NACCHO Aboriginal Health and #Smoking : @KenWyattMP announces $35.2 million funding #ACCHO Anti-smoking programs

These health services are all delivering frontline services to prevent young Indigenous people taking up smoking and to encourage existing smokers to quit.

Reducing smoking rates is central to the Government’s efforts to close the gap in life expectancy, but requires a consistent, long-term commitment”

Minister for Indigenous Health, Ken Wyatt

Over 100 NACCHO Articles about smoking

REDUCING INDIGENOUS SMOKING TO CLOSE THE GAP

The Australian Government will provide $35.2 million next financial year to continue anti-smoking programs targeted to Aboriginal and Torres Strait Islander people in regional and remote areas.

Minister for Indigenous Health, Ken Wyatt, said the Government had approved the continuation of funding to 36 Aboriginal Community ControlledHealth Services and one private health service.

“These health services are all delivering frontline services to prevent young Indigenous people taking up smoking and to encourage existing smokers to quit,”  .

“Reducing smoking rates is central to the Government’s efforts to close the gap in life expectancy, but requires a consistent, long-term commitment.

“Smoking causes the greatest burden of disease, disability, injury and earlydeath among Indigenous people and accounts for 23 per cent of the health gap between Indigenous and non-Indigenous Australians.”

Under the Council of Australian Governments (COAG) National Healthcare Agreement, all governments have committed to halving the 2008 adult daily smoking rate among Indigenous Australians, of 44.8 per cent, by 2018.

“The rate of smoking among Aboriginal and Torres Strait Islander people is still far higher than among other Australians and is damaging their health in many ways,” Minister Wyatt said.

It’s unlikely now that we will meet the COAG target, but we are making progress.

“It’s important that anti-smoking programs are meaningful for Indigenous people and changes made in recent years have ensured that only programs which are evidence based and effective are receiving grants.”

Continued funding for the 37 health services follows a preliminary evaluation of the Tackling Indigenous Smoking program which found that it was operating effectively and using proven approaches to changing smoking behaviour.

Aboriginal Health ” managing two worlds ” : How Katherine Hospital, once Australia’s worst for Indigenous health, became one of the best

 

” Katherine Hospital in the Northern Territory has gone from one of the worst facilities in the country when it comes to Indigenous health care to one of the best.

Their secret: engaging with Indigenous patients and supporting doctors.”

Dr Quilty his high level of specialist training has meant that patients who would have had to be evacuated to Royal Darwin Hospital can now receive treatment in Katherine. Full Story below

Photo above : Gaye is a 50 year-old cancer patient from Mataranka in the NT. Supplied: Simon Quilty

NACCHO support INFO

Aboriginal Patient Journey Mapping Tools Project:

Communicating complexity

The Managing Two Worlds Together project aims to add to existing knowledge of what works well and what needs improvement in the system of care for Aboriginal patients from rural and remote areas of South Australia (and parts of the Northern Territory). It explores their complex patient journey.

The relationship between patients and health care providers is the foundation of care and requires communication across cultures, geography and life experiences. As a staff member in one rural Aboriginal Community Controlled Health Service put it: ‘It’s like managing two worlds together, it doesn’t always work’.

Download Stage 3 Study Managing Two World Study Report

NACCHO Aboriginal Health News Alert :

Do we need to close the gap on Aboriginal hospital experiences ?

How Katherine Hospital, once Australia’s worst for Indigenous health, became one of the best

As published ABC NEWS  By Hagar Cohen for Background Briefing

When physician Simon Quilty arrived at the hospital, it was going through a major crisis.

“What had happened in 2010 is that the hospital found itself in a situation where things were falling apart,” he says.

A number of doctors complained to the NT Medical Board about a lack of supervision and the impractical workload. The hospital was on the verge of shutting down.

More than one in four Indigenous patients left Katherine Hospital before completing treatment, often without informing staff, the worst rate in the nation. These “take own leave” cases are complex, but one factor is Indigenous patients’ perception of inadequate treatment.

It’s an issue plaguing the health system nationally: a 2014 Federal Health Department report found that racism contributes to the low rates of access to health services by Aboriginal people.

Similarly, the number of patients who “discharge against medical advice” is recorded and recognised by health departments as a key indicator for the quality of Aboriginal healthcare.

In the NT, 11 per cent of all Indigenous patients discharge themselves against medical advice.

“These people have very complex illnesses,” says Dr Quilty. “Many of them are highly likely, if not treated well, to resolve in significant injury or death. Hospitals in remote locations really need high expertise to deal with the very sick patients that turn up here.

“Thirteen and 15-year-olds are developing type 2 diabetes, they’ve got kidney impairment by the time they’re 22 and they’re on dialysis in their early 30s. It’s a bit terrifying really.”

Back from the brink

The NT Department of Health conducted an investigation into the staffing crisis at the Katherine Hospital. Its findings weren’t released publicly.

Background Briefing can reveal that the final report concluded that there were “significant deficiencies in nearly all the essential dimensions of safe clinical service provision”, adding that the “root cause is that the medical service model is unsustainable and becomes more unsustainable with each passing year”.

Six years ago, a new general manager and a group of new doctors arrived with an ambition to turn things around.

Katherine Hospital

They’ve brought highly trained specialist doctors who are invested in the community, interpreters are used regularly and families of Indigenous patients are consulted on complex treatment plans.

In the past, interpreters were available but rarely used. Families weren’t a part of the consultation process. Many of the doctors were junior, and staff turnover was high.

The new management has made huge inroads in the way the hospital cares for Aboriginal patients.

This year, only 4 per cent of the Indigenous patients “took own leave”, making Katherine one of the best performing hospitals in the nation when it comes to caring for Aboriginal patients.

Systematic use of interpreters

In 2006, when respected Indigenous lawman Peter Limbunya, from the remote community of Kalkarindji, stayed in the hospital for 10 days, he did not have access to an interpreter, despite not speaking English.

At the end of his treatment, Mr Limbunya, who was part of the legendary Wave Hill walk off in the 60s, was flown to a remote airstrip 5 kilometres away from his community.

His family wasn’t told he’d be back that day and nobody was there to meet him. He died of dehydration.

During the inquest into his death, the coroner found that interpreters were not in use at the hospital.

His cousin, lifetime activist and advocate for Aboriginal people Josie Crawshaw, remains outraged. She says her uncle would have known “absolutely nothing” about his treatment and what was going on.

But things have come along way since then. The hospital’s Aboriginal liaison officer, Theresa Haidle, says improving the way doctors communicate is the key to developing Indigenous patients’ trust in their treatment plans.

Regular use of interpreters has been an essential part of Ms Haidle’s work. She says they’ve been key in making sure patients understand their illnesses and treatment options.

“English isn’t their first language. It may not even be their second or third either. If there’s any doubt, we get interpreters in, or even on the phone.”

The systematic use of interpreters is a big change at Katherine Hospital.

Ms Haidle says the hospital has a lot further to go when it comes to providing a culturally safe environment, but overall, the relationship with the Aboriginal community is getting better all the time.

“It’s like a big learning process for everybody,” she says.

“We have to break it down as simple as we can,” she says. “There’s not an Aboriginal word that means cancer, so how do you explain those things?

“I remember one day a lady had this fungus, and there’s no words for those things on women’s bodies, or inside. So I heard the interpreter telling her: ‘You know, like mushrooms growing?’ They got her to stay and get it treated.”

Changing doctors’ attitudes

Pip Tallis, who is training to be a physician at Katherine Hospital, has worked in hospitals in Alice Springs and Darwin, where she says many of her Indigenous patients left before their treatment was complete.

“I found it really hard to understand why,” she says.

“It was frustrating as a doctor, and there was a lot of frustration among the staff and no-one really took the time to understand why people were taking their own leave, or really did anything to change it.

“I think, there was a bit of hands up in the air. ‘Whatever, what can we do about it? It’s their problem.'”

The NT town of Katherine, seen from the air

Dr Tallis says that her perspective has changed since coming to work at Katherine Hospital.

“I’ve spent six months working with the team here and observing how they engage with the patients, and I think that they do significant things to result in people not taking their own leave,” she says.

“Previously I was very inflexible. Now I spend a lot more time appreciating why people take their own leave.

“I’m also picking up the subtle signs on a patient who’s starting to not engage. I’ll sit down with them and explore their issues. And if they say they want to just go for a walk, you just say, ‘Would you like to take some medicine with you just in case you don’t come back?'”

Care plans to lower ‘take own leave’ rates

The introduction of weekly meetings to go over care plans for the Indigenous patients means everyone in the hospital can keep up with what’s happening with individual patients

These meetings are attended by social workers, doctors, nurses and admin staff.

At one such meeting, Dr Tallis mentions Jason, a 30-year-old patient from the remote community of Ngukurr, 330 kilometres south-east of Katherine.

Jason has tuberculosis, and has left the hospital during treatment once before. His family has convinced him to return. Dr Tallis explains at the meeting that Jason doesn’t like the hospital food, and that special food is being provided for him.

“We tried really hard to engage him,” she says. “We even got bacon and eggs for him in the mornings so he doesn’t complain about porridge, he’s got a DVD player, USB drive, he got pizza the other day. So we tried really hard to make it possible.”

But there’s still a cultural divide. At the end of the meeting, Jason explains to another doctor that he thinks “white fella” medicine is too slow.

“I want to go back to bush medicine,” he says. “It’s better and works fast because we learned it from old people.”

More support for staff

The hospital’s general manager, Angela Brannelly, says the 2010 investigation into the staffing crisis recommended major changes to the way the hospital operates, its level of staffing and supervision.

She says supporting the medical staff was one of her first priorities.

“We took it very seriously and made some really serious changes to the way that the medical team was supported here. It was around ensuring that someone’s got their back,” she says.

Dr Quilty, who joined the hospital in 2012, was the first physician to have ever been employed at the hospital. Last year he won the Royal Australian College of Physicians’ medal for clinical service in rural and remote areas.

A dark-skinned doll

His high level of specialist training has meant that patients who would have had to be evacuated to Royal Darwin Hospital can now receive treatment in Katherine. Since 2012, there has been a decrease of 43 per cent in the number of total aeromedical evacuations to Darwin.

Many Indigenous patients who live in remote communities don’t like going to Darwin to receive medical treatment because it’s far from family and the hospital is bigger and less personal.

Gaye, 50, a cancer patient who was transferred to Darwin for chemotherapy says she felt lonely in Darwin. “In Darwin I was always sad and crying a lot,” she says.

No-one in Darwin had realised that Gaye was deaf, which made communication with medical staff virtually impossible. In Katherine her deafness was recognised by the nurses and she was given a hearing aid, which she says made a huge difference to her mental health.

Katherine Hospital now employs two full-time physicians.

Still no Aboriginal doctors

Katherine Hospital employs 24 doctors but none of them are Indigenous.

Ms Brannelly admits the hospital hasn’t done enough to attract Aboriginal doctors.

“That’s good advice for us, and it’s probably where we need to go in that space around seeking out Aboriginal medical officers to come and work for us,” she says.

“I think we have some work to do there, absolutely.”

NACCHO Press Release : Aboriginal Health #18C and #Racism : Proposed changes to #18C will throw Reconciliation out the window

It is so disappointing that after all the talk in Canberra in February and the goodwill that was generated, the Government is sending such a poor message to Aboriginal people about acceptance in our own country,

“Racism and discrimination have well documented negative impacts on mental health. If we fail to deal with the alarming rates of poor Mental Health in Aboriginal people, it will have ongoing detrimental impacts in preventing and managing chronic disease

 Young Aboriginal and Torres Strait Islander people take their own lives at a rate five times that of other Australians and infant mortality rates are going backwards “

NACCHO Chair Matthew Cooke said just a month after the Prime Minister committed to a new partnership with Aboriginal people through the Redfern Statement, he has put forward measures that would have potentially devastating impacts on the health and well-being of Aboriginal people.

Download a copy of the NACCHO Press Release or read in full below

NACCHO Press Release response to 18c amendments

Download NACCHO full submission to #RDA #18c enquiry here

submission-to-inquiry-into-freedom-of-speech-and-rda-draft

The Kenbi land claim was a hard-fought land rights battle, but it represents so much more than a battle over land. It was a story that epitomised the survival and the resilience of the first Australians, the survival and resilience of the Larakia people“.

Prime Minister Malcolm Turnbull

Great photo opportunity above for the PM during the 2016 election campaign , but what would be the #healthyfutures for these children with increased racial hate speech ?  

 ” In question time today, I asked Senator Brandis about the watering down of section 18C of the Racial Discrimination Act.

What insulting, offensive or humiliating comments does the Prime Minister think people should be able to say to me?

It’s sad that on Harmony Day, a day that celebrates Australia’s cultural diversity, inclusiveness and builds a sense of belonging for everyone, the Government wants to give permission for more racial hate speech

  Being the target of racist, hurtful comments is deeply distressing and causes deep harm “

Senator Malarndirri McCarthy addressing the Senate see video and text below

Along with powerful videos of MPs Linda Burney and Tony Burke addressing Parliament over 18C

“The challenging thing with regard to proposals to change the act is that they are being put forward by those who have never felt vulnerable. These are the people who have never been on the receiving end of racist comments or attacks.

“Our first Australians hold a special place in the Australian community. Our government should be taking action to empower, rather than to disempower them. To be serious about ‘Closing the Gap’, the evidence is clear around racism and all Australian governments should be doing everything in their power to address these issues .”

Members of the Public Health Association of Australia (PHAA) were shocked by the Government’s announcement being made on World Harmony Day the intention to change Section18c of the Racial Discrimination Act 1975, according to PHAA CEO Michael Moore.

”  The government’s reforms should, as the Inquiry recommended, address that problem specifically, and not be distracted with an abstract ideological debate, divorced from the social realities.

Section 18C is not needed to protect members of minority groups who are popular in the wider community. It is needed to protect members of unpopular minorities, and also vulnerable minorities, especially our First Peoples, Aboriginal & Torres Strait Islanders.

We support the idea of improving the process for handling section 18C complaints, so that trivial or spurious complaints are terminated quickly.”

Rod Little and Dr Jackie Huggins, Co-chairs, National Congress of Australia’s First Peoples

As leaders of 10 organisations representing a wide range of culturally diverse communities in Australia, we are profoundly disappointed at today’s announcement by the Federal government of its intention to amend section 18C of the Racial Discrimination Act.

The Government’s planned changes to the Racial Discrimination Act and the Human Rights Commission will weaken the protection of Aboriginal Australians from racial abuse in this country at a time when suicide rates in Indigenous communities are among the worst in the world, the peak body for Aboriginal medical services said today.

NACCHO Chair Matthew Cooke said just a month after the Prime Minister committed to a new partnership with Aboriginal people through the Redfern Statement, he has put forward measures that would have potentially devastating impacts on the health and well-being of Aboriginal people.

Mr. Cooke said all Senators must carefully consider the issues and rise above petty point scoring politics to defeat these amendments – which are based on an hysterical media campaign about the merits of the legislation due to a single court case and a recently published cartoon.

“Any changes to section 18C will alienate the very Aboriginal people the government says it is trying to support, and create even deeper divisions in our community,” he said.

“I urge all Senators to respect the voice of the first Australian peoples in this debate, listen to Aboriginal people about what needs to be done to close the gap, and vote down changes to laws that are likely to make it even wider.”

Mr Cooke said it was outrageous that watering down racial hate laws is a priority for the Government when the latest Closing the Gap report showed just one of seven targets are on track, and the Don Dale Royal Commission is shining a light on the treatment of Aboriginal children in detention.

Young Aboriginal and Torres Strait Islander people take their own lives at a rate five times that of other Australians and infant mortality rates are going backwards.

“It is so disappointing that after all the talk in Canberra in February and the goodwill that was generated, the Government is sending such a poor message to Aboriginal people about acceptance in our own country,” Mr Cooke said.

“Racism and discrimination have well documented negative impacts on mental health. If we fail to deal with the alarming rates of poor Mental Health in Aboriginal people, it will have ongoing detrimental impacts in preventing and managing chronic disease.

“The Government’s priorities should be on positive measures like the National Aboriginal and Torres Strait Islander Health Plan, which recognises the impacts of racism and discrimination inherent in the health system, and supporting the Aboriginal Community Controlled Health sector to fix the national crisis in Aboriginal health.”

PHAA urges all MPs and Senators to leave 18c alone

“Members of the Public Health Association of Australia (PHAA) were shocked by the Government’s announcement being made on World Harmony Day the intention to change Section18c of the Racial Discrimination Act 1975,” according to PHAA CEO Michael Moore.

Earlier this week Mr Moore attended a meeting on Aboriginal and Torres Islander Health where the issue of impact of racial discrimination on health was discussed at length. “The challenging thing with regard to proposals to change the act is that they are being put forward by those who have never felt vulnerable. These are the people who have never been on the receiving end of racist comments or attacks”.

“Our first Australians hold a special place in the Australian community. Our government should be taking action to empower, rather than to disempower them. To be serious about ‘Closing the Gap’, the evidence is clear around racism and all Australian governments should be doing everything in their power to address these issues”.

“A similar impact on health will be experienced by anyone who is discriminated against on the grounds of their racial or ethnic background,” said Mr Moore.

“It really is those who are vulnerable, and those who have been subjected to hateful jibes and vilification, who should be the ones making suggestions for change rather than those who are in the dominant group,” added Mr Moore.

“The PHAA calls on all MPs and Senators to leave the Act as it is”.

“People who already feel exposed to inappropriate comments do not need to be made even more vulnerable,” Mr Moore added.

The Report of the Parliamentary Joint Committee on Human Rights “Freedom of Speech in Australia” set the tone. Over ten thousand submissions were made and the Committee did not recommend changes. Of the twenty two recommendations, there was no consensus about a change to Section 18c.

Mr Moore concluded that “MPs and Senators should be taking guidance from the Parliamentary Committee on Human Rights that examined the issue rather than kowtowing to a small hump of ultraconservatives who have played political games in order to get the numbers for a proposal that will undermine the health of the most vulnerable groups in Australia”.

Harmony Day 21 March 2017

As leaders of organisations representing a wide range of culturally diverse communities in Australia, we are profoundly disappointed at today’s announcement by the Federal government of its intention to amend section 18C of the Racial Discrimination Act.

If implemented, these proposals will weaken, perhaps emasculate, existing legal protections against racist hate speech. They will give a free pass to ugly and damaging forms of racial vilification which do not satisfy the stringent legal criteria of harassment and intimidation. The publication of virtually any derogatory generalisation about an entire community group would, of itself, be permissible.

To offend, insult or humiliate a person or group because of their race or ethnic background necessarily sends a message that such people, by virtue of who they are, and regardless of how they behave or what they believe, are not members of society in good standing.

This cannot but vitiate the sense of belonging of members of the group and their sense of assurance and security as citizens, and constitutes an assault upon their human dignity. This has nothing to do with a contest of ideas or free speech – which is in any event protected under section 18D – and falls far short of the mutual respect about which we have heard.

Under the government’s proposals vulnerable community groups will now have no peaceful, legal means of redress against these kinds of attacks against their dignity. This would send a signal from government of a more lenient attitude to racism and would damage social cohesion. It is especially ironic that the government has put forward these proposals on Harmony Day.

The proposal to insert a generic “reasonable person” standard into the legislation has superficial appeal, but is unfair and unworkable. The proverbial person in the pub or on the “Bondi tram” does not have the background knowledge and insight into the particularities of a minority group that would be needed to make a fair and informed assessment of what is reasonably likely to “harass or intimidate” members of that group.

Under the existing law, the assessment is made by a reasonable member of the targeted community, that is, by a member of that community who is neither overly sensitive nor overly thick-skinned. This is both more logical and more just.

A generic reasonable person test would also create the possibility that members of a group that happens to be unpopular at any time for any reason would be unfairly treated. Section 18C is not needed to protect members of minority groups who are popular in the wider community. It is needed to protect members of unpopular minorities, and also vulnerable minorities, especially our First Peoples, Aboriginal & Torres Strait Islanders.

We support the idea of improving the process for handling section 18C complaints, so that trivial or spurious complaints are terminated quickly.

We note that the Parliamentary Joint Committee on Human Rights was unable to reach a consensus, or even a majority opinion, in favour of any of the government’s proposals to amend the substantive law. Its recommendations were all limited to suggested reforms to the complaints-handling process.

This is the sensible way forward. The problems identified by the QUT case and the Bill Leak complaint all related to deficiencies of process. The government’s reforms should, as the Inquiry recommended, address that problem specifically, and not be distracted with an abstract ideological debate, divorced from the social realities.

Rod Little and Dr Jackie Huggins, Co-chairs, National Congress of Australia’s First Peoples

John Kennedy, President, United Indian Association

George Vellis, Co-ordinator, and George Vardas, Secretary, Australian Hellenic Council NSW

Peter Wertheim AM, Executive Director, Executive Council of Australian Jewry

Patrick Voon, Immediate Past President, Chinese Australian Forum

Tony Pang, Deputy Chair/Secretary, Chinese Australian Services Society

Randa Kattan, CEO, Arab Council Australia

Vache Executive Director, Armenian National Committee of Australia

 

Senator McCarthy:  My question is to the Minister representing the Prime Minister, Senator Brandis. The Prime Minister has on at least 16 occasions ruled out his government amending section 18C of the Racial Discrimination Act. Today, on Harmony Day, we learned that the Turnbull government is proposing the removal of the words ‘insult’, ‘offend’ and ‘humiliate’ from section 18C. What insulting, offensive or humiliating comments does the Prime Minister think people should be able to say to me?

Senator Brandis: Might I begin by correcting the premise of your question: the Prime Minister has never, not on 16 occasions and not once, said that the government would never reform section 18C of the Racial Discrimination Act. He did say, as was the case at the time, that it was not a priority for the government.

Nevertheless, I think we all know that events have happened in this country in the recent past, in particular, the treatment of the QUT students, which was disgraceful, and the treatment of the late Bill Leak, which was disgraceful. The report of the Parliamentary Joint Committee on Human Rights, to which Labor senators and members of the House of Representatives continue, proposed beneficial law reform. What the Prime Minister and I announced a short while ago was a strengthening of the antivilification provisions of the Racial Discrimination Act.

What you did not mention in your question, which I think is a very important consideration, is the insertion, into section 18C of the Racial Discrimination Act, of a prohibition against racial harassment. Did you know that in 1991, when the then—

Senator Brandis: If your leader, Senator Wong, would just control herself, I might be able to address your question. You may or may not know that in 1991 the then Human Rights and Equal Opportunity Commission—

Senator Cameron: On relevance. The question was: ‘What insulting, offensive or humiliating comments does the Prime Minister think that people should be able to say to the senator?’ That was the question, and he has not gone near it. He should actually take off that Harmony Day badge. It is absolutely crazy that he has that on.

The PRESIDENT: On the point of order, the Attorney-General has been giving a detailed response to a detailed question. He is aware of the question.

Senator BRANDIS: In 1991, when the current part IIA of the Racial Discrimination Act was recommended, the Human Rights and Equal Opportunity Commission actually recommended to the parliament that one of the grounds of racial vilification should be harassment. That was one of the grounds recommended by the predecessor body of the Human Rights Commission. For some unaccountable reason that was not done by the then Labor government.

The PRESIDENT: Senator McCarthy, a supplementary question.

Senator McCarthy:  Minister Wyatt has twice indicated he would cross the floor to vote against changes to section 18C. What consequences will there be for members of the coalition who vote against the Turnbull government’s attempt to water down protections against racism?

Senator Brandis: I am absolutely certain that every member of the coalition will be voting for these changes to strengthen section 18C, every last one of them.

The PRESIDENT:  Senator McCarthy, a final supplementary question.

Senator McCarthy:  When asked why the government had no plans to amend section 18C, the Prime Minister said, ‘We did not take an 18C amendment proposal to the election.’ Why is Prime Minister Turnbull willing to cave in to the Right of his party room on section 18C, while he continues to refuse a free vote on marriage equality, despite the defeat of his proposed plebiscite?

Senator Brandis: Although I am a little loath to dwell on internal politics, may I say that strengthening protections against racial vilification and vindicating freedom of speech are causes that are embraced by all elements of the Liberal Party and the coalition. You may say that section 18C of the Racial Discrimination Act and the complaint-handling procedures of the Australian Human Rights Commission Act are perfect and incapable of reform. You may say that, but if you do you would be alone because there is no serious person in this country who has followed human rights debate who says that section 18C in its current form, which actually omits to prohibit racial harassment, or the complaint-handling procedures of the Human Rights Commission cannot be improved. Certainly, that is what Professor Gillian Triggs has said, and I agree with her. (Time expired)

 

QUESTIONS WITHOUT NOTICE: TAKE NOTE OF ANSWERS

Racial Discrimination Act 1975

Senator McCarthy:  The answer was incredibly disappointing, in particular on this day, Harmony Day. As we reflect on Harmony Day, I want to go to some of the answers to me and my questions by Senator Brandis. I want to begin with Senator Brandis’s response in terms of Prime Minister Malcolm Turnbull. I asked, first up, about the fact that Mr Turnbull has said on at least 16 occasions that he had ruled out his government amending section 18C of the Racial Discrimination Act. Senator Brandis said that he had not said that—certainly not that many times. I just want to point out some very important media coverage of the moments when Mr Turnbull denied that it was a distraction for his government. In news.com, on 31 August 2016: ‘The government has no plans to make changes to section 18C’. He said it again on 30 August in The Australian:

It’s filled the op-ed pages of newspapers for years and years but the government has no plans to make any changes to section 18C. We have other more pressing, much more pressing priorities to address.

Then again on 14 November 2016, on ABC 7.30, Mr Turnbull said:

18(C) is talked about constantly on the ABC. It’s talked about constantly in what’s often called the ‘elite media’. I’ve focused overwhelmingly on the economy.

It appears that Prime Minister Turnbull has changed tack. Today is one of the most significant days in Australia and across the world. The purpose behind Harmony Day is to reflect on the diversity of culture across this country, something that unfortunately has been really stained by the Prime Minister’s move to change the Racial Discrimination Act on this day in particular. It is incredibly sad. It really is a watering down of protections against racial vilifications. The irony of it being done on this day! The Attorney-General says he does not believe the Australian people are racist.

Senator Brandis: No, I do not.

Senator McCarthy:  As a white man growing up in Petersham, attending private schools, I am sure you have never been denied access or service in a shop. You have never had taxis drive past, pretending not to see you. You have never received hateful letters and emails because of your race or the colour of your skin. I really wish I could believe there are not any racists in Australia. But certainly my personal experience, and my family’s experience, informs me of the reality that I live in this country. It is deeply unfortunate.

I asked you in my question: what else do you need to say to me and to many other people of different races in this country that you cannot say now? What is it that you are so determined to say that you cannot say to people now?

My predecessor, Senator Nova Peris, had a disgraceful time in this Senate, standing here, being called all sorts of things—in fact, even on her Twitter account today—in terms of what racism she received from the general public. Just to clarify, in case you were thinking I meant it occurred in the Senate; I meant this is where she raised the issue about the racism that was displayed against her by the general public across Australia. It is really important to put this on the record. She stood courageously here to point out from her own personal experiences that racism is very much alive and strong in this country. We as parliamentarians in both the Senate and the House of Representatives must show leadership about the importance of harmony, diversity and cultural respect. That is something that is not happening now today in the Turnbull government.

Being the target of racist, hurtful comments is deeply distressing and causes deep harm. expired)

 

NACCHO Aboriginal Health : New publication confirms important improvements in the health of Aboriginal people

 

 ” The Overview of Aboriginal and Torres Strait Islander health status 2016 provides a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people.

The Overview shows that that the health of Aboriginal and Torres Strait Islander people continues to improve slowly and there have been a decline in the death rates for Aboriginal and Torres Strait Islander people and also a significant closing of the gap in death rates between Aboriginal and Torres Strait Islander and non-Indigenous people. The infant mortality rate has declined significantly. “

Dr Michael Adams, Senior Research Fellow, Australian Indigenous HealthInfoNet, Western Australia and Associate Professor, Ted Wilkes pictured above launching the report on Close the Gap Day 2017

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

The Overview provides an accurate, evidence based summary of many health conditions in a form that makes it easy for time poor professionals to keep up to date with the current health status of Aboriginal and Torres Strait Islander people throughout Australia. We have a greater focus on strengths based approaches which you will see in our introduction.”

HealthInfoNet Director, Professor Neil Drew

Download PowerPoint 1   overview-2016-key-facts

Download PowerPoint 2  overview-2016-key-facts-figures-tables

There have also been improvements in a number of areas contributing to health status such as the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy has decreased.

There has been a slight decrease in the proportion of low birth weight babies born to Aboriginal and Torres Strait Islander mothers between 2004 and 2014. Age-standardised death rates for respiratory disease in NSW, Qld, WA, SA and NT declined by 26% over the period 1998-2012 for Aboriginal and Torres Strait Islander people.

http://www.healthinfonet.ecu.edu.au/health-facts/overviews

Key facts

Population

  • At 30 June 2016, the estimated Australian Aboriginal and Torres Strait Islander population was 744,956.
  • In 2016, it was estimated that NSW had the highest number of Aboriginal and Torres Strait Islander people (229,951people, 31% of the total Aboriginal and Torres Strait Islander population).
  • In 2016, it was estimated that the NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 30% of the NT population identifying as Aboriginal and/or Torres Strait Islander.
  • In 2016, around 35% of Aboriginal and Torres Strait Islander people lived in a capital city.
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Births and pregnancy outcomes

  • In 2015, there were 18,537 births registered in Australia with one or both parents identified as Aboriginal and/or Torres Strait Islander (6.1% of all births registered).
  • In 2015, Aboriginal and Torres Strait Islander mothers were younger than non-Indigenous mothers; the median age was 25.1 years for Aboriginal and Torres Strait Islander mothers and 31 years for all mothers.
  • In 2015, total fertility rates were 2,271 births per 1,000 for Aboriginal and Torres Strait Islander women and 1,807 per 1,000 for all women.
  • In 2014, the average birthweight of babies born to Aboriginal and Torres Strait Islander mothers was 3,215 grams compared with 3,355 grams for babies born to non-Indigenous mothers.
  • In 2014, the proportion of low birthweight (LBW) babies born to Aboriginal and Torres Strait Islander women was twice that of non-Indigenous women (12% compared with 6.2%).
  • For 2004 to 2014 there was a slight decrease in the proportion of LBW babies born to Aboriginal and Torres Strait Islander mothers.

Mortality

  • For 2015, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1.7 times the rate for non-Indigenous people.
  • Between 1998 and 2013, there was a 16% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
  • For Aboriginal and Torres Strait Islander people born 2010-2012, life expectancy was estimated to be 69.1 years for males and 73.7 years for females, around 10-11 years less than the estimates for non-Indigenous males and females.
  • For 2013-2015, age-specific death rates were higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than for non-Indigenous people across all age-groups, and were much higher in the young and middle-adult years.
  • For 2013-2015, the infant mortality rate was higher for Aboriginal and Torres Strait Islander infants than for non-Indigenous infants living in NSW, Qld, WA, SA and the NT; the rate for Aboriginal and Torres Strait Islander infants was highest in the NT.
  • For 1998 to 2014, there were significant declines in infant mortality rates for Aboriginal and Torres Strait Islander infants.
  • In 2013, the leading causes of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT were cardiovascular disease, neoplasms (mainly cancers) and injury.
  • For 2008-2012, for direct maternal deaths the rate ratio was 2.2 times higher for Aboriginal and Torres Strait Islander women than for non-Indigenous women.

Hospitalisation

  • In 2014-15, 4.4% of all hospital separations were for Aboriginal and Torres Strait Islander people.
  • In 2014-15, the age-adjusted separation rate for Aboriginal and Torres Strait Islander people was 2.4 times higher than that for non-Indigenous people.
  • In 2014-15, the main cause of hospitalisation for Aboriginal and Torres Strait Islander people was for ‘Factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 50% of all Aboriginal and Torres Strait Islander separations.
  • In 2014-15, the rate of overall potentially preventable hospitalisations was around three times higher for Aboriginal and Torres Strait Islander people than those for non-Indigenous people.

Selected health conditions

Cardiovascular disease (CVD)

  • In 2012-2013, 13% of Aboriginal and Torres Strait Islander people reported having a long-term heart or related condition; after age-adjustment, these conditions were around 1.2 times more common for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2011, CVD was the third largest contributor (12%) to total disease burden among Aboriginal and Torres Strait Islander people.
  • In 2014-15, hospitalisation rates for circulatory disease were almost twice as high for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2015, ischaemic heart disease was the leading cause of death of Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT; the age-adjusted death rate due to ischaemic heart disease for Aboriginal and Torres Strait Islander people was twice the rate for non-Indigenous people.
  • For 1998 to 2014 the gap in CVD mortality rates between Aboriginal and Torres Strait Islander and non-Indigenous people narrowed.

Cancer

  • For 2006-2010, age-adjusted cancer incidence rates were slightly lower for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA and the NT than for non-Indigenous people.
  • For 2006-2010, the most common cancers diagnosed among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA and the NT were lung and breast (females) cancers.
  • In 2011, cancer and other neoplasms (cancerous and non-cancerous tumours) were responsible for 9.4% of the total burden of disease among Aboriginal and Torres Strait Islander people.
  • In 2014-15, age-adjusted hospitalisation rates for cancer were lower for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA and the NT than for non-Indigenous people.
  • For 2009-2013, the age-adjusted death rate for cancer for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1.3 times higher than for non-Indigenous people.

Diabetes

  • In 2012-2013, 13% of Aboriginal and Torres Strait Islander people reported having diabetes; after age-adjustment, Aboriginal and Torres Strait Islander people were more than three times more likely to report having some form of diabetes than non-Indigenous people.
  • In 2015, Aboriginal and Torres Strait Islander people were more likely to have diabetes recorded as the principal cause of hospital admission compared to non-Indigenous people.
  • In 2015, Aboriginal and Torres Strait Islander people living in NSW, Qld, SA, WA and the NT died from diabetes at five times the rate of non-Indigenous people.

Social and emotional wellbeing

  • In 2012-2013, after age-adjustment, Aboriginal and Torres Strait Islander people were 2.7 times as likely as non-Indigenous people to feel high or very high levels of psychological distress.
  • In 2014-2015, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over experienced at least one significant stressor in the previous 12 months.
  • In 2012-2013, 91% of Aboriginal and Torres Strait Islander people reported on feelings of calmness and peacefulness, happiness, fullness of life and energy either some, most, or all of the time.
  • In 2014-2015, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
  • In 2014-15, there were 16,941 hospital separations with a principal diagnosis of ICD ‘Mental and behavioural disorders’ identified as Aboriginal and/or Torres Strait Islander.
  • In 2015, the death rate for ICD ‘Intentional self-harm’ (suicide) for Aboriginal and Torres Strait Islander people was two times the rate reported for non-Indigenous people.

Kidney health

  • For 2010-2014, after age-adjustment, the notification rate of end-stage renal disease was 6.6 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2011, kidney and urinary diseases accounted for 2.5% of the total burden of disease among Aboriginal and Torres Strait Islander people.
  • In 2014-15, ‘care involving dialysis’ was the most common reason for hospitalisation among Aboriginal and Torres Strait Islander people.
  • For 2010-2014, the age-adjusted death rate from kidney disease was 2.7 times higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT than for non-Indigenous people.

Injury, including family violence

  • In 2014-15, after age-adjustment, Aboriginal and Torres Strait Islander people were hospitalised for injury at almost twice the rate for non-Indigenous people.
  • In 2014-15, 19% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assaults, compared with 2% among non-Indigenous people.
  • In 2015, age-adjusted death rates from intentional self-harm were two times higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than for non-Indigenous people, land transport accidents nearly three times higher and injury from assault over eight times higher.

Respiratory disease

  • In 2012-2013, 31% of Aboriginal and Torres Strait Islander people reported having a respiratory condition. After age-adjustment, the level of respiratory disease was 1.2 times higher for Aboriginal and Torres Strait Islander than non-Indigenous people.
  • In 2012-2013, 18% of Aboriginal and Torres Strait Islander people reported having asthma.
  • In 2011, respiratory diseases were responsible for 7.9% of the total burden of disease among Aboriginal and Torres Strait Islander people.
  • In 2014-15, age-adjusted hospitalisation rates for Aboriginal and Torres Strait Islander people were 5.0 times higher for chronic obstructive pulmonary disease, 3.1 times higher for influenza and pneumonia, 2.1 times higher for whooping cough and 1.8 times higher for asthma and acute upper respiratory infections, than for non-Indigenous people.
  • In 2015, chronic lower respiratory disease was the leading cause of death from respiratory disease and the third highest cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT.
  • For 1998 to 2012, age-adjusted death rates for respiratory disease in NSW, Qld, WA, SA and NT declined by 26% for Aboriginal and Torres Strait Islander people.

Eye health

  • In 2015-2016, after age-adjustment, vision impairment and blindness among Indigenous adults were both three times higher than in non-Indigenous adults.
  • In 2012-2013, eye and sight problems were reported by 33% of Aboriginal and Torres Strait Islander people.
  • In 2012-2013, myopia and hyperopia for Aboriginal and Torres Strait Islander people were reported at 0.8 and 1.1 times the proportions for non-Indigenous people.
  • In 2015, the estimated prevalence of active trachoma among Aboriginal and Torres Strait Islander children aged 5-9 years living in at-risk communities in the WA, SA and the NT was 4.6%.
  • In the period 2011-12 to 2012-13, after age-adjustment, Aboriginal and Torres Strait Islanders were less likely to be hospitalised for diseases of the eye and adnexa than non-Indigenous people.

Ear health and hearing

  • In 2012-2013, ear disease/hearing problems were reported by 12% of Aboriginal and Torres Strait Islander people.
  • In 2014-15, the hospitalisation rate for ear disease for Aboriginal and Torres Strait Islander children aged 4-14 years was 1.4 times higher than the rate for non-Indigenous children.

Oral health

  • In 2014-15, the proportion of Aboriginal and Torres Strait Islander children aged 4-14 years with reported tooth or gum problems was 34%, a decrease from 39% in 2008.
  • In 2012-13, around 49% of adults reported no tooth loss; around 47% had lost one or more teeth; and around 5% reported complete tooth loss.
  • In 2014-15, age-adjusted national potentially preventable hospitalisation rates for dental conditions were 1.3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.

Disability

  • In 2012, the overall rate of disability among Aboriginal and Torres Strait Islander Australians was 23%; after age adjustment, the rate of disability for Aboriginal and Torres Strait Islander was 1.7 times the rate for non-Indigenous people.
  • In 2014-15, 6% of disability service users were Aboriginal and Torres Strait Islander people, with most aged under 50 years (84%).

Communicable diseases

  • For 2009-2013, after age-adjustment, the notification rate for tuberculosis was 11.3 times higher for Aboriginal and Torres Strait Islander people than for Australian born non-Indigenous people.
  • In 2015, the age-adjusted notification rate for hepatitis B was three times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • For 2011- 2015, there was a 22% decline in the hepatitis B notification rates for Aboriginal and Torres Strait Islander people.
  • In 2015, the age-adjusted notification rate for hepatitis C was almost five times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • For 2012-2014, the average notification rate for Haemophilus influenzae type b among Aboriginal and Torres Strait Islander people was 5.3 times the rate in the total population.
  • For 2011-2014, the rate of invasive pneumococcal disease for Aboriginal and Torres Strait Islander people decreased.
  • In 2007-2010, the age-adjusted notification rate of meningococcal disease was 2.7 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people; the rate for Aboriginal and Torres Strait Islander children aged 0-4 years was 3.8 times higher than for non-Indigenous children.
  • In 2015, Aboriginal and Torres Strait Islander people had higher crude notification rates for gonorrhoea, syphilis and chlamydia than non-Indigenous people.
  • In 2015, age-adjusted notification rates of human immunodeficiency virus (HIV) diagnosis were 1.3 times higher for Aboriginal and Torres Strait Islander than non-Indigenous people.

Factors contributing to Aboriginal and Torres Strait Islander health

Nutrition and breastfeeding

  • In 2012-2013, 54% of Aboriginal and Torres Strait Islander people reported eating an adequate amount of fruit per day but only 8% of Aboriginal and Torres Strait Islander people reported eating an adequate amount of vegetables per day.
  • In 2012-2013, on average, Aboriginal and Torres Strait Islander people consumed 41% of their total daily energy in the form of discretionary foods.
  • In 2012-2013, 83% of Aboriginal and Torres Strait Islander people reported consuming dairy foods daily.
  • In 2012-2013, 54% of Aboriginal and Torres Strait Islander people reported consuming sugar daily.
  • In 2012-2013, Aboriginal and Torres Strait Islander people living in remote areas were more likely to eat bush food compared with non-Indigenous people.
  • In 2011, the joint effect of all dietary risks combined (13 identified) contributed 9.7% to the burden of disease for Aboriginal and Torres Strait Islander people.
  • In 2012-2013, 83% of Aboriginal and Torres Strait Islander children aged 0 – 3 years had been breastfed, compared with 93% of non-Indigenous children.

Physical activity

  • In 2012-2013, 47% of Aboriginal and Torres Strait Islander adults in non-remote areas met the target of 30 minutes of moderate intensity physical activity on most days.
  • In 2012-2013, after age-adjustment, 61% of Aboriginal and Torres Strait Islander people in non-remote areas reported that they were physically inactive, a similar level to that of non-Indigenous people.

Bodyweight

  • In 2012-2013, 69% of Aboriginal and Torres Strait Islander adults were classified as overweight or obese; after age-adjustment, the level of obesity/overweight was 1.2 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2012-2013, around 30% of Aboriginal and Torres Strait Islander children aged 2-14 years were overweight or obese.

Immunisation

  • In 2016, 95% of Aboriginal and Torres Strait Islander children aged five years were fully immunised against the recommended vaccine-preventable diseases.

Tobacco use

  • In 2014-2015, 39% of Aboriginal and Torres Strait Islander people aged 15 years and over reported they were current smokers; after age-adjustment, this proportion was 2.8 times higher than the proportion among non-Indigenous people.
  • In 2014-2015, 36% of Aboriginal and Torres Strait Islander people reported they had never smoked.
  • In 2014, 45% of Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy, compared with 13% of non-Indigenous mothers.
  • For 2009 to 2014, the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy decreased.

Alcohol use

  • In 2011, alcohol use was responsible for 8.3% of the total burden of disease among Aboriginal and Torres Strait Islander people.
  • In 2012-2013, 23% of Aboriginal and Torres Strait Islander adults abstained from alcohol; this level was 1.6 times higher than among the non-Indigenous population.
  • In 2012-2013, after age-adjustment, lifetime drinking risk was similar for both the Aboriginal and Torres Strait Islander and non-Indigenous population.
  • For 2010 to 2013, there was a significant decline for risky drinking in the proportion (from 32% to 23%) of Aboriginal and Torres Strait Islander people aged 14 years and older.
  • For 2011-12 to 2012-13, after age-adjustment, for a principal diagnosis related to alcohol use, Aboriginal and Torres Strait Islander males were hospitalised at 4.5 times and females at 3.6 times the rates of non-Indigenous males and females.
  • In 2008-2012, the age-adjusted death rates for alcohol-related deaths for Aboriginal and Torres Strait Islander people was 4.9 times higher than for non-Indigenous people.

Illicit drug use

  • In 2011, illicit substance use was responsible for 3.7% of the total burden of disease for Aboriginal and Torres Strait Islander people.
  • In 2014-2015 (69%) and 2012-2013 (52%) of Aboriginal and Torres Strait Islander people aged 15 years and older reported they had never used illicit substances.
  • In 2014-2015, 30% of Aboriginal and Torres Strait Islander people aged 15 years and over reported that they had used an illicit substance in the previous 12 months.
  • In 2014-2015, hospitalisation for mental/behavioural disorders from use of amphetamines had the highest rate of separations due to drug use and was more than three times higher for Aboriginal and Torres Strait Islander people than non-Indigenous people.
  • In 2010-2014, the rate of drug-induced deaths was 1.9 times higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than for non-Indigenous people.

Volatile substance use

  • For 2012-13 to 2014-15, hospitalisation due to poisoning either accidental or from toxic effects of organic solvents including petroleum derivatives, glues and paints was between two to five times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • For 2012-13 to 2014-15, hospitalisation separations due to mental and behavioural disorders from use of volatile solvents, Aboriginal and Torres Strait Islander people were hospitalised at a rate nine times higher than non-Indigenous people.
  • For 2008-2012, deaths from accidental poisoning by and exposure to noxious substances for Aboriginal and Torres Strait Islander males in NSW, Qld, WA, SA and NT was nearly twice as many as non-Indigenous males.

Environmental health

  • In 2014-15, 21% of Aboriginal and Torres Islander people were living in overcrowded households.
  • In 2014-15, 82% of Aboriginal and Torres Strait Islander households were living in houses of an acceptable standard.
  • In 2014-15, 26% of Aboriginal and Torres Strait Islander households reported structural issues within their dwelling.
  • In 2014-15, over 90% of Aboriginal and Torres Strait Islander households reported that they had access to working facilities for washing people clothes and bedding; working facilities for preparing food and working sewerage facilities.
  • In 2014-15, after age adjustment, Aboriginal and Torres Strait Islander people were hospitalised for diseases related to environmental health at 2.3 times the rate of non-Indigenous people.
  • For 2010-2014, Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT died as a result of diseases associated with poor environmental health at 1.7 times the rate of non-Indigenous people

The Overview, which draws on the most up-to-date, authoritative sources and undertakes some special analyses, is freely available on the HealthInfoNet web resource, along with downloadable PowerPoint presentations of key facts, tables, and figures.

It is an important part of the HealthInfoNet’s commitment to collaborative knowledge exchange, which contributes to closing the gap in health between Aboriginal and Torres Strait Islander people and other Australians by making research and other knowledge available in a form that is easily understood and readily accessible to both practitioners and policy makers.

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

The Overview provides an accurate, evidence based summary of many health conditions in a form that makes it easy for time poor professionals to keep up to date with the current health status of Aboriginal and Torres Strait Islander people throughout Australia. We have a greater focus on strengths based approaches which you will see in our introduction.’

About the HealthInfoNet: Now in its 20th year, this is a massive Internet resource that informs practice and policy in Aboriginal and Torres Strait Islander health by making up to date research and other knowledge readily accessible via any platform.

In this way, the HealthInfoNet contributes to closing the gap in health between Aboriginal and Torres Strait Islander peoples and other Australians.

Working in the area of translational research with a population health focus, the HealthInfoNet makes research and other information freely available in a form that has immediate, practical utility for practitioners and policy-makers in the area of Aboriginal and Torres Strait Islander health, enabling them to make decisions based on the best available evidence www.healthinfonet.ecu.edu.au

NACCHO #AboriginalHealth #Referendum #Treaty : Indigenous leaders play hardball on #recognition

 

“People are being clear-eyed here, we don’t want to forgo history by just taking whatever is on offer, we’re part of a struggle that goes back to the 19th century.

We owe it to past leaders like Sir Doug Nichols, William Cooper and so many others, to not accept reform that is no improvement on 1967 and just a bit of editing.

We want constitutional reform but why go to all the expense of having a referendum just to put poetry in?’’

 Referendum Council co-chair Pat Anderson and former NACCHO chair 2002-2003

In interview todays Australian Artice 1 Below

“Aboriginal people will not accept a feel-good, symbolic stamp on a fundamentally unfair system,

The system needs to be improved. We need to change the way we do business in Aboriginal affairs. Constitutional recognition must mean real reform. It must create a genuine paradigm shift, or Aboriginal people will reject it,”

Jeremy Clark and Jill Gallagher CEO VACCHO the co-convenors of the latest dialogue, held in Melbourne over three days. Read full report Article 2 below

 ” The question of guaranteed Indigenous parliamentary representation is especially timely as Australia considers the argument that treaties, rather than a constitutional statement, might provide more substantive political recognition.

However, treaties require that Indigenous people acknowledge the legitimacy of the state. Indigenous people need to determine the conditions under which they might provide that acknowledgement. They may, for example, want a more inclusive state; one that recognises a substantive and meaningful citizenship.

Guaranteed parliamentary representation responds to colonialism’s present as well as its past. Colonisation was not a single event “done” to Indigenous peoples.

Dominic O’Sullivan  Associate Professor, Charles Sturt University Article 3 below

Aboriginal leaders have warned they will campaign against a constitutional recognition referendum if all that is on offer is a so-called minimalist “politicians’ model”, which avoids a treaty and indigenous representation in parliament.

Meeting in Melbourne as part of a national series of community discussions, about 100 Aboriginal leaders and community members agreed there was a view in Canberra that the minimalist model — deleting a reference to race, adjusting another section on race and adding a statement of recognition — was a “done deal”.

They said recent statements by indigenous Liberal minister Ken Wyatt that they should temper­ expectations of what a referendum would produce, and by West Australian Liberal senat­or Dean Smith that treaties needed to be “off the table” for constitutional recognition to occur, had caused great concern.

The boilover came at the seventh­ of 12 meetings to be held ­nationwide, in a process climaxing with a constitutional convention at Uluru in May marking the 50th anniversary of the successful 1967 referendum on Aboriginal and Torres Strait Islander people’s rights.

Participants were in agreement that they were prepared to support a “no” case against the referendum, and politicians should not assume they would eventually capitulate and accept minimalism.

However, they insisted they were not talking about shooting down a successful outcome, merely an unsatisfactory one, and said their views were not radical and were broadly representative of indigenous Australia.

Lengthy discussion was had around the fact the delegates, who included traditional owners, elders, chief executives of community organisations, and other “mainstream” indigenous representatives, were ambitious about a positive result but would not be accepting, as one put it, “beads and trinkets”.

“People are being clear-eyed here, we don’t want to forgo history by just taking whatever is on offer, we’re part of a struggle that goes back to the 19th century,” Referendum Council co-chair Pat Anderson told The Australian. “We owe it to past leaders like Sir Doug Nichols, William Cooper and so many others, to not accept reform that is no improvement on 1967 and just a bit of editing.

“We want constitutional reform but why go to all the expense of having a referendum just to put poetry in?’’

A July 2015 gathering of 40 indigenous leaders at Kirribilli House with Tony Abbott and Bill Shorten resolved that “a minimalist approach … does not go far enough and would not be acceptable to Aboriginal and Torres Strait Islander peoples”.

“We’ve been saying since the 1840s that we wanted substantive change and we said it again at Kirribilli,” Ms Anderson said. “It’s this generation’s turn but it’s got to be for all Australians, not just for us. We need to win the hearts and minds of the Australian public on this because we can’t just pass on a legacy of nothingness — why would we support that?”

The Melbourne gathering was also sharply critical of a perception that the four indigenous federal MPs — Mr Wyatt and Labor’s lower-house MP Linda Burney, and senators Patrick Dodson and Malarndirri McCarthy — were token representatives of indigenous people. However, the meeting felt that rather than speaking for indigenous people they spoke for their electorates and the four of them in turn supported a minimalist outcome.

Overwhelming support has emerged at all seven meetings for an indigenous parliamentary “body”, or what Cape York leader Noel Pearson describes as a “hook” that could be inserted in the Constitution, and off which other legislative solutions could be hung. This body would likely be elected, with responsibility for giving parliament input on laws affecting indigenous Australians — input parliament would then be required to consider but which would be non-binding.

It is a solution supported by constitutional conservatives because it is viewed as being possible to create this body without endangering the sovereignty of parliament and without the threat of constant litigation over its powers — for example, whether the laws on which it was consulted were deemed constitutionally safe.

There could also be a statutory Declaration of Recognition drafted outside the Constitution.

A more far-reaching proposal would see the insertion of a prohibition against racial discrimination into the Constitution — a proposal thought unlikely to win wide support.

Treaties, or agreement-making, were backed at the Melbourne meeting, as was expected given the Victorian government is in treaty talks. They were also supported at Hobart, Dubbo, Broome, Darwin, Perth and Sydney.

Following the Uluru meeting the 16-member referendum council is required to report within a month on next steps.

Participants at all the gatherings have addressed the need for the post-Uluru discussion, including whether to hold a referendum at all or whether the desired outcomes can better be achieved through legislative change.

Article 2  :Indigenous Australia’s ‘line in sand’ on recognition: substantial change or nothing

Indigenous Australians have rejected a referendum that offers only minimal recognition in the constitution, insisting they will walk away unless more meaningful change is offered.

They have challenged political leaders to discuss what is emerging as their key proposal, an Indigenous body being recognised in the constitution, or be prepared to leave the recognition challenge to the next generation.

After seven of 12 planned Indigenous-only dialogues, it is clear that a statement recognising Aboriginal and Torres Strait Islanders in the nation’s founding document and some “tinkering” with the race power will not win Indigenous support.

“[People] clearly understand they are part of a struggle that goes back to the 19th century – and we owe it to past leaders like Sir Doug Nicholls, William Cooper and so many others, to not accept reform that is no improvement on 1967 and just a bit of editing. There has to be substantial change,” Ms Anderson said.

A 1967 referendum ended the practice of not counting Aboriginals and Torres Strait Islanders in the population and gave the Commonwealth the power to make laws for Indigenous people.

Ms Anderson conceded that Indigenous leaders faced a “hard sell” to win the support of Prime Minister Malcolm Turnbull and other politicians, but added: “Our brief under our terms of reference was to go out and ask Aboriginal and Torres Strait Islander people what they want – and this is what’s emerging.”

The nation’s most senior Aboriginal politician, Aged Care and Indigenous Health Minister Ken Wyatt, recently urged those attending the dialogues to think big but be prepared to accept a judgment by political leaders on what is likely to secure passage of the referendum.

The emphatic view to emerge from the dialogues is that Aboriginal people will oppose anything they consider inadequate and could even mount their own “no” case to minimalist recognition.

Ms Anderson said an Indigenous body recognised in the constitution was emerging as the preferred vehicle to deliver substantial reforms. The Referendum Council has commissioned work on what such a body would look like and this would be produced in coming weeks, she said.

“At the moment it’s just a framework, but people are definitely sold on the idea that we must have some input, locked into the constitution, where we can talk directly to Parliament as equal partners.”

There are five more Indigenous dialogues before an Indigenous constitutional convention at Uluru on the weekend leading up to the 50th anniversary of the 1967 referendum in May.

Mr Clark and Ms Gallagher said the Melbourne dialogue saw healthy debate about sovereignty and treaties, “but one basic fact was clear: our people want real change, not minimalism”.

The concern of many delegates at the dialogues is that politicians have already agreed on a “minimalist model” they consider capable of winning support at a referendum. This would involve removing section 25 of the constitution, which says the states can ban people from voting based on their race; minor change to the race power and the addition of some symbolic words of recognition.

The co-convenors of the Melbourne dialogue said a voice to Parliament, in the form of an Aboriginal body embedded in the constitution, emerged as a strong priority in the discussions.

“This body could consult on laws and policies about our people, to help hold government to account. It could work under and incorporate the principles of the UN Declaration on the Rights of Indigenous Peoples, which could be articulated in statement of acknowledgement or a legislated declaration,” they said.

“The body could help drive reforms to enable agreement-making, so that a truth and reconciliation process can be pursued. As delegates pointed out: we can’t have reconciliation without having some truth.”

Mr Wyatt, the first Indigenous person to be elected to the House of Representatives and the first to be appointed to the executive of the Commonwealth government, recently said he was opposed to having an Indigenous body enshrined in the constitution, and did not believe it would be supported by the broader population.

Article 3 : Why guaranteed Indigenous seats in parliament could ease inequality

Dominic O’Sullivan  Associate Professor, Charles Sturt University

Indigenous Labor MP Linda Burney says her party is trying to identify and remove structural obstacles to preselection. AAP/Mick Tsikas from the Conversation

New South Wales Greens MP Dawn Walker used her inaugural speech this month to argue for guaranteed Indigenous parliamentary representation. The argument for designated seats is not a new one. It was considered and rejected by the Carr state government in 1998; Indigenous people would continue to compete for democratic voice like other minority groups.

Walker’s concern is for a secure and “direct [Indigenous] voice in our democracy”. New Zealand’s Indigenous population has had this voice since 1867.

In 2017, New Zealand’s unicameral parliament has seven designated Maori seats. From 1867 to 2017, Maori have almost always had cabinet membership and a recognised capacity to influence policymaking.

In Fiji, guaranteed representation of various kinds occurred between independence in 1970 and the most recent coup in 2006. It is true that it sometimes contributed to political unrest. However, the present regime’s extreme of no guaranteed Indigenous representation at all is among the variables helping to create Fiji’s seemingly irresolvable political instability.

In Norway, there is a distinctive Sami parliament. Its consultation agreement with the national parliament recognises the particular character of indigenous people’s citizenship. It does not eliminate political differences with the state, but it does provide a path to agreement on most of the 40 to 50 legislative measures on which it facilitates consultation each year.

The question of guaranteed Indigenous parliamentary representation is especially timely as Australia considers the argument that treaties, rather than a constitutional statement, might provide more substantive political recognition.

However, treaties require that Indigenous people acknowledge the legitimacy of the state. Indigenous people need to determine the conditions under which they might provide that acknowledgement. They may, for example, want a more inclusive state; one that recognises a substantive and meaningful citizenship.

Guaranteed parliamentary representation responds to colonialism’s present as well as its past. Colonisation was not a single event “done” to Indigenous peoples. It is a political system under which justice cannot occur and its essential rationale is exclusive. Designated seats in parliament are a step towards inclusivity.

Treaties look to a post-colonial future. They require societies to describe in real terms, not just in the abstract, what a fair and reasonable political community would entail. They presume Indigenous voice. They require recognition that colonialism gives Indigenous peoples a shared and distinctive political history; a voice that cannot always be effectively expressed by other people.

The mining lobby’s call for restrictions on native title is a contemporary example. It is a point that concerns Indigenous peoples only because their relationships with the state are uniquely colonial. These are relationships that do not concern other citizens for the same reasons or in the same ways.

Recognising difference allows liberal political communities to extend their concern for individual rights to Indigenous people as much as they extend them to anyone else. Individual identity is shaped by culture and communal relationships.

Governments are increasingly recognising that Indigenous exclusion from the policy process is among the reasons for sustained policy failure. Guaranteed representation reduces the distance between policymakers and the people for whom policy is made.

The argument remains even as Australian political parties are exploring ways of increasing the number of Indigenous people preselected as party candidates. For example, federal Labor MP Linda Burney, who is Indigenous, explains that her party is trying to identify and remove structural obstacles to preselection.

It is a concession to the possibility that racism exists within the party itself. However, parties would also need to set aside the fact that they have no electoral incentive to court Indigenous votes. There are simply not enough of them. Designated seats would create an incentive to compete for Indigenous support.

Australia’s democracy is not well equipped to consider the implications of prior occupancy, culture or colonial legacy. Democratic structure determines whether public decisions are the outcome of an inclusive political process. It determines whether people have had equal opportunities to contribute to decision-making, and it is reasonable to expect Indigenous people to require some benefit in return for recognising the legitimacy of the state.

Guaranteed parliamentary representation is not the only mechanism for ensuring Indigenous political voice. It may not, ultimately, be one that Indigenous Australians choose to pursue. However, it is one that has served New Zealand Maori well for 150 years, and is worth considering in response to John Rawls’ argument that:

The unity of society and the allegiance of its citizens to their common institutions rest not on their espousing one rational conception of the good, but on an agreement as to what is just for free and equal moral persons with different and opposing conceptions of the good

NACCHO Aboriginal Health : Download report ALP Communique National Health Policy March 2017 Summit

 

 ” Participants agreed that Aboriginal and Torres Strait Islander peoples faced persistent and acute barriers to health equity and therefore must remain a top priority. Many of these barriers, like racism, are structural, evident both within the health system andmore widely.

In response, Indigenous health leaders and other participants called for governments to re-commit to Indigenous self-determination, which also acknowledges the importance of the cultural determinants of health.

Aboriginal and Torres Strait Islander peoples and communities should be supported in leading the design and delivery of health policy and services in partnership with governments and other stakeholders.”

From Tackling health inequality and other whole-of-government challenges 22/40

See relevant Aboriginal and Torres Strait Islander Health extracts below or

Download the 8 page Document Here

National Health Policy Summit – Communique March 17

Please note NACCHO welcomes health policy documents and press releases from all parties

” The communiqué includes an appropriate focus on equity and socio-economic disadvantage. The specific issue of Aboriginal and Torres Strait Islander disadvantage was raised by Bill Shorten in his opening speech and discussed in several sessions.

As was also to be expected, problems with Commonwealth-state relations – or the need to improve coordination between the different spheres of government – were raised in a several sessions

STEPHEN DUCKETT Review . Labor charts a health policy rethink see Article 2 below

At the roundtable discussions in Canberra NACCHO was represented by chair Matthew Cooke pictured at the summit with MP Stephen Jones

Watch Interview with Matthew CroakeyTV

Walking the talk in Indigenous health

National Aboriginal Community Controlled Health Organisation (NACCHO) chair Matthew Cooke put Labor on notice to address racism in the health system, which Lowitja Institute CEO Romlie Mokak said was the “burning issue” in Indigenous health.

Cooke said the problem is not just in the way Indigenous people are treated in the system but also in how governments and their agencies exclude Indigenous organisations that should be involved “at every level of decision-making”.

He said NACCHO members had been “spearheading” self-determination for more than 40 years – a principle now being adopted by non-Indigenous people wanting to make community decisions about their health care and about health services and systems in communities.

“But Labor forgot us with Medicare Locals and the Liberals forgot us with the PHN (Primary Health Networks) transition… We were left out in the makeup of governance structures, clinical councils and community networks.

“We face a lot of arrogance, a lot of racism in the health system,” he said.

Cooke said a statement this week by Indigenous Health Minister Ken Wyatt, calling on PHNs to work with ACCOs was “very welcome”.

Extract above from Croakey

The Report : Protection, prevention and promotion

4. Participants highlighted the chronic disease crisis, noting that at least one-third of these diseases are preventable. They also emphasised the main risk factors that contribute to this crisis, such as weight gain, unhealthy foods, lack of physical activity, tobacco use, and alcohol. Participants noted that these were national challenges and would require system-wide responses to promote health and wellbeing across all age groups.

5. A common theme was the impact of inequity on health. It was recognised that some groups faced particular challenges and would benefit from more targeted government support – such as Aboriginal and Torres Strait Islander peoples, people in remote Australia, mothers and infants, and people with disability. However, the broad range of social determinants impact heavily on health. Participants also recognised that mental health and suicide are key issues affecting Australian families and  communities, particularly affecting young people and LGBTIQ people, and these require national, coordinated strategies.

6. Participants called on governments to focus on implementation and action, not reviews. They felt that the evidence was already quite clear in most areas, although they noted that ongoing support for national surveys and data collection is required to monitor progress, for example through the National Health Survey. Participants argued that the Commonwealth could improve implementation by partnering more closely with communities, states and territories, the public health sector and industry. They also called for stronger public health messaging from governments, to improve Australians’ understanding of how people’s health is strongly influenced by surrounding environments and how people can be empowered to manage their own health. Participants felt that establishing environments that facilitate making the healthy choice the easy choice is an important role of government.

7. Participants also called on governments to adopt a ‘health in all policies’ approach. This would recognise that a wide range of factors – like education, housing, employment and economic inequality – affect health. Such an approach would help to break down silos within government. For example, the group argued that governments should address climate change and its impacts on health, and better integrate health and disability policy.

As well as this overall approach, participants called for targeted interventions on some issues – like mass media campaigns on tobacco, restrictions on marketing of junk food and alcohol (particularly to children), breaking the nexus between these unhealthy products and sport, as well as implementing taxation measures to mitigate the harmful consumption of alcohol and junk food – in particular sugar-laden soft drinks

Mental health and suicide prevention

18. Participants agreed that more needed to be done in the short term to address Australia’s mental health burden and the growing rate of suicide. There was an agreed view that the National Mental Health Commission’s review and recommendations were a solid framework for reform and it was time to implement this plan.

19. There was agreement mental health should be given a higher priority, substantially more funding, and that it was a weak point of the health system given it is 20 per cent of the health burden. It was also established that mental health should be an important part of the economics agenda within an ‘invest to save’ context. Participants highlighted a range of challenges and issues including the urgent need to address service delivery gaps, particularly in psychosocial support and between the GP and the ED, investment to be made in services and at a community level, and an emphasis to build the evidence base as well as building resilience across communities.

20. In relation to suicide prevention challenges, participants highlighted the need to address trauma in Aboriginal and Torres Strait Islander communities, develop a national suicide prevention strategy including a standalone strategy for children and young people, build workforce capacity, improve and better co-ordinate data collection and provide community connections in hospital systems. Suicide Prevention Australia raised its view there is a need to establish a National Office for Suicide Prevention and put before Parliament a National Suicide Prevention Bill.

21. Participants also emphasised the need for the Commonwealth to lead state and territory collaboration on issues around funding and service delivery. There was also agreement from participants that long-term national leadership was urgently required to address mental health and suicide prevention. This would involve establishing clear national targets for action, and supporting timely and transparent reporting on progress.

Ensuring universal access for all Australians

26. Participants agreed that Australians have a right to universal access to world-class health care. But they emphasised that rising out-of-pocket costs have become a critical barrier to access. They also highlighted that barriers to access are higher for some people (including Indigenous Australians), in some areas (including regional, rural and remote Australia), and for some services (including mental health, allied health and dental services).

STEPHEN DUCKETT Review .

Labor charts a health policy rethink :

Stephen Duckett is Director, Health Program, Grattan Institute

The Labor Party has released a summary of the proceedings of its ‘National Health Policy Summit’, held in Canberra on 3rd March. Good on the ALP for holding the summit. Trouble is, the ‘communique’, while summarising the views of the quite diverse range of participants, gives no clear indication of where Labor might be heading.  

The summit process

First, some background. The summit was initiated by federal Labor’s Shadow Health Minister, Catherine King, together with Shadow Minister for Ageing and Mental Health, Julie Collins. It was held in Parliament House with about 180 attendees, including more than 20 Labor MPs. Labor Leader Bill Shorten was present for the whole day. Attendees included consumer organisation representatives; past and present presidents of the Australian Medical Association; private-sector lobbyists including from private hospitals and insurers, and from the pharmacy and devices industries; academics; and a scattering of clinicians.

There were eight ‘round table’ sessions: Protection, prevention and promotion; Primary, secondary and community care; Hospitals; Mental health and suicide prevention; Tackling health inequality and other whole-of-government challenges; Ensuring universal access for all Australians; Innovation across the health system; and Equipping Australia’s health workforce for the future. Session chairs gave feedback at the end of the day, before concluding comments from Bill Shorten.

The summit themes

The communiqué includes an appropriate focus on equity and socio-economic disadvantage. The specific issue of Aboriginal and Torres Strait Islander disadvantage was raised by Bill Shorten in his opening speech and discussed in several sessions.

As was also to be expected, problems with Commonwealth-state relations – or the need to improve coordination between the different spheres of government – were raised in a several sessions.

Less expected was a pervasive call for better data, and access to data. Data recommendations were made by six of the eight round tables: Protection, prevention and promotion (where there was support for national surveys to monitor progress); Primary, secondary and community care (support for indicators of results); Hospitals (where improved data and data sharing could improve the quality and efficiency of patient care); Ensuring universal access (better use of data in primary care); Innovation (data to improve efficiency); and Equipping Australia’s health workforce for the future (better workforce data).

Several round tables saw opportunities to improve the efficiency of the health care systems by investing in primary care; using the workforce more effectively; and creating better links between hospitals and other facilities (for example, some people who present at hospital emergency departments which could be treated in primary care or in the resident’s aged-care facility).

Another common theme was the need for health-sector policymakers to build on the strengths of Medicare and keep in touch with local communities (‘decision-making is too centralised in the hands of insiders in Canberra’; and that there needs to be a ‘stronger narrative from governments on the purpose of health policies and programs’).

The next steps

The Summit communiqué commits Labor to work with participants (and others) to ‘refine and develop its policies over this term of Parliament’ and that it have more detailed discussions around the Summit priority issues.

Evaluation

I co-chaired one of the round table sessions, so any evaluation I make of the summit is from that ‘insider’ perspective. What struck me was the openness and energy of the summiteers. The media were allowed in. There were lots of new ideas. Summiteers were not at all the ‘usual suspects’. They came with views from across the political spectrum, the common theme being a desire to influence the policy process.

And it truly was a ‘listening’ exercise. For example, Bill Shorten sat in one of the sessions I attended and took copious notes but did not attempt to articulate existing policy. Likewise, the Shadow Minister for Families and Social Services, Jenny Macklin, who co-chaired my session, essentially listened and took notes.

The challenge for Labor, though, is what it does next. The communiqué commits the ALP to working with summit participants (and others) to ‘refine and develop its policies over this term of Parliament’. The communiqué is a mix of problem statements and broad policy directions. The devil will be in the detail, as the alternative government seeks to balance pragmatic political reality, fiscal responsibility, and the policy aspirations articulated by the summiteers.

Time will tell whether unleashing the enthusiasm of summiteers pays off in better health policy for patients and taxpayers.

Comment:  It is interesting that there was little or no discussion on the role of private health insurance. This is the ‘elephant in the room’ which is eroding Medicare. John Menadue

Our #ACCHO Members #ClosethegapDay Good News Stories from Cape York #closethegap

 ” Apunipima services around 7,500 people living in 11 remote and very remote Cape York communities. In 2015-16 over 80% of Cape York’s Aboriginal and Torres Strait Islander population have accessed Apunipima’s services.

Apunipima runs the health service in Mossman Gorge, has opened new health care facilities in Aurukun and Napranum, and will be opening a new facility in Coen this year.

There is incontrovertible evidence that community driven, community led, culturally appropriate primary health care is key to improving health outcomes amongst Aboriginal and Torres Strait Islander people.”

Photo above :Apunipima Cape York Health Council carried out 127 health screenings for students at the Cape York Aboriginal Australian Academy.  AURUKUN youngsters received a free health check last week in a bid to prevent chronic disease

16 March marks Close the Gap Day – a day to bring awareness to the Close the Gap campaign and to work out how best to address the challenges of closing the health, employment and education gap for Aboriginal and Torres Strait Islander people.

The Prime Minister’s 2017 Close the Gap Report highlights the health challenges facing Aboriginal and Torres Strait Islander people. Apunipima continues to work across physical, social, and emotional challenges to close the gap for the Aboriginal and Torres Strait Islander people of Cape York.

People living in remote communities have worse health outcomes than those living in rural, regional and metropolitan areas

‘14 % of Aboriginal and Torres Strait Islander people live in very remote areas and make up 45% of very remote populations’

What Apunipima is doing:

See opening quote

By increasing the number of community controlled facilities in our communities, we improve access to healthcare and health literacy, employ local people and build community and individual capacity.

Halve the gap in mortality rates for Indigenous children under five within a decade (by 2018)

Nationally, this target is not on track.

‘Our investment in the early years is twofold: improving integration of services across health, child care, early childhood education and school resulting in better access to the right services; and intensive support for the children and families who need it most.’

What Apunipima is doing:

Apunipima’s Maternal and Child Health team’s award winning Baby One Program™ is an Aboriginal and Torres Strait Islander Health Worker led program designed to support women, babies and families from pregnancy until the bub is 1000 days old (nearly three).

In 2015-16,

  • 85 per cent of pregnant women and their families in Cape York were signed up to the Baby One Program™
  • 45 per cent accessed antenatal care before the thirteenth week of their pregnancy
  • 100 per cent received five or more antenatal visits during pregnancy with an average of more than 13 antenatal contacts per pregnancy 83 per cent of babies were born within normal weight range
  • 91 per cent of Cape York babies were born after 36 weeks gestation
  • 80 per cent of children under five were recorded as fully immunised

Close the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation (by 2031). 

Nationally, this target is not on track.

‘Over the longer term, Indigenous mortality rates have declined significantly by 15 per cent since 1998. There have been significant improvements in the Indigenous mortality rate from chronic diseases, particularly from circulatory diseases (the leading cause of death) since 1998. However, Indigenous mortality rates from cancer (second leading cause of death) are rising and the gap is widening. There have been improvements in health care access and reductions in smoking which should contribute to long-term improvements in the health of Aboriginal and Torres Strait Islander peoples.’

What Apunipima is doing:

As chronic disease accounts for three quarters of the mortality gap Apunipima is dedicated to preventing and managing chronic disease on Cape York.

Diabetes and chronic kidney disease accounts for the greatest burden of chronic disease amongst our patients.

We employ three Diabetes Nurse Educators, and a Care Coordination team that helps chronic disease patients navigate the health system and access specialist care.

Apunipima provides a GP in each of the 11 communities in which we work.

We are actively working to reduce smoking and improve nutrition, through a range of activities including working closely with community stores, drafting healthy eating guidelines and community cooking demonstrations and classes. These are both key factors in achieving good health.

‘While smoking rates have continued to decline in Australia, the smoking rates of Indigenous Australians aged 15 and over are significantly higher than the broader population.’

What Apunipima is doing:

Apunipima received a Tackling Indigenous Smoking Regional Grant as part of the National Tackling Indigenous Smoking program.

Nationally, the goal of the program is to improve the health of Aboriginal and Torres Strait Islander people through local efforts to reduce harm from tobacco.

The Apunipima Tackling Indigenous Smoking (TIS) Team will work closely with Cape York communities to deliver locally appropriate programs and activities that aim to:

  • Engage community members in tobacco cessation activities
  • Improve access to culturally appropriate quit support
  • Encourage and support smokers to quit
  • Encourage and support non-smokers to avoid uptake
  • Raise awareness in communities about the health impacts of smoking and passive smoking
  • Support communities to establish smoke-free homes, workplaces and public spaces

Apunipima’s strategic objectives aim to reduce overall smoking rates by 25 % by 2018 and antenatal smoking rates by 75 % by 2018.

‘Governments are working together to develop the Fifth National Mental Health Plan to improve the wellbeing of all Australians and prioritise Aboriginal and Torres Strait Islander mental health and suicide prevention.’

What Apunipima is doing:

Recognising that mental health is as important as physical health, Apunipima has developed a Social and Emotional Wellbeing Strategy and appointed a team to deliver a range of programs designed to improve people’s capacity and resilience.

Programs include Healthy Relationship training, working with prisoners at Lotus Glen, and Community Support Groups which provide social and emotional wellbeing education and support, especially for Men’s Health.

Apunipima’s Maternal and Child Health team includes a social worker and we also have a Partners in Recovery Coordinator who helps people who have been in mental health facilities reintegrate into community.

Apunipima’s Health Promotion and Men’s Health teams also support a range of community groups like Women’s and Men’s Groups, as well as on-country cultural activities.

‘Between 2006 and 2015 there was a significant decline in the Indigenous kidney disease mortality rate (by 47 per cent)’

What Apunipima is doing:

Apunipima employs a nurse with a special interest in kidney health to support the management of chronic kidney disease on the Cape.

Aboriginal and Torres Strait Islander people are three and a half times more likely to suffer from type 2 diabetes than their non-Aboriginal and Torres Strait Islander counterparts.

Diabetes is the leading cause of chronic kidney disease amongst Aboriginal and Torres Strait Islander people who are nine times more likely to experience end stage kidney disease than their non-Aboriginal and Torres Strait Islander counterparts.

As part of addressing the rates of renal failure on Cape York, Apunipima has been monitoring and managing the renal function tests of those at risk with around half of the diabetic patients and 2/3 of the Cardio-Vascular Disease patients up to date over the last six months, for this annual check.

‘However, cancer mortality rates are rising and the gap between Indigenous and non-Indigenous Australians dying from cancer is widening. Between 1998 and 2015, there was a 21 per cent increase in the cancer mortality rate for Indigenous Australians and a 13 per cent decline for non-Indigenous Australians.’

What Apunipima is doing:

Apunipima provides a GP in each of the 11 communities in which we work.

We encourage people to come for health checks and assist people to travel and stay in Cairns if they are in need of further tests.

We are actively working to reduce smoking through Tackling Indigenous Smoking and improve nutrition, (through a range of activities including working closely with community stores, drafting healthy eating guidelines and community cooking demonstrations and classes) both key factors in achieving good health.

Health workforce

‘It is important to have a strong Indigenous health and aged care workforce to provide culturally appropriate services to the Aboriginal and Torres Strait Islander community, and for the mainstream health care system to employ Indigenous health professionals’

What Apunipima is doing:

Apunipima has a workforce of around 180 employees, with 52% identifying as Aboriginal and/or Torres Strait Islander.

Currently around 25% of Apunipima employees are community based (both living and working in community), which is contributing to Apunipima’s strategic objective to build capacity in Cape York communities.

Apunipima employs 95 people who identify as Aboriginal and/or Torres Strait Islander, of which 36 are employed as Health Workers in Queensland, making it one of the largest non- government employers of health workers in the state.

We ensure our Health Workers are provided with appropriate qualifications (with 23 health workers currently enrolled in either Cert III or Cert IV PHC Practice), and are supported to pursue Australian Health Practitioners Regulation Agency registration as Health Practitioners should they choose to do so.

63% of our current Health Workers are community based, increasing community employment numbers and helping to address the social determinants of health.

Suicide

‘Indigenous suicide rates are double that of non-Indigenous Australians. During 2011 to 2015, among Indigenous Australians, 71 per cent of suicides were male.’

What Apunipima is doing:

Apunipima is addressing this issue through on country and cultural activities, supporting community to develop local solution, increasing community employment, working with men, women, girls and boys to create safe spaces to share challenges and solutions, building community capacity, providing a social worker, engaging with partner agencies and organisations and building our Social and Emotional Wellbeing team.

NACCHO #ClosetheGapday Editorial Comment and Download #CTG 2017 Progress and Priorities Report

 ” Achieving health equality for Aboriginal and Torres Strait Islander people will be impossible without a sincere, committed effort to understand and address racism in this country. That is why the Close the Gap Campaign continues to call for a national inquiry into the prevalence of racism and its impact.

The old cliché about persisting with the same failure in the hope of a different outcome is sadly the lived reality of much of the government policies regarding our people.

It is time to do something different.”

NACCHO CEO Pat Turner AM and Co- Chair Close the Gap Campaign

Opinion editorial 16 March see below in full ” It’s time to re-think Aboriginal and Torres Strait Islander health

Closing the gap in health equality between Aboriginal and Torres Strait Islander people and other Australians is an agreed national priority but governments are failing to meet nearly every key measure. This has to change.”

That’s the blunt assessment delivered by Close the Gap Campaign co-chairs, Jackie Huggins and Patricia Turner :

Photo : NACCHO CEO Pat Turner and #CTG co chair Dr Jackie Huggins launch 2017 #CloseTheGap Progress & Priorities Report

Dr Huggins, who is also co-chair of the National Congress of Australia’s First Peoples, and Ms Turner, who is chief executive of the National Aboriginal Community Controlled Health Organisation, released the Close the Gap Campaign 2017 Progress and Priorities Report in Sydney today (  16 March ) to mark National Close the Gap Day.

Download the report HERE     CTG Report 2017

CTG 2017 report : 15 Recommendations :  “We have the Solutions

New Engagement ( The remaining 12 below )

  1. The Federal, State and Territory governments renew the relationship with Aboriginal and Torres Strait Islander peoples, by engaging with sector leaders on the series of calls in the Redfern Statement, and that they participate in a National Summit with Aboriginal and Torres Strait Islander leaders in 2017, to forge a new path forward together.
  2. The Federal Government restore previous funding levels to the National Congress of Australia’s First Peoples as the national representative body for Aboriginal and Torres Strait Islander peoples, and work closely with Congress and the Statement signatories to progress the calls in the Redfern Statement.
  3. The Federal Government hold a national inquiry into racism and institutional racism in health care settings, and hospitals in particular, and its contribution to Aboriginal and Torres Strait Islander inequality, and the findings be incorporated by the Department of Health in its actioning of the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

It’s time to re-think Aboriginal and Torres Strait Islander health

Op-ed by Patricia Turner, CEO, National Aboriginal Community Controlled Health Organisation and co-chair of the Close the Gap Campaign.

Today [16 March 2017] is National Close the Gap Day. It is a day to acknowledge our resilience and a day to focus attention on the significant gap in health equality between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.

The facts are indisputable. Governments at all levels are failing Australia’s First Peoples. We have shorter lifespans and we are sicker and poorer than the average non-Indigenous Australian.

The Close the Gap Campaign began in 2006. One of the Campaign’s first accomplishments was to convince the Federal Government of the need to plan and set targets to improve health equality for Aboriginal and Torres Strait Islander people.

We’ve now had almost a decade of Closing the Gap Strategy by successive federal governments. Prime Minister Malcolm Turnbull’s most recent report to Parliament, in February 2017, was not good news. Most of the Closing the Gap targets are unlikely to be met by 2030. Frustratingly, child mortality rates are going backwards.

Today, the Close the Gap Campaign’s Progress and Priorities Report 2017 reflects on the continuing failure of the Government’s Closing the Gap Strategy and outlines a series of recommendations that can begin to turn the tide.

As a co-chair of Close the Gap Campaign and CEO of the National Aboriginal Community Controlled Health Organisation, I see the impact of a lack of coordination between federal, state and territory governments on addressing Aboriginal and Torres Strait Islander health.

The Federal Government’s recent announcement to refresh the strategy is timely and a dialogue should begin with Aboriginal and Torres Strait Islander peak health organisations on how to address the health challenges our people face.

We expect much more from the state and territory governments. The Federal Government has a clear leadership role but the states are simply not doing enough to address inequality in their jurisdictions.

New arrangements between state, territory and federal governments must begin with a clear focus on addressing the social and cultural determinants of health.

Aboriginal and Torres Strait Islander affairs should not be managed in siloes. Instead, we need to take account of the factors that contribute to good health: housing, education, employment and access to justice. Aboriginal and Torres Strait Islander leaders from across these sectors are already working together to make these policy connections – governments must follow suit.

Cultural determinants matter. There is abundant evidence about the importance of self-determination, freedom from the grind of casual and systemic racism, discrimination and poverty. For over 200 years we have been burdened with laws, systems and institutes that perpetuate disadvantage.

But our cultures and traditions still endure; we remain the traditional custodians of the land you walk on.

Last year, 140 Aboriginal community-controlled health organisations (ACCHOs) provided nearly 3 million episodes of care to over 340,000 clients by more than 3,000 Indigenous staff. It is clear that putting Aboriginal health in Aboriginal hands works.

Recently, Flinders University highlighted the success of the Central Australian Aboriginal Congress in Alice Springs, noting its ability to provide a one stop-shop with outreach services, free medicine and advocacy.

The benefits of having Aboriginal health in Aboriginal hands are evident in other case studies which show reductions in the numbers of young smokers, increased immunisations rates, and increased numbers of child health checks in our local communities.

The Federal Government’s rhetoric about economic empowerment and opportunity should be replaced with significant public policy initiatives and the delivery of specific outcomes. Politicians often speak about the optimism, resilience and determination of our people but how about speaking today, right now, about meaningful actions, engagement and self-determination for us all.

CTG 2017 report 15 Recommendations :  “We have the Solutions

Prime Minister, and all Members of Parliament I say to you that Aboriginal and Torres Strait Islander people have the solutions to the difficulties we face.

Consider for a moment the 2.5 million episodes of care delivered to our people by Aboriginal Community Controlled Heath Organisations each year.

This community-controlled work is echoed by many of our organisations here today, and amplified by countless individual and community efforts working for change.

Imagine this work stretching out over decades as it has.

We need a new relationship that respects and harnesses this expertise, and recognises our right to be involved in decisions being made about us.

A new relationship where we have a seat at the table when policies are developed.”

Dr Jackie Huggins Redfern Statement Parliamentary Event, 14 February 2017

Reinvigorating the national approach to health inequality

4.     State and Territory governments recommit to the Close the Gap Statement of Intent, and develop and implement formal partnerships with the Federal Government with agreed roles, funding and accountability with the provision of annual reports on their efforts to close the gap from each jurisdiction.

 

5.     The Federal, State and Territory governments work together to develop a National Aboriginal and Torres Strait Islander Health Workforce Strategy to meet the vision of the National Health Plan.

Social and Cultural Determinants of Health

6.     The Federal Government develop a long-term National Aboriginal and Torres Strait Islander Social and Cultural Determinants of Health Strategy.

Implementation Plan

The Implementation Plan is a major commitment by the Federal Government and must be adequately resourced for its application and operation. As such, the Government should:

7.     Identify geographic areas with both high levels of preventable illnesses and deaths and inadequate services, and development of a capacity-building plan for Aboriginal Community Controlled Health Organisations (ACCHOs) in those areas.

8.     Fund the process required to develop the core services model and the associated workforce, infrastructure, information management and funding strategies required.

9.     Ensure Aboriginal and Torres Strait Islander health funding is maintained at least at current levels until the core services, workforce and funding work is finalised, when funding should be linked directly with the Implementation Plan.

10. Ensure the timely evaluation and renewal of related frameworks upon which the Implementation Plan relies.

 

11. Finalise and resource the National Plan for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing. This plan should incorporate and synthesise the existing health, mental health, suicide and drugs policies and plans – and should be an immediate priority of all governments.

12. Ensure that the consultation process for the next iteration of the Implementation Plan be based on genuine partnership with Aboriginal and Torres Strait Islander people, in a way that is representative and properly funded so that First Peoples can be full and equal development partners.

Primary Health Networks

13. The Federal Government mandate formal agreements between Primary Health Networks (PHNs) and ACCHOs in each region that:

a.     specify Aboriginal and Torres Strait Islander leadership on Indigenous issues and identify the specific roles and responsibilities of both the PHNs and the ACCHOs.

b.     include workforce targets for Aboriginal and Torres Strait Islander health professionals and include mandatory Aboriginal and Torres Strait Islander representation on the clinical committees of every PHN.

14. The Federal Government mandate ACCHOs as preferred providers of health services for Aboriginal and Torres Strait Islander people provided through PHNs.

15. The Federal Government develop and implement agreed accountability, evaluation and reporting arrangements to support the provision of primary health care for Aboriginal and Torres Strait Islander peoples in each PHN area.[i]

Summary

The Campaign believes that the PHN program has the potential to make a significant positive difference in health outcomes for all Australians if they are culturally safe and properly engaged with the Aboriginal and Torres Strait Islander community within their network area.

The ability of PHNs to deliver culturally safe, high-quality primary health care for Aboriginal and Torres Strait Islander people will be seen in the lived experience of the people.

Engagement

It is essential that Federal Government ensure that the PHNs are engaging with ACCHOs to ensure the best primary health care is afforded to Aboriginal and Torres Strait Islander people, as well as the broader community. Competitive tendering processes for PHNs that award contracts to organisations that are able to write the best proposal may well be at the expense of organisations that can provide the best services in terms of access, quality and outcomes.

However, formal partnerships between PHNs and ACCHOs should reduce rather than exacerbate current funding inequities and inefficiencies.

It is the Campaign’s view that ACCHOs must be considered the ‘preferred providers’ for health services for Aboriginal and Torres Strait Islander people.

Where there is either no existing ACCHO or insufficient ACCHO services, capacity should be built by the establishment of new ACCHOs or within existing ACCHOs (or have capacity development of existing ACCHOs) within the PHN area to extend their services to the identified areas of need.

Where it is appropriate for mainstream providers to deliver a service, they should be looking to partner with ACCHOs to better reach the communities in need.[i]

The Campaign welcomes the collaboration between the Department of Health and the National Aboriginal Community Controlled Health Organisation to develop the Primary Health Networks (PHNS) and Aboriginal Community Controlled Health Organisations (ACCHOS) – Guiding Principles which are intended to provide:

…guidance for actions to be taken by each party across six key domains: Closing the Gap; cultural competency; commissioning; engagement and representation; accountability, data and reporting; service delivery; and research.[ii]

Having a shared understanding of the key domains of focus and the principles of engagement and collaboration are a good start, however, more can be done to formalise the relationship between PHNs and ACCHOs.

Cultural Safety

The need for culturally safe services, with safe spaces that support the holistic concept of health is well established.

ACCHOs continue to be the exemplar for cultural safety standards as they are, by their very existence, best placed to respond to the health needs of the community based on implicit cultural understanding.[iii]

Again, it is encouraging to see some indications that the PHNs are looking to incorporate culturally safe practices as evidenced by the Guiding Principles document between PHNs and ACCHOs. The Guiding Principles state:

‘An understanding of Aboriginal and Torres Strait Islander culture is important to partners who wish to engage with Aboriginal and Torres Strait Islander people effectively and as equals.

Underpinning the Guiding Principles is a shared knowledge that will ensure:

  • respectful culturally sensitive consultation
  • recognition that Aboriginal and Torres Strait Islander health outcomes will be achieved when Aboriginal and Torres Strait Islander people control them, and
  • that commissioned service delivery will be a strengths-based approach reflecting the United Nations Declaration on the Rights of Indigenous Peoples.’[iv]

Respect of culture must be embedded in all PHN practice and management, from formalised cooperation with ACCHOs, the delivery of services and the investments made in the non-Indigenous workforces so that they understand and value Cultural Safety and its importance for Aboriginal and Torres Strait Islander people seeking care.

 The Close the Gap Campaign

Close the Gap Campaign co-chair Jackie Huggins highlighted the resilience of Indigenous people and cautioned against feeling disheartened by the slow pace of change.

“When Tom Calma started the Close the Gap Campaign in 2006, he set a 25-year goal to achieve health equality between Aboriginal and Torres Strait Islander peoples and non-Indigenous peoples,” Dr Huggins said.

This was an intentionally ambitious time frame. Nevertheless, Tom and the other early Campaign members knew that every inch the gap closed between First Australians and non-Indigenous Australians translated into lives saved and lives improved.

The Australian community agreed. Since then more than 220,000 Australians have signed the close the gap pledge for change.

“Despite the significant challenges we face to make health equality a reality in this country, it is the commitment of the hundreds of thousands of people that have pledged their support to closing the gap that give us courage and strength to press on.

“In communities across Australia we are seeing more and more of our people rising above the obstacles of institutional racism, generational trauma and low expectations to become nurses, doctors, social workers, youth workers, health workers, administrators, teachers and community leaders.

Our people, with the support of the many non-Indigenous people committed to health equality, are best placed to lead the changes needed today, tomorrow and over the next decade,” Dr Huggins said.

 

 

 

 

 

NACCHO #IWD2017 Aboriginal Women’s #justjustice :Indigenous, disabled, imprisoned – the forgotten women of #IWD2017

 

” Merri’s story is not uncommon. Studies show that women with physical, sensory, intellectual, or psychosocial disabilities (mental health conditions) experience higher rates of domestic and sexual violence and abuse than other women.

More than 70 per cent of women with disabilities in Australia have experienced sexual violence, and they are 40 per cent more likely to face domestic violence than other women.

Indigenous women are 35 times more likely to be hospitalised as a result of domestic violence than non-Indigenous women. Indigenous women who have a disability face intersecting forms of discrimination because of their gender, disability, and ethnicity that leave them at even greater risk of experiencing violence — and of being involved in violence and imprisoned

Kriti Sharma is a disability rights researcher for Human Rights Watch

This is our last NACCHO post supporting  International Women’s Day

Further NACCHO reading

Women’s Health ( 275 articles )  or Just Justice  See campaign details below

” In-prison programs fail to address the disadvantage that many Aboriginal and Torres Strait Islander prisoners face, such as addiction, intergenerational and historical traumas, grief and loss. Programs have long waiting lists, and exclude those who spend many months on remand or serve short sentences – as Aboriginal and Torres Strait Islander people often do.

Instead, evidence shows that prison worsens mental health and wellbeing, damages relationships and families, and generates stigma which reduces employment and housing opportunities .

To prevent post-release deaths, diversion from prison to alcohol and drug rehabilitation is recommended, which has proven more cost-effective and beneficial than prison , International evidence also recommends preparing families for the post-prison release phase. ‘

Dying to be free: Where is the focus on the deaths occurring post-prison release? Article 1 Below

Article from Page 17 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

As the world celebrates International Women’s Day, this week  I think of ‘Merri’, one of the most formidable and resilient women I have ever met.

A 50-year-old Aboriginal woman with a mental health condition, Merri grew up in a remote community in the Kimberley region of Western Australia. When I met her, Merri was in pre-trial detention in an Australian prison.

It was the first time she had been to prison and it was clear she was still reeling from trauma. But she was also defiant.

“Six months ago, I got sick of being bashed so I killed him,” she said. “I spent five years with him [my partner], being bashed. He gave me a freaking [sexually transmitted] disease. Now I have to suffer [in prison].”

I recently traveled through Western Australia, visiting prisons, and I heard story after story of Indigenous women with disabilities whose lives had been cycles of abuse and imprisonment, without effective help.

For many women who need help, support services are simply not available. They may be too far away, hard to find, or not culturally sensitive or accessible to women.

The result is that Australia’s prisons are disproportionately full of Indigenous women with disabilities, who are also more likely to be incarcerated for minor offenses.

For numerous women like Merri in many parts of the country, prisons have become a default accommodation and support option due to a dearth of appropriate community-based services. As with countless women with disabilities, Merri’s disability was not identified until she reached prison. She had not received any support services in the community.

Merri has single-handedly raised her children as well as her grandchildren, but without any support or access to mental health services, life in the community has been a struggle for her.

Strangely — and tragically — prison represented a respite for Merri. With eyes glistening with tears, she told me: “[Prison] is very stressful. But I’m finding it a break from a lot of stress outside.”

Today, on International Women’s Day, the Australian government should commit to making it a priority to meet the needs of women with disabilities who are at risk of violence and abuse.

In 2015, a Senate inquiry into the abuse people with disabilities face in institutional and residential settings revealed the extensive and diverse forms of abuse they face both in institutions and the community. The inquiry recommended that the government set up a Royal Commission to conduct a more comprehensive investigation into the neglect, violence, and abuse faced by people with disabilities across Australia.

The government has been unwilling to do so, citing the new National Disability Insurance Scheme (NDIS) Quality and Safeguard Framework as adequate.

While the framework is an important step forward, it would only reach people who are enrolled under the NDIS. Its complaints mechanism would not provide a comprehensive look at the diversity and scale of the violence people with disabilities experience, let alone at the ways in which various intersecting forms of discrimination affect people with disabilities.

The creation of a Royal Commission, on the other hand, could give voice to survivors of violence inside and outside the NDIS. It could direct a commission’s resources at a thorough investigation into the violence people with disabilities face in institutional and residential settings, as well as in the community.

The government urgently needs to hear directly from women like Merri about the challenges they face, and how the government can do better at helping them. Whether or not there is a Royal Commission, the government should consult women with disabilities, including Indigenous women, and their representative organizations to learn how to strengthen support services.

Government services that are gender and culturally appropriate, and accessible to women across the country, can curtail abuse and allow women with disabilities to live safe, independent lives in the community.

Kriti Sharma is a disability rights researcher for Human Rights Watch

 

croakey-new

How you can support #JustJustice

• Download, read and share the 2nd edition – HERE.

Buy a hard copy from Gleebooks in Sydney (ask them to order more copies if they run out of stock).

• Send copies of the book to politicians, policy makers and other opinion leaders.

• Encourage journals and other relevant publications to review #JustJustice.

• Encourage your local library to order a copy, whether the free e-version or a hard copy from Gleebooks.

• Follow Guardian Australia’s project, Breaking the Cycle.

Readers may also be interested in these articles:

Aboriginal Health #Sugartax debate : Sugar consumption is critical to reducing chronic health conditions, including diabetes says NACCHO

sugar-tax

“The high costs of transporting food and groceries to remote communities mean that Aboriginal and Torres Strait Islander people in these areas are already paying inflated prices for these types of products, and all other grocery items.

“These communities are also less able to pay higher costs and have limited access to alternatives, particularly fresh fruit and vegetables – which, because of the long distances they need to be transported, are often past their prime and overpriced when they arrive,”

“Reducing sugar consumption is critical to reducing chronic health conditions, including diabetes; however, there needs to be more work done on how these issues would be overcome before NACCHO could support any tax-based approach such as a sugar tax.”

Chair Matthew Cooke from peak Indigenous health body, National Aboriginal Community Controlled Health Organisation (NACCHO) has expressed reservations about the tax to MJA InSight.

See NACCHO Previous obesity articles HERE

 “sugary drinks were “killing the population” in remote communities, after the senate heard evidence of an “astounding” level of soft drink sales at remote community stores.

Senator Scullion said he has been working with remote stores to restrict the sale of larger bottles of soft drink.

“I’ve been trying to negotiate the two litre and 1.5 litres off the shelves completely,”

“It’s a difficult thing but the evidence shows that whatever portion you buy, a child will drink oneand-a-half litres.”

More recently he went to a community store where water was free, but despite trying to “hide the full-strength coke” it was the popular choice.

He gave one example where a remote community store was drawing half of its total profits from soft drink sales.

“It was the most expensive liquid in that store and everyone went straight there,”

Indigenous affairs minister, Nigel Scullion,

 ” TAXES on unhealthy foods, not subsidies on fruit and vegetables, are effective at reducing the burden of obesity, new research suggests, amid renewed clamour for a sugary drinks tax.

Researchers at the University of Melbourne have found that a subsidy on fresh fruit and vegetables would not on its own produce health gains, because it would lead to an undesirable increase in sodium and energy intake.”

Authored by Sarah Colyer from MJA Insight

However, adding a subsidy to a package of taxes on sugar, fat, salt and sugar-sweetened beverages could be effective, they wrote. The combination of taxes plus the subsidy could avert 470 000 disability-adjusted life years and save $3.4 billion from the health budget, the modelling study found.

The study drew on detailed New Zealand price–elasticity data – which track variations in product uptake with changes in product prices – to quantify disease risk reductions associated with each change in risk factor exposure.

A sugar tax would be most cost-effective, the study found, followed by a salt tax, a saturated fat tax and a sugar-sweetened beverages tax.

Writing in the journal PLOS Medicine, Dr Linda Cobiac and colleagues said that their findings added to the “growing evidence of large health benefits and cost-effectiveness of using taxes and regulatory measures to influence the consumption of healthy foods”.

The findings about the subsidy might at first appear counterintuitive, they said.

“However, using price subsidies or discounts as an incentive to purchase more fruits and vegetables may have the effect of increasing real income available to buy food, including unhealthy products, and could therefore lead to an overall increase in dietary measures such as saturated fat, sodium, or total energy intake,” they wrote.

The federal government is facing growing pressure from public health advocates to tax sugary drinks, with the Australian Greens pledging to introduce a bill on the measure later in 2017.

Writing in the MJA, the University of Sydney’s Professor Stephen Colagiuri urged the government to make the tax a priority as part of a multicomponent strategy against obesity.

That call was echoed in a separate report released last week by the Obesity Policy Coalition, whose member organisations include Cancer Council Victoria, Diabetes Australia (Victoria) and Deakin University.

In his MJA article, Professor Colagiuri cited the introduction of Mexico’s sugary drinks tax in 2014, which was followed by a 12% decline in the consumption of taxed beverages and a spike in bottled water consumption.

“The ongoing impact of [Mexico’s] tax has been challenged with new data suggesting a small increase in sales of SSBs [sugar-sweetened beverages] in 2015, but still lower than the increase in pre-tax sales,” he wrote.

“Arguments that an SSB tax is an ineffective means to reduce consumption are inconsistent with food industry claims of potential damage and job losses, which instead may point to the industry believing that a tax would substantially impact consumption.”

Professor Colagiuri noted that Australia was among the largest global markets for sugar-sweetened beverages, with males aged 4–30 years drinking an average 750 mL (two cans) per day.

“Government pays for health services and consequently has a right and duty to address externalities to promote and protect public health,” he wrote.

However, the federal government last week continued its resistance to any form of sugar tax, with health minister Greg Hunt commenting: “We’re committed to tackling obesity, but increasing the family’s weekly shop at the supermarket isn’t the answer.”

Decrying the proposed tax as a “nanny state” response, assistant minister for health, Dr David Gillespie, noted that Denmark had repealed its sugar tax and dropped plans for a tax on saturated fats.

Indigenous affairs minister, Nigel Scullion, said in 2016 that sugary drinks were “killing the population” in remote communities, after the senate heard evidence of an “astounding” level of soft drink sales at remote community stores.

David Butt, CEO of the National Rural Health Alliance told MJA InSight that his organisation supported “the possibility of taxing sugar-sweetened beverages and using the revenue to subsidise access to healthier food options”.

Professor Andrew Wilson, director of the Menzies Centre for Health Policy at the University of Sydney, said that compared with taxing sugar per se or salt, the proposed tax on sugary drinks had “the virtue of being fairly easy to define”.

“However, these drinks are so cheap to make that the tax will need to be substantial,” he added.

A recent report by the Grattan Institute recommended that sugar-sweetened beverages be taxed at a rate of 40 cents per 100 grams of sugar, increasing the price of a 2-litre bottle of soft drink by 80 cents. This would raise about $500 million a year, according to the Grattan Institute, which predicted a resultant 15% drop in consumption of sugary drinks and a small decrease in obesity rates.

Professor Wilson stressed that any taxation approach should be “part of a package that includes education and support for good nutrition, promotion and facilitation of physical activity, with particular focus on school-aged and older teens, planning considerations and, possibly for some areas and groups, subsidies for fruit and vegetables”.

Dr Cobiac agreed, commenting: “Our modelling shows that the potential health benefits of using taxes and subsidies to improve dietary choices and the nutritional quality of our foods in Australia are huge, but ultimately, they are just one of a number of measures that are needed to tackle obesity.”

Dr Cobiac noted that 13 other countries had announced taxes on unhealthy foods or sugar drinks in the past 5 years.

“It was true that Denmark had revoked its policies,” she said; however, she added that it was likely that as early initiators “they did not fully foresee or plan for dealing with the resulting backlash from the food industry”.

“We will never know what effect the taxes would have had in Denmark; they were repealed before there was a chance to properly evaluate them,” Dr Cobiac said.

“While many people want to eat better and lose weight, it is not easy to sustain the changes in behaviour when we live in an environment where unhealthy foods are widely available, heavily marketed and cheap.

“That environment is unlikely to change without a really comprehensive strategy to tackle the obesity problem.”

Please leave your comment below

7 thoughts on “Sugar tax: what you need to know”

    1. Anonymous says:

      This debate has been going around and around for far too long. In the meantime, overweight and obesity rates are increasing. Public health advocates need to change tack and get on with their ‘real’ jobs to make a positive difference. Scrap the idea of additional taxes on processed foods. And as for ‘modelling studies’ to underpin an evidence base to guide action. We know what to do: listen to people demonstrating ‘Lived Experience’.

    1. Andrew says:

      I second the previous comment. “Modelling” is not evidence. Let’s see real world evidence first — does a tax on sugar actually reduce obesity rates? That is the only evidence that counts.

      As a side point, imposing a “sugar tax” will cause food manufacturers to substitute sugar with other sweeteners, e.g. stevia. The long term health implications of stevia (and other additives) are unknown. Of course public health “experts” love to pretend that they are omniscient and infallible, but some caution is warranted. Let’s not repeat the massive public health failures of the past, such as the notorious food pyramid which was based on the flimsiest of evidence.

    1. Dr Rosemary Stanton says:

      We do know what to do, but the political power of the processed food industry means we get obstruction to anything that might decrease sales of its products. Junk food and drinks contribute 35% of adults’ and over 40% of children’s energy intake. That is the elephant in the room and we need multiple actions to tackle it. A sugar tax is one that is simple to implement, especially applied to drinks.

      Even more importantly, we need to stop promoting junk food and drinks. That means stopping advertising these products during TV programs that children watch. It means sporting teams and sports heros not acting as walking billboards. It needs bans on advergames for children where product placement of junk foods and drinks are visible for the time spent playing the game – which may be 30 minutes. It needs schools to stop selling children junk food and drinks from the school canteen (which negates anything they might learn in the classroom).

      We also need to talk about foods rather than nutrients. The Dietary Guidelines talk about foods. Sadly, almost no one follows them – as shown by the fact that less than 7% eat even the minimal amount of vegetables and fruit recommended, and junk food consumption is so high.

    1. Roger McMaster-Fay MRCOG FRANZCOG says:

      Oh great, another tax and it worked so well on cigarettes!. We are one of the most highly taxed countries in the world! We need a new paradigm to tackle this problem and we doctors should be able to come up with one. What about tax deductions for people who loose weight?

    1. Dr. ARC says:

      Lot’s of salient comments from Rosemary and Roger. I do not believe that drinks alone are the major cause of obesity. As always if you put more calories in than you need or use in exercise the extra calories are stored as fat, period! We need to return to the era of good home cooking and stop eating out at expensive restaurants and quick take away options which are loaded with fat and sugar. Then and only then can we begin to tackle the problem of obesity.

    1. Virginia Fazio says:

      What will the food industry use to replace ingredients that are taxed? Instead of sugar in foods will they use starches and intense sweeteners? Metabolically very little difference between starch and sugar. Will saturated fat be replaced with unsaturated fats that may be less heat stable and produce byproducts may have other health risks? Will consumers go back to adding more salt during cooking and at the table to processed foods with lower salt levels? Research needs to be on the whole diet outcomes if some processed foods carry an additional tax. We know that how the food industry meet consumer demand for low cholesterol and low saturated fat foods did not always result in a “healthy” food. Perhaps as a community we need improved cooking and gardening skills so we rely less on highly processed foods.

  1. Andrew Jamieson says:

    Education, education, education!! Where is ‘health’ on the syllabus at our schools? What public education is there on nutrition despite the valiant efforts of the likes of Rosemary Stanton. We might as well tax cars even more more as we kill lots of people with them! And it has been well pointed out that sugar alone is not responsible for our health woes. Logically we need more put GST on food, however no government would seriously consider this