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

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

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

Minister for Indigenous Health, Ken Wyatt

Over 100 NACCHO Articles about smoking

REDUCING INDIGENOUS SMOKING TO CLOSE THE GAP

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

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

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

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

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

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

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

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

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

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

Aboriginal Health #obesity : 10 major health organisations support #sugartax to fund chronic disease and obesity #prevention

Young Australians, people in Aboriginal and Torres Strait Islander communities and socially disadvantaged groups are the highest consumers of sugary drinks.

These groups are also most responsive to price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption ,

A health levy on sugary drinks is not a silver bullet – it is a vital part of a comprehensive approach to tackling obesity, which includes restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

We must take swift action to address the growing burden that overweight and obesity are having on our society, and a levy on sugary drinks is a vital step in this process.”

Rethink Sugary Drink campaign Download position statement

health-levy-on-sugar-position-statement

Read NACCHO previous articles Obesity / Sugartax

Amata SA 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.

See NACCHO Story

SBS will be showing That Sugar Film this Sunday night 2 April at 8.30pm.

There will be a special Facebook live event before the screenings

 ” The UK’s levy on sugar sweetened beverages will start in 2018, with revenue raised to go toward funding programs to reduce obesity and encourage physical activity and healthy eating for school children.

We know unhealthy food is cheaper and that despite best efforts by many Australians to make healthier choices price does affect our decisions as to what we buy.”

Sugar tax adds to the healthy living toolbox   see full article 2 below

 ” Alarmingly, with overweight becoming the perceived norm in Australia, the number of people actively trying to lose weight is declining.   A recent report by the Australian Institute of Health and Welfare found that nearly 64 per cent of Australians are overweight or obese.  This closely mirrors research that indicates around 66 per cent of Americans fall into the same category.

With this apparent apathy towards personal health and wellbeing, is it now up to food and beverage companies to combat rising obesity rates?

Who is responsible for Australia’s waistlines?  Article 3 Below

Ten of Australia’s leading health and community organisations have today joined forces to call on the Federal Government to introduce a health levy on sugary drinks as part of a comprehensive approach to tackling the nation’s serious obesity problem.

The 10 groups – all partners of the Rethink Sugary Drink campaign – have signed a joint position statement calling for a health levy on sugary drinks, with the revenue to be used to support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

This latest push further strengthens the chorus of calls in recent months from other leading organisations, including the Australian Medical Association, the Grattan Institute, the Australian Council of Social Services and the Royal Australian College of General Practitioners.

Craig Sinclair, Chair of the Public Health Committee at Cancer Council Australia, a signatory of the new position statement, said a health levy on sugary drinks in Australia has the potential to reduce the growing burden of chronic disease that is weighing on individuals, the healthcare system and the economy.

“The 10 leading health and community organisations behind today’s renewed push have joined forces to highlight the urgent and serious need for a health levy on sugary drinks in Australia,” Mr Sinclair said.

“Beverages are the largest source of free sugars in the Australian diet, and we know that sugary drink consumption is associated with increased energy intake and in turn, weight gain and obesity. Sugary drink consumption also leads to tooth decay.

“Evidence shows that a 20 per cent health levy on sugar-sweetened beverages in Australia could reduce consumption and prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years, while generating $400-$500m in revenue each year to support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

“The Australian Government must urgently take steps to tackle our serious weight problem. It is simply not going to fix itself.”

Ari Kurzeme, Advocacy Manager for the YMCA, also a signatory of the new position statement, said young Australians, people in Aboriginal and Torres Strait Islander communities and socially disadvantaged groups have the most to gain from a sugary drinks levy.

The Rethink Sugary Drink alliance recommends the following actions to tackle sugary drink consumption:
• A public education campaign supported by Australian governments to highlight the health impacts of regular sugary drink consumption
• Restrictions by Australian governments to reduce children’s exposure to marketing of sugar-sweetened beverages, including through schools and children’s sports, events and activities
• Comprehensive mandatory restrictions by state governments on the sale of sugar-sweetened beverages (and increased availability of free water) in schools, government institutions, children’s sports and places frequented by children
• Development of policies by state and local governments to reduce the availability of sugar-sweetened beverages in workplaces, government institutions, health care settings, sport and recreation facilities and other public places.

To view the position statement click here.

Rethink Sugary Drink is a partnership between major health organisations to raise awareness of the amount of sugar in sugar-sweetened beverages and encourage Australians to reduce their consumption. Visit www.rethinksugarydrink.org.au for more information.

The 10 organisations calling for a health levy on sugary drinks are:

Stroke Foundation, Heart Foundation, Kidney Health Australia, Obesity Policy Coalition, Diabetes Australia

the Australian Dental Association, Cancer Council Australia, Dental Hygienists Association of Australia,  Parents’ Voice, and the YMCA.

Sugar tax adds to the healthy living toolbox 

Every day we read or hear more about the so-called ‘sugar tax’ or, as it should be more appropriately termed, a ‘health levy on sugar sweetened beverages’.

We have heard arguments from government and health experts both in favour of, and opposed to this ‘tax’. As CEO of one the state’s leading health charities I support the state government’s goal to make Tasmania the healthiest population by 2025 and the Healthy Tasmania Five Year Strategic Plan, with its focus on reducing obesity and smoking.

However, it is only one tool in the tool box to help us achieve the vision.

Our approach should include strategies such as restricting the marketing of unhealthy food and limiting the sale of unhealthy food and drink products at schools and other public institutions together with public education campaigns.

Some of these strategies are already in progress to include in our toolbox. We all have to take some individual responsibility for the choices we make, but as health leaders and decision makers, we also have a responsibility to create an environment where healthy choices are made easier.

This, in my opinion, is not nannyism but just sensible policy and demonstrated leadership which will positively affect the health of our population.

 Manufacturers tell us that there are many foods in the marketplace that will contribute to weight gain and we should focus more on the broader debate about diet and exercise, but we know this is not working.

A recent Cancer Council study found that 17 per cent of male teens drank at least one litre of soft drink a week – this equates to at least 5.2 kilograms of extra sugar in their diet a year.

Evidence indicates a significant relationship between the amount and frequency of sugar sweetened beverages consumed and an increased risk of developing type 2 diabetes.  We already have 45,000 people at high risk of type 2 diabetes in Tasmania.

Do we really want to say we contributed to a rise in this figure by not implementing strategies available to us that would make a difference?

I recall being quite moved last year when the then UK Chancellor of the Exchequer George Osborne said that he wouldn’t be doing his job if he didn’t act on reducing the impact of sugary drinks.

“I am not prepared to look back at my time here in this Parliament, doing this job and say to my children’s generation… I’m sorry. We knew there was a problem with sugary drinks…..But we ducked the difficult decisions and we did nothing.”

The UK’s levy on sugar sweetened beverages will start in 2018, with revenue raised to go toward funding programs to reduce obesity and encourage physical activity and healthy eating for school children. We know unhealthy food is cheaper and that despite best efforts by many Australians to make healthier choices price does affect our decisions as to what we buy.

In Mexico a tax of just one peso a litre (less than seven cents) on sugary drinks cut annual consumption by 9.7 per cent and raised about $1.4 billion in revenue.

Similarly, the 2011 French levy has decreased consumption of sugary drinks, particularly among younger people and low income groups.

The addition of a health levy on sugar sweetened beverages is not going to solve all problems but as part of a coordinated and multi-faceted approach, I believe we can effect change.

  • Caroline Wells, is Diabetes Tasmania CEO

3. Who is responsible for Australia’s waistlines? from here

Alarmingly, with overweight becoming the perceived norm in Australia, the number of people actively trying to lose weight is declining.   A recent report by the Australian Institute of Health and Welfare found that nearly 64 per cent of Australians are overweight or obese.  This closely mirrors research that indicates around 66 per cent of Americans fall into the same category.

With this apparent apathy towards personal health and wellbeing, is it now up to food and beverage companies to combat rising obesity rates?

Unfortunately it is not clear cut.  While Big Food and Big Beverage are investing in healthier product options, they also have a duty to shareholders to be commercially successful, and to expand their market share. The reality is that unhealthy products are very profitable.  However companies must balance this against the perception that they are complicit in making people fatter and therefore unhealthier with concomitant disease risks.

At the same time, the spectre of government regulation continues to hover, forcing companies to invest in their own healthy product ranges and plans to improve nutrition standards.

The International Food and Beverage Alliance (a trade group of ten of the largest food and beverage companies), has given global promises to make healthier products, advertise food responsibly and promote exercise. More specific pledges are being made in developed nations, where obesity rates are higher and scrutiny is more thorough.

However companies must still find a balance between maintaining a profitable business model and addressing the problem caused by their unhealthy products.

An example of this tension was evident when one leading company attempted to boost the sale of its healthier product lines and set targets to reduce salt, saturated fat and added sugar.  The Company also modified its marketing spend to focus on social causes.  Despite the good intentions, shareholders were disgruntled, and pressured the company to reinstate its aggressive advertising.

What role should governments play in shaping our consumption habits and helping us to maintain healthier weights? And should public policy be designed to alter what is essentially personal behaviour?

So far, the food and beverage industry has attempted to avoid the burden of excessive regulation by offering relatively healthier product lines, promoting active lifestyles, funding research, and complying with advertising restrictions.

Statistics indicate that these measures are not having a significant impact.  Subsequently, if companies fail to address the growing public health burden, governments will have greater incentive to step in.  In Australia, this is evident in the increased political support for a sugar tax.  The tax has been debated in varying forms for years, and despite industry resistance, the strong support of public health authorities may see a version of the tax introduced.

Already, Australia’s food labelling guidelines have been amended and tightened, and a clunky star rating system introduced to assist consumers to make healthier choices. Companies that have worked to address and invest in healthy product ranges must still market them in a responsible way. Given the sales pressure, it is tempting for companies to heavily invest in marketing healthier product ranges.  However they have an obligation under Australian consumer law to ensure products’ health claims do not mislead.

We know that an emboldened Australian Competition and Consumer Commission (ACCC) is taking action against companies that deliberately mislead consumers.  The food industry is firmly in the its sights, with a case currently underway against a leading food company over high sugar levels in its products. This shows that the Regulator will hold large companies to account, and push for penalties that ‘make them sit up and take notice.’

At a recent Consumer Congress, ACCC Chair Rod Sims berated companies that don’t treat consumers with respect.  He maintains that marketing departments with short-term thinking, and a short-sighted executive can lead to product promotion that is exaggerated and misleading.  All of which puts the industry on notice.

With this in mind, it is up to Big Food and Big Beverage to be good corporate citizens.  They must uphold their social, cultural and environmental responsibilities to the community in which they seek a licence to operate, while maintaining a strong financial position for their shareholders. It is a difficult task, but there has never been a better time for companies to accept the challenge.

Eliza Newton, Senior Account Director

NACCHO Aboriginal Health #disability and @NDIS : Your Top 10 Questions answered about the National Disability Insurance Scheme

What is the NDIS?

Will the NDIS mean more or less support?

Is the NDIS diagnosis based or needs based?

Am I eligible for the NDIS?

Where is the NDIS available now?

What supports does the NDIS cover?

How does the NDIS process work?

I have an NDIS plan. What’s next?

When will the NDIS be here for all Australians?

Where can we get more help

Full details below or download Help Guide Here :

NDIS your Questions answered Download

By any measure Aboriginal and Torres Strait Islander people with disabilities are some of the most disadvantaged Australians, often facing multiple barriers to their meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Strait Islanders is significantly higher than the general population. The Productivity Commission’s Overcoming Indigenous Disadvantage Report released mid- November 2014, highlighted that almost half of the Aboriginal and Torres Strait Islander population have some form of disability or long term health condition, twice the prevalence of disability experienced by other Australians.

The First Peoples Disability Network (FPDN) welcomes the implementation of the National Disability Insurance Scheme and recognises its huge potential to provide Aboriginal and Torres Strait Islander people greater access to disability support “

Damian Griffis is the CEO of the First Peoples Disability Network, an national organisation of and for Aboriginal and Torres Strait Islander people, families and communities with lived experience of disability.

Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities HERE

See full article here or 2 below

  ” The National Disability Insurance Scheme (NDIS) is the most significant policy reform for people with a disability since the Disability Services Act 1986 (DSA). The NDIS has proven potential to enable people with disabilities to live good lives.

The National Disability Insurance Agency (NDIA) reports that around 5% of NDIS participants are of Indigenous heritage.

The NDIA has branded the new scheme as a way of expanding individual and family choice in the services and supports people with disabilities can access. As we have noted previously, individual ‘choice’ requires ‘opportunities’ to exist in local communities. The more remote or rural a community the fewer opportunities available. As such, limited ‘opportunities’ in communities lead to limited ‘choice’ for Indigenous people with disability on NDIS plans who live in rural or remote communities.”

Dr John Gilroy and Associate Professor Jennifer Smith-Merry’s 

Originally published in Croakey  see full article 1 below

Dr John Gilroy is a Koori man from the Yuin Nation, and a doctor of sociology in Indigenous health, specialising in disability studies.

Every Australian Counts

NDIS: Your Questions Answered

The NDIS was launched in trial sites on 1 July 2013. The Scheme is being progressively rolled out over the next few years across Australia. In each State or Territory, the roll out will be staged to ensure the transition is as smooth as possible. Everyone who needs the NDIS will have access by 2020.

Download the Every Australian Counts NDIS: Your Questions Answered

NDIS your Questions answered Download

Endeavour Foundation Discover. This guide has been developed for individuals, families and people with an intellectual disability who are about to navigate the National Disability Insurance Scheme (NDIS).Note not an NDIS publication

NDIS 168 Page

What is the NDIS?

The existing disability system throughout Australia is inefficient, fragmented, unfair, underfunded and leaves most people with disability without the support they need. Plus, people with disability and their families don’t get enough say in the type of supports they receive.

The NDIS stands for the National Disability Insurance Scheme. It’s a new government policy that aims to transform the way Australia supports people with permanent and significant disability.

The foundations of the NDIS are built on two key pillars:

It’s a universal system. The NDIS is a national program similar to Medicare. It will provide supports to all eligible Australians ensuring people with disability and their families get the support they need when they need it.

It’s about more choice and control. The NDIS is based on the idea that people with disability and their families should be empowered to set their own goals and choose their own supports. This is achieved by giving them control over their own support budget.

Will the NDIS mean more or less support?

Under the existing disability system around 220,000 Australians receive funded disability supports. Under the NDIS approximately 460,000 people will receive funded supports, and the average support package will almost double from $18,000 to $35,000.

The NDIS is about making sure you have the right support in the right place at the right time to help you participate in the community and economy. If your needs change over time, you can have your plan reviewed and level of support adjusted. You will have complete choice and control over what’s in your plan and who provides your supports so you can make the most of your package.

Is the NDIS diagnosis based or needs based?

Needs based. The NDIS does not have a list of conditions that automatically include or exclude you from support. It’s based on what you need to live a full life, and how much your disability affects your ability to carry out everyday activities. In the case of children, it’s about whether a disability is likely to be permanent or result in a developmental delay.

This is a big change from the existing system where children without a diagnosis often miss out on funding or their parents are forced to lie about their disability to get support.

Am I eligible for the NDIS?

To access the NDIS you must:

have a significant and permanent disability – this includes people with psychosocial disability

be an Australian citizen, permanent resident or a New Zealand citizen on a Protected Special Category Visa

enter the Scheme before you turn 65.

If you’re unsure whether you meet the above criteria, a good yardstick is if you’re currently receiving funded support, you can expect to be eligible for the NDIS. For individuals who may benefit from early intervention, the eligibility criteria to access the NDIS is more flexible.

Where is the NDIS available now?

The NDIS is being introduced in stages throughout Australia. Existing service users and new participants will enter the scheme progressively. Full scheme transition began in July 2016 in many parts of Australia. There’s still a few more years until it will be here for everyone. The best way to find out when the NDIS is coming to you is by visiting the government’s website: www.ndis.gov.au

As the NDIS rolls out, local offices will open. Here are the current office locations:

Australian Capital Territory

Offices in:

Belconnen, Braddon, Tuggeranong and Woden

New South Wales

Offices in:

Bankstown, Batemans Bay, Bega, Blacktown, Campbelltown, Charlestown, Chatswood, Gosford, Katoomba, Liverpool, Maitland, Moree, Newcastle, Parramatta, Penrith, Tamworth, Taree and Windsor.

Northern Territory

Office in:

Tennant Creek

Queensland

Charters Towers, Palm Island and Townsville

South Australia

Offices in:

Elizabeth, Modbury, Murray Bridge, Noarlunga, Port Adelaide and St Marys

Tasmania

Offices in:

Devonport, Hobart and Launceston

Victoria

Offices in:

Colac, Corio, Darebin, Geelong and Greensborough

Western Australia

Midland

What supports does the NDIS cover?

The types of supports you might get include therapies such as physiotherapy, mobility and technological aids and home modifications.

And it’s not just about covering the ‘essentials’ – your plan could include things such as recreational activities, developing skills like shopping or cooking and help with finding a job. No two people are exactly the same, so neither are the supports in their plan. The NDIS is about you living the life you want – not just getting by.

Some of the supports the NDIS will cover include:

Transport assistance

Therapies

Guide & assistance dogs

Case management

Crisis/emergency support

Personal care

Support for community inclusion

Respite

Specialist employment services

Specialist housing support

Domestic assistance

Aids, equipment, home & vehicle modifications

How does the NDIS process work?

Step one to accessing the NDIS is to find out if you are eligible. Remember, under the new system more people with disability will receive funded supports than ever before. If you are already using disability services and supports you will be contacted by the NDIS or a representative when it’s time to transition. Others may need to present proof of disability such as a statement from your doctor explaining your disability and how it affects your life. The Access checklist on the NDIS website is a good place to start; http://www.myplace.ndis.gov.au/ndisstorefront/ndis-access-checklist

Step two is to start the planning process by talking to the NDIS or one of their representatives. The idea is to talk through your support needs and goals together and come up with the best ways that are reasonable and necessary to meet these goals. And you don’t have to do it alone – you can invite a family member or friend or support worker to come along too. Together with the planner you will develop a support package.

Every Australian Counts tip: Think about your planning meeting as the chance to get the most out of your NDIS support package – the more time you spend preparing, the better your plan will be. So before your meeting, think about what you’ll need to live the life you want. It can also be helpful to chat to your family and carers about what’s missing in your current supports, activities and plans.

I have an NDIS plan. What’s next?

At your NDIS planning meetings you will come up with how to put your plan into action. Most importantly, that means coming up with the supports and services you need to live your life to the full.

This means that for the first time ever, you can decide exactly where your supports come from. This can be through the service providers you’re using now, finding completely new ones, or even self-managing your supports – it’s completely up to you!

If you disagree with an NDIS assessment or are unhappy with your support package, you have the right to ask for a review from the NDIS. You also have the right to get an advocate, friend or independent representative to help you out in this process.

Every Australian Counts tip: The NDIS was set up to give you the power to choose your own supports and service providers. You can do your own research or get help from advice and advocacy organisations. It can also be useful to talk to other people with disability, family members or carers about what works or doesn’t work for them. Remember, your plan is not a one-off decision. If or when your needs change, so can your plan.

When will the NDIS be here for all Australians?

The NDIS will be here for all Australians who need it (460,000 people) no later than 30 June 2019. Rollout information and timetables can be found online: www.ndis.gov.au

Ten ways the NDIS will benefit all Australians.

It’s a national system. If you, or someone you love, is born with a disability or acquires one later in life, you all no longer run the risk of falling through holes in Australia’s safety net based on what state or territory you live in.

People with a disability and their families and carers can participate in the social, economic, and cultural life of the nation with the supports and programs they choose.

Families will be able to access support and services for assistance in meeting the needs of their family member with a disability, reducing physical, emotional and financial stress.

The NDIS is based on equality. You will be able to equally access existing services regardless of when and where your disability was acquired.

There will no longer be an expectation of unpaid care as the norm.

As a Medicare-type system, the NDIS will provide people with a disability and their families and carers with the regular care, support, therapy and equipment they need from a secure and consistent pool of funds for these services and support.

It focuses on early intervention and delivering supports which produce the best long term outcomes, maximising opportunities for independence, participation and productivity.

Each NDIS plan is individualised and person-centred. Support is based on the choices of the person with a disability and their family.

The NDIS is fiscally responsible. It is not welfare but an investment in individual capacity leading to more positive results for people with a disability, their families and carers.

All Australians benefit from the NDIS because disability can affect anyone, anytime. Everyone will benefit from a more inclusive, more diverse community. Every Australian Counts will keep you up to date with all the NDIS news, information, stories and experience on our website; everyaustraliancounts.com.au

Where can I find out more?

For Aboriginal and Torres Strait Islanders

http://fpdn.org.au/

For everybody

www.everyaustraliancounts.com.au

The Every Australian Counts website is an online hub for the disability community that’s packed with useful information, videos and news.

www.ndis.gov.au

The official NDIS website includes an access checklist, factsheets and information to help prepare you for the NDIS.

For people with disability

www.afdo.org.au

The Australian Federation of Disability Organisations (AFDO) represents people with disability. They can connect you with advocacy support.

For carers

www.carersaustralia.com.au

Carers Australia is the national peak body representing carers. Through their website you can access carer support and services.

For disability support workers

www.ndp.org.au

Proposed Aboriginal Community Controlled Health Organisation NDIS Network

Localised, community-based services from John Gilroy article

Research shows that Aboriginal community controlled organisations are an essential component of addressing the health and social needs of Indigenous communities. In a recent review of existing community-based mental health services, Jen Smith-Merry found that the services offered for Indigenous people were most successful when developed by local communities or ‘localised’ and adapted carefully (and genuinely) to community needs.

John Gilroy’s research shows the important role of Indigenous community controlled organisations in forming relationships and referral pathways to disability services. These organisations function as the “social glue” between Indigenous communities, and disability and community organisations.

Expressions of Interest

Joe Archibald the NDIS Manager at Galambila ACCHO at Coffs Harbour is looking to establish a network of ACCHO NDIS health workers :

Express interest in this group EMAIL JOE HERE

Contact

NDIS must promote and support community-based programs to meet Indigenous people’s needs.

Dr John Gilroy and Dr Jennifer Smith-Merry write:

The National Disability Insurance Scheme (NDIS) is the most significant policy reform for people with a disability since the Disability Services Act 1986 (DSA). The NDIS has proven potential to enable people with disabilities to live good lives.

The National Disability Insurance Agency (NDIA) reports that around 5% of NDIS participants are of Indigenous heritage.

The NDIA has branded the new scheme as a way of expanding individual and family choice in the services and supports people with disabilities can access. As we have noted previously, individual ‘choice’ requires ‘opportunities’ to exist in local communities. The more remote or rural a community the fewer opportunities available. As such, limited ‘opportunities’ in communities lead to limited ‘choice’ for Indigenous people with disability on NDIS plans who live in rural or remote communities.

Services, supports and capacity building

The original inquiry into the NDIS identified the importance of a balance between an individualised support system and the block-funding of services and programs to ensure efficient and effective roll-out of the NDIS. The work that we have been involved in supports this view, arguing that Indigenous people should be able to utilise services at their own pace that meet their cultural and personal needs rather than being pushed through a government imposed time-frame.

The government has released the policy framework for NDIS Information, Linkages and Capacity Building (ILC), and the subsequent Commissioning Framework. The ILC, formally Tier 2 of the NDIS, provides funding for the development of programs to help connect people with the disability, health and social supports, and services that are appropriate for them. It also supports capacity building for communities, organisations and individuals, that is not tied to a person’s individualised funding package. In doing this, it aims to also offer support for those who are not eligible for individualised funding packages.

Ensuring equal access and resourcing

There is growing concern that services for the most disadvantaged of the population of people with disabilities may become under-resourced or absent in light of the NDIS roll-out. There is much evidence that this disadvantage is heightened by geographic location, such as very remote communities. The ILC has been designed to provide the opportunity for the needs of these groups to be better met, but only if there is a proactive prioritisation of their needs.

Informed by several of our existing research and community projects, below we present some recommendations for the government, regarding the types of block-funded programs and services needed in local Indigenous communities to ensure that they benefit from the NDIS roll-out.

We preface these recommendations with the observation that there is a big problem with the implementation of the ILC, as the funding has been severely curtailed in its first stages. Bruce Bonyhady, former chair of the NDIS, warns that the current funding for community inclusion programs is: “not sufficient and means that one of the key foundations on which the NDIS is being built is weak”. This funding gap needs to be addressed immediately as there will be significant benefit to indigenous communities if the funding targets appropriate areas.

Crisis Intervention Services

Disability services providers have reported that many Indigenous people engage in the formal services system only when the quality or quantity of family and kinship care is depleted. As such, a large proportion of Indigenous people engage in the disability services sector when in a crisis situation.

Crisis services should be made more disability inclusive, and should act as a channel for encouraging the utilisation of appropriate individualised funding package supports. Targeted capacity building programs are also needed, to enable families and kinship groups to provide support. Such programs should be individualised and culturally and contextually appropriate. Block-funded models enable organisations that have established rapport with communities, to deliver such services in a culturally appropriate manner.

Transition support services

While many Indigenous people only engage with services at times of crisis, the impact of the services provided during crises can be sustained as the crisis abates. The most effective way of doing this is by supporting individualised transition support services which help people to re-establish their lives. This could involve connecting people with appropriate individualised support packages or funding of ‘peer support’ or community buddy programs.

Case Management and advocacy services.

Some bureaucrats wrongly use the terms “case management” and “advocacy” synonymously. The major difference between these two service types is that formal advocates are called upon when a person feels that their human rights have been violated. In comparison, case managers are typically called upon to assist people to join up services and supports by navigating the complex bureaucracy of the formal service systems, including health and disability.

It is pivotal to have a balance of these two service types under the NDIS to enable people with disabilities access to supports that foster the protection of their human rights and enable them to navigate the NDIS bureaucracy.

Early Childhood Intervention

There is limited research focused on the needs of Indigenous children with disability. A recent study found that young children with cognitive impairment are at risk of social exclusion, and need interventions to promote inclusion in family and cultural events as they age.

The government has identified early childhood intervention (ECI) as an area for block-funding investment, in recognition that the market-based principles of the NDIS could not work for this service type. ILC block funding can be used for early intervention and allows novel or creative community-based solutions to develop. This will allow the development of services which may meet local needs but are not ‘standard’ service types. Evidence-based practice is great if the evidence is there, but it should not be a straight-jacket, limiting what is possible.

Localised, community-based services

Research shows that Aboriginal community controlled organisations are an essential component of addressing the health and social needs of Indigenous communities. In a recent review of existing community-based mental health services, Jen Smith-Merry found that the services offered for Indigenous people were most successful when developed by local communities or ‘localised’ and adapted carefully (and genuinely) to community needs.

John Gilroy’s research shows the important role of Indigenous community controlled organisations in forming relationships and referral pathways to disability services. These organisations function as the “social glue” between Indigenous communities, and disability and community organisations.

Workforce Training and Development

The efficiency and effectiveness of the NDIS requires a healthy, vibrant workforce. There are many reports examining what the disability services workforce looks like. However, the roll out of the NDIS will completely reshape the workforce.

National Disability Services are managing a workforce development fund to explore ways to build a workforce that can sustain the NDIS. NDS will need to explore ways to build the number and proportion of Indigenous people working in the sector and also explore successful ways to build a workforce that is culturally competent in supporting Indigenous people and their families.

The CEO of First Peoples Disability Network, Damian Griffis, told ABC Lateline in 2015 that Indigenous people are already working as informal disability workers, stating “There are a lot of Indigenous people that by any other definition would be called support workers today, but they need to be valued and respected for that work and they are already in existence.”

Research shows that over 10% of Indigenous people have provided unpaid assistance to a person with a disability. Agencies could pilot approaches to recruit and train family members that balance people’s human rights with individual duty-of-care in the context of the NDIS.

Translation and Interpreter Services

There are many regions of Australia where the English is a second or third language. Notwithstanding that, there are many Indigenous peoples who require hearing or communication supports. Interpreter and translation services are under-resourced and in high need across the country. It would be discriminatory for NDIS users to have to use their packages to access these service types as this would deplete the funding available for other services in comparison with other NDIS participants. These services should instead be funded at a community level either through the ILC or a specialised program.

Foster Social and Cultural Capital Building

There exists plethora of research showing the important role played by Indigenous community controlled organisations in the health and community services sector. Such organisations provide the opportunities needed to bring together Indigenous people with disability to have their voices heard as a collective. For example, the many NDIS specific gatherings around Australia have brought together Indigenous people with disability to share their stories and experiences. This knowledge should be valued and harnessed. One way that this could take place is through ILC funding of community-based peer-support programs.

The roll out of the NDIS has enabled Indigenous community controlled organisations and services to continue working in local communities. Such organisations and services are being supported to provide services and supports under the NDIS in NSW. Block-funding will enable Aboriginal community controlled organisations to continue their role in representing their communities whilst supporting NDIS participants.

Interagency Networks and Engagement

Jen Smith-Merry’s Research to Action Guide produced for the Centre for Applied Disability Research showed that interagency forums do help with linking across organisations and sectors, but that this is most effective when it happens organically and collaboratively rather than being mandated. Through sharing stories and good practice, interagency forums help disparate actors to understand the different practices and knowledges operating in sectors outside of their own.

 There is evidence of a conflict at the interface of the formal service system and Indigenous communities in how disability is defined and conceptualised. A recent report concluded that many Indigenous people find the definition of disability to be stigmatising. Rather than trying to ascertain how Indigenous peoples define disability, the focus of scholarly exploration should be on ways to bridge the cultural interface in how disability is defined and embodied as a social construct.

Great work has been undertaken by National Disability Services, to foster relationship building between the disability services sector and local Indigenous programs, by implementing the principles of interagency commissioning. Sadly, the government did not extend the funding for these networks to continue. This is a significant problem that won’t be immediately fixed by an underfunded ILC.

A healthy balance

The NDIS is a huge win for the disability rights movement. The new scheme provides an opportunity to address the equality and equity gaps between Indigenous and non-Indigenous people with disabilities. However, there needs to be a balance between block-funding and the individualised packages provided by the NDIS, so that the scheme can meet its full potential. The examples given here provide some ideas for how ILC funding might work, but only dialogue with consumers and communities will point us truly in the right direction.

*Dr John Gilroy is a Koori man from the Yuin Nation, and a doctor of sociology in Indigenous health, specialising in disability studies. He is a Senior Lecturer and Indigenous Stream Lead at the Centre for Disability Research and Policy, University of Sydney

*Associate Professor Jennifer Smith-Merry’s research focuses on the implementation of policy in service settings, and consumer experiences of this. She is Mental Health Stream Lead at the Centre for Disability Research and Policy, The University of Sydney.

Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities

Introduction

By any measure Aboriginal and Torres Strait Islander people with disability are amongst some of the most disadvantaged Australians; often facing multiple barriers to meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Islander people is significantly higher than of the general population. Until recently, the prevalence of disability in Aboriginal and Torres Strait Islander communities has only been anecdotally reported. However, a report by the Commonwealth Steering Committee for the Review of Government Service Provision made the following conclusions:

The proportion of the indigenous population 15 years and over, reporting a disability or long-term health condition was 37 per cent (102 900 people). The proportions were similar in remote and non-remote areas. This measure of disability does not specifically include people with a psychological disability. [note 1]

The high prevalence of disability, approximately twice that of the non-indigenous population, occurs in Aboriginal and Torres Strait Islander communities for a range of social reasons, including poor health care, poor nutrition, exposure to violence and psychological trauma (e.g. arising from removal from family and community) and substance abuse, as well as the breakdown of traditional community structures in some areas. Aboriginal people with disability are significantly over-represented on a population group basis among homeless people, in the criminal and juvenile justice systems[note 2], and in the care and protection system (both as parents and children).[note 3]

The advent of the National Disability Insurance Scheme (NDIS) presents an opportunity for Aboriginal and Torres Strait Islander people with disabilities to engage – many for the first time – with the disability service system in a substantive way. Currently, most Aboriginal and Torres Strait Islander people with disabilities remain at the periphery of the disability service system. This continues to occur for a range of reasons some of which are well established. However, one factor that remains little understood is the reluctance of Aboriginal and Torres Strait Islander people with disabilities to identify as people with disability. This preference to not identify presents a fundamental barrier for the successful implementation of the NDIS. The First Peoples Disability Network (Australia) (FPDN) argues that it has a central role in addressing not only this fundamental barrier but also in facilitating the roll out of the NDIS more broadly into Aboriginal and Torres Strait Islander communities.

FPDN argues passionately that for positive change to happen in the lives of Aboriginal and Torres Strait Islander people with disability, the change must be driven by community itself. It cannot be imposed, implied, intervened or developed with well-meaning intention from an external service system that the vast majority of Aboriginal and Torres Strait Islander people with disabilities have little or no experience of in the first place.

Throughout many communities across the country, Aboriginal and Torres Strait Islander people with disability are supported and accepted as members of their communities. However, many communities lack the resources to adequately support people with disability. Furthermore, the service system tends to operate from a ‘doing for’ as opposed to ‘doing with’ approach, which only further disenfranchises communities because they simply do not feel that they can self-direct their future. The NDIS does have the potential to address some of these concerns by giving Aboriginal and Torres Strait Islander people with disability the opportunity to self-direct their funding, for instance. The challenge in this area will be that many Aboriginal and Torres Strait Islander people with disability have had little or no experience in self-managing funds.

It must be remembered that in many ways the social movement of Aboriginal and Torres Strait Islander people with disability is starting from an absolute baseline position. This is reflected, for example, by the fact that few Aboriginal and Torres Strait Islander people with disability have an understanding of the language of the disability service system. It is the view of FPDN that the application of the NDIS in Aboriginal and Torres Strait Islander communities will need to have a different look and approach to what is advocated for with regard the rest of the Australian population. It may be that the application of the NDIS in Aboriginal and Torres Strait Islander communities takes a longer process. But the FPDN argues that it is critical to get it right as it is the experience of many Aboriginal and Torres Strait Islander people that they are usually the first to be blamed when new programs are not taken up by Aboriginal and Torres Strait Islander people.

FPDN has developed a 10-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander people with disabilities. The development of this 10 point plan is based upon extensive consultation as well as drawing upon the decade long experience of the FPDN in advocating for the rights of Aboriginal and Torres Strait Islanders people with disabilities.

The plan was launched in May 2013 at Parliament House, Canberra.

Ten-point plan

  • Recognise that the starting point is the vast majority of Aboriginal people with disability do not self-identify as people with disability. This occurs for a range of reasons including the fact that in traditional languages there are no comparable words for disability. Also, many Aboriginal people with disability are reluctant to take on the label of disability; particularly when they already experience discrimination based on their Aboriginality. In many ways disability is a new conversation in many communities. In these instances the NDIS is starting from a baseline position. As a consequence change in this area is likely to happen on a different timeline to that of the mainstream NDIS.
  • Awareness raising via a concerted outreach approach informing Aboriginal and Torres Strait Islander people with disability, their families and communities about their rights and entitlements, and informing Aboriginal and Torres Strait communities about the NDIS itself and how to work this new system effectively. There is no better way to raise awareness then by direct face-to-face consultation. Brochures and pamphlets will not be appropriate as this is a new conversation in many communities.
  • Establish the NDIS Expert Working Group on Aboriginal and Torres Strait Islander People with disability and the NDIS. In recognition of the fact that there is a stand-alone building block for the NDIS focused upon Aboriginal and Torres Strait Islander people with disability, FPDN views it not only as critical but logical that a specific Expert Working Group be established to focus on Aboriginal and Torres Strait Islander people with disability. The new working group would operate in the same way the four current working groups do, that is it would be chaired by two members of the National People with Disability and Carers Council. To ensure its effectiveness but also critically to influence prominent Aboriginal leaders as well as the disability sector, members would be drawn from Aboriginal and Torres Strait Islander people in community leadership positions, as well as involving prominent disability leaders. The FPDN believes such an approach is warranted not only because of the degree of unmet need that is well established but also because this has the potential to be a very practical and meaningful partnership between government, the non-government sector, and Aboriginal and Torres Strait Islander communities.
  • Build the capacity of the non-Indigenous disability service system to meet the needs of Aboriginal people with disability in a culturally appropriate way. Legislate an additional standard into the Disability Services Act focused upon culturally appropriate service delivery and require disability services to demonstrate their cultural competencies.
  • Conduct research on the prevalence of disability and a range other relevant matters. Critically, this work must be undertaken in partnership with Aboriginal and Torres Strait Islander people with disability to ensure a culturally appropriate methodology. There remains very little reference material about disability in Aboriginal and Torres Strait Islander communities. This needs to be rectified to ensure that we are getting a true picture of the lived experience of Aboriginal and Torres Strait Islander people with disability.
  • Recognise that  a workforce already exists in many Aboriginal and Torres Strait Islander communities that does important work, often informally. This work needs to valued and recognised, with the potential for employment opportunities in some communities.
  • Recognise that it’s not always about services. Many communities just need more resources so that they can continue to meet the needs of their own people with disabilities. There may be perfectly appropriate ways of supporting people already in place, however what is often lacking is access to current technologies or appropriate technical aids or sufficient training for family and community members to provide the optimum level of support.
  • Recruitment of more Aboriginal and Torres Strait Islander people into the disability service sector.
  • Build the capacity of the social movement of Aboriginal and Torres Strait Islanders with disability by supporting existing networks and building new ones in addition to fostering Aboriginal and Torres Strait Islander leaders with disability. These networks play a critical role in breaking down stigma that may exist in some communities but are also the conduits for change, and will be integral to the successful implementation of the NDIS in Aboriginal and Torres Strait Islander communities.
  • Aboriginal and Torres Strait Islander ‘Launch’ sites focused upon remote, very remote, regional and urban settings. It is critical that this major reform be done right. Therefore it is appropriate to effectively trial its implementation. To this end, FPDN can readily identify key communities that would be appropriate as trial sites.

 

 

NACCHO Aboriginal #Ear Health : #ClosingtheGapDay and hearing loss: an invisible barrier obstructs progress

 

“Avoidance is a way of coping with anxiety about being shamed. Repeated avoidance results in limited engagement and poor outcomes for programs designed to Close the Gap.

The use of hearing loss responsive communication strategies can help to deal with this barrier

 These strategies can be as important as culturally appropriate processes in programs.

Indeed, there is an overlap between the two. For those with hearing loss, what is said in culturally familiar language within a culturally familiar process is easier to understand.”

Hearing loss among Indigenous Australians is a largely unseen barrier to Closing the Gap programs, according to Dr Damien Howard and Jody Barney, who explain how to be “hearing loss responsive” in service delivery and communications.

Originally published

 ” Indigenous Australians have one of the highest levels of ear disease and hearing loss in the world.

Rates are up to ten times more than non-Indigenous Australians and the National Aboriginal Community Controlled Health Organisation estimates Indigenous healthcare is currently 30 to 50 years behind the rest of the country “

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How to submit ? Email to Colin Cowell NACCHO Media   4.30 pm  day before publication

Communication difficulties caused by the widespread unidentified hearing loss among Indigenous people in Australia continue to undermine the effectiveness of Closing the Gap programs.

An Aboriginal worker with mild hearing loss once commented: “You see that look, the look that tells you they are thinking you are some stupid blackfella and you don’t want to say you don’t understand; ‘Can you tell me it again?’

“You just want to get away and never want to work with them again if you can help it.”

Many people act on these kinds of feelings. They seek to avoid people, situations and service providers because of these reactions. The everyday communication difficulties caused by their hearing loss contribute to anxiety and disengagement. They will often seek to avoid education, health and employment support services designed to help them.

For instance, people may not go to health clinics, or do not comply with provided treatment. Avoidance of specialist medical appointments is one feature of this. In some specialist medical visits to remote communities, 50% of patients do not attend booked appointments. This can have dire health implications for individuals. It is also an immense waste of resources.

When hearing loss begins early in life, it has greater impact than the late onset hearing loss that is experienced by non-Indigenous Australians who are hard of hearing. Their hearing loss is generally caused by occupational noise exposure and ageing.

Indigenous hearing loss is usually caused by endemic childhood middle ear disease. Children with current ear disease often have a temporary hearing loss. Repeated infections can cause lasting damage and some level of permanent mild to moderate hearing loss. Up to 70% of Indigenous people are affected — fewer in urban communities, more in remote communities.

The impact of this hearing loss is pervasive.

We know that school attendance rates for Indigenous children with hearing loss are below those for other students. We know they experience more difficulty with learning when they do attend school. We know they display more behavioural problems when at school. We know Indigenous workers with hearing loss have difficulty securing and holding jobs, have greater performance difficulties and frequently avoid participation in workplace training.

There is also increasing concern about hearing loss as a factor in the over-representation of Indigenous people in the criminal justice system; 94% of prison inmates in the Northern Territory have been found to have a significant degree of hearing loss.

Those familiar with Indigenous disadvantage may wonder why they have not heard about the incidence and impact of hearing loss among adults. One reason is that early onset conductive hearing loss is mostly invisible.

First, most Indigenous people who are hard of hearing are not aware that their hearing is not normal. The early origin of their hearing loss means it is something they have experienced for most of their life. For them, what they how they hear is ‘normal’. If asked, they would deny having a hearing loss.

Second, service providers (teachers, nurses, doctors, trainers, health professionals, social workers and police among them) are unlikely to recognise poor hearing as an issue for people they work with. Communication difficulties arising from hearing loss are generally attributed only to language and cultural differences, or to limited intelligence or poor motivation. The latter two perceptions, when noticed by clients astute in reading body language, can further compound disengagement.

It is easy to imagine that hearing aids are all that is needed to resolve issues. They can help some, but will not resolve all communication difficulties.

The communication issues experienced by an adult with early onset hearing loss are the result of both current hearing loss and the ‘legacy effects’ of unidentified hearing loss since childhood. These may include a preference for visual communication strategies, anxiety related to an intense fear of being ‘shamed’ and a limited store of contextual knowledge that helps with understanding what is said.

A store of contextual knowledge is what people normally acquire through fully hearing what is said to them, and around them. Without a store of relevant contextual knowledge — the big picture — what is said in any situation is harder to understand. So people with early onset hearing loss not only have trouble hearing what is said, but they also frequently have difficulty understanding what they hear.

Avoidance is a way of coping with anxiety about being shamed. Repeated avoidance results in limited engagement and poor outcomes for programs designed to Close the Gap.

The use of hearing loss responsive communication strategies can help to deal with this barrier. These strategies can be as important as culturally appropriate processes in programs. Indeed, there is an overlap between the two. For those with hearing loss, what is said in culturally familiar language within a culturally familiar process is easier to understand.

Other key components of hearing loss responsive service provision include the following:

  • using highly visual communication strategies
  • minimising background noise during conversations
  • using the language clients know best
  • using ‘pre-learning’ – providing information in advance to help explain the context, so people can better understand what will be discussed
  • services having amplification devices to use as part of service delivery
  • training staff in the use of more effective communication strategies — this includes training workers to recognise hearing loss, develop necessary skills and avoid responses that prompt shame, anxiety and disengagement

We believe Closing the Gap programs will continue to fall short of targeted outcomes until they are designed to be responsive to the needs of those with hearing loss.

NACCHO Save a dates Register your event here

22 March2017 Indigenous Ear Health Workshop  in Adelaide

asohns-2017-ieh-workshop-22march2017-adelaide

The 2017 Indigenous Ear Health Workshop to be held in Adelaide in March will focus on Otitis Media (middle ear disease), hearing loss, and its significant impact on the lives of Indigenous children, the community and Indigenous culture in Australia.

The workshop will take place on 22 March 2017 at the Adelaide Convention Centre in Adelaide, South Australia.

The program features keynote addresses by invited speakers who will give presentations aligned with the workshop’s main objectives:

  • To identify and promote methods to strengthen primary prevention and care of Otitis Media (OM).
  • To engage and coordinate all stakeholders in OM management.
  • To summarise current and future research into OM pathogenesis (the manner in which it develops) and management.
  • To present the case for consistent and integrated funding for OM management.

Invited speakers will include paediatricians, public health physicians, ear nose and throat surgeons, Aboriginal health workers, Education Department and a psychologist, with OM and hearing updates from medical, audiological and medical science researchers.

The program will culminate in an address emphasising the need for funding that will provide a consistent and coordinated nationwide approach to managing Indigenous ear health in Australia.

Those interested in attending may include: ENT surgeons, ENT nurses, Aboriginal and Torres Strait Islander health workers, audiologists, rural and regional general surgeons and general practitioners, speech pathologists, teachers, researchers, state and federal government representatives and bureaucrats; in fact anyone interested in Otitis Media.

The workshop is organised by the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) and is held just before its Annual Scientific Meeting (23 -26 March 2017). The first IEH workshop was held in Adelaide in 2012 and subsequent workshops were held in Perth, Brisbane and Sydney.

For more information go to the ASOHNS 2017 Annual Scientific Meeting Pre-Meeting Workshops section at http://asm.asohns.org.au/workshops

Or contact:

Mrs Lorna Watson, Chief Executive Officer, ASOHNS Ltd

T: +61 2 9954 5856   or  E info@asohns.org.au

NACCHO Aboriginal Health #KHW17 #Kidneysfirst :Ten bad food habits that will kill you

 ‘ Almost half of heart-related deaths are caused by 10 bad ­eating habits.

Diets high in salt or sugary drinks are responsible for ­thousands of deaths from heart disease, stroke and type 2 ­diabetes, according to a study. Scientists also blamed a lack of fruit and vegetables and high ­levels of ­processed meats.

Researchers looked at all 702,308 deaths from heart ­disease, stroke and type 2 diabetes in the US in 2012 and found that 45 per cent were linked with “suboptimal consumption” of 10 types of nutrients. They mapped data on dietary habits from population surveys, along with estimates from previous research of links between foods and disease, on to data about the deaths to come up with the figures.”

Originally published in The Australian

This is our last NACCHO post supporting Kidney Health Week / Day

Further NACCHO reading

Sugar Tax     Obesity     Diabetes    Nutrition/Healthy Foods

The highest proportion of deaths, at 9.5 per cent, was linked with eating too much salt, while a low intake of nuts and seeds was linked with 8.5 per cent.

Eating processed meats was linked with 8.2 per cent of deaths and a low amount of seafood omega-3 fats with 7.8 per cent. Low intake of vegetables ­accounted for 7.6 per cent and low intake of fruit 7.5 per cent.

Sugary drinks were linked with 7.4 per cent, a low intake of whole grains with 5.9 per cent, low polyunsaturated fats with 2.3 per cent and high unprocessed red meats with 0.4 per cent.

The research, published in the journal JAMA, also found men’s deaths were more likely to have links to poor diet than women’s.

Key Points

Question  What is the estimated mortality due to heart disease, stroke, or type 2 diabetes (cardiometabolic deaths) associated with suboptimal intakes of 10 dietary factors in the United States?

Findings  In 2012, suboptimal intake of dietary factors was associated with an estimated 318 656 cardiometabolic deaths, representing 45.4% of cardiometabolic deaths. The highest proportions of cardiometabolic deaths were estimated to be related to excess sodium intake, insufficient intake of nuts/seeds, high intake of processed meats, and low intake of seafood omega-3 fats.

Meaning  Suboptimal intake of specific foods and nutrients was associated with a substantial proportion of deaths due to heart disease, stroke, or type 2 diabetes.

Abstract

Importance  In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.

Objective  To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.

Design, Setting, and Participants  A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics.

Exposures  Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.

Main Outcomes and Measures  Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.

Results  In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes.

See for full text

The authors, from Cambridge University and two US institutions, said that their results should help to “identify priorities, guide public health planning and inform strategies to alter dietary habits and improve health”.

In an editorial, Noel Mueller and Lawrence Appel, of the Johns Hopkins Bloomberg School of Public Health, said: “Policies that affect diet quality, not just quantity, are needed … There is some precedence, such as from trials of the Mediterranean diet plus supplemental foods, that modification of diet can reduce cardiovascular disease risk by 30 per cent to 70 per cent.”

Keeping your kidneys healthy

It is important to maintain a healthy weight for your height. The food you eat, and how active you are, help to control your weight.

Healthy eating tips include:

  • Eat lots of fruit, vegetables, legumes and wholegrain bread and rice.
  • At least once a week eat some lean meat such as chicken and fish.
  • Look at the food label and try to choose foods that have a low percentage of sugar and salt and saturated fats.
  • Limit take-away and fast food meals.

Exercise regularly

It’s recommended that you do at least 30 minutes of physical activity most days of the week  – exercise leads to increased strength, stamina and energy.

The key is to start slowly and gradually increase the time and intensity of the exercise. You can break down any physical activity into three ten-minute bursts, which can be increased as your fitness improves

Drink plenty of fluids and listen to your thirst.

If you are thirsty, make water your first choice. Water has a huge list of health benefits and contains no kilojoules, is inexpensive and readily available.

Sugary soft drinks are packed full of ‘empty kilojoules’, which means they contain a lot of sugar but have no nutritional value.

Some fruit juices are high in sugar and do not contain the fibre that the whole fruit has.

The role of the kidneys is often underrated when we think about our health.

In fact, the kidneys play a vital role in the daily workings of your body. They are so important that nature gave us two kidneys, to cover the possibility that one might be lost to an injury.

We can live quite well with only one kidney and some people live a healthy life even though born with one missing. However, with no kidney function death occurs within a few days!

The kidneys play a major role in maintaining your general health and wellbeing. Think of them as a very complex, environmentally friendly, waste disposal system. They sort non-recyclable waste from recyclable waste, 24 hours a day, seven days a week, while also cleaning your blood.

Most people are born with two kidneys, each one about the size of an adult fist, bean-shaped and weighing around 150 grams each. The kidneys are located at both sides of your backbone, just under the rib cage or above the small of your back. They are protected from injury by a large padding of fat, your lower ribs and several muscles.

Your blood supply circulates through the kidneys about 12 times every hour. Each day your kidneys process around 200 litres of blood. The kidneys make urine (wee) from excess fluid and unwanted chemicals or waste in your blood.

Urine flows down through narrow tubes called ureters to the bladder where it is stored. When you feel the need to wee, the urine passes out of your body through a tube called the urethra. Around one to two litres of waste leave your body each day as urine.

Resource Library

Kidneys are the unsung heroes of our bodies and perform a number of very important jobs:

  • Blood pressure control – kidneys keep your blood pressure regular.
  • Water balance – kidneys add excess water to other wastes, which makes your urine.
  • Cleaning blood – kidneys filter your blood to remove wastes and toxins.
  • Vitamin D activation – kidneys manage your body’s production of this essential vitamin, which is vital for strong bones, muscles and overall health.

All this makes the kidneys a very important player in the way your body works and your overall health.

NACCHO Aboriginal #kidneysfirst Health #KHW17: International research finds food subsidies and taxes improve dietary choices

marmot

The global food system is causing a staggering toll on human health. And this is very costly, both in terms of real healthcare expenses and lost productivity.

Our findings suggest that subsidies and taxes are a highly effective tool for normalizing the price of foods toward their true societal costs. 

This will not only prevent disease but also reduce spiraling healthcare costs, which are causing tremendous strain on both private businesses and government budgets.”

Senior author Dariush Mozaffarian, M.D., Dr.P.H., dean of the Friedman School

kidney-week

Here are some sobering facts on #obesity from a report by @KidneyHealth as we mark #KidneyHealthWeek
bit.ly/2mrsBRJ
#KHW17

2025

#Kidneyfirst Aboriginal Health Key points

risk

Aboriginal and Torres Strait Islander people are more likely to have end stage kidney disease and be hospitalised or die with chronic kidney disease than non-Indigenous people.4

The greater prevalence of chronic kidney disease in some Aboriginal and Torres Strait Islander communities is due to the high incidence of traditional risk factors, including diabetes, high blood pressure and smoking, in addition to higher levels of inadequate nutrition, alcohol abuse, streptococcal throat and skin infection, poor living conditions and low birth weight, which is linked to reduced nephron development.4

Aboriginal and Torres Strait Islander people experience a higher burden of disease; two and a half times that of non-Indigenous people.

A large part of the burden of disease is due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease.

This higher burden can be reduced by identifying chronic disease earlier and through the management of risk factors and the disease itself. See more about the management of risk factors here.

A new systematic review and meta-analysis finds that lowering the cost of healthy foods significantly increases their consumption, while raising the cost of unhealthy items significantly reduces their intake.

Food subsidies and taxes significantly improve dietary choices

Interventions that alter food prices can improve people’s diets, leading to more healthy choices and fewer unhealthy choices

While everyone has a sense that food prices matter, the magnitude of impact of food taxes and subsidies on dietary intakes, and whether this varies by the food target, has not been clear. For the review, a team of researchers identified and pooled findings from a total of 30 interventional and longitudinal studies, including 11 that assessed the effect of higher prices (taxation) of unhealthy foods and 19 that assessed the effect of lower prices (subsidies) of healthy foods.

The findings were published in PLOS ONE on March 1.

“To date, evidence on effectiveness of fiscal policies on diet has mostly come from cross-sectional studies, which cannot infer causality. This is why we evaluated studies that examined the relationship between food price and diet over time,” said co-first author Ashkan Afshin, M.D., former postdoctoral fellow at the Friedman School of Nutrition Science & Policy at Tufts University and now at the University of Washington. “Our results show how 10 to 50 percent changes in price of foods and beverages at checkout could influence consumers’ purchasing behaviors over a relatively short period of time.”

In the pooled analysis, each 10 percent decrease in price of fruits and vegetables increased their consumption by 14 percent, and each 10 percent decrease in price of other healthy foods increased their consumption by 16 percent. A change in price of fruits and vegetables was also associated with body mass index (BMI): for every 10 percent price decrease, BMI declined by 0.04 kg/m2.

Conversely, each 10 percent price increase of sugar-sweetened beverages and unhealthy fast foods decreased their consumption by 7 percent and 3 percent, respectively. Every 10 percent price increase in unhealthy foods and drinks was associated with a trend toward lower BMI (per 10 percent price increase: -0.06 kg/m2), but this did not achieve statistical significance.

By merging findings from 23 interventional and 7 prospective cohort studies, the researchers evaluated relationships between the change in the price of specific foods or beverages and the change in their intake. Studies evaluated people’s reported intake or data on sales of foods and beverages. The study populations included children, adults, or both; and countries included the United States, the Netherlands, France, New Zealand, and South Africa. Price change interventions were conducted in various settings such as cafeterias, vending machines and supermarkets. The findings were centrally pooled in a meta-analysis.

Co-first author is Jose Penalvo, Ph.D., M.Sc., Friedman School of Nutrition Science & Policy at Tufts University. Additional authors on this study are Liana Del Gobbo, Ph.D., Stanford University School of Medicine; Jose Silva, M.D., Boston Medical Center; Melody Michaelson, M.Sc., Tufts University School of Medicine; Martin O’Flaherty, M.D., Ph.D., University of Liverpool; Simon Capewell, M.D., D.Sc., University of Liverpool; Donna Spiegelman, D.Sc., Harvard T.H. Chan School of Public Health; and Goodarz Danaei, M.D., D.Sc., Harvard T.H. Chan School of Public Health.

This work was supported by awards from the National Heart, Lung, and Blood Institute of the National Institutes of Health (HL098048, HL115189) and from The New York Academy of Sciences’ Sackler Institute for Nutrition Science. For conflicts of interest disclosure, please see the study.

Afshin, A., Penalvo, J., Del Gobbo, L., Silva, J., Michaelson, M., O’Flaherty, M., Capewell, S., Spiegelman, D., Danaei, G., Mozaffarian, D. (2017, March 1). The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis. PLOS ONE. doi: 10.1371/journal.pone.0172277

About the Friedman School of Nutrition Science and Policy at Tufts University

The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States. The school’s eight degree programs – which focus on questions relating to nutrition and chronic diseases, molecular nutrition, agriculture and sustainability, food security, humanitarian assistance, public health nutrition, and food policy and economics – are renowned for the application of scientific research to national and international policy.

NACCHO #Aboriginal Health and #Racism #justjustice : The importance of teaching doctors and nurses about unconscious bias

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 “Australian universities, medical schools and health systems grappling with how to include Aboriginal and Torres Strait Islander people in their institutions as participants and staff – and how to produce equality of outcomes – need to deal with both overt and systemic factors of racism.

In Australia, the inability to deal with unconscious bias and racism has serious health effects on Aboriginal and Torres Strait Islander people. These include increased stress, mental ill-health and suicide, systemic racism in education, sports, justice and the public sector.

In a national survey of Aboriginal patients, 32.4% reported racial discrimination in medical settings most or all of the time. “

Gregory Phillips, Associate Professor and Research Fellow in Aboriginal Health at the Baker IDI Heart & Diabetes Institute, considers the coroner’s recommendations in light of Australia’s “inability to deal with unconscious bias and racism”, in and out of the health system. He says our responses must go far beyond cultural awareness training and its implicit judgements:

Image above : Equality can only work if everyone starts from the same place, whereas equity is about making sure people get access to the same opportunities. Interaction Institute for Social Change | Artist: Angus Maguire/madewithangus.com, CC BY

NACCHO Resources

Cultural awareness isn’t enough

 ” Teaching health professionals about Indigenous health will effectively require teaching about unconscious bias and racism; one’s own culture, values and motivations. It requires training in “unlearning” preconceptions, regular reflections on one’s own practices; as well as education about Aboriginal and Torres Strait Islander cultures.”  See Below

” The National Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 (the Framework) was recently launched by the Australian Health Ministers’ Advisory Council .

This ten year framework seeks to guide delivery of culturally safe, responsive, and quality health care to Aboriginal and Torres Strait Islander people and communities.

Download the COAG Cultural Respect Framework here :

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Ms Dhu coronial findings show importance of teaching doctors and nurses about unconscious bias

Originally published at The Conversation and then Croakey /JustJustice

In delivering her findings of the coronial inquest into the death of 22-year-old Ms Dhu during time spent in a Western Australian jail cell, state coroner Ros Fogliani was highly critical of some actions of police and medical staff.

She reportedly said Ms Dhu’s medical care in one instance was “deficient” and both police and hospital staff were influenced by preconceived notions about Aboriginal people.

Ms Dhu died on 4 August 2014 from staphylococcal septicaemia – a severe bacterial infection – and pneumonia, which were complicated by a previously obtained rib fracture. Released CCTV footage showed Ms Dhu moaning from pain, saying it was ten out of ten.

It was reported an emergency doctor considered her pain real but exaggerated for “behavioural gain”. Another doctor also noted Ms Dhu suffered from “behavioural issues” while a constable thought she was “faking” her suffering.

Ms Dhu’s case is not the first instance of mistreatment of an Aboriginal person in custody or a medical setting, nor is it likely the last. And while coroner Fogliani’s recommendations included mandatory, ongoing cultural competency training for police officers, to assist with health issues and other dealings with Aboriginal people, this isn’t enough.

For thirty years, Australian institutions have implemented cultural awareness programs. The thinking was if they taught staff about Aboriginal and Torres Strait Islander cultures, it would result in better lecturers, clinicians and policy-makers – and magically produce equity.

But this assumes Aboriginal culture is the problem. Like a deaf student in an all-hearing classroom, it is not the deaf student or their needs that are the problem, but a system that thinks an all-verbal and all-hearing teaching style is equal. The idea of equality itself entrenches systemic discrimination.

Unconscious bias

Singer Gurrumul Yunupingu has been suffering from chronic Hepatitis B since he was a child. ALAN PORRITT/AAP Image

 

 

 

In April, Darwin Hospital staff were under fire for allegedly leaving Aboriginal singer Gurrumul Yunupingu to bleed internally for eight hours. Media reported hospital staff noted Gurrumul’s liver damage was self-inflicted (a result of repeated heavy alcohol use) rather than being due to his chronic hepatitis B infection he had since he was a child.

We don’t know whether these allegations are true, but we do know unconscious bias exists in Australia. It refers to the instant judgements we make about other people and situations based on our own values, experiences and cultural and gender beliefs.

These judgements impact significantly on hiring and promotion decisions, how medical students make decisions, and in public discourse.

Regardless of merit or facts, research shows black or Indigenous people are more likely to be seen as less trustworthy; women to be risky prospects, and overweight people as irresponsible. Those with power and privilege judge those with less power for their inability to compete on terms set by the powerful.

So how is unconscious bias different to racism? Like an iceberg, unconscious bias is said to represent the beliefs, values and experiences (below water) that give rise to overt expressions of discrimination (above water).

There are two problems with these definitions, however. They don’t reveal how beliefs, values and experiences got into the subconscious in the first place. They may also imply it is not the responsibility of those with unconscious bias to change their implicit beliefs and explicit actions.

In Australia, the inability to deal with unconscious bias and racism has serious health effects on Aboriginal and Torres Strait Islander people. These include increased stress, mental ill-health and suicide, systemic racism in education, sports, justice and the public sector.

In a national survey of Aboriginal patients, 32.4% reported racial discrimination in medical settings most or all of the time. These people felt they had been treated unfairly (which included being treated rudely or with disrespect; being ignored, insulted, harassed, stereotyped or discriminated against) because they were Aboriginal or Torres Strait Islander.

Equality vs Equity

Public discussion about racism in Australia is often met with denial, discomfort and fragility. Some blame AFL player Adam Goodes for calling out racism – shooting the messenger is a common reaction.

Some stand with whistle blowers and defend their right to speak truth to power. Others completely deny racism’s existence, wishing it would go away because “we treat everyone the same”.

But the impulse to treat everyone the same confuses equality of inputs with equality of outcomes. As the below diagram shows, treating everyone with equal inputs (the same boxes) produces an inequality of outcomes (not everyone can access the game).

Alternatively, treating everyone differently, according to their needs and humanity is more likely to produce equality of outcomes where everyone can access the game. Equity deals not only with overt discrimination but the systemic factors that give rise to it.

Australian universities, medical schools and health systems grappling with how to include Aboriginal and Torres Strait Islander people in their institutions as participants and staff – and how to produce equality of outcomes – need to deal with both overt and systemic factors of racism.

Cultural awareness isn’t enough

Teaching health professionals about Indigenous health will effectively require teaching about unconscious bias and racism; one’s own culture, values and motivations. It requires training in “unlearning” preconceptions, regular reflections on one’s own practices; as well as education about Aboriginal and Torres Strait Islander cultures.

Most importantly, if the clinician cannot see themselves, their privilege and power as a potential problem, this will inadvertently re-establish racism and unconscious bias.

People had mixed reactions when Adam Goodes spoke out on racism in Australia. DEAN LEWINS/AAP Image

Educators have found patiently moving Australian medical students who were initially hostile to Aboriginal health curricula through their discomfort to reach the “a-ha” moment, is a key teaching strategy in producing better prepared doctors.

Further, cultural awareness training assumes that even if we could train every individual staff member in a hospital to be perfectly culturally competent, they would then go on to magically produce better health outcomes.

But the systemic factors – workplace culture, policies, power, funding and criteria on which decisions are made – are critical if we want a culturally equitable society.

Improving outcomes for Aboriginal and Torres Strait Islander people includes moving from a goal of equality to equity; teaching about racism and unconscious bias, not just culture; and making explicit the deeper transformational work of institutional decolonisation. We need to ask: how can power be shared? On whose terms are decisions made? Who owns institutions and services? Whose criteria are used to judge effectiveness?

The answer is that Aboriginal and Torres Strait Islander definitions and measurement tools of success are more likely to contribute to producing better outcomes than those where unconscious bias and racism is implicit. The work of admitting and addressing institutional racism remains.

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

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

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Readers may also be interested in these articles:

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

sugar-tax

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

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

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

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

See NACCHO Previous obesity articles HERE

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

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

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

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

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

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

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

Indigenous affairs minister, Nigel Scullion,

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

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

Authored by Sarah Colyer from MJA Insight

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please leave your comment below

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

    1. Anonymous says:

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

    1. Andrew says:

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

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

    1. Dr Rosemary Stanton says:

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

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

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

    1. Roger McMaster-Fay MRCOG FRANZCOG says:

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

    1. Dr. ARC says:

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

    1. Virginia Fazio says:

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

  1. Andrew Jamieson says:

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

 

NACCHO Aboriginal Health supports the @Lungfoundation first ever Australia-wide #Indigenous Lung Health Checklist

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 ” Lung Foundation Australia in collaboration with the Queensland Government’s Indigenous Respiratory Outreach Care Program (IROC) have developed the Checklist specifically for the Indigenous community.

It only takes a few minutes to answer 8 questions that could save your or a loved one’s life.

It can be completed on a mobile phone, tablet or computer.

indigenous_lunghealthchecklist_page_2

The Indigenous Lung Health Checklist is narrated by the Lung Foundation’s Ambassador and Olympic Legend Cathy Freeman.

Read or Download the PDF Brochure

indigenous_lunghealthchecklist

Please go to the site as Indigenous peoples are almost twice as likely to die from a lung-related condition than non-Indigenous Australians.

# Indigenous Lung Health Checklist at

http://indigenouslungscheck.lungfoundation.com.au/.

NACCHO Aboriginal Health and #Obesity #junkfood : 47 point plan to control weight problem that costs $56 billion per year

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 ” JUNK food would be banned from schools and sports venues, and a sugar drink tax introduced, under a new blueprint to trim the nation’s waistline.

The 47-point blueprint also includes a crackdown on using junk food vouchers as rewards for sporting performance and for fundraising.

State governments would be compelled to improve the healthiness of foods in settings controlled by them like hospitals, workplaces and government events.

And they would have to change urban planning rules to restrict unhealthy food venues and make more space for healthy food outlets. “

Originally published as Move to ban junk food in schools

Updated Feb 21 with press release from Health Minister Greg Hunt See below

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions.see article 2 below  

One hundred nutrition experts from 53 organisations working with state and federal bureaucrats have drawn up the obesity action plan to control the nation’s weight problem that is costing the nation $56 billion a year.

The review of state and federal food labelling, advertising and health policies found huge variation across the country and experts want it corrected by a National Nutrition Policy.

The nation is in the grip of an obesity crisis with almost two out of three (63 per cent) Australian adults, and one in four (25 per cent) Australian children overweight or obese.

Obesity is also one of the lead causes of disease and death including cancer.

More than 1.4 million Australians have Type 2 diabetes and new cases are being diagnosed at the rate of 280 per day.

Stomach, bowel, kidney, liver, pancreas, gallbladder, oesophagus, endometrium, ovary, prostate cancer and breast cancer in postmenopausal women have all been linked to obesity.

Half of all Australians are exceeding World Health Organisation’s recommendations they consume less than 13 teaspoons or sugar a day with most of the white stuff hidden in drinks and processed food, the Australian Bureau of Statistics Health Survey shows.

Teenage boys are the worst offenders consuming 38 teaspoons of sugar a day which makes up a quarter of their entire calorie intake.

Dr Gary Sacks from Deakin University whose research underpins the obesity control plan says it’s time for politicians to put the interests of ordinary people and their health above the food industry lobbyists

“It’s a good start to have policies for restricting junk foods in school canteens, but if kids are then inundated with unhealthy foods at sports venues, and they see relentless junk food ads on prime-time TV, it doesn’t make it easy for them to eat well,” he said.

That’s why the experts want a co-ordinated national strategy that increases the price of unhealthy food using taxes and regulations to reduce children’s exposure to unhealthy food advertising.

The comprehensive examination of state and federal food policies found Australia is meeting best practice in some areas including the Health Star Rating food labelling scheme, no GST on basic foods and surveys of population body weight.

While all States and Territories have policies for healthy school food provision they are not all monitored and supported, the experts say.

Jane Martin, Executive Manager of the Obesity Policy Coalition and a partner in the research, said a piecemeal approach would not work to turn the tide of obesity in Australia.

“When nearly two-thirds of Australians are overweight or obese, we

know that it’s not just about individuals choosing too many of the wrong foods, there are strong environmental factors at play – such as the all pervasive marketing of junk food particularly to children,” she said.

The new policy comes as a leading obesity experts says a tax on sugary drinks in Australia would be just as logical as existing mandatory controls on alcohol and tobacco

Professor Stephen Colagiuri from the University of Sydney’s Charles Perkins Centre claims a ‘sugar tax’ help individuals moderate their sugary beverage intake, in much the same way as current alcohol, tobacco, and road safety measures like seat belts and speed restrictions preventing harmful behaviours.

The UK will introduce a sugar tax next year and in Mexico a sugar tax introduced in 2014 has already reduced consumption of sugary drinks by 12 per cent and increased the consumption of water.

Australian politicians have repeatedly dismissed a sugar tax on the grounds it interferes with individual rights.

However, Professor Colagiuri says “individual rights can be equally violated if governments fail to take effective and proportionate measures to remove health threats from the environment in the cause of improving population health.”

Originally published as Move to ban junk food in schools

ARTICLE 2 Australia would save $3.4bn if junk food taxed and fresh food subsidised, says study 

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O as published in the Guardian

Australian researchers say subsidising fresh fruit and vegetables would ensure the impact of food taxes on the household budget would be negligible. Photograph: Dave and Les Jacobs/Getty Images/Blend Images

Health experts have developed a package of food taxes and subsidies that would save Australia $3.4bn in healthcare costs without affecting household food budgets.

Linda Cobiac, a senior research fellow at the University of Melbourne’s school of public health, led the research published on Wednesday in the journal Plos Medicine.

Cobiac and her team used international data from countries that already have food and beverage taxes such as Denmark, but tweaked the rate of taxation and also included a subsidy for fresh fruit and vegetables so the total change to the household budget would be negligible.

They then modelled the potential impact on the Australian population of introducing taxes on saturated fat, salt, sugar and sugar-sweetened beverages, and a subsidy on fruits and vegetables. Their simulations found the combination of the taxes and subsidy could result in 1.2 additional years of healthy life per 100 people alive in 2010, at a net cost-saving of $3.4bn to the health sector.

“Few other public health interventions could deliver such health gains on average across the whole population,” Cobiac said.

The sugar tax produced the biggest gains in health, followed by the salt tax, the saturated fat tax and the sugar-sweetened beverage tax.

The fruit and vegetable subsidy, while cost-effective when added to the package of taxes, did not lead to a net health benefit on its own, the researchers found.

The researchers suggest introducing a tax of $1.37 for every 100 grams of saturated fat in those foods with a saturated fat content of more than 2.3%, excluding milk; a salt tax of 30 cents for one gram of sodium above Australian maximum recommended levels; a sugar-sweetened beverage tax of 47 cents a litre; a fruit and vegetable subsidy of 14 cents for every 100 grams; and a sugar tax of 94 cents for every 100ml in ice-cream with more than 10 grams of sugar per 100 grams; and 85 cents for every 100 grams in all other products.

The taxes exclude fresh fruits, vegetables, meats and many dairy products.

“You need to include both carrots and sticks to change consumer behaviour and to encourage new taxes,” Blakely said. “That’s where this paper is cutting edge internationally.

“We have worked out the whole package of taxes with minimal impact on the budget of the household, so you can see an overall gain for the government. The government would be less interested in the package if it was purely punitive, but this provides subsidies and savings to health spending that could be reinvested back into communities and services.”

He said taxing junk foods also prompted food manufacturers to change their products and make them healthier to avoid the taxes.

“For those who might say this is an example of nanny state measures, let’s consider that we don’t mind asbestos being taken out of buildings to prevent respiratory disease, and we’re happy for lead to be taken from petrol. We need to change the food system if we are going to tackle obesity and prevent disease.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions. “This is a very good paper,” he said.

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A Grattan Institute report published in November found introducing an excise tax of 40 cents for every 100 grams of sugar in beverages as part of the fight against obesity would trigger a 15% drop in the consumption of sugary drinks. Australians and New Zealanders consume an average of 76 litres of sugary drinks per person every year.

In a piece for the Medical Journal of Australia published on Monday, the chair of the Council of Presidents of Medical Colleges, Prof Nicholas Talley, wrote that “the current lack of a coordinated national approach is not acceptable”.

More than one in four Australian children are now overweight or obese, as are more than two-thirds of all adults.

Talley proposed a six-point action plan, which included recognising obesity as a chronic disease with multiple causes. He also called for stronger legislation to reduce unhealthy food marketing to children and to reduce the consumption of high-sugar beverages, saying a sugar-sweetened beverage tax should be introduced.

“There is evidence that the food industry has been a major contributor to obesity globally,” he wrote. “The health of future generations should not be abandoned for short-term and short-sighted commercial interests.”

Press Release 21 February Greg Hunt Health Minister

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

PDF printable version of Turnbull Government committed to tackling obesity – PDF 269 KB

The Turnbull Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

But unlike the Labor Party, we don’t believe increasing the family grocery bill at the supermarket is the answer to this challenge.

We already have programmes in place to educate, support and encourage Australians to adopt and maintain a healthy diet and to lead an active life – and there’s more to be done.

Earlier this month, the Prime Minister flagged that the Government will soon be announcing a new focus on preventive health that will give people the right tools and information to live active and healthy lives. This will build on the significant work already underway.

Yesterday, we launched the second phase of the $7 million Girls Make Your Move campaign to increase physical activity for girls and young women. This is now being rolled out across Australia.

Our $160 million Sporting Schools program is getting kids involved in physical activity. Already around 6,000 schools across the country have been involved – with many more to come. This is a great programme that Labor wants to axe.

Our Health Star Rating system helps people to make healthier choices when choosing packaged foods at the supermarket and encourages the food industry to reformulate their products to be healthier.

The Healthy Weight Guide website provides useful advice including tips and tools to encourage physical activity and healthy eating to achieve and maintain a healthy weight.

The Healthy Food Partnership with the food industry and public health groups is increasing people’s health knowledge and is supporting them to make healthier food and drink choices in order to achieve better health outcomes.

We acknowledge today’s report, but it does not take into account a number of the Government programs now underway.

Obesity and poor diets are complex public health issue with multiple contributing factors, requiring a community-wide approach as well as behaviour change by individuals. We do not support a new tax on sugar to address this issue.

Fresh fruit and vegetables are already effectively discounted as they do not have a GST applied.

Whereas the GST is added to the cost of items such as chips, lollies, sugary drinks, confectionery, snacks, ice-cream and biscuits.

We’re committed to tackling obesity, but increasing the family’s weekly shop at the supermarket isn’t the answer