NACCHO Aboriginal Health and Alcohol Research : New ADAC APP a will be ‘game changer’ to gauge realistic drinking habits says @ScottADAC

“Obviously there’s people who want the research done to help their community.

Once we get this app going, it’ll become very clear very quickly where the money should be spent.

That doesn’t mean you’ve just got to chuck money at them, but having Aboriginal-controlled issues and understanding which way they want to go.”

Jimmy Perry, a Ngarrindjerri/Arrernte man and an Aboriginal health worker involved in the project, said communities had a positive response.

 Read over over 200 Aboriginal Health Alcohol and Other Drugs articles published by NACCHO over the past 7 years 

Download the APP Research


Originally published HERE 

Researchers say a new app has the potential to more accurately reflect the nation’s drinking habits.

The ADAC and app researchers hoped the app would be available to download by the end of the year.

Key points : 

  • App developers say it will get a more accurate drinking history than a face-to-face interview with a trained health professional
  • The Aboriginal Drug and Alcohol Council says the app could replace the National Drug Strategy Household Survey
  • Researchers say alcohol consumption among Aboriginal women is under-represented by up to 700 per cent in national surveys

The Grog App was designed for use by Indigenous Australians but could be used by anyone.

Dr Kylie Lee, a senior research fellow at the Centre of Research Excellence in Indigenous Health and Alcohol who was also involved in the app’s development, said the new technology would create a more accurate database.

“Aboriginal women, their drinking is under-represented in the national surveys by up to 700 per cent and 200 per cent in men.

“Undeniably we need to do better … this app offers a great opportunity to do that.”

Researchers believe the app would elicit greater detail than the National Drug Strategy Household Survey which has been used for more than 30 years.

Dr Lee said the prospect of collating improved data collection on the difficult topic of drug and alcohol consumption was “exciting”.

“I think it really could be a game changer because it’s giving an opportunity for a safe place where they can just tell their story in terms of what they use or what they drink,” she said.

How it works

Take a Virtual Tour HERE

Participants answer a range of broad and specific questions on the app about alcohol and based on that information, they are allocated into a category on a sliding scale from ‘non-drinker’ to ‘high risk’.

Dr Lee said immediate feedback was very helpful.

She said the app could alleviate issues in the way alcohol data was typically collected, for example participants were more likely to be asked about standard drinks but not non-standard containers.

“Like a soft drink bottle, a juice bottle, a sports bottle et cetera so the app has facilities to show how much you put in the bottle,” Dr Lee said.

“It’s very exciting the level of detail you’re going to get.”

Professor Kate Conigrave, the app’s chief investigator and an addiction specialist at Royal Prince Alfred Hospital, agreed the new technology could provide greater clarity.

“I’m aware of the traps,” she said.

“One patient I saw had been recorded by a doctor as drinking three standard drinks a day but when I took a drinking history I said, ‘what do you drink them out of?’, and he showed me a sports bottle,” Professor Conigrave said.

“He was drinking three full sports bottles of wine a day, so that’s about 30 standard drinks a day.”

PHOTO: Professor Conigrave says the images used in the app can trigger the participant’s memory, making their drinking history more accurate. (Supplied: Kate Conigrave)

Professor Conigrave said the national health survey often contained “tiny” numbers from Indigenous communities.

“The sample sizes are so small, it’s hard to get a meaningful picture,” she said.

She said the app would provide a level of comfortability and anonymity which may lead to more accurate data, than an interview with a trained health professional.

“People can be a bit embarrassed about what they’re drinking and it can be a bit hard to admit to someone you know, ‘when I drink I have 12 cans of beer,'” she said.

Taking it to the communities

The app is in its second phase of testing.

In the first phase, Aboriginal and Torres Strait Islanders in remote, regional and urban parts of South Australia and Queensland were asked to describe their drinking habits.

Research on the app has now progressed to the second round, during which the focus was on the technology’s validity as an on-the-ground survey tool.

Scott Wilson, who was leading the development of the app at the Aboriginal Drug and Alcohol Council (ADAC), said the second phase was a “major prevalence study” which would include participants from the local hospital and prison.

The location for the trial has not been made public.

“In the big major surveys people in those areas are always excluded,” Mr Wilson said.

“When you consider that I might be in hospital for an alcohol-related illness or I might be in jail because of an alcohol or drug-related crime, my voice or results are never included.”

The ADAC and app researchers hoped the app would be available to download by the end of the year.

In the meantime, they planned to have discussions with the government over the future use of the app and pursue grant opportunities.

Dr Lee said she was excited for the potential of the new technology.

“Eventually I think it would be a great tool to roll out nationally … using it in the same way as the National Drug Strategy Household Survey,” she said

NACCHO Aboriginal Youth Health : ‘Dark days of old Don Dale’: John Paterson CEO @AMSANTaus and Human rights groups condemn #NT Government and Minister Dale Wakefield’s new youth justice laws

“ The NT government talks proudly about its commitment to Aboriginal-led solutions, to co-design and to collaboration,

So why was this bill kept from those who are part of those solutions and collaborations until the moment it was introduced into the parliament?

The bill went “far beyond” clarifying technical matters,

It does not reflect the royal commission recommendations or the government’s previous policy position to accept and implement those recommendations.

These amendments bring back the draconian treatment of young people and will see children restrained and isolated at the discretion of detention staff.

Far from reducing ambiguity as the minister claims, the amendments reintroduce ambiguity with subjective definitions and powers.

The Chief Executive Officer of AMSANT, John Paterson The Aboriginal Medical Services Alliance of the Northern Territory (AMSANT) today condemned the Labor Government and Minister Wakefield in the strongest possible terms for its behaviour in avoiding debate and scrutiny in order to ram through retrograde changes to the Youth Justice Act for the operation of youth detention.

Read The Guardian Amnesty coverage 

Read full AMSANT Press Releases Part 1 Below

Read over 60 NACCHO Aboriginal Health and Don Dale detention articles 

“The Territory Labor Government is creating generational change and safer communities by overhauling the Youth Justice system and putting at-risk young people back on track.

“The safety of youth detention staff and detainees is absolutely paramount. These amendments will help to better manage security risks that puts lives in danger.

“Last year we amended the Youth Justice Act to ensure that force, restraints and isolation could not be used for the purpose of disciplining a young person in detention.

“The new amendments provide clarity by removing ambiguities in the Act to ensure that youth detention staff can better respond to serious and dangerous incidents. Laws often need adjusting to reflect operational realities

Minister for Territory Families, Dale Wakefield Read Full Press release Part 2 Below 

Part 1

Mr Paterson, said “The Minister has been misleading and disingenuous in her speeches and answers to the limited questioning that was allowed in the Legislative Assembly. Despite the Minister’s assertions, these amendments are not mere technical clarifications.

They are substantive changes that erode the small improvements that were made in 2018 in response to the Royal Commission.

They will allow harsh treatment of young people in detention to continue unopposed and unscrutinised.”


Mr Paterson said that the Bill passed this afternoon with no scrutiny, is clearly intended to retrospectively make lawful, actions that were unlawful under the law as it existed until today. “We must ask ourselves whether this unseemly and undemocratic haste is intended to defeat legal actions currently on foot by young people who believe their treatment in detention has been unlawful.

Does the government know that unlawful treatment occurred and is now seeking to avoid accountability? It is difficult to draw any other conclusion despite the Minister’s obfuscation in the Assembly” said Mr Paterson.

AMSANT believes that the harsh treatment of young people now permitted under the law will lead to increased tensions and incidents in detention. When the next major incident occurs, the government, not the young people, must be held to account. “Let’s not forget” said Mr Paterson “that a large proportion of young people in detention have significant cognitive disabilities.

The government is condoning the use of restraint, isolation and physical force against young people with disabilities because they do not have the capacity to comply with the demands of the detention environment.

Right now, young people are being restrained in handcuffs and waist shackles to simply walk from one part of Don Dale to another under the control of a guard.”

“AMSANT is disgusted by this behaviour by a government and calls on the Chief Minister to withdraw this legislation prior to it receiving the assent of the Administrator. To do otherwise is to walk away from the Royal Commission recommendations.” said Mr Paterson. Mr Paterson seeks to remind the Chief Minister of his words and apparent distress when he responded to the Royal Commission.

The Chief Minister said in November 2017, “Our youth justice and child protection systems are supposed to make our kids better, not break them, they are supposed to teach them to be part of society, not withdraw”. “This legislation is not consistent with that statement”, Mr Paterson concluded

Protestor at Alice Springs Market yesterday 

1.2 Youth Justice Amendment Bill a return to the bad old days!

Aboriginal Medical Services Alliance of the Northern Territory (AMSANT) Chief Executive Officer, John Paterson, today called on the Chief Minister to halt the progress of the Youth Justice Amendment Bill 2019 through the Legislative Assembly until Aboriginal people and organisations have the chance to have a say.

“The government talks proudly about its commitment to Aboriginal led solutions, to co-design and to collaboration” said Mr Paterson.

“So why was this Bill kept from those who are part of those solutions and collaborations until the moment it was introduced into the Parliament?”

“The Minister has said the Bill simply clarifies technical matters and keeps faith with 2018 amendments.” Mr Paterson said.

“The Bill goes far beyond that. It undoes the positive progress in the 2018 changes which were a start in implementing the Royal Commission recommendations. The government consulted with Aboriginal organisations and other youth advocates and we supported the 2018 amendments.”

Mr Paterson said that this Bill is a u-turn on the progress in 2018. It does not reflect the Royal Commission recommendations or the Government’s previous policy position to accept and implement those recommendations.

“These amendments bring back the draconian treatment of young people and will see children restrained and isolated at the discretion of detention staff. Far from reducing ambiguity as the Minister claims, the amendments reintroduce ambiguity with subjective definitions and powers.”

Mr Paterson also questioned the need for retrospective effect of these amendments. “The only reason for retrospective effect is to legalise actions that were illegal when they were taken.” AMSANT said that the safety of both staff and young people is important and called on the government to work with Aboriginal organisations and other experts to explore the safety concerns and solutions. The government needs to think more carefully about the way forward. “

If the workforce cannot safely deliver a detention system under current laws which give quite considerable powers over the young people, the government needs to look at the skills, training and support of the workforce to ensure that they can. Attacking the human rights of young people is not the solution” Mr Paterson emphasised.

Mr Paterson noted that under the Diagrama Foundation which runs 70% of youth detention in Spain, for example, highly qualified staff with expertise in youth development, trauma and de-escalation work with young people in a therapeutic way that does not involve restraint, force and isolation. “Diagrama facilities rarely experience incidents of the kind seen last year at Don Dale.

Mr McGuire from Diagrama told audiences in Darwin last year that it is at least 10 years since there was a significant incident at a Diagrama facility. And Diagrama experiences a reoffending rate of only 20% across all its residents compared to 80% in the NT.”

Part 2

Passage of Youth Justice Act Amendments to Manage Security

Risks in the Territory’s Youth Detention Centres

March 2019

Today the Territory Labor Government passed amendments to the Youth Justice Act which will clarify and tighten the existing framework for managing safety and security risks within the youth detention centres.

The amendments will provide youth detention centre staff with a clear and unambiguous framework for exercising their powers, and will enable them to have a very clear guideline in their decision making when responding to dangerous and challenging situations.

The amendments include:

  • Clarify the circumstances in which force and restraints may be used, to account for situations where detainees mayact in a way that threatens the safety or security of a detention centre, but not in a way that presents an imminent risk
  • Create a consistent test to determine what is a reasonable use of force and restraints
  • Clarify the meaning of an emergency situation, which is relevant to the general application of all uses of force • Clarify the definition of separation
  • Enable screening and pat down searches of detainees in a broader range of circumstances
  • Include an express power to transfer a detainee from one detention centre to another

The amendments will remove any uncertainty around the operation of existing powers in the legislation, for both youth detention centre staff and detainees.

The amendments will apply retrospectively to the date in which the original provisions of the Act commenced (May 2018). This will remove any doubt about the original intention of these key provisions in the legislation.

NACCHO Aboriginal Health and Alcohol @FAREAustralia : Overcoming #Indigenous #FamilyViolence. Download new study from @marcialangton #unimelb where experts find success in Alcohol Management Plans but fear government failure to understand the magnitude of the alcohol problem

Our research found that average annual hospital admissions for assault fell from 32.25 per 1,000 people to 5.7 over 11 years, in line with tightening alcohol supply restriction,

We’ve identified propositions for better AMP outcomes long-term, through realistic financial support and stronger community-led governance “

The Associate Provost and Chair of Australian Indigenous Studies, Professor Marcia Langton, who co-authored the paper, says since the AMP was introduced there has been a reduction in violent assaults and the severity of family violence across the traditional lands of the Thaayorre and Mungkan peoples on the western coast of Cape York Peninsula

Paper Title: The Alcohol Management Plan at Pormpuraaw, Queensland, Australia: An ethnographic community-based study

Download Alcohol Management Plan Melbourne Uni

Authors: Kristen Smith, Marcia Langton, Richard Chenhall, Penelope Smith & Shane Bawden

Read over 200 NACCHO Aboriginal Health Alcohol and Other Drug articles published over pst 7 years 

Alcohol Management Plans (AMPs), including one that has helped dramatically reduce violent assault rates in the remote Indigenous community of Pormpuraaw in far north Queensland, are under threat.

Coinciding today with the 5th Annual Overcoming Indigenous Family Violence Forum in Melbourne, University of Melbourne researchers have released a new study on the successes and challenges of the Pormpuraaw AMP.

While the dramatic drop in hospital admissions showed the AMP was working extremely well, Foundation for Alcohol Research and Education (FARE) Chief Executive Michael Thorn is concerned that AMPs are under threat and riddled with problems stemming from government inertia.

Mr Thorn said the Pormpuraaw AMP study highlighted the need for genuine government investment overseen by a strong national alcohol strategy for protecting children, women, families and communities from alcohol harms.

“The good news is that an AMP can be an effective tool to significantly reduce alcohol harm, including family violence. But there’s a gulf between the well-intended rhetoric of governments to address harms in Indigenous communities and the unrealistic, unsustainable government action on the ground,” Mr Thorn said.

The University of Melbourne in-depth, community-based study investigated how AMP controls, restrictions and responses are understood and managed with Australian Aboriginal communities.

Research Fellow and lead author of the paper, Dr Kristen Smith, says most community members in

Pormpuraaw welcomed the reduced violence and community disharmony.

“There is strong community commitment to ‘place-based’ programs, but there are many issues that are being experienced in the community which are not being addressed,” Dr Smith said.

Dr Smith said the biggest concern was government failure to understand the magnitude of the alcohol problem and therefore underestimate resourcing.

“Underfunding is compounded over time through erratic political and policy decisions that fail to reliably meet the community’s needs for treatment services or address issues such as ‘sly-grogging’, gambling and criminalisation,” she said.

Professor Langton said the AMPs were too vulnerable to political and policy instabilities to ensure their long-term success. “We’ve identified propositions for better AMP outcomes long-term, through realistic financial support and stronger community-led governance,” she said.

NACCHO Aboriginal Health #Drugs #Alcohol : Minister @senbmckenzie An additional 72 Local Drug Action Teams #LDATs will be rolled out across the nation to tackle the harm caused by drugs and alcohol misuse on individuals and families.


“ It’s fantastic to welcome 72 new LDATs to the program who will develop and deliver local plans and activities to prevent alcohol and drug misuse in their local communities.

Today’s announcement brings the total number of LDATs to 244 across Australia, exceeding our target of 220 by 2020.

LDATs bring together community organisations to tackle substance misuse which can have devastating impacts on our communities – especially in rural and regional areas – and it’s clear that our communities are increasingly becoming empowered to take action at the local level.

The LDAT partnerships include local councils, service providers, schools, police, young people, Indigenous and primary health services and other non-government organisations, and the teams will have support from the Alcohol and Drug Foundation to assist in prevention activities,” 

Minister for Regional Services, Senator Bridget McKenzie

Download the list 

List of all LDATs by jurisdication and grant round Feb 2019


May 2018 : The Senator with Alcohol and Drug Foundation CEO Dr Erin Lalor and  General Manager of Congress’ Alice Springs Health Services, Tracey Brand in Alice Springs talking about the inspirational Central Australian Local Drug Action Team at Congress and announcing 92 Local Drug Action Teams across Australia building partnerships to prevent and minimise harm of ice alcohol & illicit drugs use by our youth with local action plans

Part 1 Press Release 

Speaking at the Wellington LDAT site in Sale, Victoria, the Minister for Regional Services, Senator Bridget McKenzie today congratulated the local community organisations, along with their partners, that will receive funding from the Federal Government through the fourth round of the successful Local Drug Action Team Program.

The new LDATs are being supported through the $298 million investment under the National Ice Action Strategy to combat drug and alcohol misuse across Australia.

Each of the 72 LDATs will receive an initial $10,000 to help them to refine a local community action plan. Each team will have an opportunity to apply for additional funding to support the delivery of local activities once their plans are finalised.

The Member for Gippsland Darren Chester welcomed today’s funding announcement.

“It’s important that we try to stop people in our community from trying illicit drugs for the first time and reduce binge drinking and alcohol abuse,” Mr Chester said. “One way of doing that is to ensure that everyone feels they are part of the community.”

”Gippsland is no different to other areas and drugs and alcohol are ruining lives and devastating families. Ice and other drugs do not discriminate.

“Many of us personally know families in our community who are dealing with the fallout of these insidious drugs.

“This funding enables the community to band together to fight the problem.”

Minister McKenzie said the LDATs announced will be supported to identify and deliver evidence based prevention, promotion and harm-reduction activities which will work for their local community.

Minister McKenzie acknowledged the importance of LDATs for driving change at a local level and highlighted the great work coming out of the program.

“The Hepburn LDAT, for instance, in Victoria is working to prevent and minimise harm from alcohol and drug misuse by improving access to education and skills development for young people,” Minister McKenzie said.

“The team has developed a 19-week program to up-skill young people and help them to build confidence, improve their knowledge about health and reconnect with their community.”

The Local Drug Action Team Program is a key component of the National Ice Action Strategy.

For free and confidential advice about alcohol and other drugs treatment services, please call the National Alcohol and Other Drug Hotline on 1800 250 015.

More information about LDATs can be found on the Alcohol and Drug Foundation website.

Alcohol and other drug-related harms are mediated by a number of factors – those that protect against risk, and those that increase risk. For example, factors that protect against alcohol and other drug-related harms include social connection, education, safe and secure housing, and a sense of belonging to a community.

Factors that increase risk of alcohol and other drug-related harms include high availability of drugs, low levels of social cohesion, unstable housing, and socioeconomic disadvantage. Most of these factors are found at the community level and must be targeted at this level for change.

Alcohol and other drugs are a community issue, not just an individual issue. Community action to prevent alcohol and other drug-related harms is effective because:

  • the solutions and barriers (protective/risk factors) for addressing alcohol and other drug-related harm are community-based
  • it creates change that is responsive to local needs
  • it increases community ownership and leads to more sustainable change

We encourage Local Drug Action Teams (LDATs) to link with and/or build on existing activity approaches that have been shown to work.

Select an existing evidence-based activity

Existing activities may have an alcohol and other drug focus, or possibly a different overall focus such as preventing gambling harm, or enhancing mental wellbeing. Be prepared to look outside the alcohol and other drug sector for possible approaches; for example, activities that share a focus on strengthening communities to improve other health and social outcomes.

A limited number of existing activities are listed below. You may also find other activities through local health services, peak bodies and by drawing on local knowledge and networks you have access to.

Existing strong and connected community activities in Australia:

Delivered by the Alcohol and Drug Foundation , the Good Sports Program works with local sporting clubs across Australia to provide a safe and inclusive environment, where everyone can get involved. The activity has run for nearly two decades and is proven to reduce harm and positively influence health behaviours, as well as strengthen club membership and boost participation.

Established 25 years ago, Big hART engages disadvantaged communities around Australia in art.

Community Hubs provides a welcoming place for migrant women and their children to learn about the Australian education system. With strong evaluation to support the effectiveness of the program, Community Hubs focuses on engagement, English, early-years and vocational pathways.

A national organisation that uses sport and art to improve the lives of people experiencing complex disadvantage.

If you have found some existing activities that could be incorporated, it is useful to seek out further information to find out if it is relevant.

You might want to consider the following questions (some answers may be available online, others you may have to seek directly from the organisation):

  • Does the activity align with your community needs?
  • Is the activity available in your geographic area? If face-to-face delivery is not available, is remote access an option?
  • Has the activity been shown to be effective at strengthening community cohesion and connection, and reducing and preventing alcohol and other drug-related harms? What evidence is available to demonstrate this?

Due to the limited number of existing activities available and the need for tailored approaches, many Local Drug Action Teams will work with partners to develop and deliver a targeted activity in their community. Review the paragraph below d. Determine resources required and Map your steps for insight into what is required when developing new approaches.

NACCHO and @RACGP Aboriginal Women’s Health and #FamilyViolence : How to identify and provide early intervention for victims and perpetrators.

About four in 10 women who were physically injured [as a result of family violence] visited a health professional for their injuries
This information [from the report] offers important insights for those involved in family and domestic violence policy, as well as organisations which provide services for Aboriginal and Torres Strait Islander peoples, aimed at preventing violence and supporting those affected by violence.’

ABS Director of the Centre of Excellence for Aboriginal and Torres Strait Islander Statistics, Debbie Goodwin said.

 ” Chapter 16 of the RACGP NACCHO National Guide : ‘Family abuse and violence’, provides key recommendations on prevention interventions – screening, behavioural and environmental.

These recommendations aim to support healthcare professionals to develop a high level of awareness of the risks of family abuse and violence, and how to identify and provide early intervention for victims and perpetrators.”

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (

Published by NewsGP Morgan Liotta

The report forms part of the Australian Bureau of Statistics’ (ABS) publication National Aboriginal and Torres Strait Islander Social Survey, 2014–15 and compares sociodemographic factors of Aboriginal and Torres Strait Islander women who experienced family violence with those who did not in the year prior to the 2014–15 survey.

Key findings show that, among Aboriginal and Torres Strait Islander populations, around two in three women (72%) compared with one in three men (35%) were likely to identify an intimate partner or family member as at least one of the perpetrators in their most recent experience of physical violence.

Approximately one in 10 Aboriginal and Torres Strait Islander women experienced family violence based on their most recent experience of physical violence.

Almost seven in 10 (68%) women who had experienced family violence reported that alcohol and/or other substances contributed to the incident:

  • More than half of women (53%) who had experienced family violence reported alcohol (by itself or with other substances) was a contributing factor
  • More than one in 10 (13%) reported that other substances alone were a contributing factor

When compared with Aboriginal and Torres Strait Islander women who had not experienced any physical violence, those who had were:

  • more likely to report high or very high levels of psychological distress (69% compared with 34%)
  • more likely to have a mental health condition (53% compared with 31%)
  • more likely to report they had experienced homelessness at some time in their life (55% compared with 26%)
  • less likely to trust police in their local area (44% compared with 62%)
  • just as likely to trust their own doctor (77% compared with 83%)

The report underlines the role of GPs’ support for such people.

GP resources

  • The RACGP and the National Aboriginal Community Controlled Health Organisation (NACCHO)’s National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (National Guide), Chapter 16: ‘Family abuse and violence’, provides key recommendations on prevention interventions – screening, behavioural and environmental. These recommendations aim to support healthcare professionals to develop a high level of awareness of the risks of family abuse and violence, and how to identify and provide early intervention for victims and perpetrators.
  • The RACGP’s Abuse and violence: Working with our partners in general practice (White book), Chapter 11: ‘Aboriginal and Torres Strait Islander violence’, outlines statistics and recommendations for healthcare professionals to show leadership at a community level through local organisations by advocating for provision of services that meet the needs of Aboriginal and Torres Strait Islander peoples experiencing family violence.

NACCHO Aboriginal Health and #SocialDeterminants : Download @AIHW Report : Indicators of socioeconomic inequalities in #cardiovascular disease #heartattack #stroke, #diabetes and chronic #kidney disease @ACDPAlliance

 ” Most apparent are inequalities in chronic disease among Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Social and economic factors are estimated to account for slightly more than one-third (34%) of the ‘good health’ gap between the 2 groups, with health risk factors such as high blood pressure, smoking and risky alcohol consumption explaining another 19%, and 47% due to other, unexplained factors.

 An estimated 11% of the total health gap can be attributed to the overlap, or interactions between the social determinants and health risk factors (AIHW 2018a).

Download the AIHW Report HERE aihw-cdk-12

‘By better understanding the role social inequality plays in chronic disease, governments at all levels can develop stronger, evidence based policies and programs aimed at preventing and managing these diseases, leading to better health outcomes across our community,’

AIHW spokesperson Dr Lynelle Moonn noted that these three diseases are common in Australia and, in addition to the personal costs to an individual’s health and quality of life, they have a significant economic burden in terms of healthcare costs and lost productivity

AIHW Website for more info 

Government investment is essential to encourage health checks, improve understanding of the risk factors for chronic disease, and implement policies and programs to reduce chronic disease risk, particularly in areas of socioeconomic disadvantage,

Chair of the Australian Chronic Disease Prevention Alliance Sharon McGowan said that the data revealed stark inequities in health status amongst Australians.

Download Press Release Here : australianchronicdiseasepreventionalliance

The Australian Chronic Disease Prevention Alliance is calling on the Government to target these health disparities by increasing the focus on prevention and supporting targeted health checks to proactively manage risk.

AIHW Press Release

Social factors play an important role in a person’s likelihood of developing and dying from certain chronic diseases, according to a new report from the Australian Institute of Health and Welfare (AIHW).

The report, Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease, examines the relationship between socioeconomic position, income, housing and education and the likelihood of developing and dying from several common chronic diseases—cardiovascular disease (which includes heart attack and stroke), diabetes and chronic kidney disease.

Above image NACCHO Library

The report reveals that social disadvantage in these areas is linked to higher rates of disease, as well as poorer outcomes, including a greater likelihood of dying.

‘Across the three chronic diseases we looked at—cardiovascular disease, diabetes and chronic kidney disease— we saw that people in the lowest of the 5 socioeconomic groups had, on average, higher rates of these diseases than those in the highest socioeconomic groups,’ said AIHW spokesperson Dr Lynelle Moon.

‘And unfortunately, we also found higher death rates from these diseases among people in the lowest socioeconomic groups.’

The greatest difference in death rates between socioeconomic groups was among people with diabetes.

‘For women in the lowest socioeconomic group, the rate of deaths in 2016 where diabetes was an underlying or associated cause of death was about 2.4 times as high as the rate for those in the highest socioeconomic group. For men, the death rate was 2.2 times as high,’ Dr Moon said.

‘Put another way, if everyone had the same chance of dying from these diseases as people in the highest socioeconomic group, in a one year period there would be 8,600 fewer deaths from cardiovascular disease, 6,900 fewer deaths from diabetes, and 4,800 fewer deaths from chronic kidney disease.’

Importantly, the report also suggests that in many instances the gap between those in the highest and lowest socioeconomic groups is growing.

‘For example, while the rate of death from cardiovascular disease has been falling across all socioeconomic groups, the rate has been falling more dramatically for men in the highest socioeconomic group—effectively widening the gap between groups,’ Dr Moon said.

The report also highlights the relationship between education and health, with higher levels of education linked to lower rates of disease and death.

‘If all Australians had the same rates of disease as those with a Bachelor’s degree or higher, there would have been 7,800 fewer deaths due to cardiovascular disease, 3,700 fewer deaths due to diabetes, and 2,000 fewer deaths due to chronic kidney disease in 2011–12,’ Dr Moon said.

Housing is another social factor where large inequalities are apparent. Data from 2011–12 shows that for women aged 25 and over, the rate of death from chronic kidney disease was 1.5 times as high for those living in rental properties compared with women living in properties they owned. For men, the rate was 1.4 times as high for those in rental properties.

Dr Moon noted that these three diseases are common in Australia and, in addition to the personal costs to an individual’s health and quality of life, they have a significant economic burden in terms of healthcare costs and lost productivity.

‘By better understanding the role social inequality plays in chronic disease, governments at all levels can develop stronger, evidence based policies and programs aimed at preventing and managing these diseases, leading to better health outcomes across our community,’ she said

Underlying causes of socioeconomic inequalities in health

There are various reasons why socioeconomically disadvantaged people experience poorer health. Evidence points to the close relationship between people’s health and the living and working conditions which form their social environment.

Factors such as socioeconomic position, early life, social exclusion, social capital, employment and work, housing and the residential environment— known collectively as the ‘social determinants of health’—can act to either strengthen or to undermine the health of individuals and communities (Wilkinson & Marmot 2003).

These social determinants play a key role in the incidence, treatment and outcomes of chronic diseases. Social determinants can be seen as ‘causes of the causes’—that is, as the foundational determinants which influence other health determinants such as individual lifestyles and exposure to behavioural and biological risk factors.

Socioeconomic factors influence chronic disease through multiple mechanisms. Socioeconomic disadvantage may adversely affect chronic disease risk through its impact on mental health, and in particular, on depression. Socioeconomic gradients exist for multiple health behaviours over the life course, including for smoking, overweight and obesity, and poor diet.

When combined, these unhealthy behaviours help explain much of the socioeconomic health gap. Current research also seeks to link social factors and biological processes which affect chronic disease. In CVD, for example, socioeconomic determinants of health have been associated with high blood pressure, high cholesterol, chronic stress responses and inflammation (Havranek et al. 2015).

The direction of causality of social determinants on health is not always one-way (Berkman et al. 2014). To illustrate, people with chronic conditions may have a reduced ability to earn an income; family members may reduce or cease employment to provide care for those who are ill; and people or families whose income is reduced may move to disadvantaged areas to access low-cost housing.

Action on social determinants is often seen as the most appropriate way to tackle unfair and avoidable socioeconomic inequalities. There are significant opportunities for reducing death and disability from CVD, diabetes and CKD through addressing their social determinants.


Australians as a whole enjoy good health, but the benefits are not shared equally by all. People who are socioeconomically disadvantaged have, on average, greater levels of cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD).

This report uses latest available data to measure socioeconomic inequalities in the incidence, prevalence and mortality from these 3 diseases, and where possible, assess whether these inequalities are growing. Findings include that, in 2016:

  • males aged 25 and over living in the lowest socioeconomic areas of Australia had a heart attack rate 1.55 times as high as males in the highest socioeconomic areas. For females, the disparity was even greater, at 1.76 times as high
  • type 2 diabetes prevalence for females in the lowest socioeconomic areas was 2.07 times as high as for females in the highest socioeconomic areas. The prevalence for males was 1.70 times as high
  • the rate of treated end-stage kidney disease for males in the lowest socioeconomic areas was 1.52 times as high as for males in the highest socioeconomic areas. The rate for females was 1.75 times as high
  • the CVD death rate for males in the lowest socioeconomic areas was 1.52 times as high as for males in the highest socioeconomic areas. For females, the disparity was slightly less, at 1.33 times as high
  • if all Australians had the same CVD death rate as people in the highest socioeconomic areas in 2016, the total CVD death rate would have declined by 25%, and there would have been 8,600 fewer deaths.

CVD death rates have declined for both males and females in all socioeconomic areas since 2001— however there have been greater falls for males in higher socioeconomic areas, and as a result, inequalities in male CVD death rates have grown.

  • Both absolute and relative inequality in male CVD death rates increased—the rate difference increasing from 62 per 100,000 in 2001 to 78 per 100,000 in 2011, and the relative index of inequality (RII) from 0.25 in 2001 to 0.53 in 2016.

Often, the health outcomes affected by socioeconomic inequalities are greater when assessed by individual characteristics (such as income level or highest educational attainment), than by area.

  • Inequalities in CVD death rates by highest education level in 2011–12 (RII = 1.05 for males and 1.05 for females) were greater than by socioeconomic area in 2011 (0.50 for males and 0.41 for females).

The impact on death rates of socioeconomic inequality was generally greater for diabetes and CKD than for CVD.

  • In 2016, the diabetes death rate for females in the lowest socioeconomic areas was 2.39 times as high as for females in the highest socioeconomic areas. This compares to a ratio 1.75 times as high for CKD, and 1.33 for CVD. For males, the equivalent rate ratios were 2.18 (diabetes), 1.64 (CKD) and 1.52 (CVD).viii

Part 2


NACCHO Aboriginal #MentalHealth and #SuicidePrevention : @ozprodcom issues paper on #MentalHealth in Australia is now available. It asks a range of questions which they seek information and feedback on. Submissions or comments are due by Friday 5 April.

 ” Many Australians experience difficulties with their mental health. Mental illness is the single largest contributor to years lived in ill-health and is the third largest contributor (after cancer and cardiovascular conditions) to a reduction in the total years of healthy life for Australians (AIHW 2016).

Almost half of all Australian adults have met the diagnostic criteria for an anxiety, mood or substance use disorder at some point in their lives, and around 20% will meet the criteria in a given year (ABS 2008). This is similar to the average experience of developed countries (OECD 2012, 2014).”

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

“Clearly Australia’s mental health system is failing Aboriginal people, with Aboriginal communities devastated by high rates of suicide and poorer mental health outcomes. Poor mental health in Aboriginal communities often stems from historic dispossession, racism and a poor sense of connection to self and community. 

It is compounded by people’s lack of access to meaningful and ongoing education and employment. Drug and alcohol related conditions are also commonly identified in persons with poor mental health.

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

Read over 200 Aboriginal Mental Health Suicide Prevention articles published by NACCHO over the past 7 years 

Despite a plethora of past reviews and inquiries into mental health in Australia, and positive reforms in services and their delivery, many people are still not getting the support they need to maintain good mental health or recover from episodes of mental ill‑health. Mental health in Australia is characterised by:

  • more than 3 100 deaths from suicide in 2017, an average of almost 9 deaths per day, and a suicide rate for Indigenous Australians that is much higher than for other Australians (ABS 2018)
  • for those living with a mental illness, lower average life expectancy than the general population with significant comorbidity issues — most early deaths of psychiatric patients are due to physical health conditions
  • gaps in services and supports for particular demographic groups, such as youth, elderly people in aged care facilities, Indigenous Australians, individuals from culturally diverse backgrounds, and carers of people with a mental illness
  • a lack of continuity in care across services and for those with episodic conditions who may need services and supports on an irregular or non-continuous basis
  • a variety of programs and supports that have been successfully trialled or undertaken for small populations but have been discontinued or proved difficult to scale up for broader benefits
  • significant stigma and discrimination around mental ill-health, particularly compared with physical illness.

The Productivity Commission has been asked to undertake an inquiry into the role of mental health in supporting social and economic participation, and enhancing productivity and economic growth (these terms are defined, for the purpose of this inquiry, in box 1).

By examining mental health from a participation and contribution perspective, this inquiry will essentially be asking how people can be enabled to reach their potential in life, have purpose and meaning, and contribute to the lives of others. That is good for individuals and for the whole community.


In 2014-15, four million Australians reported having experienced a common mental disorder.

Mental health is a key driver of economic participation and productivity in Australia, and hence has the potential to impact incomes and living standards and social engagement and connectedness. Improved population mental health could also help to reduce costs to the economy over the long term.

Australian governments devote significant resources to promoting the best possible mental health and wellbeing outcomes. This includes the delivery of acute, recovery and rehabilitation health services, trauma informed care, preventative and early intervention programs, funding non-government organisations and privately delivered services, and providing income support, education, employment, housing and justice. It is important that policy settings are sustainable, efficient and effective in achieving their goals.

Employers, not-for-profit organisations and carers also play key roles in the mental health of Australians. Many businesses are developing initiatives to support and maintain positive mental health outcomes for their employees as well as helping employees with mental illhealth continue to participate in, or return to, work.

Scope of the inquiry

The Commission should consider the role of mental health in supporting economic participation, enhancing productivity and economic growth. It should make recommendations, as necessary, to improve population mental health, so as to realise economic and social participation and productivity benefits over the long term.

Without limiting related matters on which the Commission may report, the Commission should:

  • examine the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • examine how sectors beyond health, including education, employment, social services, housing and justice, can contribute to improving mental health and economic participation and productivity;
  • examine the effectiveness of current programs and Initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • assess whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  • draw on domestic and international policies and experience, where appropriate; and
  • develop a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

The Commission should have regard to recent and current reviews, including the 2014 Review of National Mental Health Programmes and Services undertaken by the National Mental Health Commission and the Commission’s reviews into disability services and the National Disability Insurance Scheme.

The Issues Paper
The Commission has released this issues paper to assist individuals and organisations to participate in the inquiry. It contains and outlines:

  • the scope of the inquiry
  • matters about which we are seeking comment and information
  • how to share your views on the terms of reference and the matters raised.

Participants should not feel that they are restricted to comment only on matters raised in the issues paper. We want to receive information and comment on any issues that participants consider relevant to the inquiry’s terms of reference.

Key inquiry dates

Receipt of terms of reference 23 November 2018
Initial consultations November 2018 to April 2019
Initial submissions due 5 April 2019
Release of draft report Timing to be advised
Post draft report public hearings Timing to be advised
Submissions on the draft report due Timing to be advised
Consultations on the draft report November 2019 to February 2020
Final report to Government 23 May 2020

Submissions and brief comments can be lodged

Online (preferred):
By post: Mental Health Inquiry
Productivity Commission
GPO Box 1428, Canberra City, ACT 2601


Inquiry matters: Tracey Horsfall Ph: 02 6240 3261
Freecall number: Ph: 1800 020 083

Subscribe for inquiry updates

To receive emails updating you on the inquiry consultations and releases, subscribe to the inquiry at:


 Definition of key terms
Mental health is a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Mental illness or mental disorder is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria.

Mental health problem refers to some combination of diminished cognitive, emotional, behavioural and social abilities, but not to the extent of meeting the criteria for a mental illness/disorder.

Mental ill-health refers to diminished mental health from either a mental illness/disorder or a mental health problem.

Social and economic participation refers to a range of ways in which people contribute to and have the resources, opportunities and capability to learn, work, engage with and have a voice in the community. Social participation can include social engagement, participation in decision making, volunteering, and working with community organisations. Economic participation can include paid employment (including self-employment), training and education.

Productivity measures how much people produce from a given amount of effort and resources. The greater their productivity, the higher their incomes and living standards will tend to be.

Economic growth is an increase in the total value of goods and services produced in an economy. This can be achieved, for example, by raising workforce participation and/or productivity.

Sources: AIHW (2018b); DOHA (2013); Gordon et al. (2015); PC (2013, 2016, 2017c); SCRGSP (2018); WHO (2001).

An improvement in an individual’s mental health can provide flow-on benefits in terms of increased social and economic participation, engagement and connectedness, and productivity in employment (figure 1).

This can in turn enhance the wellbeing of the wider community, including through more rewarding relationships for family and friends; a lower burden on informal carers; a greater contribution to society through volunteering and working in community groups; increased output for the community from a more productive workforce; and an associated expansion in national income and living standards. These raise the capacity of the community to invest in interventions to improve mental health, thereby completing a positive reinforcing loop.

The inquiry’s terms of reference (provided at the front of this paper) were developed by the Australian Government in consultation with State and Territory Governments. The terms of reference ask the Commission to make recommendations to improve population mental health so as to realise higher social and economic participation and contribution benefits over the long term.

Assessing the consequences of mental ill-health

The costs of mental ill-health for both individuals and the wider community will be assessed, as well as how these costs could be reduced through changes to the way governments and others deliver programs and supports to facilitate good mental health.

The Commission will consider the types of costs summarised in figure 4. These will be assessed through a combination of qualitative and quantitative analysis, drawing on available data and cost estimates, and consultations with inquiry participants and topic experts. We welcome the views of inquiry participants on other costs that we should take into account.


NACCHO Aboriginal Health @IndigenousPHAA #Prevention : Download @_PHAA_ Report : Saving lives a million at a time: Australia’s #top10publichealth successes over the last 20 years

As we edge closer to the federal election, it’s critical our parties consider what public health successes we must achieve next, and how they can lead on issues such as Aboriginal and Torres Strait Islander health, obesity, nutrition, environmental and ecological issues such as climate change, and advancing health equity.”

PHAA CEO Terry Slevin

Today the Public Health Association Australia (PHAA) launched its new report, the Top 10 Public Health Successes Over the Last 20 Years at Australian Parliament House.

PHAA CEO Terry Slevin stated, “Public health initiatives have prevented an extraordinary amount of ill health and death in our communities – there is a saying in our field that nurses and doctors save lives, and public health professionals also save lives – they just do so a million at a time.”

The report has been compiled by Australia’s leading public health experts, and the top ten achievements are presented in no particular order as they are all considered to have been of equal importance to Australian public health.

The top ten public health successes include:

  • Folate: reduced neural tube defects
  • Immunisation and eliminating infectious disease
  • Containing the spread of HPV and its related cancers
  • Oral health: reduced dental decay
  • Reduced incidence of skin cancer
  • Tobacco control: reduced deaths caused by smoking
  • Reduced the road death and injury toll
  • Gun control: reduced gun deaths in Australia
  • Contained the spread of HIV
  • Prevented deaths from bowel and breast cancer

Download the PHAA report HERE 

PHAA Top 10 Public Health Successes_FINAL

“This report paints a clear picture of exactly which programs and initiatives have had the greatest impact – from cancer screening to vaccines, from road safety to tobacco control. These have all saved thousands of lives and protected the health of millions of Australians.”

“Public health is about preventing or minimising harm – it is always better than cure. We aim to intervene before illness, death or injury occurs, creating safe and healthy environments for all Australians. This is why in public health, we’re for birthdays,” Mr Slevin said.

“We aspire to give Australians more birthdays (five more for each person is our starting goal) and other important celebrations – weddings, births, graduations – all of the significant milestones we value in life. Perhaps most importantly, we want Australians to be healthy enough to really enjoy these extra years and milestones,” Mr Slevin said.

“So the next question we ask is, who will be the policy leaders and decision makers to help us achieve this aspiration? The report acknowledges key decision makers at the federal, state and territory government levels who were instrumental in making the top ten public health successes happen.”

“As we edge closer to the federal election, it’s critical our parties consider what public health successes we must achieve next, and how they can lead on issues such as Aboriginal and Torres Strait Islander health, obesity, nutrition, environmental and ecological issues such as climate change, and advancing health equity.”

The UK has just released a new preventive health vision statement proving that western conservative governments can prioritise prevention. This is key not just because it is the most effective form of public health practice, but also the most economically sound.

“Preventive public health measures are often cheap to implement and more than pay for themselves through reduced health care costs and increased productivity through keeping people out of hospitals.”

“Public health investment in Australia currently amounts to less than 2% of the national health budget, and has been generally declining since at least 2001. It is essential we allocate adequate resources to public health programs and initiatives to build a healthier population, stem the tide of chronic disease that is enveloping the nation, and reduce future health expenditure,” Mr Slevin said.

“We owe it to ourselves and to our children to look back in twenty years’ time and say we did all we could.”

NACCHO Aboriginal #RefreshtheCTGRfresh and #FASD2018 @GregHuntMP and @KenWyattMP unveil a new National Fetal Alcohol Spectrum Disorder (FASD) Strategic Action Plan 2018- 2028 and more than $7 million in new funding.

“Success is underpinned by a team effort, with collaboration between families, communities, service providers and governments.

FASD requires a national approach, linking in closely with local solutions. We are acknowledging the scale of the issue in Australia and intensifying efforts to address it.”

The Minister for Indigenous Health and Minister for Aged Care, Ken Wyatt AM, said the Government’s approach to FASD was to invest in activities which have been shown to be effective.

“This plan will show us the way forward to tackle the tragic problem of FASD – guiding future actions for governments, service providers and communities in the priority areas of prevention, screening and diagnosis, support and management, and tailoring needs to communities.

Alongside the plan’s release, I am pleased to announce a new investment of $7.2 million to support activities that align with these priority areas.

This funding will enable work to start immediately and help protect future generations and give children the best start possible.

Minister for Health Greg Hunt said the Government is committed to reducing the impact of FASD on individuals, families and communities.

Download a PDF copy of Plan 

National Fetal Alcohol Spectrum Disorder Strategic Action Plan 2018-2028

The forum delegates agreed that there was an urgent need for action to prevent FASD in our Top End communities, and across the Northern Territory.

It is essential that our responses do not stigmatise women or Aboriginal people.

It is important that we don’t lay blame, but instead work together, to support our women and young girls.

Everyone is at risk of FASD, so everyone must be informed the harmful effects of drinking while pregnant.

Our men also need to step up and support our mothers, sisters, nieces and partners, to ensure that we give every child the best chance in life.”

A landmark Top End Foetal Alcohol Spectrum Disorder (FASD) forum* was held in Darwin on 30-31 May 2018

Read over 25 NACCHO Aboriginal Health and FASD articles published over 6 years

The Federal Government is stepping up its fight against Fetal Alcohol Spectrum Disorder (FASD) today by unveiling a new national action plan and more than $7 million in new funding.

Fetal Alcohol Spectrum Disorder is the term used to describe the lifelong physical and neurodevelopmental impairments that can result from fetal alcohol exposure.

FASD is a condition that is an outcome of parents either not being aware of the dangers of alcohol use when pregnant or planning a pregnancy, or not being supported to stay healthy and strong during pregnancy.

This funding will enable new work to get underway and build on proven programs – to help protect future generations and give children the best possible start in life.

Key Points of action plan

FASD will be tackled across a range of fronts – including prevention, screening and diagnosis, support and management, and priority populations at increased risk of harm.

PREVENTION: $1.47 million including new consumer resources and general awareness activities – including national FASD Awareness Day, translation of awareness materials into a variety of First Nations languages, and promotion of alcohol consumption guidelines, and bottle shop point of sale warnings.

SCREENING: $1.2 million to support new screening and diagnosis activities, which will include reviewing existing tools and developing new systems and referral pathways, to assist professionals in community settings.

MANAGEMENT: $1.2 million goes to management and support activities, including tailored resources for people working in the education, justice and police sectors.

LOCAL TARGETING: $1.27 million to develop targeted resources, to meet local cultural and community needs.

BUILDING ON SUCCESS: $1.55 million to continue proven activities – with support for Australia’s FASD Hub, a one-stop shop containing the FASD Register and public awareness campaigns.

The Strategic Action Plan also establishes an expert FASD Advisory Group – which will report to the National Drug Strategy Committee on the progress being made, while promoting successful models and highlighting emerging issues and evidence.

From the FASD Workshop in Perth this week 

The plan is committed to breaking FASD’s impact on

  • Encounters with the law
  • Family breakdowns
  • Deaths in custody
  • Suicides and chronic health conditions

FASD requires a national approach, linking in closely with local solutions.

We are acknowledging the scale of the issue in Australia and intensifying efforts to address it.

The activities and actions outlined in the priority areas of the Plan are intended to guide future action – they are not compulsory and can be adopted as needed, along with other interventions and programs, based on local needs.

Activities should be evidence informed and based on best available research and data – actions should be tailored to individual communities and regions.

Since 2014, the Liberal National Government has provided almost $20 million in direct funding to tackle

Aboriginal Health Alcohol and Other Drugs : Minister @KenWyatt and John Havnen #NACCHO deliver #NIDAC18 keynotes : What is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal communities? 

 ” All of us want to see better health for First Nations Australians. 

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference NIDAC18 will be an important part of that solution – and I look forward to hearing the outcomes. ” 

Minister Indigenous Health Ken Wyatt see full speech Part 2 below

Read over 200 NACCHO Aboriginal Health Alcohol and Other Drugs articles we have published over past 6 years 

Part 1 NACCHO Keynote by John Havnen Senior Policy Officer 

The harmful use of alcohol is a problem for the Australian community as a whole – alcohol misuse and alcohol-related disease remains a recognised as a nationwide problem.

It is estimated that in 2011 alcohol misuse caused 5.1% of the total burden of disease in Australia.

Alcohol related harm has clear social and economic determinants and it is closely related to disadvantage.

As such Aboriginal and Torres Strait Islander communities, which as we all know rate disproportionately in all measures of disadvantage, experience higher rates of alcohol misuse and alcohol-related harm than non-indigenous Australians.

This discrepancy leads to Aboriginal and Torres Strait Islander people experiencing significant health and social problems in a rate unequal to non-Indigenous Australians. But not all of us drink, in the 2016 National Drug Strategy Household Survey, Indigenous Australians aged 14 and over were more likely to abstain from drinking alcohol than non-Indigenous Australians.

This abstinence rate has been increasing over the last decade with more and more of us deciding not to drink.

So although there are proportionately more Indigenous people than non-Indigenous people who refrain from drinking, those of us who do drink are more likely to do so at high-risk levels.

In 2014-15 the National Aboriginal and Torres Strait Islander Social Survey found 19% of Indigenous Australians over the age of 15 exceeded the lifetime risk guidelines for alcohol consumption.

This is no more than 2 standard drinks per day on average or no more than 4 drinks per occasion.

Even though the rate of harmful drinking has declined in recent years, this has been mainly in non-remote areas, so there is still high rates of harmful drinking in remote areas and drinking at risky levels puts a person at risk of medical and social problems.

Due to these high levels of risky drinking, Aboriginal and Torres Strait islanders are more likely to be hospitalised for alcohol-related conditions and accidents than non-Indigenous Australians including acute intoxication, liver disease, injuries, suicide or self-harm and cancer.

There is big differences in the rates with Indigenous males over 9 times more likely to need hospitalisation and Indigenous females 13 times more than non-Indigenous Australians.

These drinking patterns highlight that it is possible that risky drinking and binge drinking has been normalised within some communities and this could potentially act as a barrier to seeking treatment when needed.

However, alcohol is not the only substance that presents a major concern for in Aboriginal and Torres Strait Islander people.

In 2014-15, the National Aboriginal and Torres Strait Islander Social Survey stated that 30% of Indigenous Australians over the age of 15 years reported using an illicit substance in the previous 12-months.

This was an increase from 23% in 2008. The substances most commonly used by Aboriginal and Torres Strait islanders were cannabis with 19% reporting, non-prescription analgesics and sedatives (such as painkillers, sleeping pills and tranquillisers) at 13%, and amphetamines or speed with a rate of 5%.

Smoking has overtime become common place in Aboriginal and Torres Strait islander communities and whilst tobacco smoking is declining in Australia, rates remain disproportionately high among Aboriginal and Torres Strait Islander people.

Indigenous Australians more than twice as likely to be current daily smokers as non-Indigenous Australians.

Despite declines in rates of smoking in Aboriginal and Torres Strait Islander people in the last 20 years there appears to have been no change to the gap in smoking prevalence between the Indigenous and non-Indigenous Australian adult population.

Tobacco-related disease is responsible for between 1.5 and 8 times more deaths in the Aboriginal and Torres Strait islander community than in non-Indigenous Australians.

The harmful use of alcohol, in addition to tobacco and other drugs, are both the cause and effect of serious harm to physical health.

The health status of Aboriginal and Torres Strait Islander people is considerably lower than for non-Indigenous Australians with 71.0% of Indigenous Australians reporting having a long-term health condition compared with 55.3% of non-Indigenous Australians.

Those with long-term health conditions are also more likely to be a daily smoker or misuse alcohol and other drugs. Aboriginal and Torres Strait Islander people who experience multiple diagnoses are more likely to have more difficulty accessing treatment and have poorer outcomes when they do receive treatment than either a physical health condition or an alcohol or other drug disorder alone.

There is a well-known high rate of co-morbidity of substance use disorders with other mental health / social and emotional wellbeing issues, and medical conditions in particular chronic diseases.

These issues tend to cluster in individuals and communities along with other markers of social, economic and intergenerational disadvantage.

These high rates of comorbidity contribute to complexities in the treatment and causality of disorders and remains a significant challenge for the delivery of effective healthcare services for our people.

This is in part due to the complexity of the mental and physical health issues individuals display, and in part because of the burden of multiple disadvantages including; poverty and intergenerational disadvantage and this can reduce the capacity to engage consistently and meaningfully in treatment.

So, what is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal and Torres Strait Islander communities?

Existing mainstream models of practice in the alcohol and other drug field have been developed within Western systems of knowledge and focus on a biomedical model with an emphasis on biological factors and discounts any psychological, environmental, and social influences. As a result, it is not generalisable to Aboriginal and Torres Strait islander culture and ignores important indigenous perspectives and needs.

Including the need for access to culturally appropriate and comprehensive services to address multiple problems, and the need for local links with Indigenous services.

Western alcohol and other drug services are based on an abstinence model and focuses on residential rehabilitation which is aimed more on the needs of alcohol users and not illicit drug users.

Residential alcohol and drug programs provide care and support for people within a residential community setting and can be medium to long-term duration of anywhere from 4 weeks to 12 months and but again only supports residents’ psychological needs only.

This model also lacks consideration to the prevention and early intervention strategies of risky drinking and drug use, lacks acknowledgement of family, culture and community which we know are important aspects in the holistic model of care.

Despite a paucity of data, the knowledge of how to prevent alcohol misuse among the general population – while not consistently translated to policy and practice – is extensive.

The evidence for the effectiveness of such programs for Indigenous Australians, however, remains scant.

Racism is still present in mainstream services so many Aboriginal and Torres Strait Islanders might have limited access to mainstream health services.

Systemic racism in the health system directly influences Indigenous Australians’ quality of and access to healthcare.

The severity of this impact intensifies levels of psychological stress, which is closely linked to poorer mental and physical health outcomes.

Racism not only provides a major barrier to Aboriginal and Torres Strait Islander peoples’ access to health care but also to receiving the same quality of healthcare services available to non-Indigenous Australians.

There is also a tendency to stereotype Aboriginal and Torres Strait Islanders as ‘drunks’ or ‘alcoholics’ which, as I have previously discussed today is not necessarily the case.

So, what will work if mainstream alcohol and other drug services have limited evidence for our people?

Historically, reactions to the concerns of alcohol and other drug misuse among Aboriginal and Torres Strait Islander people were driven not by governments, but by Aboriginal and Torres Strait Islander people themselves who recognised the fact that mainstream services were non-existent or largely culturally inappropriate.

Today, Indigenous Australians are acutely aware of the impacts of alcohol and other drugs and have been actively involved in responding to alcohol and other drugs misuse in their communities.

Any initiative to reduce the harmful effects of alcohol and other drugs in Aboriginal and Torres Strait Islander communities should be developed with, and led by, those communities.

There is value in supporting these communities, including the evaluation of strategies implemented so that communities can learn from their own and from other communities’ experience.

Any action that attempts to treat alcohol and other drugs needs to come from a holistic model of care that is comprehensive and culturally appropriate.

Awareness of the land, the physical body, clan, relationships, and lore, it is the social, emotional and cultural wellbeing of the whole community and not just the individual.

This is why western models of treatment just won’t work.

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

A holistic approach locally designed and operated by Indigenous people is favoured in its ability to be tailored to community needs and in a cultural context that is owned and supported by the community. 

Despite inadequate funding and resources, the ACCHOs sector has been identified as having a unique role in making alcohol and other drug treatment services more accessible.

One of the unique attributes of Aboriginal controlled drug and alcohol services is that they are a practical expression of Aboriginal peoples’ self-determination, reflected in their governance and treatment models.

A recent example of what works is the pilot of an integrated model of care within Central Australian Aboriginal Congress based in Alice Springs.

Congress developed an integrated non-residential treatment model for Aboriginal and Torres Strait Islanders with alcohol and other drug issues and it is based on providing care for all aspects of health through three streams of care:

Social and cultural support – which is delivered by Indigenous workers with cultural knowledge, language skills and an in-depth knowledge of the Aboriginal community alongside social workers. This stream includes case management and care coordination, advocacy on behalf of clients, social support, cultural support, access to medical care, and opportunistic alcohol and other drug counselling and brief interventions.

Psychological therapy – which is carried out by qualified therapists delivering evidence-based treatments including cognitive behaviour therapy (CBT) and related psychological therapies and access to neuropsychological assessment and treatment. And:

Medical treatment – which is provided by Congress GPs and other members of the primary health care team, and includes medical assessments of alcohol and other drug clients, management of chronic disease and prescription of pharmacotherapies where appropriate to assist with alcohol withdrawal.

This model recognises the comorbidities that occur with alcohol and other drug clients and sought to address within a holistic approach that is adaptable based on needs of individuals.

In 2016-17, in the presenting alcohol and other drug clients, 28% received only one stream of care, 59% received two-streams and the remainder, 13% received all three streams of care.

The Congress ‘three streams model’ of care for alcohol and other drug treatment has been developed over many years to provide a single, integrated multidisciplinary service organised around social and cultural support; psychological therapy; and medical care.

In doing so, it reduces demands on clients presenting with alcohol and other drug issues to navigate multiple health care providers, and attempts to address their holistic needs, including advocacy and support around the social determinants of health and wellbeing including housing, welfare and employment, criminal justice, and basic life needs.

This is a great example of how well it can work when the system is correct and can be used as a model for other ACCHOs to learn from.

The diversity of Aboriginal Australia means that no service model can be simply transferred from one place to another. Instead, the strength of Aboriginal community-controlled health services is their capacity to adapt successful models to the particular needs, strengths and histories of the communities they serve.

But funding is a barrier in implementing optimal services in many regions.

A recent report on organisations conducting Indigenous-specific alcohol and other drug services found that a lack of government commitment to funding community-controlled organisations has compromised the capacity of Indigenous Australians to address alcohol and other drug issues within their own communities.

In addition, the capacity of Aboriginal community-controlled organisations to deliver services was severely constrained by staff shortages, lack of trained and qualified staff, and very limited access to workforce development programs.

Treatment is also not the only key, continuing to increase the community awareness and education about the effects of alcohol and other drugs and the treatment options for dealing with issues is vital.

Including a range of health promotion activities and groups including exercise and nutrition programs, tobacco use treatment and preventions groups to address the holistic needs is essential and well help to reduce the levels of risky drinking and the efficacy of treatment once in treatment.

We need to enable our people to have control over their health and improve health literacy on risky behaviours to help stop the impacts of alcohol and other drugs.

 Part 2 Minister Indigenous Health Ken Wyatt keynote 

Good morning. In West Australian Noongar language I say “kaya wangju” – hello and welcome.

I acknowledge the traditional custodians of the land on which we’re meeting, the Kaurna people, and pay my respects to Elders past and present.

The 5th National Indigenous Drug and Alcohol Conference is a positive opportunity to make progress on a difficult issue.

The conference theme is Responding to Complexity – and there certainly is no one-size-fits-all solution to the challenges our people face.

This is why we have to attack the scourge of drug and alcohol dependency and abuse on multiple fronts.

To form new partnerships.

To speak and to listen, with open minds and hearts.

All of us want to see better health for First Nations Australians.

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

Working together, we are making progress, reducing binge drinking rates among our people from 38 per cent to 31 per cent between 2008 and 2014–15.

But there is still much work to be done.

As we see in the Aboriginal and Torres Strait Islander Health Performance Framework report, social determinants are estimated to make up 34 per cent of the gap in health outcomes between First Nations’ people and other Australians.

Together, with behavioural risk factors, such as alcohol, drug and tobacco use, they account for 53.2 per cent of the health gap.

Alcohol and drug abuse has a broad and insidious impact.

We have a moral and social imperative to work together to put an end to violence and dysfunction and the drug- and alcohol-driven neglect of children in our communities.

Our Government is committed to working with families and individuals to address substance misuse and to break the cycle of disadvantage that prevents children from attending school, and adults from going to work.

Particularly for the protection of children, we have invested over $10 million to provide better diagnosis and management, develop best practice interventions and services to support high-risk women.

A 10-year FASD Strategic Action Plan is in the final stage of development.

Just as important, we see outstanding examples of local warriors for health – like June Oscar and her team in Fitzroy Crossing – who have tackled alcohol in their communities, with life-changing results for children and families.

We must try harder to understand and address the underlying causes of alcohol and drug misuse.

The percentage of First Nations’ people who drink is no greater than for other Australians – in fact, there are many of our people who do not drink at all.

Equally, the impacts of trauma on the health of our communities cannot be ignored, because they add to the complexity of the challenge.

Trauma is no excuse for substance abuse, violence or neglect – but understanding its history can help us reduce its impact.

It reaches across generations of Aboriginal and Torres Strait Islander people, and must be acknowledged and addressed.

Significant health impacts have resulted from displacement from family and country, institutionalisation, racism, abuse and neglect.

This has led to increasingly high rates of incarceration and juvenile detention, suicide, family violence, children being taken into care, and poorer physical and mental health.

63 per cent of First Nations’ prisoners are incarcerated as a result of violent crimes and offences that cause harm.

First Nations’ offenders are also more likely to be under the influence of alcohol when they offend.

It’s a sad fact, that alcohol was involved in 80 per cent of cases of domestic homicide, where both the offender and the victim were First Nations’ people.

That’s more than three times the level of domestic homicides involving other Australians.

It’s also known that First Nations people who engage in alcohol-related crime are themselves more likely to be the victims of such offences.

The question is, how do we reduce high-risk levels of alcohol consumption?

Harm reduction programs can minimise the immediate danger posed by alcohol misuse; but our broader aim should be to reduce alcohol intake.

Our Government is investing in a series of activities which have been shown to be effective.

These range from alcohol restrictions to treatment and rehabilitation.

Under the Indigenous Advancement Strategy, the Government has committed around $70 million in 2017–18 to support over 80 Indigenous alcohol and other drug treatment services.

They are located in places with high First Nations’ populations, in capital cities and regional centres as well as outer regional and remote areas.

Alcohol is a particular problem in the Northern Territory.

Our Government recognises this and is providing more than $91 million over seven years for targeted local action to reduce alcohol related harm.

A significant part of our national support to reduce risk also includes primary healthcare and population health programs addressing smoking and alcohol, in urban, regional and remote locations across Australia.

Poor mental health as a result of drug and alcohol problems is a huge issue and one which I am pleased will be addressed during this important conference.

It is equally high on our Government’s agenda.

The Australian Health Ministers’ Advisory Council recently endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023.

The council has prioritised development of a national Indigenous Health and Medical Workforce Plan, which aims to increase the number of Aboriginal doctors, nurses and health workers on country and in our towns and cities.

Primary Health Networks across Australia also have mental health and Aboriginal and Torres Strait Islander health among their priorities.

I am very keen to ensure Primary Health Networks provide a strong platform for culturally comfortable drug, alcohol and mental health services.

To that end, we have targeted more than $85 million to improve access for integrated, culturally appropriate and safe mental health services for First Nations people.

Our Primary Health Networks are also currently investing a further $79 million on the provision of alcohol and other drug services specifically designed to meet the needs of First Nations people, at the local level.

While the effects of alcohol and drugs can be dire, the insidious damage caused by tobacco is significant.

Statistics show that smoking is responsible for 23 per cent of the gap in health outcomes between First Nations’ people and other Australians.

That is why reducing smoking rates among Aboriginal and Torres Strait Islander people is central to our efforts to close the gap.

By supporting locally linked projects within a national campaign, we are seeing some success.

The daily smoking rate for First Nations’ people aged 15 years and over has declined from 49 per cent in 2002 to 39 per cent in 2014–15, with most of this since 2008, when targeted measures commenced.

However, the daily smoking rate in remote areas is still 47 per cent, and worryingly, the number of First Nations’ women smoking while pregnant remains far too high, at 46 per cent.

To continue supporting change for the better – through funding certainty and proven programs – we have gone to a four-year, $300 million funding commitment for the successful Tackling Indigenous Smoking program.

We are supporting Aboriginal and Torres Strait Islander specific education programs, as part of the National Tobacco Campaign.

“Don’t Make Smokes Your Story” targets First Nations’ smokers aged 15 years and over.

Since its third phase concluded at the end of June, evaluation has shown its effectiveness.

86 per cent of First Nations smokers were aware of the campaign.

7 per cent had quit and 26 per cent said they had reduced the amount they smoke.

If we can maintain this sort of momentum, I am we will see significant improvements in health in future.

We have also had significant success in reducing petrol sniffing, which can cause brain damage and even death.

Independent research undertaken since 2005 indicates that in communities with low aromatic fuel, petrol sniffing has dropped by 88 per cent.

Low aromatic fuel, subsidised by the Government, has now replaced regular unleaded in around 175 outlets in the Northern Territory, Queensland, Western Australia and South Australia.

There were special factors related to petrol sniffing which make it impractical to apply the same approach to alcohol and drug misuse.

But there is one big lesson from that success.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference will be an important part of that solution – and I look forward to hearing the outcomes.