NACCHO Aboriginal Health Research News : Featuring @FaCtS_Study @Mayi_Kuwayu @HealthInfoNet and @LowitjaInstitut #ResearchIntoPolicy New report spotlights governments’ secrecy on Indigenous health program outcomes

The current Closing the Gap Refresh process has again highlighted the need for Governments to ensure effective engagement with Aboriginal and Torres Strait Islander organisations and communities.

Together we can make informed decisions about creating sustainable and positive change.

This has to be done in a way where both insights and power are genuinely shared, not one way traffic.”

Romlie Mokak, CEO of the Lowitja Institute.

 

1. COMMUNITY PRIORITIES WILL TRANSLATE INTO EFFECTIVE ABORIGINAL AND TORRES STRAIT ISLANDER POLICIES

2. Study Question:  What would it take to address Family Violence in Aboriginal and Torres Strait Islander Communities?

3. HealthInfoNet : Access to online Aboriginal and Torres Strait Islander health information just got easier

1. COMMUNITY PRIORITIES WILL TRANSLATE INTO EFFECTIVE ABORIGINAL AND TORRES STRAIT ISLANDER POLICIES

Aboriginal and Torres Strait Islander leadership in health research and evidence-based policy is critical to closing the gap for Australia’s First Peoples’ health.

A Community priorities into policy forum was held in Canberra Monday  highlighting three research projects to inform strategic decisions in policy development, service delivery and evaluation.

These projects reflect Aboriginal and Torres Strait Islander community priorities, and were commissioned and funded by the Lowitja Institute.

Governments need increased focus and collaboration with Aboriginal and Torres Strait Islander organisations and communities to grow the knowledge and evidence base, and face future challenges in holding mainstream health organisations to account.

“Each of the projects discussed at this forum contribute to an emerging body of research on the value of engaging Aboriginal and Torres Strait Islander people in every stage of health research,” Mr Mokak said.

Research leaders highlighting how deficit discourses have real world outcomes for health and wellbeing:

Download Copy

deficit-discourse-summary-report

“Discourses of deficit occur when discussion of Aboriginal and Torres Strait Islander affairs is reduced to a focus on failure and dysfunction, and Aboriginal and Torres Strait Islander identity becomes defined in negative terms, eclipsing the complex reasons for inequalities, and overlooking diversity, capability and strength,” Dr Hannah Bulloch from National Centre for Indigenous Studies said.

Professor Margaret Kelaher from the University of Melbourne will argue that the potential benefits of programs for Aboriginal and Torres Strait Islander people are not being fully realised due to limitations in how evaluations are being conducted, what is being evaluated, and how the evidence generated is being translated into action. She will present an evaluation framework to improve the benefits of evaluation for Aboriginal and Torres Strait Islander people.

SEE CROAKEY REVIEW

Information about evaluation tenders for Aboriginal and Torres Strait Islander health programs is locked away by governments, according to a new research report.

Original Published here

A review of publicly advertised evaluation tenders over the past ten years found that only five percent of tender documents and 33 percent of evaluation reports were publicly available.

The report, An Evaluation Framework to Improve Aboriginal and Torres Strait Islander Health, makes sweeping recommendations to improve the transparency and accountability of evaluations, as well as the quality of tender processes.

Prepared for the Lowitja Institute by the University of Melbourne’s Margaret Kelaher, Joanne Luke, Angeline Ferdinand and Daniel Chamravi, the report is one of a number of new publications launched at a Community Priorities into Policies forum, convened by the Lowita Institute in Canberra today.

Follow #ResearchIntoPolicy for live tweeting of the discussions, which are being covered by UTS scholar and Croakey contributing editor Dr Megan Williams for the Croakey Conference News Service.

The report calls for tender documents, evaluation reports and responses to evaluation to be stored on a publicly accessible database, so they are accessible to the communities in which data are collected.

Reforms needed

It also calls for sweeping reforms to evaluation of Aboriginal and Torres Strait Islander health programs to ensure they better meet the needs of communities and follow the principles of ethical research.

The researchers said the failure to release evaluation reports was a frustration not only for evaluators, Aboriginal and Torres Strait Islander people, and program implementers – but also commissioners.

“The value of releasing evaluation reports was recognised by all parties,” the report said. “Although decisions not to release evaluation reports are typically made by commissioning agencies, these decisions often reflect political rather than program imperatives.

“Exceptions were cases where there were concerns about the quality of the evaluation; however, this is likely to make up a small proportion of the reports that are not released.”

The researchers said the Department of the Prime Minister and Cabinet was moving to release all evaluations in either report or summary form, but that past evaluations should also be released.

“Lack of access to information about evaluations and their findings is a significant barrier to building the evidence base in Aboriginal and Torres Strait Islander health. It also prevents evidence-based priority setting and quality assurance processes around evaluation.”

Ethical gaps

The report noted that evaluation contracts, particularly around intellectual property, are often at odds with community expectations and ethical frameworks.

“The most important finding from this review of government tenders is that there is no consistency regarding ethics requirements for evaluations involving Aboriginal and Torres Strait Islander populations. Nor is there an ethic to give Aboriginal communities a voice in the evaluation through meaningful engagement or control of the evaluation.”

The report also found that, although there were some positive examples, accepted principles for working with Aboriginal and Torres Strait Islander people are not widely or consistently integrated into programs, tender documents or program evaluations.

For example, principles of holistic concept of health, partnerships and shared responsibility, cultural respect, engagement, capacity building, accountability and governance were not well integrated into evaluations.

“It was not uncommon for a program to stipulate that its outcomes were related to holistic health but then have indicators that were largely biomedical,” the researchers reported.

The report proposes a framework for the evaluation of policies, programs and services for Aboriginal and Torres Strait Islander peoples, noting that the lack of a coherent framework has meant “a reduction in the quantity, quality, scope and use of available evidence”.

While efforts were underway to improve evaluation processes, the researchers said it was recognised that systemic change was required.

They called for tender processes to support evaluation proposals that are most likely to benefit Aboriginal and Torres Strait Islander people, and for evaluation contracts and agreements to be consistent with principles for working with Aboriginal and Torres Strait Islander people and ethical frameworks.

A directory of current evaluations should be developed, and training should be provided to specifically support Aboriginal and Torres Strait Islander leadership in evaluation, the researchers said.

The report gives several examples of positive approaches to evaluation, but notes that “the most constant criticism from Aboriginal and Torres Strait Islander communities about evaluation and other types of research is that the findings are not translated into action and thus not of benefit to communities”.

For example, many of the issues examined in the Royal Commission into the Protection and Detention of Children in the Northern Territory arose from unaddressed recommendations in the 2007 Little Children are Sacred report and the 1991 report of the Royal Commission on Aboriginal Deaths in Custody.

Press Release Continued

A project led by the Secretariat National Aboriginal and Islander Child Care will be presented by Professor Kerry Arabena, also from the University of Melbourne. The project looks at service delivery integration initiatives targeted to the early childhood development needs of Aboriginal and Torres Strait Islander children.

The Lowitja Institute Research Leadership Award announced at the event and wa presented by the Ms Kate Latimer, CEO of the Cranlana Program

and ’s 2018 Leadership Award goes to , a Chief Investigator on the . Congratulations Ray

The Australian National University is seeking partnerships with Aboriginal and Torres Strait Islander communities to conduct research to find out what communities need to promote and improve safety for families.  We want to partner and work with local organisations and communities to make sure the research benefits the community.
 
Who are we?
We work at the Australian National University (ANU). The study is led by Aboriginal and Torres Strait Islander researchers.  Professor Victoria Hovane (Ngarluma, Malgnin/Kitja, Gooniyandi), along with Associate Professor Raymond Lovett (Wongaibon, Ngiyampaa) and Dr Jill Guthrie (Wiradjuri) from NCEPH, and Professor Matthew Gray of the Centre for Social Research and Methods (CSRM) at ANU will be leading the study.
 
Study Question:  What would it take to address Family Violence in Aboriginal and Torres Strait Islander Communities?
 
How are we going to gather information to answer the study question?
A Community Researcher (who we would give funds to employ) would capture the data by interviewing 100 community members, running 3 focus groups for Men /  Women / Youth (over 16).
We would interview approx. 5 community members to hear about the story in your community.
We know Family Violence happens in all communities.  We don’t want to find out the prevalence, we want to know what your communities needs to feel safe. We will also be mapping the services in your community, facilities and resources available in a community.  All this information will be given back to your community.
 
What support would we provide your service?
We are able to support your organisation up to $40,000 (including funds for $30 vouchers), this would also help to employ a Community Researcher.
Community participants would be provided with a $30 voucher to complete a survey, another $30 for the focus group, and another $30 for the interview for their time.
What will we give your organisation?
We can give you back all the data that we have captured from your community, (DE identified and confidentialised of course).We can give you the data in any form you like, plus create a Community Report for your community.  There might be some questions you would like to ask your community, and we can include them in the survey.
 
How long would we be involved with your community / organisation?
Approximately 2 months
 
How safe is the data we collect?
The data is safe. It will be DE identified and Confidentialised.  Our final report will reflect what Communities (up to 20) took part in the study, but your data and community will be kept secret.  Meaning, no one will know what data came from your community.
 
If you think this study would be of benefit to your community, or if you have any questions, please do not hesitate to contact Victoria Hovane and the FaCtS team on 1800 531 600 or email facts.study@anu.edu.au.

 

3. HealthInfoNet : Access to online Aboriginal and Torres Strait Islander health information just got easier

 

 

The Australian Indigenous HealthInfoNet this week launched a new responsive design website.

VIEW HERE

The HealthInfoNet has been bringing together the latest information, evidence, research and knowledge about Aboriginal and Torres Strait Islander health in one place and making it freely accessible for over 20 years.

A comprehensive custom built database and re design of the front of the web resource means that the new responsive design will support the workforce more than ever before, on any platform in any location.

HealthInfoNet Director, Professor Neil Drew, says ‘Now more than ever those working in Aboriginal and Torres Strait Islander health need prompt access to relevant, reliable information as well as quick, easy search options. Our new evidenced based responsive design has been the result of in depth review of site mapping and analytics, a national user survey of what users want and access most and extensive collaboration with users and other stakeholders across the country. This has resulted in the design of a cleaner, visual and more accessible site which can now be accessed on any platform be it a tablet or mobile phone”.

Renae Bastholm, HealthInfoNet IT Manager who developed the responsive site said ”The content you know and trust is still there, but a simpler and easier navigation will mean a shorter search time to get to what you need and a quicker loading time.  We have structured the new site to be intuitive so our users don’t have to think too much about navigation. The new platform allows us to custom design the information to our users’ needs and quickly display information”.

“The real dividend” says Professor Drew “is that for a site of this size and a national user base with diverse needs, is the ease of getting directly to the information you need when you need it. This supports the time poor health workforce and ensures the relevant information gets to where it’s needed most. Updating the site and utilising the latest technology to meet users’ needs is an ongoing focus”.

Both the HealthInfoNet and the Alcohol and Other Drugs Knowledge Centre are now available in this new format. www.Aodknowledgecentre.ecu.edu.au (note new location).

NACCHO Aboriginal Health and #Sugartax : @4Corners #Tippingthescales: #4corners Sugar, politics and what’s making us fat #rethinksugarydrinks @janemartinopc @OPCAustralia

On Monday night Four Corners investigates the power of Big Sugar and its influence on public policy.

“How did the entire world get this fat, this fast? Did everyone just become a bunch of gluttons and sloths?”  Doctor

The figures are startling. Today, 60% of Australian adults are classified as overweight or obese. By 2025 that figure is expected to rise to 80%.

“It’s the stuff of despair. Personally, when I see some of these young people, it’s almost hard to imagine that we’ve got to this point.”  Surgeon

Many point the finger at sugar – which we’re consuming in enormous amounts – and the food and drink industry that makes and sells the products fuelled by it.

Tipping the scales, reported by Michael Brissenden and presented by Sarah Ferguson, goes to air on Monday 30th of April at 8.30pm. It is replayed on Tuesday 1st of May at 1.00pm and Wednesday 2nd at 11.20pm.

It can also be seen on ABC NEWS channel on Saturday at 8.10pm AEST, ABC iview and at abc.net.au/4corners.

See Preview Video here

 ” In 2012-13, Aboriginal and Torres Strait Islander people 2 years and over consumed an average of 75 grams of free sugars per day (equivalent to 18 teaspoons of white sugar)1. Added sugars made up the majority of free sugar intakes with an average of 68 grams (or 16 teaspoons) consumed and an additional 7 grams of free sugars came from honey and fruit juice. “

NACCHO post – ABS Report abs-indigenous-consumption-of-added-sugars 

Amata was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

The thing that I say in community meetings all the time is that, the reason we’re doing this is so that the young children now do not end up going down the same track of diabetes, kidney failure, dialysis machines and early death, which is the track that many, many people out here are on now,”

NACCHO Post : Mai Wiru, meaning good health, and managed by long-time community consultant John Tregenza.

See Previous NACCHO Post Aboriginal Health and Sugar TV Doco: APY community and the Mai Wiru Sugar Challenge Foundation

4 Corners Press Release

“This isn’t about, as the food industry put it, people making their own choices and therefore determining what their weight will be. It is not as simple as that, and the science is very clear.” Surgeon

Despite doctors’ calls for urgent action, there’s been fierce resistance by the industry to measures aimed at changing what we eat and drink, like the proposed introduction of a sugar tax.

“We know about the health impact, but there’s something that’s restricting us, and it’s industry.”  Public health advocate

On Monday night Four Corners investigates the power of Big Sugar and its influence on public policy.

“The reality is that industry is, by and large, making most of the policy. Public health is brought in, so that we can have the least worse solution.”  Public health advocate

From its role in shutting down debate about a possible sugar tax to its involvement in the controversial health star rating system, the industry has been remarkably successful in getting its way.

“We are encouraged by the government here in Australia, and indeed the opposition here in Australia, who continue to look to the evidence base and continue to reject this type of tax as some sort of silver bullet or whatnot to solve what is a really complex problem, and that is our nation’s collective expanding waistline.” Industry spokesperson

We reveal the tactics employed by the industry and the access it enjoys at a time when health professionals say we are in a national obesity crisis.

“We cannot leave it up to the food industry to solve this. They have an imperative to make a profit for their shareholders. They don’t have an imperative to create a healthy, active Australia.”  Health advocate

NACCHO post – Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

 “This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

BACKGROUND

 ” This campaign is straightforward – sugary drinks are no good for our health. It’s calling on people to drink water instead of sugary drinks.’

Aboriginal and Torres Strait Islander people in Cape York experience a disproportionate burden of chronic disease compared to other Australians.’

‘Regular consumption of sugary drinks is associated with increased energy intake and in turn, weight gain and obesity. It is well established that obesity is a leading risk factor for diabetes, kidney disease, heart disease and some cancers. Consumption of sugary drinks is also associated with poor dental health.

Water is the best drink for everyone – it doesn’t have any sugar and keeps our bodies healthy.’

Apunipima Public Health Advisor Dr Mark Wenitong

Read over 48 NACCHO articles Health and Nutrition HERE

https://nacchocommunique.com/category/nutrition-healthy-foods/

Read over 24 NACCHO articles Sugar Tax HERE  

https://nacchocommunique.com/category/sugar-

NACCHO Aboriginal Health @VACCHO_org @Apunipima join major 2018 health groups campaign @Live Lighter #RethinkSugaryDrink launching ad showing heavy health cost of cheap $1 frozen drinks

NACCHO Aboriginal Health #Junkfood #Sugarydrinks #Sugartax @AMAPresident says Advertising and marketing of #junkfood and #sugarydrinks to children should be banned

NACCHO Aboriginal Health and #CulturalSafety Debate : Media VS Health Sector : Should we have culturally appropriate spaces in hospitals ?

Once again the debate about cultural safety has escalated nationally thru News Ltd newspapers with the Daily Telegraph leading off on Tuesday (3 April ) with a front page “cultural safety expose “ and 4 hours nonstop coverage and commentary on SkyNews from the usual suspects Peta Credlin , Alan Jones , Andrew Bolt , Ben Fordham , Paul Murray, Troy Branston in addition to blanket radio coverage across Australia.

See 2 SkyNews Broadcasts below

The policy issue being heavily criticised by the media but not health authorities and experts is that the NSW Health has recommended its emergency departments to provide “culturally appropriate space’’ for the families of Aboriginal patients.

The new policy in NSW to provide a “culturally appropriate space’’ or “designated Aboriginal waiting room’’ was introduced after research found Indigenous patients were at least 1.5 times more likely to leave hospitals before emergency treatment.

In Victoria some hospitals and services have separate areas for Indigenous patients and their families to meet, rest or engage with specialist hospital staff.

See Part 1 Below for NSW Health policy extracts and download document

Above Editorial Daily Telegraph 3 April

Firstly those in favour of this cultural safety policy include

 ” Well, I think it’s good that issues like cultural safety are entering the popular narrative. We need to do better when it comes to delivering care to Aboriginal and Torres Strait Islander people, and I think we need to ask them what will and won’t work.

The truth is that health outcomes for Indigenous Australians are significantly worse than non-Indigenous Australians according to just about every possible metric.

The AMA strongly supports Aboriginal control when it comes to primary care and when it comes to Aboriginal and Torres Strait Islanders being in larger health facilities like our hospitals, I think we need to do everything we can to make them- the appropriate settings for them to seek care.

If that means spending a little bit of money on waiting areas, if that means making subtle changes to outpatient clinics or to inpatient wards to make Indigenous people feel more at home, I don’t think non-Indigenous people should find that threatening”

1.Dr Michael Gannon President AMA

For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations.

As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

2. AMA (NSW) President, Prof Brad Frankum

“ It isn’t mandatory in the sense they’ve got to do it, it’s mandatory in the sense you’ve got to think about what is culturally appropriate (and) what might help the local community,”

3.Health Minister Brad Hazzard­ said many hospitals had already decided to introduce a culturally appropriate­ space.

“Among other benefits, culturally competent care increases accurate and timely diagnosis and increases attendance rates at follow-up appointments

Positive results such as these worked to overcome reluctance to engage with mainstream healthcare services, as well as improving rates of self-discharge against medical advice.”

4.President Simon Judkins the Australasian College for Emergency Medicine said it believed emergency departments must move towards a place of respect and acknowledgment of Indigenous culture

The college also called for a focus on increasing the numbers of Aboriginal and Torres Strait Islander people working across all health professions, including emergency medicine.

“All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.

This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment.

It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

5.Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative.

” The policy was about improving the health of Aboriginal people and people who are not Aboriginal should not be threatened by the fact we’re trying to look out for a very vulnerable part of our community ”

6.NSW Health deputy secretary Susan Pearce

” The policy is flexible, allowing local health districts to carry out initiatives in consultation with their local Aboriginal community to make their hospital settings more culturally inclusive, in ways that best suit the community,”

7.NSW Health spokeswoman .

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital

Racism is a significant barrier to Aboriginal health improvement say Donna Ah Chee 2015 Read in full here or Part 4 Below

” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma see Part 5 Below

Part 1 NSW Policy

Download The Policy document in full

NSW Policy Doc

Local processes should be in place to monitor numbers of patients who ‘Did not Wait’ for treatment following triage, including rates for Aboriginal and non-Aboriginal patients.

Strategies to address issues identified should be implemented and evaluated

2.1.3 Considerations for Aboriginal patients

 Section 4.1 acknowledges the higher rates of Aboriginal patients who choose not to wait for treatment in ED when compared to non-Aboriginal patients.

An important contributor to this issue is Aboriginal patients feeling safe to stay and wait. The use of local Aboriginal art in ED waiting rooms can provide links to culture and community; advice should be sought on appropriate art from the local Aboriginal community.

If available in the hospital, relatives may access the designated Aboriginal waiting room for families and carers. If no room exists, a culturally appropriate space within the local hospital should be identified.

Patients identifying as Aboriginal people should be provided with information regarding access to Aboriginal Health Workers that may be available. Access to any of these services may

4.1 Monitoring of rates of patients who ‘Did not Wait’

 EDs should maintain a local auditing system to monitor trends in rates of DNW. Review of data should also be undertaken by Aboriginal and non-Aboriginal patients as there is significant evidence in the literature of higher rates of DNW among Aboriginal patients presenting to ED

Addressing this issue is in line with the Australian Commission on Safety and Quality in Healthcare’s guidance on Improving care for Aboriginal and Torres Strait Islander People.

Locally designed strategies to manage identified reasons for patients who DNW should be implemented with outcomes reviewed. Consideration may be given to follow up of patients who DNW who are considered to have high risk issues or are from a vulnerable patient group.

Part 2 AMA (NSW) President: culturally appropriate spaces in EDs are a welcome addition to NSW public hospitals

Access to healthcare is critical to the wellbeing of all Australians and removing barriers to it is important, AMA (NSW) President, Prof Brad Frankum, said.

“It is essential that hospitals and all healthcare facilities make an effort to provide safe and welcoming spaces to facilitate access to care.

“Public hospitals try to do this in a range of ways, including the design of spaces, the provision of information in different languages, access to translators and other services to ensure patients get the best from their healthcare.

“For this reason, AMA (NSW) applauds the NSW Government for encouraging hospitals to ensure that they consider the needs of Indigenous patients in creating a safe and welcoming environment in hospitals,” Prof Frankum said.

“Indigenous patients continue to suffer unacceptably poorer health outcomes compared to other Australians.

“For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations,” Prof Frankum said.

“As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

“It is disappointing to see those who clearly do not have the same personal experiences of navigating our healthcare system making inappropriate comments about such an important health policy,” Prof Frankum said

Part 3 : Culturally safe healthcare starts in the waiting room

The Public Health Association of Australia (PHAA) called for cultural safety in Aboriginal and Torres Strait Islander healthcare last week, along with a number of other leading health groups and medical practitioners.

As an extension of this, the PHAA supports all viable and suitable cultural safety measures in the provision of healthcare to Aboriginal and Torres Strait Islander people, including culturally appropriate waiting rooms.

Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative, saying, “All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.”

 

“This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment,” she said.

Ms Parter continued, “It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

“The history of the stolen generations and the role that Australian hospitals held during these events has left a strong effect on Aboriginal and Torres Strait Islander people, and in order to overcome this and move toward Reconciliation we need to work together to ensure Australian hospitals are a safe space for all,” Ms Parter said.

Michael Moore, CEO of the PHAA supported Ms Parter’s statements, saying, “Evidence shows that healthcare has the best outcomes when the patient and provider can share knowledge and understanding in a respectful and welcoming environment.

We also know that Aboriginal and Torres Strait Islander patients are at least 1.5 times more likely to leave hospital before receiving treatment compared to non-Indigenous patients.”

“This resembles the gaps in health outcomes which Close the Gap campaigners are working hard to resolve, and a trial on the mid-north coast in NSW showed that culturally appropriate waiting rooms resulted in a 50% reduction in Aboriginal and Torres Strait Islander patients leaving before accessing treatment. This really demonstrates the strength of this type of cultural safety initiative in a tangible way,” Mr Moore said.

“We ensure that hospitals are safe environments for children, elderly people, disabled people, and other groups with certain needs, it’s now time we ensure that the cultural needs of patients are also taken into careful consideration,” Mr Moore said.

 

Part 4 Racism and the hospital system : Donna Ah Chee

 Read in full here

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital (3).

This difference led one key study to conclude that ‘there may be systematic differences in the treatment of patients identified as Indigenous’ in Australia’s public hospitals (4), a conclusion supported by studies showing poorer survival rates for cancer for Indigenous people, due to their being less likely to have treatment, having to wait longer for surgery, and being referred later for specialist treatment (5). This is not good enough and we need to use the current spotlight on racism to look at these deeper issues as well”, she suggested.

“Such systemic differences in care provided by hospitals contribute to Aboriginal and Torres Strait Islander people’s low level of trust for hospitals as institutions – the 2008 National Aboriginal and Torres Strait Islander Social Survey found that little more than 60% of Aboriginal and Torres Strait Islander people said that they felt hospitals could be trusted (6).

This level of distrust is reflected in the fact that Aboriginal and Torres Strait Islander people are five times as likely to leave hospital against medical advice or be discharged at their own risk compared to other Australians (7).

“Addressing these institutional barriers to appropriate care is complex but possible and we can do it as a nation of we finally come to terms with the seriousness of the problem (8).

“It will take a strong commitment to action. There needs to be a greater awareness in the Australian community about the adverse health consequences of racism for Aboriginal people.

If any good is to come out of the racism shown towards Adam Goodes I hope it is an awareness of the harm this does to our people across the nation which is currently symbolised by the suffering of one man: Adam Goodes.

Racism is a serious problem that Australia is yet to properly address. It should never be trivialised. It needs to be dealt with”, she concluded.

References

  1. Paradies, Y., Harris, R. & Anderson, I. 2008, The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda, Discussion Paper No. 4, Cooperative Research Centre for Aboriginal Health, Darwin.
  2. ANTaR website http://www.antar.org.au/node/2… accessed September 26 2011
  3. Australian Health Ministers Advisory Council (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. AHMAC. Canberra. page 131
  4. Cunningham J (2002). “Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous.” Medical Journal of Australia 176(2): 58-62
  5. Condon J R, Barnes T, et al. (2005). “Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.” Medical Journal of Australia 182(6

 

 ” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma

Originally published by MJA here

Download a PDF of this Report Paper for references 1-20

MJA Cultural Safety

Read 20 + previous NACCHO articles Cultural Safety  

In Australia, the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients in order to achieve optimum care outcomes.

Where “business as usual” health care is perceived as demeaning or disempowering — that is, deemed racist or culturally unsafe — it may significantly reduce treatment adherence or result in complete disengagement,1,2 even when this may be life-threatening.3

Peak Indigenous health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to Indigenous health improvement.4 It follows that a more specific embedding of cultural safety within mandatory standards for safe, quality-assured clinical care may strengthen the currently inadequate Closing the Gap mechanisms related to health care delivery.

The causes of inequitable health care are many. Western biomedical praxis differs from Indigenous foundational, holistic attention to the physical, emotional, mental and spiritual wellbeing of the person and the community.5 An article published in this issue of the MJA6 deals with the link between culture and language in improving communication in Indigenous health settings, a critical component of delivering cultural safety.

Integrating cultural safety in an active manner reconfigures health care to allow greater equity of realised access, rather than the assumption of full access, including procession to appropriate intervention.

As an example of the need to improve equity, a South Australian study found that Indigenous people presenting to emergency departments with acute coronary syndrome were half as likely as non-Indigenous patients to undergo angiography.7 More broadly, Indigenous people admitted to hospital are less likely to have a procedure for a condition than non-Indigenous people.8

Cardiovascular disease is the leading cause of death in Indigenous Australians.9 Cancer is the second biggest killer: the mortality rate for some cancers is three times higher for Indigenous than for non-Indigenous Australians.10 Clinical leaders in these two disease areas have identified the need for culturally safe health care to improve Indigenous health outcomes.

Cultural safety is an Indigenous-led model of care, with limited, but increasing, uptake, particularly in Australia, New Zealand and Canada. It acknowledges the barriers to clinical effectiveness arising from the inherent power imbalance between provider and patient,11 and moves to redress this dynamic by making the clinician’s cultural underpinning a critical focus for reflection.

Moreover, it invites practitioners to consider: “what do I bring to this encounter, what is going on for me?” Culturally safe care results where there is no inadvertent disempowering of the recipient, indeed where recipients are involved in the decision making and become part of a team effort to maximise the effectiveness of the care. The model pursues more effective practice through being aware of difference, decolonising, considering power relationships, implementing reflective practice, and by allowing the patient to determine what safety means.11

Along with an emphasis on provider praxis, cultural safety focuses on how institutional care is both envisaged and delivered.12 Literature on cultural safety in Australia is scant but growing.13 Where evidence is available, it identifies communication difficulties and racism as barriers not only to access but also to the receipt of indicated interventions or procedures.11

There is evidence of means to overcome these barriers. An Australian study undertaken across ten general practices tested the use of a cultural safety workshop, a health worker toolkit, and partnerships with mentors from Indigenous organisations and general practitioners.13 Cultural respect (significant improvements on cultural quotient score, along with Indigenous patient and cultural mentor rating), service (significant increase in Indigenous patients seen) and clinical measures (some significant increases in the recording of chronic disease factors) improved across the participating practices.

In addition, a 2010 study by Durey14 assessed the role of education, for both undergraduate students and health practitioners, in the delivery of culturally responsive health service, improving practice and reducing racism and disparities in health care between Indigenous and non-Indigenous Australians. The study found that cultural safety programs may lead to short term improvements to health practice, but that evidence of sustained change is more elusive because few programs have been subject to long term evaluation..

Newman and colleagues10 identified clinician reliance on stereotypical narratives of indigeneity in informing cancer care services. Redressing these taken-for-granted assumptions led to culturally engaged and more effective cancer care. In a similar manner, Ilton and colleagues15 addressed the importance of individual clinician cultural safety for optimising outcomes, noting that provider perceptions of Indigenous patient attributes may be biased toward conservative care.

The authors, however, went beyond the clinician–patient interaction to stress the outcome-enhancing power of change in the organisational and health setting. They proposed a management framework for acute coronary syndromes in Indigenous Australians.

This framework involved coordinated pathways of care, with roles for Indigenous cardiac coordinators and supported by clinical networks and Aboriginal liaison officers. It specified culturally appropriate warning information, appropriate treatment, individualised care plans, culturally appropriate tools within hospital education, inclusion of families and adequate follow-up.

Willis and colleagues16 also called for organisational change as an essential companion to individual practitioner development. Drawing on 12 studies involving continuous quality improvement (CQI) or CQI-like methods and short term interventions, they acknowledged evidence gaps, prescribing caution, and argued for such change to be undertaken in the service of long term controlled trials, as these would require 2–3 years to see any CQI-related changes.

Sjoberg and McDermott,17 however, noted the existence of barriers to change: the challenge (personal and professional) posed by Indigenous health and cultural safety training may not only lead to individual but also to institutional resistance.17 Dismantling individual resistance requires the development of a critical disposition — deemed central to professionalism and quality18 — but in a context of strengthened and legitimating accreditation specific to each discipline. The barriers thrown up by institutional resistance, manifesting as gatekeeping, marginalisation or underfunding, may require organisational change mandated by standards.

NACCHO Media Alerts : Top 10 Current Aboriginal Health News Stories to keep you up to date

1. Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

3.Nurses PAQ continues political membership campaign spreading false and misleading information about our cultural safety

4.AMSANT has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

5.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People.

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

9.Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

10. Your guide to a healthy Easter : #Eggs-actly  

 

1.Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

“These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,”

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this.

Read full article in Easter Monday The Australian or Part B below

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

Read full press release here

 

3.Nurses PAQ continues political membership campaign spreading false and misleading information about cultural safety

SEE NACCHO Response

SEE an Indigenous Patients Response

See Nurses PAQ Misleading and false campaign

4. AMSANT  has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

Read full AMSANT press Release

Listen to interview with Donna Ah Chee

Press Release @NACCHOChair calls on the Federal Government to work with us to keep our children safe

#WeHaveTheSolutions Plus comments from CEO’s @Anyinginyi @DanilaDilba

4.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

Read full Story HERE

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People;

Read Download Full Transcript

Senator Patrick Dodson

Download the report from HERE

Community Groups Call For Action on Indigenous Incarceration Rates

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

The Australian Government has committed $29.4 million to extend the Healthy Ears – Better Hearing, Better Listening Program, to help ensure tens of thousands more Indigenous children and young adults grow up with good hearing and the opportunities it brings.

Read Press Release HEAR

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

This week the Tangentyere Women’s Family Safety Group from Alice Springs were in Canberra. They shared with politicians, their own solutions for their own communities, and they are making an enormous difference.
Big thanks to all the Tangentyere women who made it to Canberra.

Read Download the Press Release

TANGENTYERE WOMEN’S FAMILY SAFETY GROUP (FED

9. Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

Read press releases and link to Download the National Guide

10. Your guide to a  healthy Easter : #Eggs-actly  

And finally hope you had a Happy Easter all you mob ! After you have enjoyed your chocolate eggs and hot cross buns , this is how much exercise you will require to work of those Easter treats .

For medical and nutrition advice please check with your ACCHO Doctor , Health Promotion / Lifestyle teams or one of our ACCHO nutritionists

 

Part B Full Text The Australian Article Easter Monday

There is no reason it should have happened, especially not in a first-world country like Australia, but it has: indigenous communities in the country’s north are in the grip of wholly treatable sexually transmitted diseases.

In the case of syphilis, it is an epidemic — West Australian Labor senator Patrick Dodson ­described it as such, in a fury, when health department bureaucrats mumbled during Senate estimates about having held a few “meetings” on the matter.

There have been about 2000 syphilis notifications — with at least 13 congenital cases, six of them fatal — since the outbreak began in northern Queensland in 2011, before spreading to the Northern Territory, Western Australia and, finally, South Australia.

What’s worse, it could have been stopped. James Ward, of the South Australian Health and Medical Research Institute, wrote in mid-2011 that there had been a “downward trend” over several years and it was likely at that point that the “elimination of syphilis is achievable within indigenous ­remote communities”.

But governments were slow to react, and Ward is now assisting in the design of an $8.8 million emergency “surge” treatment approach on the cusp of being rolled out in Cairns and Darwin, with sites in the two remaining affected states yet to be identified.

It will be an aggressive strategy — under previous guidelines, you had to have been identified during a health check as an active carrier of syphilis to be treated. Now, anyone who registers antibodies for the pathogen during a blood prick test, whether actively carrying syphilis or not, will receive an ­immediate penicillin injection in an attempt to halt the infection’s geographical spread.

This is key: the high mobility of indigenous people in northern and central Australia means pathogens cross jurisdictions with ­impunity. Australian Medical ­Association president Michael Gannon calls syphilis a “clever bacterium that will never go away”, warning that “bugs don’t respect state borders”.

Olga Havnen, one of the Northern Territory’s most respected public health experts, points out that many people “will have connections and relations from the Torres Strait through to the Kimberley and on to Broome — and it’s only a matter of seven or eight kilometres between PNG and the northernmost islands there in the Torres Strait”.

“This is probably something that’s not really understood by the broader Australian community,” Havnen says. “I suspect once you get a major outbreak of something like encephalitis or Dengue fever, any of those mosquito-borne diseases, and that starts to encroach onto the mainland, then people will start to get a bit worried.”

Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.
Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.

But it is not just syphilis — ­indeed, not even just STIs — that have infectious disease authorities concerned and the network of Aboriginal Community Controlled Health Organisations stretched.

Chlamydia, the nation’s most frequently diagnosed STI in 2016 based on figures from the Kirby Institute at the University of NSW, is three times more likely to be contracted by an indigenous Australian than a non-­indigenous one.

The rate was highest in the NT, at 1689.1 notifications per 100,000 indigenous people, compared with 607.9 per 100,000 non-indigenous Territorians. If you’re indigenous, you’re seven times more likely to contract gonorrhoea, spiking to 15 times more likely if only women are considered. Syphilis, five times more likely.

As the syphilis response gets under way, health services such as the one Havnen leads, the Darwin-based Danila Dilba, will be given extra resources to tackle it. “With proper resourcing, if you want to be doing outreach with those people who might be visitors to town living in the long grass, then we’re probably best placed to be able to do that,” she says.

But the extra focus comes with a warning. A spate of alleged sexual assaults on Aboriginal children, beginning with a two-year-old in Tennant Creek last month and followed by three more alleged ­attacks, has raised speculation of a link between high STI rates and evidence of child sexual assault.

After the first case, former NT children’s commissioner Howard Bath told this newspaper that STI rates were “a better indicator of background levels of abuse than reporting because so many of those cases don’t get reported to anyone, whereas kids with serious infections do tend to go to a ­doctor”. Others, including Alice Springs town councillor Jacinta Price and Aboriginal businessman Warren Mundine, raised the ­spectre of the need for removing more at-risk indigenous children from dangerous environments.

Children play AFL in Yeundumu. Picture: Jason Edwards
Children play AFL in Yeundumu. Picture: Jason Edwards

However, Sarah Giles, Danila Dilba’s clinical director and a medical practitioner of 20 years’ standing in northern Australia, warns this kind of response only exacerbates the problem. She is one of a range of public health authorities who, like Havnen, say connecting high STI figures to the very real scourge of child sex abuse simply makes no sense. They do not carry correlated data sets, the experts say.

“One of the things that’s really unhelpful about trying to manage STIs at a population level is to link it with child abuse and mandatory reporting, and for people to be fearful of STIs,” Giles says. “The problem is that when they’re conflated and when communities feel that they can’t get help ­because things might be misinterpreted or things might be reported, they’re less likely to present with symptoms. The majority of STIs are in adults and they’re sexually transmitted.”

Havnen says there is evidence of STIs being transmitted non-sexually, including to children, such as through poor hand ­hygiene, although Giles says that is “reasonably rare”. And while NT data shows five children under 12 contracted either chlamydia or gonorrhoea in 2016 (none had syphilis), and there were another five under 12 last year, Havnen points to the fact that over the past decade there has been no increasing trend in under 12s being affected. Where there has been a rise in the NT is in people aged between 13 and 19, with annual gonorrhoea notifications increasing from 64 cases in the 14-15-year-old ­female cohort in 2006 to 94 notifications in 2016.

In the 16-17-year-old female ­cohort the same figures were 96 and 141 and in the 12-13-year-old group it rose from 20 in 2006 to 33 in 2016. Overall, for both boys and girls under 16, annual gonorrhoea notifications rose from 109 in 2006 to 186 in 2016, according to figures provided to the royal ­commission into child detention by NT Health. Havnen describes the rise as “concerning but not, on its own, evidence of increasing ­levels of sexual abuse”.

Ward is more direct. Not all STIs are the result of sexual abuse, he warns, and not all sexual abuse results in an STI. If you’re a health professional trying to deal with an epidemiological wildfire, the distinction matters — the data and its correct interpretations can literally be a matter of life and death.

Indeed, in its own written cav­eats to the material it provided to the royal commission, the department warns that sexual health data is “very much subject to variations in testing” and warns against making “misleading assumptions about trends”. Ward says: “Most STIs notified in remote indigenous communities are ­assumed to be the result of sex ­between consenting adults — that is, 16 to 30-year-olds. Of the under 16s, the majority are 14 and 15-year-olds.” He says a historically high background prevalence of STIs in remote indigenous communities — along with a range of other ­infectious diseases long eradicated elsewhere — is to blame for their ongoing presence. Poor education, health services and hygiene contribute, and where drug and ­alcohol problems exist, sexually risky behaviour is more likely too. The lingering impact of colonisation and arrival of diseases then still common in broader ­society cannot be underestimated.

But Ward claims that an apparently high territory police figure of about 700 cases of “suspected child sexual offences” in the NT over the past five years may be misleading. He says a large number of these are likely to be the result of mandatory reporting, where someone under 16 is known to have a partner with an age gap of more than two years, or someone under 14 is known to be engaging in sexual activity. Ward points out that 15 is the nationwide ­median sexual debut age, an age he suggests is dropping. At any rate, he argues, child sex abuse is unlikely to be the main reason for that high rate of mandatory ­reporting in the NT.

Areyonga is a small Aboriginal community a few hours drive from Alice Springs.
Areyonga is a small Aboriginal community a few hours drive from Alice Springs.

Data matters, and so does how it is used. Chipping away at the perception of child sexual abuse in indigenous communities are the latest figures from the Australian Institute of Health and Welfare showing the rate of removals for that crime is actually higher in non-indigenous Australia.

According to a report this month from the AIHW, removals based on substantiated sex abuse cases in 2016-17 were starkly different for each cohort: 8.3 per cent for indigenous children, from a total of 13,749 removals, and 13.4 per cent for non-indigenous children, from 34,915 removals.

Havnen concedes there is a need for better reporting of child abuse and has called for a confidential helpline that would be free of charge and staffed around the clock by health professionals.

It’s based on a model already in use in Europe that she says deals with millions of calls a year — but it would require a comprehensive education and publicity campaign if it were to gain traction in remote Australia. And that means starting with the adults.

“If you’re going to do sex ­education in schools and you start to move into the area about sexual abuse and violence and so on, it’s really important that adults are ­educated first about what to do with that information,” she says. “Because too often if you just ­educate kids, and they come home and make a disclosure, they end up being told they’re liars.”

These challenges exist against the backdrop of a community already beset by a range of infectious diseases barely present elsewhere in the country, including the STIs that should be so easily treatable. It is, as Havnen is the first to admit, a complex matter.

Cheryl Jones, president of the Australasian Society for Infectious Diseases, says the answer is better primary treatment solutions and education, rather than trying to solve the problem after it has ­occurred. “For any of these public health infectious disease problems in ­remote and rural areas, we need to support basic infrastructure at the point of care and work alongside communities to come up with ­solutions,” she says.

Sisters play in the mud after a rare rain at Hoppy's 'town camp' on the outskirts of Alice Springs.
Sisters play in the mud after a rare rain at Hoppy’s ‘town camp’ on the outskirts of Alice Springs.

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this. “These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,” Turner says.

The Australian Medical ­Association has called for the formation of a national Centre for Disease Control, focusing on global surveillance and most likely based in the north, as being “urgently needed to provide national leadership and to co-ordinate rapid and effective public health responses to manage communicable diseases and outbreaks”.

“The current approach to disease threats, and control of infectious diseases, relies on disjointed state and commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians,” the association warned in a submission to the Turnbull government last year.

However, the federal health ­department has rebuffed the CDC argument, telling the association that “our current arrangements are effective” and warning the suggestion could introduce “considerable overlap and duplication with existing functions”.

“I think it (the CDC) might have some merit, if it helps to ­advocate with government about what needs to happen,” Havnen says, “but if these things are going to be targeted at Aboriginal bodies, it needs to be a genuine partnership. It’s got to be informed by the realities on the ground and what we know. That information has to be fed up into the planning process.”

NACCHO Aboriginal Health and #Cultural Safety Media Debate : The Truth behind the Nurses Code of Conduct and the false claims enforcing #WhitePriviledge “to apologise to #Indigenous clients for being white’

 

” National media outlets ( Including Peta Credlin on SkyNews and News Corp Newspapers see Part 5 below plus Today Tonight SA ) have aired wrongful claims that the codes would force white nurses to ‘apologise to Indigenous clients for being white’.

The codes do not say that – that idea was invented and then pushed on these media programs.

These stories were not based in facts, but seem to have been driven by the partisan politics of a fringe nursing group, and conservative politicians who have been approached to comment on the wrongful claims.

I am sure that some of our nursing and midwifery members and community will be hearing disturbing claims.

Let me be clear, nurses and midwives under the new code do not have to announce their ‘white privilege’ before treating Indigenous clients.

 I am really proud of these new codes, and not only because the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) contributed to their development, which included extensive consultation across nursing and midwifery and at the time no one opposed the inclusion of cultural safety “

Janine Mohamed CEO CATSINaM see IndigenousX  Part 1 below

Read over 90 NACCHO Aboriginal Health and Racism articles published last 6 Years

Read 30 NACCHO Aboriginal Health and Cultural Safety published last 6 years

” It is clear from the 2018 Closing the Gap Report tabled by Prime Minister Turnbull in February 2018 that Aboriginal and/or Torres Strait Islander Peoples still experience poorer health outcomes than non-Indigenous Australians.

It is well understood these inequities are a result of the colonisation process and the many discriminatory policies to which Aboriginal and/or Torres Strait Islander Australians were subjected to, and the ongoing experience of discrimination today.

All healthcare leaders and health professionals have a role to play in closing the gap.

The approach the NMBA has taken for nurses and midwives (the largest workforce in the healthcare system) by setting expectations around culturally safe practice, reflects the current expectations of governments to provide a culturally safe health system.

(For more information please see the COAG Health Council 4 August 2017 Communiqué).

Combined Press Release Nursing and Midwifery Board of Australia ,The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait see in full Part 2 Below

 ” I was stunned to read businessman Graeme Haycroft’s comments regarding nurses and indigenous Australians on the weekend, as part of his criticism of the new NMBA Codes and the term cultural safety which is defined in a glossary connected to the codes.

These codes were the subject of lengthy consultations with the professions of nursing and midwifery and other stakeholders including community representatives.

This review was comprehensive and evidenced-based. Our union and our national body the Australian Nursing Midwifery Federation (ANMF) were active participants in these consultations.

The codes, written by nurses and midwives for nurses and midwives, seek to ensure the individual needs and backgrounds of each patient are taken into account during treatment.”

QNMU Secretary Beth Mohle issued a statement clarifying misleading comments in the media around the NMBA’s new Codes of Conduct for nurses and midwives: See in Full part 3 Below

And just to reinforce that point, the entire premise for the segment was false.

There is no requirement for nurses to apologise for being white, which would be very awkward for the more the more than 1500 Indigenous nurses across Australia, and the countless others who also aren’t white to begin with. But, even for the nurses who are – THERE IS NO REQUIREMENT FOR THEM TO APOLOGISE FOR BEING WHITE.

So, why on Earth would Today Tonight run such a story?

Why would they base a story off the demonstrably false allegations of this Graeme Haycroft person? “

The truth behind the Nursing Code of Conduct lie ; Indigenous X Article Read in full Part 4

Watch Today Tonight TV

If you thought nursing was about quality health care, think again.

According to the Nursing and Midwifery Board of Australia, “’cultural safety’ is as important to quality care as clinical safety”. And there’s no objective test of ‘cultural safety’; it’s determined, so the Board says, by the “recipient of care”. You see, it’s not just what the nurse does that matters but “how a health professional does something”.”

Nurses’ Code of Conduct undermines those who care

 

So who is this Graeme Haycroft

Businessman . Director of Queensland Association Services Group (QAS Group), Political activist , Anti Unionist

And according to peak Nurses groups Graeme has has no previous health experience or qualifications

From a recent BIO

Graeme has spent a lifetime working in industrial relations and was the man who set up Haycroft Workplace Solutions, leading provider of workplace consulting and management that has nearly 2000 workers on the payroll.

He is chair of the Liberal National Party’s labour market policy committee, active in the HR Nicholls Society, is a regular commentator on labour market issues, and has published his thoughts in such places as the IPA Review, Courier Mail and Online Opinion. But Graeme’s most important contributions have come through what he has done, not what he has written or said.

In the 1990s Graeme famously fought the Australian Workers’ Union to set up sub-contracting for shearers in Charleville, and went on to battle the CMFEU in helping to set up union-free high-rise construction sites. When the Howard government allowed Australian Workplace Agreements (AWAs), Graeme was instrumental in creating the most widely copied template in the country, and his business helped set up about 30,000 agreements.

Lately, Graeme has been working on a exciting new project with the potential to fundamentally change the role and power of unions in this country, while improving services for workers.

He is not waiting for politicians to act; he is changing the system himself… and after years of planning he is finally ready to show us how.

So who is this new Nurses Professional Association of Queensland ? 

Queensland Association Services Group QAS Group and Sajen Legal have established a new business model for Employee Associations Queensland Association Services Group (QAS Group), who are the contracted service providers for the  NPAQ, in conjunction with Sajen Legal have developed and set up a new association business  model.

Extract from NPAQ website

Working with a small group of dedicated and experienced nurses, they have built in a strict separation  between the money earned and spent on the one hand, and the control of the Association on the other.

To launch NPAQ, the  QAS Group , have backed the provision of services for ten years under contract. They have provided all of the seed funding for the administrative and legal services including the member  Professional Indemnity Insurance policy required of the Association..

Whilst it will be many years before all the seed funding is fully repaid, at the end of our second year, the membership income was sufficient to fund all the running expenses of the NPAQ

 ” And they quote no party politics

The NPAQ executive is resolute that there will be no party politics. Every cent of your NPAQ membership money is spent on nurse services and issues

When NACCHO pointed out that NursesPAQ was ”  using the definitions of two America right wing commentators to justify mounting a political membership campaign in which you sensationalise and falsely quote out of context  aspects of our Indigenous cultural safety in Australia ”

These videos were then removed from the NPAQ news page

http://www.npaq.com.au/news.php

Part 1 Janine Mohamed CEO CATSINaM

Originally Published Indigenous X

I rang my dad over the weekend. We’d hardly begun yarning before he asked me: “What’s this about white nurses having to apologise to us for being white?”

I could have just said, “Dad, you should know better than to believe what the mainstream media says about us.”

But instead I took the time to explain the truth behind recent misleading media reports on new codes of conduct for nurses and midwives.

Media outlets have aired wrongful claims that the codes would force white nurses to ‘apologise to Indigenous clients for being white’.

The codes do not say that – that idea was invented and then pushed on these media programs.

As Luke Pearson recently wrote for IndigenousX, these stories were not based in facts, but seem to have been driven by the partisan politics of a fringe nursing group, and conservative politicians who have been approached to comment on the wrongful claims.

I took the time to have the conversation with my Dad because it is important people understand how significant these new codes are for efforts to improve the care of our people, hence I thought it important to reach out to the readers of IndigenousX too.

I am sure that some of our nursing and midwifery members and community will be hearing disturbing claims.

Let me be clear, nurses and midwives under the new code do not have to announce their ‘white privilege’ before treating Indigenous clients.

I also had the conversation because, to be honest, I am really proud of these new codes, and not only because the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) contributed to their development, which included extensive consultation across nursing and midwifery and at the time no one opposed the inclusion of cultural safety.

We are delighted the Nursing and Midwifery Board of Australia (NMBA) listened to CATSINaM in developing these new codes, and took on board our advice that cultural safety should be recognised as an integral part of ethical and competent professional practice. Further, they cited some of our work at CATSINaM in materials supporting the code.

CATSINaM has been at the forefront of advocating for cultural safety training for health professionals at all levels of health systems in order to improve care for both Indigenous clients and their families. Improving the cultural safety of workplaces is also a vital strategy for improving the recruitment and retention of Indigenous health professionals and staff. We need more of our people in the health system.

Rather than being criticised by sensationalist, inaccurate reports, the NMBA deserves credit for showing leadership in the area of cultural safety. They have set a great example for other health professions and organisations. It wouldn’t be the first time that nurses and midwives have been at the forefront of leading change.

In fact, this is also not the first time this has happened. In many ways, Australia is playing a game of ‘catch up’.

In New Zealand, cultural safety is part of the nursing and midwifery code of conduct and also in the laws that nurses and midwives must follow to be registered to practice. This happened well over 10 years ago because many Maori nurses worked hard for many years to teach their non-Maori colleagues about cultural safety and gain their support so they could provide better care for their people. This is considered completely normal in New Zealand.

Under the new codes, which took effect on 1 March, nurses and midwives must take responsibility for improving the cultural safety of health services and systems for Aboriginal and Torres Strait Islander clients and colleagues.

They are required to provide care that is “holistic, free of bias and racism”, and to recognise the importance of family, community, partnership and collaboration in the healthcare decision-making of Aboriginal and/or Torres Strait Islander people.

The codes advocate for culturally safe and respectful practice and require nurses to understand how their own culture, values, attitudes, assumptions and beliefs influence their interactions with people and families, the community and colleagues (for more information on our position on Cultural Safety please visit our website).

As part of such reflexive practice, nurses and midwives are encouraged to consider issues, such as white privilege, and how this can affect the assumptions and practices they bring to the care of clients and how they interact with their families. It must be said that privilege has been discussed in Australia for some time – although we are more used to talk about class privilege in Australia – those who have more financial resources compared to those who don’t.

Over time we have recognised there different forms of privilege – men have male privilege in contrast to women. Able-bodied people have able-bodied privilege compared to people living with different types of disabilities. Heterosexual people have heterosexual privilege compared to people who are lesbian, gay, bisexual, transgender, intersex or queer. Not to mention what we have been socialised to believe is normal!

Many people have campaigned for decades to help us learn about these different forms of privilege and do something to change inequity they cause. This has involved education, advocacy, legislation, policies and professional codes of conduct. The acknowledgement of these different forms of privilege and the non-acceptance of biased treatment has resulted in improved circumstances for women, people living with disabilities and lesbian, gay, bisexual, transgender, intersex or queer people. But there is still a long way to go in all of these areas, and especially so where they intersect.

There has been considerable work over the last 20-30 years to talk about white privilege and address the inequity that many white Australians don’t see or realise is there, although Aboriginal and Torres Strait Islander Australians live this every day.

Cultural safety training does include examining how Indigenous people have been locked out of the opportunities that most white people take for granted by past policies and this has resulted in intergenerational exclusion and Indigenous disadvantage. This means that white privilege is one of the areas that people must explore and understand. This is what the codes are asking nurses and midwives to do – to think this through so they do not make incorrect and unhelpful assumptions based on their idea of what is normal for non-Indigenous Australians, particularly white Australians.

A glossary accompanying the new codes cites CATSINaM materials. It identifies that the concept of cultural safety was developed more than 20 years ago in a First Nations’ context (in New Zealand) and holds that the recipient of care – rather than the caregiver – determines whether care is culturally safe. That means you determine if the care you receive is culturally safe.

Instead of providing care regardless of difference, such as when people say ‘I treat everyone the same’, to providing care that takes account of peoples’ unique needs. This includes their cultural needs.

While this is important for Indigenous clients, it also has the potential to improve all clients’ care by encouraging health practitioners to be more reflexive and responsive to the needs of different clients.

Despite what recent headlines might have us believe, there is widespread support for cultural safety’s implementation across the health system.

The National Aboriginal and Torres Strait Islander Health Plan: 2013-2023 (2015) and its associated Implementation Plan (both available here) identify the importance of cultural safety in addressing racism in the health system, and many health services already provide cultural safety training for their staff.

The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives are united with CATSINaM in strongly supporting the guidance around cultural safety in the new codes of conduct.

The Council of Deans of Nursing and Midwifery also considers cultural safety an integral part of competencies for registered nurses and midwives. Providing culturally safe care that is free from racism should be a normal expectation. All health professionals learning about cultural safety and building it into their codes of conduct is a very important step to this becoming a reality. Hence nurses and midwives are currently required to study Aboriginal and Torres Strait Islander health, culture, history, and cultural safety as part of their study programs.

Cultural safety is talked about and implemented in other fields, including education, and family and community services, although people in these fields are still learning about it so it is not always standard practice yet. In fact, CATSINaM recommended cultural safety training for journalists in our submission to the recent Senate Inquiry into the future of public interest journalism, and the latest media fracas indicates just how sorely this is needed.

It is important that we continue these conversations about the importance of cultural safety for healthcare and other systems – they are potentially life-saving.

 

For readers who wish to contribute to the discussion, I suggest you read the joint statement from nursing and midwifery organisations and the codes of conduct, which can be downloaded here.

Part 2

In response to Graeme Haycroft’s recent comments, we welcome the opportunity to provide further information on how important cultural safety is for improving health outcomes and experiences for Aboriginal and Torres Strait Islander Peoples.

It is clear from the 2018 Closing the Gap Report tabled by Prime Minister Turnbull in February 2018 that Aboriginal and/or Torres Strait Islander Peoples still experience poorer health outcomes than non-Indigenous Australians. It is well understood these inequities are a result of the colonisation process and the many discriminatory policies to which Aboriginal and/or Torres Strait Islander Australians were subjected to, and the ongoing experience of discrimination today.

All healthcare leaders and health professionals have a role to play in closing the gap.

The approach the NMBA has taken for nurses and midwives (the largest workforce in the healthcare system) by setting expectations around culturally safe practice, reflects the current expectations of governments to provide a culturally safe health system. (For more information please see the COAG Health Council 4 August 2017 Communiqué).

Culturally safe and respectful practice is not a new concept. Nurses and midwives are expected to engage with all people as individuals in a culturally safe and respectful way, foster open, honest and compassionate professional relationships, and adhere to their obligations about privacy and confidentiality.

Many health services already provide cultural safety training for their staff. Cultural safety is about the person who is providing care reflecting on their own assumptions and culture in order to work in a genuine partnership with Aboriginal and Torres Strait Islander Peoples.

Nurses and midwives have always had a responsibility to provide care that contributes to the best possible outcome for the person/woman they are caring for. They need to work in partnership with that person/woman to do so. The principle of cultural safety in the new Code of conduct for nurses and Code of conduct for midwives (the codes) provides simple, common sense guidance on how to work in a partnership with Aboriginal and Torres Strait Islander Peoples. The codes do not require nurses or midwives to declare or apologise for white privilege.

The guidance around cultural safety in the codes sets out clearly the behaviours that are expected of nurses and midwives, and the standard of conduct that patients and their families can expect. It is vital guidance for improving health outcomes and experiences for Aboriginal and Torres Strait Islander Peoples.

The codes were developed through an evidence-based and extensive consultation process conducted over a two-year period. Their development included literature reviews to ensure they were based on the best available international and Australian evidence, as well as an analysis of complaints about the conduct of nurses and midwives to ensure they were meeting the public’s needs.

The consultation and input from the public and professions included working groups, focus groups and preliminary and public consultation. The public consultation phase included a campaign to encourage nurses and midwives to provide feedback.

The Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives all participated in each stage of the development and consultation of the new codes. The organisations strongly support the guidance around cultural safety in the codes for nurses and midwives.

Lynette Cusack

Chair Nursing and Midwifery Board of Australia

Ann Kinnear

CEO
Australian College of Midwives (ACM)

Kylie Ward

CEO
Australian College of Nursing (ACN)

Janine Mohamed

CEO
Congress of Aboriginal and Torres Strait Islander Nurses
and Midwives

Annie Butler

A/Federal Secretary Australian Nursing and Midwifery
Federation

For more information:

Part 3 QNMU Secretary Beth Mohle has issued a statement clarifying misleading comments in the media over the weekend around the NMBA’s new Codes of Conduct for nurses and midwives.



I was stunned to read businessman Graeme Haycroft’s comments regarding nurses and indigenous Australians on the weekend, as part of his criticism of the new NMBA Codes and the term cultural safety which is defined in a glossary connected to the codes.

These codes were the subject of lengthy consultations with the professions of nursing and midwifery and other stakeholders including community representatives. This review was comprehensive and evidenced-based. Our union and our national body the Australian Nursing Midwifery Federation (ANMF) were active participants in these consultations.

The codes, written by nurses and midwives for nurses and midwives, seek to ensure the individual needs and backgrounds of each patient are taken into account during treatment.

There’s no doubt cultural factors, including how a patient feels while within the health system, can impact wellbeing. For example, culture and background often determine how a patient would prefer to give birth or pass away.

Every day, nurses and midwives consider a range of complex factors, including a patient’s background and culture to determine the best treatment. These codes simply articulate what is required to support safe nursing and midwifery practice for all.

Mr Haycroft stated that the new code “has been sponsored and supported by the QNU to promote its party political social policy.”

This statement is disturbing on a number of levels. The Queensland Nurses and Midwives’ Union (QNMU) has repeatedly refuted Mr Haycroft’s allegations we donate to political parties. We do not. Nor are we affiliated with any political party. Yet Mr Haycroft continues to repeat these claims.

Secondly, this statement demonstrates a failure to understand the basics. It is the Nursing and Midwifery Board of Australia (NMBA) that regulates the practice of nurses and midwives through its standards, codes and guidelines.

The QNMU actively participates in NMBA consultations and represents the interests of our members individually and collectively.  However, the new codes have not been “sponsored” by our union.

As a not-for-profit organisation run by nurses and midwives for nurses and midwives, the QNMU will remain steadfastly focused on advancing the values and interests of our members and the safety of those in their care.  We will not be diverted by the political or business agendas of others.

Author Luke Pearson Indigenous X

But first tonight, the contentious new code telling nurses to say “sorry for being white” when treating their Indigenous patients.

That’s how Today Tonight Adelaide began last night.

It continued:

“Now, it’s the latest in a string of politically correct changes for the health industry, but this one has led to calls for the Nursing Board boss to resign.”

It was followed by a five minute story with the new code being condemned by someone you’ve probably never heard of, Graeme Haycroft, explaining that:

“According to how the code is written, the white nurse would come in and say, ‘before I deal with you, I have to acknowledge to you that I have certain privileges that you don’t have” followed by Cory Bernardi calling it divisive.

It goes on in this vein for a full five minutes before it cuts back to the presenter, who finally says, “The Nursing and Midwifery Board has told us that the code was drafted in consultation with Aboriginal groups and has been taken out of context as it’s not a requirement for health workers to declare or apologise for white privilege”.

And just to reinforce that point, the entire premise for the segment was false. There is no requirement for nurses to apologise for being white, which would be very awkward for the more the more than 1500 Indigenous nurses across Australia, and the countless others who also aren’t white to begin with. But, even for the nurses who are – THERE IS NO REQUIREMENT FOR THEM TO APOLOGISE FOR BEING WHITE.

So, why on Earth would Today Tonight run such a story?

Why would they base a story off the demonstrably false allegations of this Graeme Haycroft person?

To answer that, it might useful to cut back to a 2005 Sydney Morning Herald story about Mr Haycroft:

“A member of the National Party and the H.R. Nicholls Society, he (Mr Haycroft) boasts that, because of a tussle he had with the Australian Workers Union 15 years ago, the union does not have a single member shearing sheep in south-western Queensland today.

Now he runs a labour hire firm with a thriving sideline in moving small-business employees off awards and collective agreements and onto the Federal Government’s preferred individual contracts, Australian Workplace Agreements.

…Mr Haycroft’s business stands out because he is targeting lower-skilled, lower-paid workers, often with poor English – the people unions say have much to fear from individual contracts.”

Cut back to 2018, and Graeme Haycroft now runs the Nurses Professional Association of Queensland, which promotes itself as an alternative to the Qld Nurses Union.

So, a man with a long history of fighting Unions, who ‘saved’ the mushroom farming business by showing businesses how to move “small-business employees off awards and collective agreements and onto the Federal Government’s preferred individual contracts, Australian Workplace Agreements.”

According to the 2005 article, “Mr Haycroft said workers had been more than happy to sign on, most with their penalty rates, holiday pay and other conditions being rolled into a flat rate.”

“However, [there is always a ‘however’], Mr Haycroft was stripped of his preferred provider status with the Office of the Employment Advocate on Thursday, after a Sydney picker, Carmen Walacz Vel Walewska, said she was sacked after she contacted the Australian Workers Union for advice on AWAs.”

With that track record, it’s hard to imagine why nurses would want to leave their current union in favour of his ‘professional association’.

It seems as though, once again, Indigenous people have become a political football and a convenient scapegoat for issues that have nothing to do with us.

Queensland has a long history of political success found through anti-Aboriginal sentiment, so what better way to undermine a Union and recruit new members to a professional association than to accuse the Union of ‘racism against white people’ and ‘political correctness gone made’ by spreading the blatantly false and misleading accusation that white nurses now have to apologise to Aboriginal people for being white?

And just like Dick Smith’s anti-immigration campaign, Blair Cottrell’s anti-African ‘community safety group’, and Prue McSween’s call for a new Stolen Generation, it seems Channel 7 is always more than happy to ignore the facts and sensationalise issues about race and racism.

There is always one more thing.

We, and others, will soon publish articles explaining what the Code of Conduct actually calls for, and explain why cultural competence and cultural safety are important (editor’s note: we did, here’s one of them), but I can’t help but be reminded of this quote from Toni Morrison:

“The function, the very serious function of racism is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being. Somebody says you have no language and you spend twenty years proving that you do. Somebody says your head isn’t shaped properly so you have scientists working on the fact that it is. Somebody says you have no art, so you dredge that up. Somebody says you have no kingdoms, so you dredge that up. None of this is necessary. There will always be one more thing.”

So, instead of working on the very real business of ensuring best practice within the nursing industry, our Indigenous experts in this area will have to take a few days away from this important work to explain that no one is asking for white nurses to apologise for being white.

Just like we have to explain that not all Aboriginal parents abuse their children, or that we don’t want to steal white people’s backyards, or that we had (and have) science, or that Australia wasn’t Terra Nullius, or, as Malcolm Turnbull suggested last year, that acknowledging Indigenous history and addressing the issue of colonial statues and place names across Australia is not a “Stalinist exercise of trying to wipe out or obliterate or blank out parts of our history”.

So long as Australian media and politics finds value, profit and opportunity in promoting racism, there will always be one more thing.

So, I might as well clear up a few others while I’m here, and empty a few more buckets out of the endless ocean of racist misinformation.

Child abuse isn’t a ‘cultural’ thing.

Police are not scared to arrest Aboriginal people out of fear of being called racist.

We don’t get free houses.

Aboriginal people using white ochre on their faces in dance and ceremony is not the same thing as white people dressing up in blackface.

We don’t get free university.

The Voice to Parliament is not a third chamber of parliament.

We are not the problem.

Anything else?

We aren’t vampires?

We don’t shoot laser beams out of our eyes?

We aren’t secretly developing a perpetual motion machine that runs on white tears?

I’m sure I, and countless others, will undoubtedly need to keep adding to this list because, as Toni Morrison tells us, there will always be one more thing.

If you thought nursing was about quality health care, think again.

According to the Nursing and Midwifery Board of Australia, “’cultural safety’ is as important to quality care as clinical safety”. And there’s no objective test of ‘cultural safety’; it’s determined, so the Board says, by the “recipient of care”. You see, it’s not just what the nurse does that matters but “how a health professional does something”.

According to the commissars at the Board, “’cultural safety’ represents a key philosophical shift from providing care regardless of difference, to care that takes account of peoples’ unique needs”.

Changes to the Code mark a philosophical shift in the industry. (Pic: supplied)

What this means is that nurses are no longer required to be colourblind; instead, they must see colour and treat patients differently because of it.

According to the Code, the Board declares, “cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation and the acknowledgment of white privilege” (no, I am not making this up — it’s on page 15 of the Code effective 1 March 2018).

The Board decrees that “non-indigenous nurses must address how they create a culturally safe work environment that is free of racism”. Now I know many nurses, including my sister who has spent 20 years working selflessly in indigenous communities, and the idea that they are subtly racist or even insensitive to their patients’ needs is as offensive as the leftist sanctimony that has infected their professional body.

The changes to the Code were endorsed by COAG. (Pic: iStock)

When a body representing some nurses had the temerity to complain about this, Board Chair Associate Professor Lynette Cusack disdainfully replied that it had been endorsed by COAG.

Well, I checked with the Federal health minister Greg Hunt and that’s not accurate. The Minister’s own advice from his Chief Nursing Officer and health department noted that “while the Commonwealth Department of Health provided feedback in the public consultation process, the final changes to cultural safety were made after (this) process. The Department did not see the final version until it was publicly released in March 2018.”

Greg Hunt is one of the smartest politicians I know; I didn’t think he would have let this get through, had he known about it, without a fight.

NACCHO Aboriginal Health News Alert :@sunriseon7 finally shines light on Indigenous issues, but is it a real awakening (for all media)? Report from @croakeyblog

” In an era of fake news it was surprising that a popular breakfast news program would stop a live feed and resort to a green screen when confronted with Indigenous outrage over the comments of a few self-appointed white social media commentators from the other day.

That the Seven Network’s breakfast program Sunrise realised its mistake and offered to have a panel of three experts explain in lucid details the issues around the media storm they had generated was welcomed by NACCHO and our members.

Sunrise journalist David Koch asked well considered questions and the expert panel was able to respond in-depth regarding the removal of Indigenous children, the importance of  early intervention with increased funding for family support services and that multi-disciplinary teams should be invested in to work with Indigenous families urgently.

Unfortunately time did not permit discussion about other issues like extra resources devoted to early children’s education and the social determinants of health.

However, it should not just be about Aboriginal experts correcting the media record when the government has known about the health concerns of Aboriginal children for years: they are not listening to us and they give plenty of cash for their own pet projects. It’s time to resource our sector appropriately to reduce the numbers of children presenting in out of home care and juvenile detention as it has become a national scandal that needs to be fixed now. ”

NACCHO CEO Pat Turner

” It shouldn’t be occurring in this day and age to have such insensitive comments made in mainstream domains and media about Aboriginal people, even if the person making them thinks they are doing it with best intentions in mind.

I think that the arrogance in not acknowledging what had gone down in the first panel until the community protested outside Channel Seven is an issue. I think it’s very good that Channel Seven convened a new panel but maybe they wouldn’t have done that if it that pressure wasn’t applied.

What should be occurring from here on is recruiting a panel of Aboriginal experts so that they call on these if they want to discuss Aboriginal issues. They should be convening an Aboriginal panel with expertise in the content matter and that way non-Indigenous Australians will have a broader exposure to the issues on the ground rather than through the few who are called in to talk about issues they have no expertise in.

It needs to be done on a regular basis. TV stations will have much more credibility for seeking informed commentary. A good journalist will seek alternative views or expert commentary and publish informed commentary. It’s never what happens.

The more we can have visibility in the Australian mainstream media, the more informed the Australian population will be. Currently they are too often informed by a minority that hold polarising views for Aboriginal people. They don’t get enough expertise to talk about these complex issues in Aboriginal health and they need to do it much more regularly ”

SAHMRI researcher James Ward

Our thanks to Croakey for this comprehensive coverage of Sunrise’s second effort on the issue, for their reflections and what needs to be done going forward. Subscribe view HERE

Sunrise finally shines light on Indigenous issues, but is it a real awakening (for all media)?

Editor: Marie McInerney

Channel Seven’s Sunrise program has finally shone a little light on complex Aboriginal and Torres Strait Islander child protection issues in the face of major criticism, formal complaints, distress and protests over an ill-informed, offensive panel discussion it aired last week.

Aboriginal community members protested for three days outside Seven’s Sydney studio over the segment that South Sea Islander and Darumbal journalist Amy McQuire and Yorta Yorta writer and public health consultant Summer May Finlay said “regurgitated mistruths” and was “sensationalist and frankly incorrect”.

Media Watch declared it was “A Sunrise to forget”.

It took a week but on Tuesday the breakfast TV show had a lengthy (by its standards) interview with three Indigenous health leaders: National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Pat Turner, Danila Dilba CEO Olga Havnen and South Australian Health and Medical Research Institute (SAHMRI) researcher James Ward.

You can watch the six minute segment here.

“We’ve got to talk about it, we’ve got to do something about it,” vowed anchor David Koch at the end of the discussion that highlighted the failure of governments to listen to Indigenous health experts, problems with government funding, systemic failures in health and child protection services, lack of community control and the conflation of sexually transmitted infection (STI) figures with child abuse.

But what Sunrise apparently didn’t feel the need to discuss was its own performance, its own journalistic standards, and the distress unleashed by last week’s ignorant and ill-informed discussion between Sunrise co-anchor Samantha Armytage and white shockjock commentators Prue MacSween and Ben Davis.

Armytage was no objective player or considered/informed moderator in the session, opening the two-minute ‘Hot Topic’ with: “Post-Stolen Generations there’s been this huge move to leave Aboriginal children where they are, even if they’re being neglected in their own families…”

(See the bottom of the Croakey  post for important reading on the placement of Indigenous children in out of home care from Victoria’s Commissioner for Aboriginal Children).

Thus it took just a minute for MacSween to follow this premise to declare it was “perhaps” time to consider a new Stolen Generation approach.

By the weekend Sunrise was clearly stung or shamed or embarrassed enough, with protesters assembling outside its studios at dawn and social media enraged, to finally do what it should have in the beginning, and invite Indigenous experts to the discussion.

“We don’t need confected outrage and anger”

But there was no mea culpa.

The show ignored the many calls for an apology, with ‘Kochie’ neatly sidestepping any culpability by referring only to how a “complex and emotional” discussion had been prompted by a newspaper report, headlined “Save Our Children”.

There was no mention of where it got it wrong, nor that it ignored three days of protests against the segment outside its Sydney studios last week, to the point of switching to a pre-recorded loop of a very quiet Martin Place for its studio backdrop on one day.

There was nothing about how, as ABC’s Media Watch revealed,  it had to take down the segment from its website because footage used to illustrate the “dangerous environment” that Indigenous children were allegedly subject to included a child getting a skin check in a film commissioned by Indigenous charity One Disease, used without permission.

It was left to Olga Havnen to have to interject at the end:

“What we need is intelligent informed discussions and looking for solutions rather than the confected outrage and anger.”

As my Croakey colleague Dr Ruth Armstrong said:

Kochie should have picked up on Olga’s comment, and asked (at least himself if not out loud) if there is any place in 2018 for a segment like ‘Hot Topic,’ where ‘social commentators’ are trotted out to shoot from the hip on issues that are far too nuanced and sensitive to be dealt with so flippantly. And will Sunrise develop a policy of going to Indigenous experts when they want to discuss Indigenous issues?

Kochie said “Let’s work together to try and get some of those changes through. It is a real issue affecting Indigenous people around the country.”

Does he know that he and his media buddies can actually have a role in improving Indigenous health and welfare? If only they will ask the right questions of the right people instead of amplifying sensationalism and misinformation.

With that in mind, the Croakey connective has come up with a few of the questions that ‘Kochie’ could have asked the panel – and/or himself and his colleagues (because many of these are surely not questions that Aboriginal and Torres Strait Islander people must be expected to explain over and over again).

Questions Kochie could have asked

  • Why is it, do you think, that mainstream media reports so badly on Indigenous issues as we did on this last week?
  • What impact does it have on Aboriginal and Torres Strait children and families when we talk about communities like that?
  • What impact does it have on the Stolen Generations?
  • What should we have done on the day?
  • Why is it, do you think, that we won’t hold the Minister and other media to account over clumsy/inaccurate/uninformed/misleading/inflammatory comments but we will target Aboriginal and Torres Strait Islander people instead?
  • What was the impact from us showing archive footage of Aboriginal people with the implication they were somehow responsible/involved/at risk in abuse?
  • What should we have shown?
  • Who should hold media outlets like us to account: regulators, (white) journalists, advertisers, politicians?
  • How can we ensure that we include Indigenous voices in our stories in the future?
  • Can you suggest cultural safety training that all Australian journalists should undertake (and what the main issues are to address), as outlined in this submission to the recent Senate public interest journalism inquiry?
  • What’s the next most important Indigenous health topic we should cover in depth?
  • Can we book you all for a regular spot on the show so we can highlight these issues properly more often?

And Qs from the Croakey connective on child protection:

  • How do we best keep Aboriginal kids safe while maintaining their ties with family and culture?
  • What are the problems with the current system?
  • What can be done to better support Aboriginal families?
  • Data shows Aboriginal people frequently experience racism in hospitals and healthcare and it leads to worse outcomes – to what extent do you think racism and bias occurs in the child protection system? What would the impacts of this be?
  • What cultural safety training do child protection workers undergo? Best practice in learning recommends immersion in Aboriginal settings and learning from Aboriginal people – how much time do staff get for this professional development?

“Mopping up the mess”

The trouble is, of course, the Sunrise segment is no isolated example, but reflects ongoing, broader issues about representation and racism in the media and widespread media practices that harm the health, wellbeing and lives of Aboriginal and Torres Strait Islander people.

They not only promote racist stereotypes but also divert the public spotlight from failures in government policies and processes, and consume the focus and energy of Aboriginal and Torres Strait Islander people, communities, and organisations.

“Black people had to do a lot of work last week and it wasn’t even Invasion Day, Sorry Day, or NAIDOC Week,” said University of Queensland senior lecturer, Dr Chelsea Bond, an Aboriginal (Munanjahli) and South Sea Islander Australian, in this must-read piece at IndigenousX.

The implications of that also came out, she wrote, at a session she chaired last week at Converge, a First Nations National Media Conference.

Turns out the dilemma for First Nations news media is deciding how much of their little resources is exhausted on mopping up the mess created by mainstream news media and how much is invested in taking charge of the narrative and producing real Indigenous news content that has context and relevance to a local and/or national audience.

Indigenous journalist Amy McQuire  also had a revealing anecdote in her IndigenousX article: Spare us your false outrage.

She remembered being outside Parliament House in Canberra in 2015, on the day of the Abbott-Turnbull leadership spill, when Armytage and all the other mainstream TV stations were broadcasting live, with an unanticipated backdrop.

In a protest planned for months, Grandmothers Against Removals campaigners had come to Canberra from across the country to draw attention to skyrocketing rates of Aboriginal child removal. McQuire wrote:

The response from ‘journalists’ Armytage and David Koch was worse than silence. In one of the ad breaks, they turned around and admonished those who had assembled behind them. Rather than listen to their stories, rather than hearing about their children, they castigated them for daring to interrupt their broadcast. As Armytage ‘tsked tsked’, Koch told them to look at the charities he donated to before addressing him.

Where to from here?

Some other things (than Sunrise) to watch:

Which TV station will be first to take up James Ward’s challenge to set up a panel of Aboriginal experts so that they call on these if they want to discuss Aboriginal and Torres Strait Islander issues?

How will Sunrise handle its next complex Indigenous issue?

What can the wider public health field can learn from Indigenous resistance, activism and critique/demolition of mainstream narratives?

And what will the wider mainstream media learn from Sunrise’s awakening?

The early signs may not be good, judging from this tweet.

Watch Here

NACCHO Aboriginal Health #Saveadate and The #Apology10 :The fact is that most of the social and health problems we see in communities today are linked to Intergenerational Trauma says Richard Weston CEO @HealingOurWay

 ”  The fact is that most of the social and health problems we see in communities today, from family violence and suicide to high rates of incarceration and child protection, can be linked to Intergenerational Trauma

So if we want to create a different future and close the gaps that still exist between Aboriginal and Torres Strait Islander people and other Australians, we need to stop putting Intergenerational Trauma in the too-hard basket.

The National Apology to the Stolen Generations in 2008 was a landmark event. It was a moment of truth telling which is critical when you’re trying to heal from trauma. But it was a starting point not a solution. The latest progress report on Closing the Gap shows that efforts to address appalling levels of disadvantage have made marginal improvements, in spite of billions of dollars in government funding.

Closing the Gap is complicated, but it’s not impossible. We just need to invest in strategies that have been proven to work and be prepared to invest beyond political cycles and social fads.

We also need to listen to what Aboriginal and Torres Strait Islander communities tell us will work.”

Richard Weston, a Meriam man who was born on Gadigal country and grew up on Noongar Boodja and is now on Ngunnawal Country, is this week’s host on the @IndigenousX Twitter account and is tweeting with the #Apology10 hashtag. See Full Croakey article below

Communities across Australia, from Kununurra to Mildura, Casuarina to Logan, the Mornington Peninsula to Cherbourg and Muswellbrook to Adelaide, will come together this month to commemorate todays 10th anniversary of the National Apology to the Stolen Generations on 13 February 2008.

See this list of events.

In this anniversary article for Croakey, The Healing Foundation CEO Richard Weston says Australia must understand that the impacts of the Stolen Generations policies, and other brutal acts of colonisation, are not consigned to the past, but “very much part of the here and now”. He says we need a serious commitment to tackle unresolved and intergenerational trauma in Aboriginal and Torres Strait Islander communities

#Apology10 is also hosting a free community concert in Canberra to mark #Apology10, featuring Archie Roach, Shellie Morris, The Preatures, Busby Marou and Electric Fields, hosted by Myf Warhurst and Steven Oliver.

See also this video series marking the National Apology being published by IndigenousX – featuring Uncle Jack Charles, Amnesty Australia’s Roxanne Moore, and Gavan Moor and Chris Dunk.

 Download the 6 Page 2018 Aboriginal / Health  days and events calendar updated 6 February  HERE

NACCHO Aboriginal Health 2018 Save a date Feb 6

National Apology was starting point, not solution: Stolen Generations trauma continues

Anniversaries are a good time for reflection and as we commemorate the 10th anniversary of the National Apology today, I hope we can use the momentum to achieve something we’ve never managed to realise before—a serious commitment to tackle unresolved and Intergenerational Trauma in Aboriginal and Torres Strait Islander communities.

Ten years on from the Apology, and 20 years on from the tabling of the Bringing Them Home report that recommended that apology in the first place, there are still thousands of our people held back by the impact of trauma. Almost every Aboriginal and Torres Strait Islander family is affected in some way.

To give you an idea of what I mean, more than 12 per cent of the people who gave evidence of abuse to the recent Royal Commission into Institutional Responses to Sexual Abuse were Aboriginal or Torres Strait Islander. But we’re not just talking about events of the past. A study in Western Australia found that one in five Aboriginal children were living in families now, where between seven to 14 major life stress events had occurred in 12 months.

Most Australians prefer to think about the Stolen Generations—and other brutal episodes in 230 years of colonisation—as a phenomenon of the past. But the impacts are very much part of the here and now.

Trauma affects the way people think and act and overwhelms their ability to cope and engage. If people don’t have the opportunity to heal from trauma, it’s likely that their experiences and negative behaviours will start to impact on others, particularly children who are susceptible to significant developmental damage when they experience trauma at a young age.

This has created a cycle of trauma, where the impact is passed from one generation to the next, creating a snowball effect of cumulative damage. Research backs this up. The Stolen Generations and their children and grandchildren are twice as likely to be arrested by police and a third less likely to be in good health, compared to other Aboriginal and Torres Strait Islander people who are already at a disadvantage.

 

The Healing Foundation is finalising the first full analysis of current needs for the Stolen Generations, particularly as they enter the aged care sector, and to address issues like national reparations. When we talk to members of the Stolen Generations, they tell us over and over again that re-building families through culture and healing is a key priority.

Why? Because a traumatised person can’t benefit from programs around education and training.  Healing strategies must be implemented alongside enablers like employment, education and economic empowerment, otherwise we will keep wasting taxpayer dollars focusing on symptoms alone.

The Healing Foundation has shown that investment in the right programs will create long term change and reduce the burden on public funds.  Over the last eight years we’ve seen reductions in violence, juvenile justice rates and out-of-home care for children where healing programs have been implemented.  For example, our men’s healing programs have led to a 50% reduction in contact with Corrective Services and a drop in family violence, while programs for young people have potentially reduced contact with the protection system by 18.5% and the juvenile justice system by nearly 14%.

To replicate these successes across Australia, we need to scale-up our healing efforts and focus on families and communities, rather than individuals.

Today will be a day of celebration to mark a major step forward in the process of healing and reconciliation.  But it’s also a day when we need to take stock of what’s working and what’s not. Over the past few weeks I’ve been reminded by young people in our communities that the future holds a great deal of hope. Despite the wrongs of the past, many of them are optimistic and motivated to create change. This gives me hope that we will have something more positive to report after the next decade—and a different future, built on a foundation of healing.

 

NACCHO Aboriginal Health and #Pain Advice @AMAPresident @RuralDoctorsAus @ACRRM @CRANAplus @NRHAlliance Changes to the availability of #codeine containing medicines come into effect 1 February 2018

” From 1 February 2018, codeine will no longer be available over the counter. This means you will need to get a prescription from your ACCHO doctor to buy codeine. For people with ongoing chronic pain, there are other treatments in addition to or instead of medication that can be very helpful

There are many different ways that people can manage their pain without using codeine. Research shows low-dose codeine is not superior to over-the-counter alternatives such as a combination of paracetamol and ibuprofen for pain relief.”

From Real Relief

Opening graphic courtesy of Redfern AMA ACCHO

From 1 February 2018 medicines containing codeine will only be available by prescription. These medications are used to treat pain. Codeine is also sometimes used in cold and flu medicines.

If you live in a rural or remote area and you think that this change will affect you, it’s a good idea to know your options and plan ahead.


If you normally take medicines with codeine for ongoing (chronic) pain you should talk to a health practitioner about your pain management options. Codeine is only recommended for a maximum of three days and is not considered an effective treatment for chronic pain.

The best place to get advice and assistance will depend on the health services available in your area and your personal preference.

Visit your health practitioner

If you have access to a local GP, they can provide information and help with managing your pain and write you a prescription if you need one. If they feel you need extra help to manage chronic pain they might refer you to see a specialist – either in person or through a service called Telehealth that is used to deliver health services across Australia without the need for travel.

Go to a community health centre or remote health service

If you don’t have a local GP, you can get advice and help at a community health centre or a remote health service in your area. Remote area nurses and registered nurses can also provide advice and, in some areas, they can write prescriptions.

Visit your local Aboriginal and Torres Strait Islander Health Service

Aboriginal and Torres Strait Islander Health and Medical services can provide holistic and culturally appropriate advice and care on all health and medical issues including pain management.

Get free advice over the phone

For free health advice 24 hours, 7 days a week, you can call Healthdirect Australia on 1800 022 222. Healthdirect can provide you with advice on all health topics, including pain management. They can also help you locate your nearest health services and chemists.

Download our NRHAM resources

Click here to download the NRHA Codeine Fact Sheet 

Click here to download the NRHA Posters

If pain is ongoing the best way to manage it is with a combination of strategies that suit your condition and personal situation. Medication alone is not effective.

Multidisciplinary pain management will address all of the factors associated with pain – including emotions, mental health, social relationships and work – to help you get the best results.

One of the best ways to manage pain is to take control of it. With access to the right education and strategies, most people with chronic pain can successfully regain quality of life without the need for opioids, surgery or other invasive treatments.

You can learn more about multidisciplinary pain management through your ACCHO GP who can refer you to your nearest pain service.

Rural Doctors RDAA are working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change

AMA Interview

Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.”

AMA President, Michael Gannon see interview in full Part 2

President of the Rural Doctors Association Australia (RDAA), Dr Adam Coltzau, said that while the up-scheduling of codeine has been well publicised, some patients will remain surprised when they can no longer buy their preferred pain medication over the counter.

“I have no doubt that starting today there will be disgruntled people who were either unaware of the coming change or who did not make plans to change their medication,” Dr Coltzau said.

“Everyone should be aware that they may consult with their pharmacist where available or where there is no pharmacist their health clinic team regarding alternative over-the-counter medications. It is imperative that consumers who have previously used over-the-counter codeine to manage pain see their health care provider regarding alternative medications or therapies that are available to them.

“And of course for those patients whose doctor or nurse practitioner recommends codeine-based products these remain available to them by prescription.

“The up-scheduling of codeine has provided a positive opportunity for both patients and prescribing practitioners to increase their knowledge of the safer and more effective pain relief medications and treatments, review their condition and re-assess their approach to management of these conditions,” Dr Coltzau said.

President of the Australian College of Rural and Remote Medicine (ACRRM), Associate Professor Ruth Stewart, said that patients should start a conversation with their GP about their pain problems to find a treatment that works for them.

“There’s no clinical evidence to suggest that over-the-counter codeine products are more effective analgesics than similar medicines without codeine,” A/Prof Stewart said.

“Talking to your GP about your pain is the best way to address it, as they’re equipped to suggest a pain management strategy based on your symptoms.

“Medication alone is often not the most effective way of treating many conditions, and a multidisciplinary pain management plan will help get the best results.

“In rural and remote areas, where people may have to travel to access their health care provider to review the management of their condition, it is important for consumers to schedule a visit with their

GP or other health care provider. Where pharmaceutical services are available, consumers can take advantage of the Government’s new Pain MedCheck program that will be rolled out across community pharmacies for a one-on-one consultation with your pharmacist.

“Online resources such as http://www.realrelief.org.au can provide consumers with the facts and information on the proven alternative pain medications that are available and there may also be specialist and allied health services available via telehealth for people living in rural and remote communities,” A/Prof Stewart said.

RDAA is working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change.

Visit www.rdaa.com.au for more information.

 Part 2

LAURA JAYES:   AMA President, Michael Gannon, joins us now live from Perth. Dr Gannon, thanks so much for your time. Is the AMA on board with this decision?

MICHAEL GANNON:   The AMA supports the decision made by Minister Greg Hunt, who in turn was taking the advice from the TGA, the Therapeutic Goods Administration. They’re the bureaucrats who have looked at the science and made a decision that brings Australia into line with 25 other countries.

LAURA JAYES:   There’s been a bit of reaction to this, you would’ve noticed, Dr Gannon, but most people do use these codeine products in a very responsible way. Are you concerned about what this might do in regional areas, where people don’t have access to this, they have to find a GP? That might delay them in seeking this medication.

MICHAEL GANNON:   Look, the Pharmacy Guild stands alone in their opposition to this change, and we’ve seen a lot of mythology out there. The important message – for people who have always required a prescription for higher doses of codeine, nothing’s changed.

Now, we’ll have more to say about that. This is a drug that is causing more harm than good in our community, and ideally over time we’ll see fewer and fewer prescriptions for opioids.

But for the lower doses of codeine that this change affects, it’s very important to deliver the message to people that there’s very clear scientific evidence that the low dose codeine-containing preparations are no more effective than the paracetamol or the anti-inflammatory alone.

That’s the message that should be delivered to a patient presenting to a community pharmacy today or in coming weeks: here’s some paracetamol, here’s some ibuprofen – it’s every bit as effective, and it’s a lot safer.

LAURA JAYES:   Well, you said myth-busting; what kind of myths did you want to bust? I’ll give you the platform to do it right here and now.

MICHAEL GANNON:   Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.

LAURA JAYES:   You sound like the AMA is preparing to actually look more deeply into opioids other than codeine. It seems like codeine is the first frontier. Why is codeine any worse than some of the others?

MICHAEL GANNON:   Well, the reason that codeine is worse is that it’s unique amongst the opioids in that’s it’s being treated in such a permissive manner. You still need a prescription for fentanyl; you still need a prescription for oxycodone; you still need a prescription for morphine.

But if anything good has come out of this conversation in recent months, it’s been that we, as doctors – whether that’s surgeons dispensing opioids after surgery, whether it’s emergency departments dispensing them in people who have presented with trauma or some other form of pain – we need to do something, because oxycodone, fentanyl, higher doses of codeine, are also causing damage in our community.

We need to look carefully at better opioids. Codeine is very much yesterday’s drug, it would not be licensed if it was invented next week. But we need to look carefully at our prescription of other opioids and really look carefully at non-pharmacological approaches to chronic pain.

LAURA JAYES:   What ones are you concerned about? Are you concerned about pseudoephedrine? Because I believe if I’ve got a bit of the flu, I go to the chemist, I get some cold and flu tablets that contain pseudoephedrine. You can certainly get through a day of work with those drugs, but are they an addictive substance? If codeine is the first one you’re concerned about, what are the next?

MICHAEL GANNON:   Pseudoephedrine is not an opioid, so it’s not used for pain relief, and the main reason to be careful with its use is it’s used to cook up methamphetamine in criminal backyard laboratories.

But you raised an important issue there, the need to monitor. We support real-time prescription monitoring. We’ve been very supportive of what’s existed in Tasmania until now. State Minister Jill Hennessy in Victoria, Federal Minister Greg Hunt, have made noises about real-time prescription monitoring. We agree with the Pharmacy Guild that that’s the way forward, especially for other licit opioids that have become drugs of abuse, like fentanyl, like oxycodone.

LAURA JAYES:   Okay, so those are the main concerns that are being abused if the opportunity is given?

MICHAEL GANNON:   Well, we are concerned about these drugs as drugs of abuse. I mean, the evidence comes from coronial reports in Victoria and other States.

LAURA JAYES:   How do people get them, though? Do they doctor shop?

MICHAEL GANNON:   Well, there is no question that some people doctor shop, but that’s a pretty ambitious effort to doctor shop for 8mg codeine tablets. But there’s no question that some people, they cook up all sorts of stories, they’re very sophisticated in how they go around collecting prescriptions for codeine 30mg tablets.

We know that fentanyl patches, that people use them, and they get the drug out of the patch for intravenous or subcutaneous administration. Australia has long been a high user of opioids, we’re a big exporter of opioids, and the story of the harm they do in the community is not a new one. But this decision, it’s at least two or three years overdue, and it brings us into line with much of the rest of the developed world.

 LAURA JAYES:   Dr Michael Gannon, thanks so much for your time today. This is a fascinating area that I agree with you we need to look a lot more closely at. We’ll get you back another time and deep-dive into that issue. Thanks so much for your time.

 MICHAEL GANNON:   Thank you, Laura.    

 

 

 

 

 

 

 

Dr Google will see you now ! NACCHO Aboriginal Health Alert @AMAPresident says Doctor #Google no substitute for a visit to your trusted ACCHO / Family GP.

 ” We live in a digital generation. People use their smartphones and the internet for absolutely everything in life, so it’s to be expected that they’ll use it in regard to their health, and we know that health is one of the main reasons that people access search engines like Google.

One of the reasons doctors do recoil in horror is that some of the quality of the information on the internet leaves a lot to be desired.

So when a patient presents to their GP or another specialist and says they’ve done their own research on vaccinations and they’ve spent 20 minutes and that’s meant to overcome hundreds, thousands of hours of research into different  ” vaccines, that’s the kind of thing that makes doctors upset.

But we need to be clever enough and sensitive enough to listen to people, and often they’ve done part of the work for us.

Dr Michael Gannon President AMA responding to a question about Dr Google from Lisa Barnes  6PR Breakfast Perth 3 January 2018

Will patients stop going to the GP?

 “According to Google, one in 20 Google searches are health-related. Google’s new health cards will include facts vetted by a team of “medical doctors”, the company says, and adds:

“Each fact has been checked by a panel of at least ten medical doctors at Google and the Mayo Clinic for accuracy.”

Google’s Isobel Solaqua also encouraged patients to still seek professional medical attention.

What we present is intended for informational purposes only — and you should always consult a healthcare professional if you have a medical concern.”

Google’s new function might be handy for giving patients more accurate information – rather than having people wind up on dusty message boards and forums with questionable advice.”

Source Dr Google will see you now :

 ” At the first sign of a headache (“brain tumour?”), aching joint (“dengue?”) or a rash (“measles?”) do you find yourself looking to Dr Google? If so, then there’s a chance that your real malaise warrants another moniker: cyberchondria.

With one in 20 Google searches a quest for health information, many of us are likely familiar with the anxiety that goes with compulsively searching online for real (or imagined) health issues.

But is all this googling actually paying off in terms of our health and wellbeing?

For some time, researchers have pointed out that our ability to find out almost anything health-related through a quick online search has its downsides.”

NACCHO would suggest you use Dr Google and download the NACCHO APP that can help you find one of the 302 ACCHO Clinics throughout Australia ( and make a booking with one of our real ACCHO Doctors)  

Download the NACCHO App HERE

And here is why

 ” Well, Dr Google should never, and will never, be a surrogate for a face to face consultation.

There’s a lot of skill in medical practice – sometimes it’s unseen to patients – but there is a skill in taking a history, performing an examination, working out which tests are and aren’t indicated, thinking about how you’re going to interpret those tests and what your follow-up plan is.”

Dr Michael Gannon on why you should see a real Doctor

Full Transcript of Interview

MICHAEL GANNON:   I think there’d be plenty of patients who would have positive experiences, and there’d be plenty of patients that are led down the garden path. I think that if you put into a search engine the basic symptoms, in my experience most patients end up diagnosing themselves with either leukaemia or a brain tumour. But if you ask for something very specific, there’s some very credible and very useful health information that gives patients an idea how to proceed.

GEOF PARRY:   Michael, I think the AMA has been concerned about Dr Google in this sense, that they’ve been presenting to doctors and some doctors have been getting a bit upset about it, and you’re sort of saying, isn’t it, that it’s a bit of a fact of life now and you have to work with it?

MICHAEL GANNON:   I think you’re exactly right, Geof. We live in a digital generation……….

See opening extract

But we need to be clever enough and sensitive enough to listen to people, and often they’ve done part of the work for us.

LISA BARNES:   You’re right though, it is about using a little bit of common sense and being a bit specific with what you’re searching for, isn’t it? Because I know I’ve used Dr Google, and yeah, I seem to come up with about 17 serious diseases that I’ve got. But if you narrow it down, you can use that information for good, can’t you?

MICHAEL GANNON:   You can. I mean, some of the State Health Departments have very high-quality information that’s available. I would encourage people to have a look at where the information’s coming from.

So, if the search engine directs them to a website of one of the learned Colleges or a State or Territory Health Department, one of the august bodies in the English-speaking world like Britain or the United States, you might get valuable information.

I use Wikipedia to look up genetic conditions and rare syndromes all the time and, although I have concerns about how often some of that information’s curated, overall it’s extremely good. It’s when people start googling individual symptoms they usually get led down the garden path.

GEOF PARRY:   Michael, I’m wondering whether it’s any different using Dr Google to, say, the sorts of things that the medical profession has had to counter in the past.

So – and I’m going to get criticised for this – but, say, iridology, where people have used iridology to sort of find out what they might be suffering from, or having their auras, their colours read, those sorts of things which, in some schools of thought, these are just quackery.

MICHAEL GANNON:   Yeah, well, you’re right, Geof. We worry a lot about the quality of the health information that’s out there.

Where this story started- I did an interview with a journalist at the Courier Mail in Brisbane, and it was based on a directive from the NHS in Britain, the NHS asking patients to try Google first. Now, that represents a failing health system.

We don’t have that problem in Australia. We hear individual stories, but overall the statistics show that it’s not hard to get an appointment to see a GP, and let’s not forget that 85 per cent of GP services are bulk billed – it costs nothing.

It represents, in a world where it’s increasingly difficult to find value for money for people on fixed wages, a visit to your GP represents value for money like no other I know in the whole community.

LISA BARNES:   And certainly, Michael, obviously the advice would be double check or get it confirmed by a doctor, don’t just take Dr Google at face value.

MICHAEL GANNON:   Well that’s exactly right, and people should never ignore danger symptoms, and individual human beings, the parents, guardians of young children, people caring for elderly relatives, et cetera, should never hesitate to seek medical attention.

The reality is that GPs and doctors in Emergency Departments do see sometimes odd and not particularly high value presentations, but we would never want a situation where someone second-guessed themselves and didn’t seek health care.

GEOF PARRY:   Yeah, is there a couple of risks – like quite serious risks – here? I mean, you can put your health at risk if you put your trust in something like Dr Google and they get it wrong, or are you just completely wasting time and wasting people’s time by going down that path?

MICHAEL GANNON:   Well, Dr Google should never, and will never, be a surrogate for a face to face consultation.

There’s a lot of skill in medical practice – sometimes it’s unseen to patients – but there is a skill in taking a history, performing an examination, working out which tests are and aren’t indicated, thinking about how you’re going to interpret those tests and what your follow-up plan is.

Medical care’s a lot more complicated than sometimes doctors get given credit for. Looking something up on a search engine can be a useful adjunct. We do need to do better with health literacy in our community. I’d love to see more biological sciences taught in high school, but for now it’s a useful tool that people can use to either give themselves reassurance or to make it clear they do need to see a doctor.

LISA BARNES:   Michael, we appreciate your time. Thank you.

MICHAEL GANNON:   Pleasure. Happy New Year to both of you.

LISA BARNES:   And to you. That’s Dr Michael Gannon, the AMA President

NACCHO Aboriginal #HealthyFutures : Making @DeadlyChoices Your 2018 New Year #HealthyChoice Resolutions

 ” In 2012–13, more than two-thirds (69%) of Aboriginal and Torres Strait Islander adults were overweight or obese (29% overweight but not obese, and 40% obese). Indigenous men (69%) and women (70%) had similar rates of overweight and obesity (ABS 2014a).

One-third (32%) of Indigenous men and more than one-quarter (27%) of Indigenous women were overweight but not obese, while 36% of Indigenous men, and 43% of Indigenous women were obese ”

See NACCHO Aboriginal Health article

Background AMA FACTS

·         According to CSIRO, four out of five Australians do not eat the recommended five servings of vegetables and two of fruit daily.

·         One-third of daily food consumption comes from discretionary foods – energy-dense foods that are typically high in saturated fats, sugar, and salt.

·         In 2014-15, nearly two-thirds (63 per cent) of Australian adults were overweight or obese, up from 57 per cent in 1995.

·         One in four children (aged 2-17) were overweight or obese in 2014-15.

·         Overweight and obesity was responsible for 7 per cent of the total health burden in Australia in 2011.

·         In 2011-12, obesity was estimated to cost the Australian economy $8.6 billion. The World Obesity Federation estimated that rose to $12 billion in 2017 and has forecast it to rise to $21 billion by 2025.

·         Australia’s obesity rate (28 per cent) is the fifth highest among Organisation for Economic Cooperation and Development (OECD) countries, behind the United States of America (38 per cent), Mexico (33 per cent), New Zealand (32 per cent), and Hungary (30 per cent).

·         Being overweight or obese is associated with a higher death rate, cutting two to four years off the life expectancy of a person with a Body Mass Index (BMI) between 30 and 35, and eight to 10 years for a person with a BMI of over 40.

·         Increased BMI is also linked to an increased risk of death from colon, rectum, prostate, cervical, and breast cancers.

See Deadly Choices Facebook Page

If you’re looking for a New Year’s Resolution that will improve your health, here are the resolutions we recommend:

The Healthy Weight Guide has been developed to provide you with the information you need to help you understand the importance of healthy eating and physical activity in achieving and maintaining a healthy weight.

Whether you already have a good understanding of what is required or if you are just starting out, the Healthy Weight Guide can help.

You might find achieving and maintaining a healthy weight easier if you break it down into the following seven steps:

Get started

An important first step towards achieving and maintaining a healthy weight is to understand what your journey will involve. You might like to start by finding out if you are a healthy weight. Setting goals and planning are also important steps. Once you are on your journey, it is important to monitor what you do to ensure you can maintain the healthy habits you set up. Registering with the Healthy Weight Guide can help you with all of these steps.

Set goals

It’s a good idea to set yourself some goals to help keep focused. Your goals might be related to your weight or about changing your behaviour, such as increasing your fitness or eating more healthily.  In the set goals section you will find some useful tips and ideas to help you decide on your goals and how you will achieve them. You will also find a downloadable goal setting form in this section. Alternatively, the My Goals section in the My Dashboard registered area will help you to set up and keep track of your goals.

Get active

Creating opportunities to be physically active every day can help you to achieve and maintain a healthy weight. In the get active section you will find helpful hints on finding out what physical activities you like and how to incorporate them into your day. For some people, planning to do physical activity at a regular time every day or week is more likely to make it a habit.  Get active also has a downloadable Physical Activity Planner to help you plan what physical activity you will do and when. The My Planner section of the My Dashboard registered area also has great tool to plan and monitor your physical activity.

Eat well

Developing healthy eating habits is important to being a healthy weight. You might like to start with a few small changes and gradually incorporate more. In the eat well section you will find some great suggestions on healthy shopping, cooking and eating out. You will also find a downloadable meal planner to help you plan and monitor your meals. The My Planner section of the My Dashboard registered area also has great tool to plan and monitor your meals and calculate your energy requirements.

Keep in check

Some people who keep track of their progress are more likely to make the changes that over time become new healthy habits. The keep in check section will give you some suggestions on how to continue to keep track of the healthy habits you have set. You might find the My Dashboard registered area useful to help you monitor your progress.

Managing the challenges

There may be times when you find managing your weight a challenge. The managing the challenges section has useful suggestions to help manage some of the common challenges you might face along the way.

Get informed and get support

In the get informed section you will find information related to achieving and maintaining a healthy weight from the Australian Dietary Guidelines and Australia’s Physical Activity and Sedentary Behaviour Guidelines. There is also information on different weight loss methods. You might find all this information helpful when setting your goals and making your healthy eating and physical activity plans. The getting support section has useful information on who you might be able to reach out to and how they might help. After all, everyone needs a helping hand.

If you’re looking for a New Year’s Resolution that will improve your health, here are 7 resolutions we also recommend: Adapted from

  1. Drink 8 glasses of water per day.  8 can be substituted for however many your body needs .Be sure to track your progress – find a way to track how many glasses you’re drinking per day, and to “check off” the days when you achieve your goal!
  2. Eat 2 servings of fruits and vegetables with every meal.  You could also choose to try for 4 different types of fruits and vegetables every day, or to try a new vegetable every month, or to achieve the recommended 9 servings of fruits and vegetables each day.  Any specific target that increases your vegetable consumption is a great resolution!
  3. Fit in some movement (or stretching) every day.  We are not saying you don’t need rest days, or you need to push yourself to exhaustion every day.  But even on your busiest days, try for a quick lunchtime walk, 10 minutes of stretching before bed, or even a quick interval workout
  4. Learn a new type of exercise, or achieve a new fitness goal.  Working on a new skill can be a great motivation to get active.  Set a resolution that you’ll learn a new activity   Or, set a specific goal in a mode of exercise you already practice (with interim steps along the way!).  Is there a certain weight you want to be able to deadlift, a certain KM time you’ve been hoping for, or a certain pose in yoga you’ve been dying to achieve?  Figure out how you’ll get there this year!
  5. Reduce added sugars (and/ or artificial sweeteners).  This is a lofty and hard-to-measure target, so I recommend you do this in smaller mini-goals.  For example, reduce the 2 tsp of sugar in your coffee to 1 tsp, or go for plain yogurt with fruit instead of sweetened, fruit-flavored yogurt.
  6. Eat at home 4 nights per week, or pack your lunch 2 times per week.  Of course, the numbers are arbitrary, so set a goal that works for you.  The point is to increase the number of home-cooked meals you prepare … so much better for your wallet and your health!
  7. Commit to a small, incremental change every month.  In January, you may order a side of veggies instead of french fries every time you go out to eat.  In February, you may switch from coffee with skim milk.  In March, you may add 5 minutes to your daily 30-minute walk.  Whatever it is, choose a small change that you can add on every single month.