NACCHO Aboriginal Health News Alert : Federal Indigenous Affairs Department latest shakeup brings in a former Vice Chief of the Defence Force, Ray Griggs

I am honoured and excited to be asked to lead a dedicated, talented and committed team of people working issues of such importance to our community.

I am very much looking forward to starting in the role and being able to bring my range of leadership and organisational skills to complement the team.

Vice Chief of the Defence Force, Ray Griggs has been called back by the government from his barely two-month-long retirement to take over from Andrew Tongue and will commence as the new Indigenous Affairs boss in the Department of the Prime Minister and Cabinet on October 2.

” We have done a lot of work to integrate the program management and delivery functions of Indigenous Affairs into PM&C. Many people at the most basic level of our corporate services have done placements out on the ground to understand the nature of what it is like to be a government business manager or an Indigenous engagement officer out in remote Australia.

Some people working in back function actually used to work in Indigenous Affairs, so we have moved some people around.

At the level of policy, we are participating in deliberations of policymaking across government. We have a standing item with the heads of department — the secretaries have a standing item on Indigenous Affairs, so we have the opportunity to interact with all the agencies.

As far as skills go, we inherited all the people working on Indigenous-specific work in all of the departments. Those people maintain their links to those departments, and we encourage that as part of our work.”

Andrew Tongue, who has been Associate Secretary, Indigenous Affairs since 2015 has from this month begun an extended sabbatical from the public service. He is expected to take up a new role on his return in 2020.

As reported by the Mandarin

A shakeup inside Australia’s federal Indigenous Affairs bureaucracy will see its top official, Andrew Tongue, replaced with the recently retired Vice Chief of the Defence Force, Ray Griggs.

The appointment follows a Royal Australian Navy career that has spanned 40 years, the last seven of which on Australia’s Defence Committee as Chief of Navy and most recently Vice Chief of the Defence Force until his retirement in July.

Griggs, whose VCDF portfolio included Indigenous employment and outreach, told The Mandarin he was “honoured and excited to be asked to lead a dedicated, talented and committed team of people working issues of such importance to our community.

While former service chiefs typically remain as government advisors long after their active service, it is rare for the government to appoint a former chief to a full time non-ceremonial role. Liz Cosson, Secretary Department of Veterans’ Affairs, and Duncan Lewis, former Secretary of the Department of Defence, both reached the rank of Major General (one rank below the service chiefs) in the Australian Army before joining the Australian Public Service full time.

From ‘dysfunctional’ to ’empowering communities’

Today’s Indigenous Affairs Group is unrecognisable from when Tongue took over from Liza Carroll, the first Associate Secretary following then self-styled ‘Prime Minister for Indigenous Affairs’ Tony Abbott’s restructure that brought several line agency functions into PM&C. The restructure quadruped its staff footprint overnight.

The group has seen an 80% turnover of its management layer in the last three years — those that stayed were largely the executives who started at or have spent time in regional offices.

Researchers who studied the then newly amalgamated departmentfound it had resorted to “dysfunctional” practices while it attempted to reconcile contradictory functions and establishing multiple sources of advice to Cabinet from within a single department.

Such blurring of lines, while detrimental at the time to Indigenous policy, did lead to much stronger understanding of the role of boundary spanners in government, and improved practices.

Tongue later addressed how they turned it around, declaring “PM&C capable of walking and chewing gum at the same time”:

The group also brought in more senior leaders who identify as Aboriginal or Torres Strait Islander, including its Deputy Secretary, Professor Ian Anderson — a Palawa man, who wears an earring, ran an Aboriginal health service, and had a long successful career as an academic with the University of Melbourne.

Education, businesses key to empowerment strategy

A substantial shift in approach followed. Closing the Gap, with a rhetoric of deficit, failure and poverty, was replaced with Closing the Gap (revamped edition), with a rhetoric of strength, success and economic empowerment.

Dr Martin Parkinson, Secretary of PM&C, argued last year, on the 50th anniversary of the 1967 Referendum that led to the establishment of Commonwealth Indigenous Affairs, that they had reached an “inflection point”.

In the span of one generation, healthcare went from nowhere to expected as a basic right, Indigenous infant mortality rate has more than halved, more Aboriginal and Torres Strait Islander students are enrolling in university than ever before, and for university graduates from an Indigenous background, the employment gap has closed.

The challenges that remain, Parkinson argued, appear to related not to indigeneity but simple poverty and remoteness — if so, the “may require different interventions than those which we have historically directed towards Indigenous Australia, particularly remote Australia.”

“So the task for the APS, and my Department in particular, is to differentiate between the sources of challenge and disadvantage, and to recognise the diversity in both aspiration and need across the country.

“We cannot do that with a one-size-fits-all approach, which is why working with empowered communities on place-based solutions has to be a key part of our approach.”

Beyond progress on closing the employment gap via education, the other significant success has been the Indigenous Procurement Policy. The Commonwealth now spends approximately $300 million a year on Indigenous businesses, having snowballed from $60 million some four years ago and just $6.2 million in 2012-13.

Public servants in the regional network, however, are still often occupied less by a burgeoning bourgeois, and more by how to address basic deficiencies, for example menstrual products in remote schools and communities.

The 10-year remote housing agreement has also expired, along with funding, so a stop-gap measure was introduced in the last budget to support the 21% of the Indigenous population in the Northern Territory that, due to such severely overcrowded houses in remote communities, are considered homeless.

Abbott sets his own targets

NACCHO Image library Abbott and Griggs 2014

The political climate around the government’s response to the Uluru Statement, the Referendum Council and managing former prime ministers, well… one former prime minister, might be more challenging for the Indigenous Affairs group’s new boss.

Griggs will seemingly be reporting to one current Prime Minister, a Minister for Indigenous Affairs also in Cabinet, several junior ministers with overlapping jurisdiction, notably the Minister for Indigenous Health, and now the Special Envoy for Indigenous Affairs.

Tony Abbott has decided to tackle poor school attendance rates in remote communities as part of his Special Envoy role, after reportedly being given “free rein” by Prime Minister Scott Morrison. He aims to deliver his first report on progress before the end of the year. There are only five more sitting weeks before the end of the parliamentary year.

Indigenous Affairs minister Nigel Scullion did not respond to an invitation to discuss the shakeup in the portfolio.

NACCHO Aboriginal Health and #Sugarydrinks : @BakerResearchAu Study reveals the damaging effects for inactive, young, obese people who consume soft drink regularly : What’s going on inside your veins ?

“ With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,”

Professor Bronwyn Kingwell, the study’s senior author : See Baker Institute Press Release Part 1

If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop.

Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out

Professor Bronwyn Kingwell. See SMH Article Part 2 What’s going on inside your veins after you drink a soft drink

See NACCHO Nutrition ,Obesity , Sugar Tax,, Health Promotion 200 + articles published over 6 years and see our policy below

 ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Press Release : Study reveals the damaging metabolic effects for inactive, young, obese people who consume soft drink regularly

We know drinking soft drink is bad for the waistline, now a study by Baker Heart and Diabetes Institute researchers provides evidence of the damaging metabolic effects on overweight and obese people who regularly consume soft drink and sit for long periods.

Researchers have quantified the detrimental effects on glucose and lipid metabolism by studying young, obese adults in a ‘real-world’ setting where up to 750ml of soft drink is consumed between meals daily and where prolonged sitting with no activity is the norm.

The results, outlined by PhD candidate Pia Varsamis in the Clinical Nutrition journal, show how habitual soft drink consumption and large periods of sedentary behaviour may set these young adults on the path to serious cardiometabolic diseases such as fatty liver disease, type 2 diabetes and heart disease.

Whilst most studies to date have focused on the relationship between soft drink consumption and obesity, the large amount of added sugars contained in these drinks has additional implications beyond weight control.

Watch TV Interview

Senior author, Professor Bronwyn Kingwell, who heads up the Institute’s Metabolic and Vascular Physiology laboratory, says the acute metabolic effects of soft drink consumption and prolonged sitting identified in this latest study are cause for concern.

“With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,” Professor Kingwell says.

She says this study quantified the effects of soft drink consumption compared to water on glucose and lipid metabolism in a context that was reflective of typical daily consumption levels, meal patterns and activity behaviours such as sitting for long periods.

The study, involved 28 overweight or obese adults aged 19–30 years who were habitual soft drink consumers. They participated in two separate experiments on different days drinking soft drink on one and water on the other both mid-morning and mid-afternoon during a 7-hour day of uninterrupted sitting.

Professor Kingwell says the combination of soft drink and prolonged sitting significantly elevated plasma glucose and plasma insulin, while reducing circulating triglycerides and fatty acids which indicates significant suppression of lipid metabolism, particularly in males.

She says the metabolic effects of a regular diet of soft drink combined with extended periods of sitting may contribute to the development of metabolic disease in young people who are overweight or obese, including predisposing men to an elevated risk of fatty liver disease.

“The acute metabolic effects outlined in this study are very worrying and suggest that young, overweight people who engage in this type of lifestyle are setting themselves on a path toward chronic cardiometabolic disease,” Professor Kingwell says. “This highlights significant health implications both for individuals and our healthcare system.”

Part 2 : Here’s what’s going on inside your veins after you drink a soft drink

Orginally published Here

Half an hour after finishing a can of soft drink, your blood sugar has spiked.

So you’re probably feeling pretty good. Your cells have plenty of energy, more than they need.

Maybe that soft drink had some caffeine as well, giving your central nervous system a kick, making you feel excitable, suppressing any tiredness you might have.

But a clever new study, published this week, nicely illustrates that while you’re feeling good, strange things are going on inside your blood vessels – and in the long run they are not good for you.

For this study, 28 obese or overweight young adults agreed to sit in a lab for a whole day while having their blood continuously sampled.

The volunteers ate a normal breakfast, lunch and dinner. At morning tea and afternoon tea, researchers from Melbourne’s Baker Heart and Diabetes Institute gave them a can of soft drink.

Their blood samples revealed exactly what happened next.

Sugar from, say, a chocolate bar is released slowly, as your digestive system breaks it down.

With a can of soft drink, almost no break-down time is needed. The drink’s sugar starts to hit your bloodstream within about 30 minutes. That’s why you get such a big spike.

Your body responds to high levels of blood sugar by producing a hormone called insulin.

Insulin pumps through the bloodstream and tells your cells to suck in as much sugar as they can. The cells then start burning it, and storing what they can’t burn.

That quickly reduces the amount of sugar in the blood, and gives you a burst of energy. So far so good.

But the sugar keeps coming. High levels of blood sugar will quickly damage your blood vessels, so the body keeps making insulin.

In fact, just having two cans of soft drink meant the volunteers’ insulin stayed significantly higher than usual – all day.

After lunch, and another soft drink for afternoon tea, their sugar and insulin levels spiked again.

And, once again, over the next few hours blood sugar dropped but insulin levels stayed stubbornly high – right through to late afternoon, when the study finished.

The study demonstrates that two cans of soft drink is all it takes to give your pancreas – the crucial organ that produces insulin – a serious workout, says Professor Bronwyn Kingwell, the study’s senior author.

Watch Video 

We get more sugar each year from beverages than all the sweet treats you can think of combined.

“If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop,” says Professor Kingwell. “Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out.

But something else interesting is happening inside your body as well.

Insulin tells your body to burn sugar. But it also tells it to stop burning fat.

Normally, the body burns a little bit of both at once. But after a soft drink, your insulin stays high all day – so you won’t burn much fat, whether you’re on a diet or not.

One of the study’s participants, Michelle Kneipp, is now trying as hard as she can to kick her soft-drink habit.

She’s switched soft drinks for flavoured sparkling water. “It still tastes like soft drink, and it’s still got the fizz,” she says.

“But it’s hard, because sugar’s a very addictive substance.”

 

NACCHO Aboriginal Health : Download @CSIROnews #FutureofHealth Report that provides a new path for national healthcare delivery, setting a way forward to shift the system from illness treatment, to #prevention.

Australians rank amongst the healthiest in the world with our health system one of the most efficient and equitable. However, the nation’s strong health outcomes hide a few alarming facts: 

  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander people
  • Australians spend on average 11 years in ill health – the highest among OECD countries
  • 63% (over 11 million) of adult Australians are considered overweight or obese
  • 60% of the adult population have low levels of literacy 
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

From CSIRO Future of Health report

Download HERE full 60 Page Report NACCHO INFO FutureofHealthReport_WEB_180910

The CSIRO Future of Health report provides a list of recommendations for improving the health of Australians over the next 15 years, focussed around five central themes: empowering people, addressing health inequity, unlocking the value of digitised data, supporting integrated and precision health solutions, and integrating with the global sector.

CSIRO Chief Executive Dr Larry Marshall said collaboration and coordination were key to securing the health of current and future generations in Australia, and across the globe.

“It’s hard to find an Australian who hasn’t personally benefitted from something we created, including some world’s first health innovations like atomic absorption spectroscopy for diagnostics; greyscale imaging for ultrasound, the flu vaccine (Relenza); the Hendra vaccine protecting both people and animals; even the world’s first extended-wear contact lenses,” Dr Marshall said.

“As the world is changing faster than ever before, we’re looking to get ahead of these changes by bringing together Team Australia’s world-class expertise, from all sectors, and the life experiences of all Australians to set a bold direction towards a brighter future.”

The report highlighted that despite ranking among the healthiest people in the world, Australians spent on average of 11 years in ill health – the highest among OECD countries.

Clinical care was reported to influence only 20 per cent of a person’s life expectancy and quality of life, with the remaining 80 per cent relying on external factors such as behaviour, social and economic support, and the physical environment.

“As pressure on our healthcare system increases, costs escalate, and healthy choices compete with busier lives, a new approach is needed to ensure the health and wellbeing of Australians,” CSIRO Director of Health & Biosecurity Dr Rob Grenfell said.

The report stated that the cost of managing mental health related illness to be $60 billion annually, with a further $5 billion being spent on managing costs associated with obesity.

Health inequities across a range of social, economic, and cultural measures were found to cost Australia almost $230 billion a year.

“Unless we shift our approach to healthcare, a rising population and increases in chronic illnesses such as obesity and mental illness, will add further strain to the system,” Dr Grenfell said.

“By shifting to a system focussed on proactive health management and prevention, we have an exciting opportunity to provide quality healthcare that leaves no-one behind.

“How Australia navigates this shift over the next 15 years will significantly impact the health of the population and the success of Australian healthcare organisations both domestically and abroad.”

CSIRO has been continuing to grow its expertise within the health domain and is focussed on research that will help Australians live healthier, longer lives.

The Future of Health report was developed by CSIRO Futures, the strategic advisory arm of CSIRO.

More than 30 organisations across the health sector were engaged in its development, including government, health insurers, educators, researchers, and professional bodies.

Australia’s health challenges:

  • Australians spend on average 11 years in ill health – the highest among OECD countries.
  • 63 per cent (over 11 million) of adult Australians are considered overweight or obese.
  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander peoples.
  • 60 per cent of the adult population have low levels of health literacy.
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

The benefits of shifting the system from treatment to prevention:

  • Improved health outcomes and equity for all Australians.
  • Greater system efficiencies that flatten the cost curve of health financing.
  • More impactful and profitable business models.
  • Creation of new industries based on precision and preventative health.
  • More sustainable and environmentally friendly healthcare practices.
  • More productive workers leading to increased job satisfaction and improved work-life balance.

More info : www.csiro.au/futureofhealth

NACCHO Aboriginal Children’s Health : Dr @SandroDemaio presents a five-point policy plan using a lifeSPANS approach to address child obesity in Australia: #NCDs #EnoughNCDs @FAREAustralia @AHPA_AU @SaxInstitute

 

” The answer to obesity will never be in telling people what to do, guilting them for making unhealthier choices in a confusing consumption landscape, or by simply banning things. We also know that education and knowledge will get us only so far.

The real answers lie not even in inspiring populations to make hundreds of healthier decisions each and every day in the face of a seductively obesogenic, social milieu.

If we are to drive long‐term, sustained and scalable change, we must tweak the system to ensure those healthier choices become the path of least resistance—and eventually preferred. And I believe we must focus, initially, on our kids.

It is time for a lifeSPANS approach to addressing obesity in Australia.”

Dr Alessandro Demaio ” A $100 Million question ” see Bio in full Part 2

Download this Paper HERE : Demaio-2018-Health_Promotion_Journal_of_Australia

Listen to Dr Sandro’s childhood obesity Podcast HERE 

  ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Compelling populations, individuals or even ourselves to act pre‐emptively on the urgent and massive challenges of tomorrow is notoriously difficult.

The concept is called temporal or future discounting, and it is well documented.1 It is the idea that we prioritise our current comfort and happiness over our future and seemingly distant safety or wellbeing.

This psychological shortcoming plays out in many ways. At the micro level, we may defer until next week what we should do today—that run, drinking more water or the dentist check‐up—as it may not reap benefits for months, or ever. Eventually, we may act on some of these but whether delayed, deferred or denied, it can reap serious health consequences.

At the macro level, it becomes even more problematic. When we combine this “delay what’s beyond tomorrow” phenomenon with short‐term political cycles in the context of systems‐based, slowly evolving and largely invisible future threats, important but not yet imminent issues are not just postponed, but ignored.

Few challenges are a greater threat to the health of Australians, nor better define future discounting, than obesity. At the individual level and in our modern, obesogenic societies, weight gain has become the norm—the biological and social path of least resistance.

Food systems have shifted from a focus on seasonal, fresh and relatively calorie‐poor staples with minimal processing or meat, to an environment where junk foods and processed foods are ubiquitous, heavily advertised, hugely profitable and, for many communities, the only feasible “choice”.

Poor nutrition is now the leading risk factor for disease in our country.2City living has come with benefits, but along with an increasingly automated and digitalised lifestyle, has seen physical activity become something we must seek out, rather than an unavoidable component of our daily lives. Factors such as these have made individual action difficult for most of us and combined with our biology, have contributed to obesity rates more than doubling in Australia since 1980 alone.3

At the policy level, a dangerous, pernicious and unhealthy status quo has evolved over decades. One which sees a population increasingly affected by preventable, chronic disease. One which can only be solved through difficult decisions from politicians and the public to make the short‐term, passive but unhealthy comfort harder; and the long‐term promise of wellbeing more attractive.

One which must see sustained public demand and political commitment for a distant goal and best scenario of nil‐effect, in the face of constant, coordinated and powerful pushback, threats and careful intimidation from largely unprecedented policy counter‐currents.

But opportunities do exist; levers throughout this gridlocked policy landscape that can be utilised to move the obesity agenda forward.

One of those is our kids.

We know that if we cannot prevent obesity in our children, those young Australians will likely never achieve wellbeing.

We know that one in four of our children is overweight or obese and that while 5% of healthy weight kids become obese adults, up to 79% obese children will never realise a healthy weight.45 We know that the school years are a time when major weight gain occurs in our lifecourse and almost no one loses weight as they age.6

Recent evidence suggests early, simple interventions not only reduce weight and improve the health for our youngest kids, but also reduce weight in their parents.78 An important network of effective implementation platforms and primed partners already exist in our schools and teachers around the nation.

Finally, a large (but likely overstated) proportion of Australians may call “nanny state” at even the whiff of effective policies against obesity, but less so if those policies are aimed at our children.

With this in mind, I was recently invited to Canberra to present on how I would spend an extra $100 million each year on preventive health for the nation.

This is the five‐point policy plan I proposed; a lifeSPANS approach to addressing child obesity—and with it, equipping a new generation of Australians to act on tomorrow’s risks, today. This is an evidence‐based package to reduce the major sources of premature deaths, starting early.

1 .SCHOOLS AS PLATFORMS FOR HEALTH

  • $3 million to support the revision and implementation of clear, mandatory guidelines on healthy food in school canteens
  • $3 million to coordinate and support the removal of sales of sugary drinks
  • $13 million to expand food and nutrition programs to remaining primary schools
  • $40 million as $5000‐10 000 means‐tested grants for infrastructure that supports healthy eating and drinking in primary schools
  • $130 million to cover 1.7 million daily school breakfasts for every child at the 6300 primary schools nationally910
  • $140 million left from sugary drink tax revenue for school staffing and programs for nutrition and physical activity

Schools alone cannot solve the child obesity epidemic; however, it is unlikely that child obesity rates can be reversed without strong school‐based policies to support healthy eating and physical activity. Children and adolescents consume 19%‐50% of daily calories at school and spend more time there than in any other environment away from home.11 Evidence suggests that “incentives” are unlikely to result in behaviour change but peer pressure might.12 Therefore, learning among friends offers a unique opportunity to positively influence healthy habits.

Trials have demonstrated both the educational and health benefits of providing free school meals, including increased fruit and vegetable consumption, knowledge of a healthy diet, healthier eating at home and improved school performance. Providing meals to all children supports low‐income families and works to address health inequalities and stigma.10

School vending machines or canteens selling sugary drinks and junk foods further fuel an obesogenic, modern food environment. Sugary drinks are the leading source of added sugar in our diet in Australia and are considered a major individual risk factor for non‐communicable diseases, such as type 2 diabetes.13 Removing unhealthy foods and drinks from schools would support children, teachers and parents and send a powerful message to communities about the health harms of these products.

Finally, it is not only about taking things away but also supporting locally driven programs and the school infrastructure to support healthier habits. Drinking fountains, play equipment and canteen hardware could all be supported through small grants aimed at further empowering schools as decisions makers and agents for healthier kids.

2.PRICING THAT’S FAIR TO FAMILIES

  • 20% increase in sugary drinks pricing with phased expansion to fast foods over three years, unlocking approximately $400 million in annual revenue to add to existing $100 million for prevention
  • More than $600 million in annual health savings expected from sugary drinks price increase of 20%
  • $10 million for social marketing campaigns to explain the new policy measures, and benefits to community
  • Compensation package for farmers and small retailers producing and selling sugary drinks (cost unknown but likely small)
  • Such legislation would also support industry to reformulate or reshape product portfolios for long‐term market planning

Today’s food environment sees increased availability of lower cost, processed foods high in salt, fats and added sugars.14 People have less time to prepare meals and are influenced by aggressive food marketing. This leads to food inequality with those from low socioeconomic backgrounds at greater risk from obesity. Obesity increases the risks of cardiovascular disease, type 2 diabetes, stroke, cancer, mental health issues and premature death.15 There are also wider societal and economic costs amounting to an estimated $8.6 billion spent in the health sector alone annually.16

Food prices should be adjusted in relation to nutritional content. Policy makers must shift their pricing focus to integrate the true societal cost of products associated with fiscally burdensome disease. In 2016, a WHO report highlighted that a 20% increase in retail price of sugary drinks lowers consumption as well as obesity, type 2 diabetes and tooth decay.17

The landmark peso per litre sugar tax from Mexico highlighted the behaviour change potential such policies possess. Sales of higher priced beverages decreased substantially in subsequent years. Importantly, the most significant decreases occurred among the poorest households.18 For Australia, a similar approach is estimated to lead to $609 million in annual health savings and raise $400 million in direct revenue.16

These legislative approaches should be framed as an expansion of our existing GST and would encourage industry to reformulate products, positively influencing the food environment.131517

This is not a sin tax or ban, it is an effective policy and pricing that is fair to families. It is also backed by evidence and supported by the public.19

3. ADVERTISING THAT SUPPORTS OUR KIDS

  • End all junk food marketing to children, and between 6 am and 10 pm on television
  • End the use of cartoons on any food or drink packaging
  • $30 million to replace junk food sponsorship of sport and arts events with healthy messaging and explanation of lifeSPANS policy approach
  • Phased expansion of advertising ban over three years to all non‐essential foods (GST language)

The food industry knows that marketing works, otherwise they would not spend almost $400 million annually on advertisements in Australia alone.20

Three of four commercial food advertisements are for unhealthy products and evidence suggests that food advertising triggers cognitive processes that influence our food choices, similar to those seen in addiction. Studies also demonstrate that food commercials including the use of cartoons influence the amount of calories that children consume and the findings are particularly pronounced in overweight children.21

Fast food advertising at sporting and arts events further reinforces a dangerous and confusing notion that sees the direct association between societal heroes or elite athleticism and the unhealthiest of foods.

Ending junk food advertising to children, including any use of cartoons in the advertisement of food and drinks, is an important step to support our kids.

4.NUTRITION LABELLING THAT MAKES SENSE TO EVERYONE

  • Further strengthen existing labelling approaches, including mandatory systems

Nutritional information can be confusing for parents, let alone children. Food packaging often lists nutritional information in relation to portion size meaning a product with a higher figure may simply be larger rather than less healthy. While the Health Star Rating system, implemented in 2014, has made substantive progress, it remains voluntary.22

Efforts should be made to strengthen the usability of existing efforts and make consistent, evidence‐based and effective labelling mandatory. Such developments would also provide stronger incentives for manufacturers to reformulate products, reducing sugar, fat and salt content.

Clearer and consistent information would help create a more enabling food environment for families to make informed choices about their food.

5.SUPPLY CHAIN SYSTEMS AS SOLUTION‐CATALYSTS

  • Utilise procurement and supply chains of schools and public institutions to drive demand for healthier foods
  • Leverage the purchasing power of large organisations to reduce the costs of healthy foods for partner organisations and communities

Coordinated strategies are needed to support the availability of lower cost, healthy foods for all communities. Cities and large organisations such as schools and hospitals could collaborate to purchase food as collectives, thus driving demand, building market size and improving economies of scale.23

By leveraging collective purchasing power, institutions can catalyse the availability of sustainable and healthy foods to also support wider, positive food environment change.

Part 2

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia.

While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health.

He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark.

He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability.

To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months.

Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition.

From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

NACCHO Aboriginal Health supports our First Nations Media @FNMediaAust #OurMediaMatters Campaign : Download nine calls for action that the Government needs to address

We are asking Governments to be part of growing and sustaining our sector for the benefit of First Nations peoples as well as developing greater understanding of our cultures for the benefit of non- Indigenous Australia

Our national network includes more than 40 organisations that service 235 broadcast locations. Collectively those radio services reach nearly 50% of Aboriginal and Torres Strait Islander people across the country with audiences of around 320,000 listeners each week

We are producing and broadcasting content in over twenty languages. We’ve been making media through film, television, radio and print for more than four decades and in recent years diversified to on-line platforms.

People watch and listen and interact because our media tell positive stories about First Nations people relevant to their community and lives, and in many places, it’s in their first language.

Our media engages our audiences in a two-way dialogue that is both culturally appropriate and relevant.

Our media is an essential service, particularly in the many areas across Australia where it is the only means of receiving emergency information and health messages, including local languages.

Our media saves lives in the immediate sense as a primary source of information, but also through the stories we tell and the impact those stories have on our people’s social and emotional wellbeing.

That’s why our media has impact and that’s why we want Governments to recognise that our media matters.

First Nations Media Australia chair Dot West

#OurMediaMatters was the message First Nations media organisations from around the country  took directly to politicians and policy makers in Canberra this week from Monday 20 August .

FNMA’s goals in calling for action are to close the gap on disadvantage, to inform, connect and empower communities, to provide meaningful jobs, skills and business opportunities, and to provide our children with opportunities, a strong sense of identity, inclusion and pride in their languages and culture.

Download the full call to action

Calls-For-Action-2018-Consolidated-CFA-Documents

Peak body First Nations Media Australia (FNMA) showcased the work of member organisations and how First Nations media services play a crucial role in increasing community cohesion, building community resilience and creating meaningful employment and economic opportunity

Picture below 2017 Conference

The Festival theme was Lutjurringkulala Nintiringama Ngapartji Ngapartji meaning ‘come together to learn and share’.

Over 100 delegates travelled the long red desert highway to be welcomed to Country, culture, big night skies and Tjukurrpa by Irrunytju traditional owners and community leaders. The opening ceremony featured a Turlku (dance) performance of the Minyma Kutjara (Two Sisters) story that passes Irrunytju community. The week-long event affirmed the remote Aboriginal and Torres Strait Islander media industry as a powerful and connected voice for generations to come.

Broadcasters

Imparja Television

Indigenous Community Television (ICTV)

National Indigenous Radio Service (NIRS)

National Indigenous Television (NITV)

Broadband for the Bush Alliance

Aboriginal Medical Services Alliance NT

Australian Communications Consumer Action Network (ACCAN)

Australian Smart Communities Association

Central Australian Aboriginal Media Association

Central Desert Shire Council

Central Land Council (CLC)

Centre for Appropriate Technology (CAT)

Centre for Remote Health (CRH)

Desert Knowledge Australia (DKA)

Ethos Global Foundation

Frontier Services

Indigenous Remote Communications Association

Infoxchange

Mid West Development Commission

National Centre of Indigenous Excellence

National Rural Health Alliance

Ninti One

Regional Development Australia, Northern Territory

Remote Area Planning and Development (RAPAD)

Swinburne Institute for Social Research

TelSoc

FNMA has identified nine calls for action to Government that address four key aims

  • To increase jobs and skills
  • To improve the sector’s capacity and sustainability
  • To enhance social inclusion, and
  • To preserve culture and language.

Some of the calls for action are budget neutral and simply ask for policy amendments to recognise First Nations broadcasters as a separate license category under the Broadcasting Services Act.

  1. Broadcasting Act Reform for First Nations Broadcasting. Download
  2. Increase in Operational and Employment Funding. Download
  3. Live and Local Radio Expansion Program. Download
  4. Strengthening of First Nations News Services. Download
  5. Expanding Training and Career Pathway Programs. Download
  6. Upgrading Infrastructure and Digital Networks. Download
  7. Recognising First Nations Broadcasters as the Preferred Channel for Government Messaging. Download
  8. Preserving First Nations Media Archives. Download
  9. Establishing an Annual Content Production Fund. Download

Other calls for action would require a funding commitment, for example to underpin First Nations media capacity to act as training and employment hubs.

NACCHO Aboriginal Health #COAG meeting Alice Springs : Time for COAG Health Council to address the Indigenous funding myth & ‘market failure’ says Ian Ring

 ” COAG Health Ministers will discuss Aboriginal and Torres Strait Island health at their meeting in Alice Springs this week.

There is much to discuss. Ten years on from the start of Closing the Gap, progress is mixed, limited and disappointing, and the life expectancy gap is widening.

This is hardly surprising.

The National Partnership Agreements on Indigenous health, which spelt out the roles, responsibilities and funding of the Commonwealth and state and territory jurisdictions, have not yet been replaced by bilateral agreements.

Formal regional structures and agreements to bring together Aboriginal community controlled health and mainstream services have yet to be formalised nationally. On the broader front, culture, racism and social, political and economic issues cry out for attention.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.”

Ian Ring AO Honorary Professorial Fellow Research and Innovation Division
University of Wollongong

Originally published in Croakey 

Much remains to be done in housing, the justice system is a debacle, and the question of an Aboriginal voice, one of the main priorities of the Uluru Statement from the Heart, remains unresolved.

Critically, the National Aboriginal and Torres Strait islander Health Implementation Plan, which was supposed to be the game changer for health, has become an unfunded plan of words not action and, after almost three years, basic core tasks such as defining service models and filling service gaps remain unfulfilled.

Misleading money myths

While money isn’t the only factor, money myths are playing an important role in the failure to close the gap.

A recent Productivity Commission report found that per capita government spending on Aboriginal and Torres Strait Islander people was twice as high as for the rest of the population.

The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.

But higher spending on Aboriginal and Torres Strait Islander people should hardly be a surprise.

We are not surprised, for example, to find that per capita health spending on the elderly is higher than on the healthier young because the elderly have higher levels of illness.

Nor is it a surprise that welfare spending is higher for Indigenous people who lag considerably in education, employment and income. There would be something very wrong with the system if it were otherwise.

The key question in understanding the relativities of expenditure on Aboriginal and Torres Strait Islander people is equity of total expenditure, both public and private, in relation to need, but the Productivity Commission’s brief is simply to report on public expenditure, and that can be misleading.

Massive market failure

For health services, while state and territory governments spend on average $2 per capita on Indigenous people for every $1 spent on the rest of the population, the Commonwealth spends $1.20 for every $1 spent on the rest of the population, notwithstanding that the burden of disease and illness for Indigenous Australians is 2.3 times the rate of the rest of the population. And total government expenditure on Aboriginal and Torres Strait Islander health is only about 60 per cent of the needs based requirements.

This is massive market failure.

The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

Mortality for the Indigenous population has flatlined since 2008 and the inevitable result is that the life expectancy gap is widening rather than closing.

This is not surprising since the Federal Government’s own reports clearly show that preventable admissions for Indigenous people, funded by the states and territories, are three times as high as for the rest of the population (see graphs below, and sources at the bottom of the post) yet use of the Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS), funded by the Commonwealth, appears at best to be a half and a third respectively of the needs based requirements for Indigenous people.

It is simply impossible for the mortality gaps to close under these conditions.

It is not that the Commonwealth is deliberately underfunding health services for Aboriginal and Torres Strait Islander people. However there are decades of experience establishing beyond all doubt that demand driven services designed to meet the needs of the bulk of the population will not adequately meet the needs of a very small minority of the population with very special needs.

In recognition of that, for over 40 years, the Commonwealth has been funding Aboriginal Community Controlled Health Services (ACCHS), which evidence shows better meet those needs, but the coverage of those services is patchy and needs to be expanded.

It has been shown that the nonviolent death rate for at risk Aboriginal people can be halved in just over three years by systematic application of knowledge we already have. It really is within the grasp of the current government to turn things around and now is the time to do it.

Priorities to address

A key requirement is to address the shortfall in Commonwealth funding for out of hospital services, which is contributing to excessive preventable admissions funded by the states and territories, and to avoidable deaths.

A vital priority is seed funding for the provision of satellite and outreach ACCHSs that Indigenous people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Additional funding is also required for mental health and social and emotional wellbeing services which are neglected in the Closing the Gap initiative.

And much more attention needs to be paid to the quality of services, with much needed investment in the training of clinicians, managers and public servants for the difficult and complex roles they have to play.

The ‘Refresh’: resource-free targets

The danger is that action will be put on hold in the belief that somehow the Closing the Gap ‘Refresh’ is going to solve everything!

The fear is that we have entered the world of magical targets – the kind where you just say what you would like to happen and that’s it, it just magically comes to pass without actually specifying, let alone actually doing all the things that are required to achieve the targets. It’s a bit like painting pictures in the sky: let’s put an end to war and famine without any thought or action about what would need to be done for those desirable things to come to pass.

With the Refresh target setting process, there seems to be a lot of emphasis on data issues while more or less completely overlooking consideration of the investment or services required to achieve the targets.

In an orthodox sensible planning process, target setting is an important element. Targets need to be directly related to overarching goals, and need to relate directly to the services, actions and investments that will be made to achieve the targets.

Timeframes setting out what is to be achieved in say 1 year, 5 years, 10 years etc are crucial, and both process and outcome targets need to be set. In the absence of this kind of process a belief that the Refresh will somehow turn things around may well be illusory.

It is extraordinary that the only response to the finding on the life expectancy target – that it not only won’t be met but is going backwards – is an apparent intent to freeze Commonwealth funding for Indigenous health services!

There is little point in having mortality goals which are clearly in jeopardy – and when the causes are not hard to define and the remedies clear – if there is insufficient action taken to actually achieve them.

The funds required for satellite and outreach ACCHS services to fill the service gaps, together with the other priorities described above, spread over a carefully prepared five year plan, are likely to be modest and would make a real and substantial improvement to the health of Indigenous people.

There is no call for some kind of special deal, but simply the same level of expenditure from both Commonwealth and state and territory governments for Australia’s Indigenous peoples that anyone else in the population with equivalent need would receive.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.

Sources:

 

NACCHO Aboriginal Health #WHA71 #IndigenousWFPHA News Alert : Virus afflicting thousands of Indigenous Australians to receive ‘rapid action’, Health Minister @GregHuntMP signals @AMSANTaus

  ” A major new taskforce will focus on Australia’s response to the blood-borne virus HTLV-1, found in Aboriginal communities at 1,000 times the rate of anywhere else in the world.

Key points:

  • Currently no prevention strategy for virus, which is transmitted by unprotected sex, blood contact, breastfeeding
  • Can cause rapidly fatal form of leukaemia, spinal cord inflammation, and is associated with severe lung condition
  • Minister calls for “rapid action for early testing” for the virus

The Federal Government will establish a new $8 million taskforce of doctors, Aboriginal health organisations and all levels of government, focused on HTLV-1, or human T-cell lymphotrophic virus type 1.”

Exclusive by ABC NEWS national Indigenous affairs correspondent Bridget Brennan

There is currently no strategy in Australia to prevent the virus, transmitted by unprotected sex, blood contact and breastfeeding, which can cause a rapidly fatal form of leukemia, and debilitating spinal cord inflammation.

As the ABC revealed last month, research by the Baker Heart and Diabetes Institute suggests thousands of Indigenous people in Central Australia unknowingly have HTLV-1, which can cause serious disease in 5-10 per cent of carriers.

There is no vaccine, and the test for HTLV-1 is not subsidised in Australia, but the Health Minister Greg Hunt told ABC he wanted “rapid action for early testing” and would ask the Medical Benefits Schedule (MBS) Review Taskforce to investigate.

“If we have a test, we can have treatment and we can also engage with research on a cure, so this can make a profound difference to the health of mothers and babies.”

“This is something we need to address on our time, on our watch, and that’s what we’re doing,”

Ancient virus affecting millions around the globe

The World Health Organisation is also considering its response to HTLV-1, convening a meeting of Australian and international public health experts.

At the agency’s annual World Health Assembly in Geneva, chief medical officer Professor Brendan Murphy told ABC “preliminary” talks were held to, “understand the epidemiology of HTLV infection and what actions might need to be taken”.

In several communities in the Alice Springs region, 45 per cent of adults have HTLV-1, and the virus is also associated with a severe, and often-fatal, lung condition called bronchiectasis.

Researchers at the Baker Institute are collaborating with five remote Aboriginal communities — which can’t be named for privacy reasons — to understand how widespread the virus is in desert communities.

HTLV-1 is a distant relative of HIV and was detected in 1979 in the United States, and later identified in Indigenous communities in Australia in 1988.

The virus is endemic to populations in Japan, the Caribbean, West Africa and South America.

‘Orphan’ virus urgently needs more research: experts

Since Australia’s rate of HTLV-1 infection was publicised, there had been a renewed push by HTLV-1 researchers around the world to prevent its spread.

Dr Louis M Mansky from the Institute for Molecular Virology at the University of Minnesota told ABC he regarded HTLV-1 as an “orphan” virus and was shocked by the rates of infection in Australia.

“There’s now a great awareness and interest in the Indigenous population of Australia, given how high the prevalence rate is,” he said.

Dr Mansky has led new research on the spread of HTLV-1 from cell to cell.

“It’s a critical part of the virus to be successfully transmitted from an infected individual to a newly infected individual, and that’s been our focus for many years now,” he said.

Dr Mansky said HTLV-1 was currently an “untreatable disease” because there had not been enough research on the retrovirus.

“It’s also quite clear that [patients] feel orphaned by society — that nobody’s really paying attention or really caring,” he said.

“Many people have not heard of HTLV-1 and it’s not had any impact on their lives, but if you do know someone, if you have been affected, it changes your whole outlook on life, quite negatively.”

Mr Hunt said Australia needed the help of other countries, “to understand what has worked”.

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.