I am really honoured to be able to work on their land and with the local Aboriginal Communities along the far South Coast of NSW.
There is well documented evidence of the disparity faced by Aboriginal people in Australia and still today our people are denied their basic human rights. The opportunity to make a change for our people is what really motivates me.
Working in the health sector has been an eye opening experience for me as we see daily the ‘real’ effects of colonisation and trans-generational trauma which presents in many forms, for our mob eg AOD, mental health, chronic disease, family breakdown to name a few. To be able to work in an organisation like Katungul, that can provide services and programs directly to our communities, and who value cultural safety is what I believe will make a genuine difference.
What are you most excited about taking on in the next 12 months?
I am keen for the challenge that lies ahead of me. Whilst I have been apart of the executive team at Katungul for nearly 4 years, to take the reins of our organisation requires a whole new level of responsibility, way of thinking and commitment.
I see my role as an opportunity to build on our successes and have us recognised for the work we do.
It disappoints me at times that our Government still does not fully value the significant role of an Aboriginal community controlled organisation, which is evident when you look at the funding options that bypass us. I believe, we hold the vital keys and answers to our solutions! I am keen to take the lead and have us write our own narrative of change as we move forward.
What can you personally bring to you role?
MMM.. talking myself up is not a big strength of mine, but when I look at my employment history I believe I can bring 30 plus years of demonstrated experience and commitment of working with Aboriginal and Torres Strait Islander Peoples with me.
When I left year 12 my first real job was with the Human Rights Commission, handling complaints of racial discrimination around Australia. This was a not just a job but a real life lesson for me, at that young age.It really opened my eyes up to the injustices my people faced. These stories have stayed with me throughout my employment journey and always motivates me to champion change.
What do you think will be your biggest challenges?
Working in any Aboriginal organisation is a hard ask, as we face many political challenges, at all levels including by our own communities. There seems to be a perception out there that we, Aboriginal organisations, receive a plethora of funding and are able to address ALLissues faced by our communities.
Unfortunately this is not the case, and we need to be clear and concise about what we can and cannot do and exceed where we are able to. Living in regional Australia itself is a challenge as local resources are limited which means we have to access support and services for our clients out of area. This is clearly evident in the AOD space with all clients requiring residential treatment/care having to leave the area and their family and Kinship networks which at times can be problematic.
What can the community expect to see from you in this role?
They can expect to see an Aboriginal woman lead with integrity, take on the challenges as they arise and to put the needs of the communities we serve at the centre of our business.
3. VicMDAS Family and Community Services team supports our clients as they strive to achieve their own goals in life.
We have specialist teams focussing on the different needs within our community:
• Aged and Disability
• Children’s Placement Services
• Family Services
• Youth Services
• Homelessness and Housing Services
Our staff work from a “Best-Interest Case Practice Model” – that means we support clients to achieve their goals and maintain their connections to their community, their families and, importantly, their culture.
4. QLD :QAIHC CEO sleeps out to raise vital funds for homelessness : Please Donate HERE
Last night ( Thursday 20 June ) the Queensland Aboriginal and Islander Health Council (QAIHC) CEO, Neil Willmett, slept out on the cold, hard concrete of Brisbane’s Powerhouse as part of the Vinnies CEO Sleepout.
The annual event raises much needed funds and awareness to address homelessness in Australia. For the CEOs involved it is one night of discomfort, but for more than 116,427 Australians, including more than 22,000 Queenslanders, homelessness is a constant reality.
This is the third year that Mr Willmett has participated in the CEO Sleepout, a cause close to his heart.
“It is well known that Aboriginal and Torres Strait Islander peoples are over-represented in the homeless population. Across Australia, approximately 25% of people who access specialist homelessness services identified as being Aboriginal and/or Torres Strait Islander,” said Mr Willmett.
Mr Willmett is striving to raise a minimum of $5,000 to help the St Vincent de Paul Society Queensland (Vinnies) provide support to people in crisis.
“I am proud to participate in the Vinnies CEO Sleepout. As the CEO of QAIHC, I lead an organisation whose membership has a positive impact on the most vulnerable. Across the whole of Queensland, the homeless population is in the thousands. Homelessness can have profound and ongoing effects on people and their health and wellbeing,” Mr Willmett said.
Funds raised at the Vinnies CEO Sleepout enables Vinnies to provide vital services to people experiencing homelessness. Vinnies provides emergency accommodation, advocacy support, budgeting services, living skills programs, emergency relief, transitional housing and access to programs that help rebuild the lives of Australians living in poverty.
Lot 4669 Forrest Avenue, Carey Park which is known as Jaycee Park will be transferred to SWAMS with the city agreeing to waive the development application fee of $34,196.
City of Bunbury Mayor Gary Brennan said the health hub would be a welcomed addition to the region.
“We are pleased to be able to provide the land to SWAMS for their health precinct and council would like to acknowledge all the hard work they do as well as the excellent service they provide to the community,” he said.
“By expanding their practice they will be able to do even more for their clients and make health care available and more accessible to those who need it.”
SWAMS chief executive Lesley Nelson thanked council for prioritising Indegenous health.
“This is about looking at a one-stop health hub to bring all of our programs and services under the one roof, in the one location,” she said.
“Strong local commitment and continuity are required to close the gap and that is why this purpose built, local facility is so important.”
During planning for the new purpose-built hub, SWAMS has partnered with University of Technology Sydney, to ensure an innovative, cutting edge design which will deliver positive outcomes for clients.
The build will include clinical and research facilities, administrative offices, dedicated maternal and child health facility and an outdoor Indigenous park in the one location.
There will also be a fenced-off children’s playground, landscaped gardens and new toilet facilities all open to the public.
Ms Nelson said they were still looking for funding partners and had sent the health hub plans out to a number of ministers.
“The total project will be around $28 million but if there is opportunities to undertake work at different stages that’s what we’ll do,” she said.
“We’re positive that it will happen, the first stage we’ll be looking at is building the health and wellbeing community centre and the landscaping and the park.
“That will get us started and showcase to the local community that something is happening on the site that is exciting.
“We know it’s important and this is part of trying to close the gap at a local level from the community – in terms of driving what they want to see here.”
SWAMS will now submit the development application to the City for assessment.
Once it has been approved, construction is expected to be completed within 12 months.
5.2 WA : AHCWA Starts new course in Aboriginal and/or Torres Strait Primary Health Care Practice
NEW COURSE STARTING THURSDAY JULY 25th 2019
If you are interested in completing the Certificate IV in Aboriginal and/or Torres Strait Primary Health Care Practice” course or would like more information please email email@example.com. or phone 92771631.
6. SA :AHCSA_ Study redefines gender policy for Aboriginal and Torres Strait Islander Peoples
7. NT : Minister Ken Wyatt Visits AMSANT office in Darwin after opening Day 2 Lowitja Conference
8.ACT : Winnunga ACCHO adviser says reports expose ACT disinterest in Aboriginal care
” THE release in late 2018 of two reports – “The Family Matters Report 2018”, which concerns Aboriginal and Torres Strait Islander children in out-of-home care or in touch with the child protection system, and the Bureau of Statistics report “Prisoners in Australia 2018″– are a wake-up call for Canberra.”
Jon Stanhope is employed as an adviser at Winnunga Nimmityjah Aboriginal Health and Community Service
“The Family Matters Report 2018”, which measures the trends in over-representation of Aboriginal children in out-of-home-care is as depressing as it is distressing. The report includes a jurisdiction-by-jurisdiction report card on the implementation of best practice in child protection as represented by the Aboriginal Child Placement Principles and the four building blocks of the Family Matters Roadmap. “The Family Matters Report” is a collaborative effort of SNAICC-National Voice for our Children, the University of Melbourne and Griffith University. In other words, it is rigorous and credible.
In summary, the report reveals (and not for the first time) that the ACT is among the worst-performing jurisdictions in Australia and, on a number of specific and major measures, the worst-performing jurisdiction in Australia when it comes to the care of Aboriginal children in contact with the child-protection system.
In relation to the Aboriginal Child Placement Principles, recognised nationally as of fundamental importance to the management and care of Aboriginal children in out-of-home care, the ACT is identified as the only jurisdiction in Australia that has refused to include in its child-protection legislation any of the recognised elements of self-determination or a human-rights-based framework for participation in child protection decision making such as consulting Aboriginal community controlled organisations and involving them in decisions about the placement or care of Aboriginal children.
In light of the ACT government’s practice of excluding Aboriginal participation in child protection it is no surprise that the ACT has the highest rate of Aboriginal children in touch with the care and protection system in Australia and the third highest rate of removal of Aboriginal children from their families in Australia. An Aboriginal child in the ACT is 14 times more likely than a non-Aboriginal child to be in out-of-home care.
Stunningly, despite these quite shameful outcomes the ACT has the lowest level of funding in Australia for intensive family support and the second lowest level of family support generally.
Unsurprisingly, there are clear linkages between children who have been removed from their family by care and protection services and poverty, disadvantage and ultimately contact with the criminal justice system. The ABS report – “Prisoners in Australia 2018” – to the extent that it exposes and details the over-representation of Aboriginal men and women in prison in the ACT, confirms the depth of the failure of the ACT government and justice system to address either the causes of or appropriate response to Aboriginal offending.
The headline finding in the ABS report is that the ACT has the highest ratio of Aboriginal people in jail in Australia. An Aboriginal person in Canberra is 17.5 times more likely than a non-Aboriginal person to be sent to prison. The next highest is WA with a ratio of 16 followed by the NT where the ratio is 12. The ACT also stands out as the jurisdiction with the highest increase in relative imprisonment of Aboriginal people between 2008 and 2018, with an increase over the 10 years of a massive 100 per cent. In that same period WA and SA reduced the relative imprisonment rate by 9 per cent and 1 per cent respectively.
There is perhaps no single better illustration of the extent of inequality in Canberra than that the city with the highest median household income, the highest rates of home ownership and private health insurance, the fastest growing median house price and the highest mean income in the nation also has the highest rate of indigenous incarceration.
There is a range of other data reported by the ABS that is as equally shocking as the raw rate of indigenous incarceration. For instance the rate of prior imprisonment (or recidivism rate) of Aboriginal prisoners currently in the AMC is a mind blowing 90 per cent, the highest in Australia. Of the 109 Aboriginal detainees in the AMC on June 30 a staggering 99 of them were recidivists.
Equally alarming is the rate of increase in the ACT in the crude imprisonment rate of Aboriginal and Torres Strait Islander people. Between 2017 and 2018 the rate in the ACT increased by 12 per cent to produce an increase over the six-year period from 2012 to 2018 of 89 per cent against a national average of 24 per cent. By way of comparison the growth in incarceration, over the same six years, in the NT, WA and SA was 8 per cent, 15 per cent and 18 per cent respectively.
That the rate of increase in the incarceration of Aboriginal people in the ACT, over the last six years, is 65 per cent higher than the national average and that the rate of relative imprisonment has doubled in the last 10 years is deeply alarming and surely demands immediate and independent investigation and an urgent response. However, for that to occur there needs to be someone in government who actually cares.
My fear is that the ACT government has sensed that the Canberra community doesn’t really care that much about the level of indigenous disadvantage and poverty in Canberra and has accordingly decided that there is no need for it to either.
Jon Stanhope is employed as an adviser at Winnunga Nimmityjah Aboriginal Health and Community Service.