NACCHO Guide to Aboriginal Health and the #Budget2018NACCHO : What @NACCHOAustralia @AMAPresident @RACP @CroakeyNews and 21 peak health groups would like to see in tonight’s #Healthbudget18 ?

 

We need political will to #CloseTheGap. There are volumes of research, strategies and action plans sitting with governments – but they are not being properly resourced and funded. Make it right in tonight’s Budget “

AMA President, Dr Michael Gannon, said that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Also read NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 ” The Federal Government must provide long-term funding certainty for the Medical Outreach Indigenous Chronic Disease Program, which is focused on preventing, detecting and managing chronic disease for Aboriginal and Torres Strait Islander people.”

RACP President Dr Catherine Yelland

Download the full submission here or read Aboriginal health extracts below

racp-2018-19-pre-budget-submission

Historical background RACP Associate Professor Noel Hayman

 “I’ve been working in the field of Indigenous health for 20 years now. The major changes, trends that I’ve seen over the years, has been improvements in infant mortality. But the one that contrasts that is the worsening mortality in middle age—we see high rates of mortality in Aboriginal people in their 40s and 50s. And this is due to chronic disease, particularly diabetes, ischaemic heart disease and chronic kidney disease.

Associate Professor Noel Hayman, Clinical Director of the Inala Indigenous Health Service in Brisbane.

He was the first Aboriginal GP in Queensland, and the first Aboriginal and Torres Strait Islander person to become a Fellow of the Australasian Faculty of Public Health Medicine at the RACP.

From Interview June 2016 Listen HERE

RACP Press Release

Doctors are calling for the Federal Government to provide long-term funding to programs that prevent, detect and manage chronic disease for Aboriginal and Torres Strait Islander people.
As detailed in the Royal Australasian College of Physicians’ pre-budget submission, these programs could help ensure better health outcomes and close the gap between Aboriginal and Torres Strait Islander health outcomes and those of the non-Indigenous community.

The RACP recommends that the Australian government :

Aboriginal and Torres Strait Islander Health

• Allocate secure long-term funding to progress the strategies and actions identified in the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) Implementation Plan.

• Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).

• Build and support the capacity of Aboriginal and Torres Strait Islander health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.

• Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, in line with the recommendations of the Fifth National Mental Health and Suicide Prevention Plan. Allocate sufficient funding for the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Strategy.

• Fund the syphilis outbreak short-term action plan and coordinate this response with long term strategies.

• Allocate long-term funding for primary health care and community- led sexual health programs to embed STI/BBV services as core primary health care (PHC) activity, and to ensure timely and culturally supported access to specialist care when needed, to achieve low rates of STIs and good sexual health care for all Australians.

• Invest in and support a long-term multi-disciplinary sexual health workforce and integrate with PHC to build longstanding trust with communities.

• Allocate funding for STI and HIV point of care testing (POCT) devices, the development of guidelines for POCT devices and Medicare funding for the use of POCT devices.

Extract from Pre budget submission

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians.

The latest ‘Closing the Gap’ report found that Australia is not on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.

The gap for deaths from cancer between Aboriginal and Torres Strait Islander and non-Indigenous Australians has in fact widened in recent years, with Aboriginal and Torres Strait Islander cancer death rates increasing by 21 percent between 1998 and 2015, while there was a 13 per cent decline for non-Indigenous Australians in the same period8.

To address these inequities and improve access to care, continuing and strengthened focus and appropriate long-term funding is required. It is imperative that there is secure funding for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan.

Funding uncertainty and frequent changes create significant issues that impact the continuity of services to patients and organisations in their ability to retain and build their capacity.

Read in full NACCHO Aboriginal Health and #Sexual Health @TheRACP 2018-19 Pre-#budget submission : Long-term funding needed to improve #Indigenous health

 

”  A December 2017 report from the Australian Institute of Health and Welfare (AIHW) shows that the mortality gaps between Indigenous and non-Indigenous Australians are widening, not narrowing.

Urgent action is needed to reverse these trends to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy within a generation (by 2031).

The following submission by the National Aboriginal Community Controlled Health Organisation (NACCHO) in relation to the Commonwealth Budget 2018 aims to reverse the widening mortality gaps.

The following policy proposals are divided into four areas below and summarised in the following table:

  1. Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
  2. Proposals that improve responsiveness of mainstream health services for Indigenous people
  3. Proposals that address specific preventable diseases
  4. Proposals that build in an Indigenous position into policy considerations that impact on health.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted ”

Download the full NACCHO submission HERE or part 3 below

NACCHO-Pre-budget-submisson-2018

Connect tonight with NACCHO #Budget2018NACCHO

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Besides our NACCHO live and recorded interviews

What will the 2018 Federal Budget mean for the health sector and consumers?

Consumers Health Forum of Australia Policy Team will be holding a free public webinar next Wednesday 16 May, 12:30pm AEST, to discuss the key health measures in the budget from a consumer perspective.

They will share our position on them, and take participants’ feedback and questions.

To join , register herehttps://chf.org.au/events/budget-2018-consumer-perspective

Part 2 Federal Budget 2018/19 – Preview and review of 21 health sector submissions

What is the number one health issue that the Government should address in tonight’s  Federal Budget?  Jennifer Doggett from Croakey analyses the pre-Budget Submissions from 21 health groups and finds surprising agreement among them on the urgent need for action in one key area.

Read on to find out what this issue is and the six key measures the Government should announce on Tuesday night if it wants to keep the health sector onside.  Check back on Wednesday to see how closely the Federal Government has followed the proposals from health and medical groups in this (possibly) pre-election Budget.

Bookmark this link for our coverage of the Federal Budget, and please use the hashtag #HealthBudget18 to share health-related budget news.

Read and subscribe here

Read full article here

2018/19 Federal Budget priorities

So what do this year’s crop of Pre-Budget submissions tell us about the current priorities of the health sector? After reviewing a slew of health-related pre-Budget submissions it is clear that there is one stand-out issue that has the overwhelming support of the health sector, with virtually every submission supporting action on this issue in some form or other.

That issue is prevention.  The clear message emerging from the submissions was that preventive health is the glaring gap in health policies at the federal level and the most pressing issue that needs to be addressed to improve the health of our community.

Almost every health-related pre-Budget submission included a strong focus on prevention, in particular those from the Public Health Association of Australia (PHAA), the Consumers Health Forum (CHF), the Australian Healthcare and Hospitals Association (AHHA), the Australian Medical Association (AMA), the Complementary Medicines Association (CMA), the Victorian Healthcare Association (VHA) and the Royal Australian College of Physicians (RACP).

The most strongly supported proposal overall was for the establishment of a national preventive health body to oversee and coordinate preventive health policies across all sectors and level of government.

The AMA’s submission reflected the reasons expressed in many submissions for such a national body: Obesity, nutrition, alcohol, tobacco and physical activity are health policy areas desperately in need of funded national strategies and measurable targets. These are best delivered through an independent, dedicated organisation.

Obesity was the most commonly mentioned health issue with a number of groups supporting a sugar tax, junk food advertising restrictions and physical activity programs.

Indigenous health

There was broad agreement across the submissions that we need to do more to close the health and life expectancy gap between Indigenous and non-Indigenous Australians and that supporting Indigenous community-controlled initiatives and services are the best way to achieve this.

Supporting and growing the Indigenous health workforce was a key feature of NACHHO’s submission, along with establishing an Aboriginal and Torres Strait Islander Commonwealth Advisory Group to support consideration, implementation and monitoring of an Indigenous position in efforts to Close the Gap and on jurisdictional agreements that have high impact on Indigenous peoples.

The AHHA and the AMA called for funding to implement the National Aboriginal and Torres Strait Islander Health Plan and the AMA also called for the Government to support the Redfern Statement.

Six key actions

After reviewing these submissions, the message is clear.  If the Government wants to win over the health sector on Tuesday night it needs to do the following:

  1. Establish a National Preventive Health Body (although this could be slightly awkward for the Government, given it abolished a similar body, the Australian National Preventive Health Agency in 2014)
  2. Announce a national obesity strategy
  3. Set up a Productivity Commission review of private health insurance
  4. Increase funding for the community-controlled Indigenous health sector
  5. Increase funding for public dental services
  6. Take action on mental health

Part 3

Widening mortality gaps require urgent action

The life expectancy gap means that Indigenous Australians are not only dying younger than non-Indigenous Australians but also carry a higher burden of disease across their life span, impacting on education and employment opportunities as well as their social and emotional wellbeing.

Preventable admissions and deaths are three times as high in Indigenous people yet use of the main Commonwealth schemes, Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) are at best half the needs based requirements.

It is simply impossible to close the mortality gaps under these conditions. No government can have a goal to close life expectancy and child mortality gaps and yet concurrently preside over widening mortality gaps.

Going forward, a radical departure is needed from a business as usual approach.

Funding considerations, fiscal imbalance and underuse of MBS/PBS

The recent Productivity Commission Report found that per capita government spending on Indigenous services was twice as high as for the rest of the population.

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

Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.

In terms of health expenditure, the Commonwealth spends $1.4 for every $1 spent on the rest of the population, notwithstanding that, on the most conservative assumptions, Indigenous people have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

This represents a significant market failure. The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

A pressing need is to address the shortfall in spending for out of hospital services, for which the Commonwealth is mainly responsible, and which is directly and indirectly responsible for excessive preventable admissions funded by the jurisdictions – and avoidable deaths.

The fiscal imbalance whereby underspending by the Commonwealth leads to large increases in preventable admissions (and deaths) borne by the jurisdictions needs to be rectified.

Ultimately, NACCHO seeks an evidenced based, incremental plan to address gaps, and increased resources and effort to address the Indigenous burden of disease and life expectancy.

The following list of budget proposals reflect the burden of disease, the underfunding throughout the system and the comprehensive effort needed to close the gap and ideally would be considered as a total package.

NACCHO recommends initiatives that impact on the greatest number of Indigenous people and burden of preventable disease and support the sustainability of the Aboriginal Community Controlled Health Organisation (ACCHO) sector – see proposals 1. a) to e) and 3. a) and b) as a priority.

NACCHO is committed to working with the Australian Government on the below proposals and other collaborative initiatives that will help Close the Gap.

National Aboriginal Community Controlled Health Organisation

NACCHO is the national peak body representing 144 ACCHOs across the country on Aboriginal health and wellbeing issues

In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.

Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following proposals are informed by NACCHO’s work with Aboriginal health services, its members, the views of Indigenous leaders expressed through the Redfern Statement and the Close the Gap campaign and its engagement and relationship with other peak health organisations, like the Australian Medical Association (AMA).

Guiding principles

Specialised health services for Indigenous people are essential to closing the gap as it is impossible to apply the same approach that is used in health services for non-Indigenous patients.

Many Indigenous people are uncomfortable seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. Access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation.

Many Indigenous people live below the poverty line so that services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Indigenous patients due to significant cultural, geographical and language disparities: ACCHOs attempt to overcome such challenges.

An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management.

They form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.

Studies have shown that ACCHOs are 23% better at attracting and retaining Indigenous clients than mainstream providers and at identifying and managing risk of chronic disease.

Indigenous people are more likely to access care if it is through an ACCHO and patients are more likely to follow chronic disease plans, return for follow up appointments and share information about their health and the health of their family.

ACCHOs provide care in context, understanding the environment in which many Indigenous people live and offering true primary health care. More people are also using ACCHOs.

In the 24 months to June 2015, our services increased their primary health care services, with the total number of clients rising by 8%. ACCHOs are also more cost-effective providing greater health benefits per dollar spent; measured at a value of $1.19:$1.

The lifetime health impact of interventions delivered our services is 50% greater than if these same interventions were delivered by mainstream health services, primarily due to improved Indigenous access.

If the gap is to close, the growth and development of ACCHOs across Australia is critical and should be a central component to policy considerations.

Mainstream health services also have a significant role in closing the gap in Indigenous health, providing tertiary care, specialist services and primary care where ACCHOs do not exist.

The Indigenous Australians’ Health Programme accounts for about 13% of government expenditure on Indigenous health.

Given that other programs are responsible for 87% of expenditure on Indigenous health, it reasonable to expect that mainstream services should be held more accountable in closing the gap than they currently are.

Greater effort is required by the mainstream health sector to improve its accessibility and responsiveness to Indigenous people and their health needs, reduce the burden of disease and to better support ACCHOs with medical and technical expertise.

The health system’s response to closing the gap in life expectancy involves a combination of mainstream and Indigenous-specific primary care providers (delivered primarily through ACCHOs) and where both are operating at the highest level to optimise their engagement and involvement with Indigenous people to improve health outcomes.

ACCHO’s provide a benchmark for Indigenous health care practice to the mainstream services, and through NACCHO can provide valuable good practice learnings to drive improved practices.

NACCHO also acknowledges the social determinants of health, including housing, family support, community safety, access to good nutrition, and the key role they play in influencing the life and health outcomes of Indigenous Australians.

Elsewhere NACCHO has and will continue to call on the Australian and state and territory governments to do more in these areas as they are foundational to closing the gap in life expectancy.

Addressing the social determinants of health is also critical to reducing the number of Indigenous incarceration. Comprehensively responding to the Royal Commission into the Protection and Detention of Children in the Northern Territory must be a non-negotiable priority.

Proposals

The following policy proposals are divided into four areas below and summarised in the following table:

  1. Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
  2. Proposals that improve responsiveness of mainstream health services for Indigenous people
  3. Proposals that address specific preventable diseases
  4. Proposals that build in an Indigenous position into policy considerations that impact on health.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted

Continued HERE NACCHO-Pre-budget-submisison-2018

NACCHO Aboriginal Health #ACCHO Deadly Good News stories : Features @AMAPresident Dr Michael Gannon visits our #NT ACCHO’s in Central Australia Plus News from #NSW #TAS #QLD #VIC #WA #SA #ACT

1. NT : This week the President of the AMA Dr Michael Gannon paid a flying visit to our ACCHO’s in Central Australia : His 2 day diary

2.1 NSW : Indigenous culture at the heart of new Katungul Aboriginal Corporation Community and Medical Services (ACC&MS) home care project

2.2 NSW : Yerin Incorporating Eleanor Duncan Aboriginal Health Centre inaugural Health Care Quality Committee

3. QLD : Apunipima celebrates the first anniversary of its Wellbeing Centres :  It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago.

4. SA : Nganampa Health Council’s 2017 Annual Report is now available

5. WA : Two Aboriginal women, leaders in Aboriginal health care in Western Australia, have been recognised for their lifelong dedication and commitment to improving the health and wellbeing of Aboriginal people.

6.VIC : The Commission for Children and Young People welcomes the appointment of  former NACCHO Chair Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People

7. TAS : A yarn with Assoc. Professor Greg Phillips April 20

8.1 ACT : Winnunga ACCHO Download the April Newsletter

8.2 ACT : Winnunga has commenced a new program for first time mothers of Aboriginal and Torres Strait Islander babies

 View hundreds of ACCHO Deadly Good News Stories over past 6 years

How to submit a NACCHO Affiliate  or Members Good News Story ?

 Email to Colin Cowell NACCHO Media    

Mobile 0401 331 251

Wednesday by 4.30 pm for publication each Thursday /Friday

1. NT : This week the President of the AMA Dr Michael Gannon paid a flying visit to our ACCHO’s in Central Australia : Here is his 2 day diary

Day 1.1 Pintupi Homelands Health Service Kintore

Thank you for welcome to Pintupi Homelands Health Service, @WDNWPT Purple House Dialysis Unit in Kintore, NT.

Social, economic, human benefits of delivering health care on country, under community control in evidence

Day 1.2 Urapuntja Health Service Utopia

Fabulous welcome to Urapuntja Health Service Utopia, NT.

Innovative, impressive primary healthcare service delivery in difficult setting. Shocking Diabetes rates. Exciting new Dialysis service. Real answers of course lie in prevention, addressing social determinants of health

Day 2 .1 Congress Alice Springs

Thank you to Congress Alice Springs for the meeting/tour. Fabulous integration of doctors, nurses, midwives, AHWs, allied health experts. Disc. housing, water, social determinants of health, proposed rural training hubs as way to build medical workforce in regional Australia

Day 2.2 Congress Alice Springs; Harm caused by cannabis

Talking to Doctors, Aboriginal Health Workers about harm caused by cannabis in Alice Springs. Any permissive messaging on Gunja extremely harmful to local Indigenous population and their mental health.

Will impair prevention messages my colleagues working so hard on

Day 2.3 : NPY  Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara Women’s Council  

Thank you to Andrea Mason, Angela Lynch NPY Women’s Council. Fascinating insights into the work of Ngangkari, wellness models, Mental

2.1 NSW : Indigenous culture at the heart of new Katungul Aboriginal Corporation Community and Medical Services (ACC&MS) home care project

 

“At the heart of our philosophy of Koori Health in Koori Hands is the health and wellbeing of our Elders,

By our Elders maintaining their lifestyle and connection to culture and country, we will be able to keep them independent and at home for longer.”

CEO of Katungul ACC&MS Robert Skeen also emphasised the connection to country experienced by Aboriginal Elders that is a key driver of the project

A new $1.4 million culturally-sensitive Indigenous seniors home care project, designed for Bateman’s Bay in New South Wales, has been agreed to and launched between aged care provider IRT Group and the Katungul Aboriginal Corporation Community and Medical Services (ACC&MS).

The project is designed to suit Indigenous cultural preferences and recognises that Aboriginal seniors have a connection to country and a desire to age in place, while also aiming to support older aboriginal people to stay in their own homes as they age.

Following the government grant funded project’s launch on 9 April signified by the signing of a Memorandum of Understanding (MoU), there is expected be a first meeting of the Project’s Steering Committee, formed to guide the project’s community-based and community-led approach to Indigenous aged care over the next three years.

IRT Group Chief Executive Officer (CEO) Patrick Reid says the project addresses barriers to accessing aged care by assisting Aboriginal seniors to apply for government home care funding assistance.

He also adds that IRT’s registered training organisations, IRT Academy, will support the project with delivery of a Certificate III training package for Indigenous trainees to provide culturally-appropriate home care services.

“Through the work of our IRT Foundation, we aim to provide equity in aged care service provisions to all seniors in the community,” Mr Reid says.

“We’re proud to partner with Katungul which has been working for the last 25 years to enable Aboriginal people to live healthy lives, enriched by a strong living culture, dignity and justice.”

Following the Project’s Steering Committee’s first meeting, a Koori Aged Care Community Yarn Up information session will also be held.

This session will have experts on hand to answer questions about the benefits of Koori Home Care, as well as the training offered by IRT Academy.

2.2 NSW : Yerin Incorporating Eleanor Duncan Aboriginal Health Centre inaugural Health Care Quality Committee

This week Yerin had their inaugural Health Care Quality Committee meeting.
The purpose of the Committee is to provide the Yerin Incorporating Eleanor Duncan Aboriginal Health Centre Board and CEO with expert clinical advice on clinical governance, patient experience and quality management of systems

3. QLD : Apunipima celebrates the first anniversary of its Wellbeing Centres :  It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago. 

“We have been able to employ community members into all positions in the centres, which include Receptionists, SEWB workers and Team Leaders.”

Our team leaders are also leaders in their community, which fits beautifully into the Apunipima Model of Care and is something that sets our service apart.”

Tanya Robinson, the Social Emotional Wellbeing Services Manager said it was important for the centres to have a strong local workforce

Last week marked the first anniversary of Apunipima’ s Wellbeing Centres in Cape York.

It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago, at centres in Aurukun, Coen, Hope Vale and Mossman Gorge.

The Social Emotional Wellbeing services were set up in 2009 by the Royal Flying Doctor Service, in April 2017 Apunipima assumed responsibility and took over the management of these centres.

The role of the Apunipima Wellbeing Centres is to support the broad social and emotional wellbeing needs of each community. Each centre works to the Apunipima Model of Care, a community driven, community led model that focuses on all aspects of cultural, emotional, environmental and spiritual wellbeing.

Setting up a new service arm within any organisation can be a challenging time, Apunipima took these challenges in their stride, keeping community at the forefront of all changes.

“It was really important that the transfer to Apunipima management of the centres had no negative impact on clients using the services. I think we can be really proud of how that unfolded; it was a seamless transition.” Said Bernard David, who was the Regional Manager for Social Emotional Wellbeing at Apunipima.

Apunipima’ s Social Emotional Wellbeing team spent a lot of time in each community, before, during and after the changeover, meeting with all of the stakeholders to ensure that community members were involved in how the program would be delivered into the future.“

Both Bernard and Tanya agree that the future is looking great for the Wellbeing Centres. “We are constantly looking at how we can better service our clients and that will be our focus in the coming months.” Said Tanya.

4. SA : Nganampa Health Council’s 2017 Annual Report is now available

The Annual Report highlights a number of significant achievements in the past year including:

Download copy here

• Excellent child and women’s health program outcomes
• An enhanced program of specialist visiting teams
• Strong Anangu employment and training outcomes
• An improved chronic disease management program leading to increased adult health checks
• Continuing high levels of participation in our sexual health screen and continued low levels of infection
• Innovative and collaborative public health programs
• Robust, leading edge information technology systems
• A continued strong financial position

To reduce our impact on the environment we have reduced the number of annual reports we have printed.

If you would like to receive a paper copy of this year’s report, or receive a notification next year by email, please send us a private message.

5. WA : Two Aboriginal women, leaders in Aboriginal health care in Western Australia, have been recognised for their lifelong dedication and commitment to improving the health and wellbeing of Aboriginal people.

 

Two Aboriginal women, leaders in Aboriginal health care were posthumously honoured with the Aboriginal Health Council of Western Australia’s prestigious lifetime achievement awards at the State Sector Conference Dinner

Donnybrook Elder Gloria Khan and Derby Elder Maxine Armstrong have dedicated their lives to advancing the agenda for Aboriginal health in WA.

AHCWA Chairperson Vicki O’Donnell said both women had made positive differences to their communities.

Maxine, who passed away in March 2018, was the last of five founding members of the Derby Aboriginal Health Service, and had served as the Derby Aboriginal Health Service Chairperson for over 15 years. Maxine was also Chairperson of the Kimberley Aboriginal Medical Service Board for over 10 years and a Director on the AHCWA Board for more than a decade.

“Maxine was a passionate advocate for Indigenous and Aboriginal health, with her driving force to ‘help her people’,” Ms O’Donnell said.

“In particular, she was steadfast in her commitment to address the alarming rate of chronic disease in indigenous communities, the unacceptable rate of suicide and the impact of drugs on individuals, their families and their communities.

“Maxine was particularly proud of her efforts to secure funding for key medical facilities such as the Derby Aboriginal Health Service Dialysis Hub and Renal Health Centres in Derby, Kununurra and Fitzroy Crossing. She was also integral to the establishment of a refuge for Indigenous women.”

Maxine’s dedication and commitment to Aboriginal primary health was passionate and instrumental in developing strong partnerships with many community stakeholders across WA and Australia.

Gloria, who passed away in February 2018, was a passionate leader who worked tirelessly to improve the health and wellbeing of Aboriginal people both in WA and across Australia.

She served as the AHCWA chairperson from 2005 to 2008, during which time she was also the Chair and the Deputy Chair of the South West Aboriginal Medical Service and Executive Director of the National Aboriginal Community Controlled Health Organisation.

Gloria also sat on several committees including the Ministerial Council for Suicide Prevention and the Telethon Kids Institute’s WA Aboriginal Child Health Survey Steering Committee, the largest and most comprehensive study into the health, wellbeing and development of Indigenous children.

“Gloria was a strong, proud Nyoongar woman who dedicated many years of service to Aboriginal health in WA and across Australia,” Ms O’Donnell said.

“Along with her kindness and compassion, she brought a wealth of knowledge to the sector as a nurse and a trained counsellor, with experience in the areas of domestic violence, sexual assault, grief and drug and alcohol abuse.

“Gloria’s depth of knowledge and understanding of Aboriginal health at the local, state and national level gave her the opportunity to advocate these issues in many forums.

“She showed true leadership, advocacy and commitment to help close the life expectancy gap between Aboriginal and non-Aboriginal people of Australia.”

Maxine and Gloria’s legacies will continue through the efforts of others to ensure the advances and progress they made will continue.

More than 260 delegates from around the state are attending AHCWA’s annual state sector conference at the Esplanade Hotel Fremantle over April 11 and 12.

Yesterday, AHCWA unveiled its revolutionary new health atlas, Mappa, which provides cutting edge mapping technology to help align patients with local healthcare providers.

Tomorrow will see Federal Indigenous Health Minister Ken Wyatt launch AHCWA’s Western Australia Aboriginal Youth Health Strategy 2018-2023: Today’s young people, tomorrow’s leaders.

Developed with and on behalf of young Aboriginal people in WA, the strategy is the culmination of almost a decade of AHCWA’s commitment and strategic advocacy in Aboriginal youth health.

Over the two days, 15 workshops and keynote speeches will be held. AHCWA will present recommendations from the conference in a report to the state and federal governments to highlight the key issues about Aboriginal health in WA and determine future strategic actions.

6.VIC : The Commission for Children and Young People welcomes the appointment of  former NACCHO Chair Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People

The Commission for Children and Young People welcomes the appointment of Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People.

Mr Mohamed is a proud Aboriginal man of the Gooreng Gooreng nation near Bundaberg in Queensland. He has dedicated the past 25 years to working towards building a stronger and healthier nation for Aboriginal and Torres Strait Islander peoples.

‘Mr Mohamed is well known as a strong and experienced advocate, and I look forward to working alongside him to advance the rights and interests of Aboriginal children and young people in Victoria,’ Principal Commissioner Liana Buchanan said.

The appointment comes at a time when Victoria has made significant commitments and some progress in tackling long-standing issues for Aboriginal children, particularly those in out-of-home care.

‘There remains much work to be done to tackle discrimination, improve services and ensure that Aboriginal children and young people in Victoria can fully enjoy the rights that many take for granted,’ Ms Buchanan said.

More information about the appointment can be found in the Minister for Families and Children media release: Introducing A New Champion For Aboriginal Young People

Mr Mohamed will begin his tenure on 28 May.

Listen to radio interview

Treaty is connected self worth and empowerment for Aboriginal youth: Justin Mohamed

Victoria has a new Commissioner for Aboriginal Children and Young People and he says the state is changing the course of the Indigenous community with its combined efforts on dealing with children in care and a treaty with the state’s Indigenous people.

Justin Mohamed will take up the position next month, well credentialed as a former head of the National Aboriginal Community Controlled Health Organisation, and a former chief executive of Reconciliation Australia.

Victoria is the only state to have a Commissioner for Aboriginal Children and Young people and the state has been grappling with a 60 per cent increase in the number of children entering care between 2013 and 2015

7. TAS : A yarn with Assoc. Professor Greg Phillips April 20

8.1 ACT : Winnunga ACCHO Download the April Newsletter

Download HERE Winnunga AHCS Newsletter April 2018 (003)

8.2 ACT : Winnunga has commenced a new program for first time mothers of Aboriginal and Torres Strait Islander babies

Download Brochure : ANFPP brochure

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

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

See 2 SkyNews Broadcasts below

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

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

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

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

Above Editorial Daily Telegraph 3 April

Firstly those in favour of this cultural safety policy include

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

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

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

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

1.Dr Michael Gannon President AMA

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

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

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

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

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

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

2. AMA (NSW) President, Prof Brad Frankum

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

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

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

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

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

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

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

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

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

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

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

6.NSW Health deputy secretary Susan Pearce

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

7.NSW Health spokeswoman .

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

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

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

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

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

Part 1 NSW Policy

Download The Policy document in full

NSW Policy Doc

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

Strategies to address issues identified should be implemented and evaluated

2.1.3 Considerations for Aboriginal patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 3 : Culturally safe healthcare starts in the waiting room

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

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

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

 

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

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

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

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

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

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

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

 

Part 4 Racism and the hospital system : Donna Ah Chee

 Read in full here

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

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

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

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

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

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

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

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

References

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

 

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

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

Martin Laverty, Dennis R McDermott and Tom Calma

Originally published by MJA here

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

MJA Cultural Safety

Read 20 + previous NACCHO articles Cultural Safety  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From Real Relief

Opening graphic courtesy of Redfern AMA ACCHO

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

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


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

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

Visit your health practitioner

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

Go to a community health centre or remote health service

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

Visit your local Aboriginal and Torres Strait Islander Health Service

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

Get free advice over the phone

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

Download our NRHAM resources

Click here to download the NRHA Codeine Fact Sheet 

Click here to download the NRHA Posters

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

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

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

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

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

AMA Interview

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

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

AMA President, Michael Gannon see interview in full Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 MICHAEL GANNON:   Thank you, Laura.    

 

 

 

 

 

 

 

NACCHO Aboriginal #MentalHealth Alert : @AMAPresident calls for a national, overarching mental health “architecture”, and proper investment in both #prevention and #treatment of mental illnesses

 

“Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.

General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.”

AMA President, Dr Michael Gannon – Source: Australian Institute of Health and Welfare

Download the AMA 2018 Position Paper

Mental-Health-2018- Position-Statement

Read over 168 NACCHO Mental Health articles published over 5 Years

The AMA is calling for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults will experience a mental health condition in their lifetime, yet mental health and psychiatric care are grossly underfunded when compared to physical health, AMA President, Dr Michael Gannon, said today.

Releasing the AMA Position Statement on Mental Health 2018, Dr Gannon said that strategic leadership is needed to integrate all components of mental health prevention and care.

“Many Australians will experience a mental illness at some time in their lives, and almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague,” Dr Gannon said.

“For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

“Australia lacks an overarching mental health ‘architecture’. There is no vision of what the mental health system will look like in the future, nor is there any agreed national design or structure that will facilitate prevention and proper care for people with mental illness.

“The AMA is calling for the balance between funding acute care in public hospitals, primary care, and community-managed mental health to be correctly weighted.

“Funding should be on the basis of need, demand, and disease burden – not a competition between sectors and specific conditions. Policies that try to strip resources from one area of mental health to pay for another are disastrous.

“Poor access to acute beds for major illness leads to extended delays in emergency departments, poor access to community care leads to delayed or failed discharges from hospitals, and poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

“Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

“As with physical health, prevention is just as important in mental health, and evidence-based prevention can be socially and economically superior to treatment.

“Community-managed mental health services have not been appropriately structured or funded since the movement towards deinstitutionalisation in the 1970s and 1980s, which shifted much of the care and treatment of people with a mental illness out of institutions and into the community.

“The AMA Position Statement supports coordinated and properly funded community-managed mental health services for people with psychosocial disability, as this will reduce the need for costly hospital admissions.”

The Position Statement calls for Governments to address underfunding in mental health services and programs for adolescents, refugees and migrants, Aboriginal and Torres Strait Islander people, and people in regional and remote areas.

It also calls for Government recognition and support for carers of people with mental illness.

“Caring for people with a mental illness is often the result of necessity, not choice, and can involve very intense demands on carers,” Dr Gannon said.

“Access to respite care is vital for many people with mental illness and their families, who bear the largest burden of care.”

The AMA Position Statement on Mental Health 2018 is available at https://ama.com.au/position-statement/mental-health-2018

Background

  • 7.3 million Australians (45 per cent) aged 16 to 85 will experience a common mental health disorder, such as depression, anxiety, or substance use disorder, in their lifetime.
  • Almost 64,000 people have a psychotic illness and are in contact with public specialised mental health services each year.
  • 560,000 children and adolescents aged four to 17 (about 14 per cent) experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.
  • Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.
  • General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.
  • About $8.5 billion is spent every year on mental health-related services in Australia, including residential and community services, hospital-based services (both inpatient and outpatient), and consultations with GPs and other specialists.

(Source: Australian Institute of Health and Welfare)

Support Contact your nearest ACCHO or

 

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

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

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

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

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

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

Will patients stop going to the GP?

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

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

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

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

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

Source Dr Google will see you now :

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

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

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

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

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

Download the NACCHO App HERE

And here is why

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

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

Dr Michael Gannon on why you should see a real Doctor

Full Transcript of Interview

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

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

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

See opening extract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NACCHO Aboriginal Health Workforce : @AMAPresident launches 5 point plan to build #Ruralhealth workforce

 ” About one third of Australia’s population, approximately 7 million people, live in regional, rural and remote areas. These Australians often have more difficulty accessing health services than urban Australians, leading them to have a lower life expectancy and worse outcomes on leading indicators of health.

Death rates in regional, rural, and remote areas (referred to as ‘rural’ in this document unless otherwise specified) are higher than in major cities, and the rates increase in line with degrees of remoteness.”

AMA President, Dr Michael Gannon

Download the AMA Position Statement HERE

AMA Position Statement on Rural Workforce Initiatives

Picture above AIDA : South Australian University’s past and present Australian Rotary Health Indigenous Health scholarship recipients.

(From left: Ian Lee, Jessica Beinke, Bodie Rodman, Olivia O’Donoghue, Kali Hayward, Jonathan Newchurch, Dr Helen Sage and Cheryl Deguara).

 ” Indigenous medical students have three weeks left to apply for the 2018 AMA Indigenous Medical Scholarship.
 
Applications close on 31 January for the Scholarship, a program that has supported Aboriginal and Torres Strait Islander students to study medicine since 1994.  The successful applicant will receive $10,000 each year for the duration of their course.
Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.”
 
THREE WEEKS LEFT TO APPLY FOR 2018 AMA INDIGENOUS MEDICAL SCHOLARSHIP see Part 2 Below

Extracts from AMA Submission

There is a strong link between the health of Indigenous people in rural communities and their access to culturally appropriate health services.

The AMA believes that:

  • greater effort should be made to encourage Indigenous people to undertake medical or health professional training, and incentives provided to encourage Indigenous and non-Indigenous doctors and medical trainees to work in rural and remote Indigenous communities;
  • Aboriginal Medical Services should be resourced to offer mentoring and training opportunities in rural Indigenous communities to Indigenous and non-Indigenous medical students and vocational trainees; and
  • training modules, resource material and ongoing advice should be developed for, and delivered to, all medical schools and rural and remote medical practices on Indigenous health issues, Indigenous-specific health initiatives and culturally appropriate service delivery.

Addressing the mal-distribution of the workforce

There are a number of fundamental reasons why rural areas are not getting their fair share of the medical workforce. These include:

  • inadequate remuneration;
  •  work intensity including long hours and demanding rosters;
  •  lifestyle factors;
  •  professional isolation and lack of critical mass of similar doctors;
  •  reduced access to professional development;
  • reduced access to locum support;
  •  hospital closures and downgrading or withdrawal of other health services;
  •  under-representation of students from a rural background;
  •  poor employment opportunities for other family members, particularly partners;
  •  limited educational opportunities for other family members; and
  •  withdrawal of community services, such as banking, from such areas.

In 2016 the AMA conducted a Rural Health Issues Survey, which sought input from rural doctors across Australia to identify key solutions to improving rural health care.

The almost 600 doctors who took part in the survey said extra funding and resources to support the recruitment and retention of doctors and other health professionals was their top priority in trying to meet the health care needs of their patients.

Doctors also said that for there to be genuine improvements in access to health care for rural patients, there needed to be:

  •  funding and resources to support improved staffing levels and workable rosters for rural doctors;
  •  access to high speed broadband;
  •  investment in hospital facilities and equipment and practice infrastructure;
  •  expanded opportunities for medical training and education in rural areas;
  • improved support for GP proceduralists; and
  •  better access to locum relief.

AMA Press Release 9 January 2018

At least one-third of all new medical students should be from rural backgrounds, and more medical students should be required to do at least one year of training in a rural area to encourage graduates to live and work in regional Australia, the AMA says.

The AMA today released its Position Statement – Rural Workforce Initiatives, a comprehensive five-point plan to encourage more doctors to work in rural and remote locations, and improve patient access to care.

The plan proposes initiatives in education and training, rural generalist pathways, work environments, support for doctors and their families, and financial incentives.

“About seven million Australians live in regional, rural, and remote areas, and they often have more difficulty accessing health services than their city cousins,” AMA President, Dr Michael Gannon, said today.

“They often have to travel long distances for care, and rural hospital closures and downgrades are seriously affecting the future delivery of health care in rural areas. For example, more than 50 per cent of small rural maternity units have been closed in the past two decades.

“Australia does not need more medical schools or more medical school places. Workforce projections suggest that Australia is heading for an oversupply of doctors.

“Targeted initiatives to increase the size of the rural medical, nursing, and allied health workforce are what is required.

“There has been a considerable increase in the number of medical graduates in recent years, but more than three-quarters of locally trained graduates live in capital cities.

“International medical graduates (IMGs) make up more than 40 per cent of the rural medical workforce and while they do excellent work, we must reduce this reliance and build a more sustainable system.”

The AMA Rural Workforce Initiatives plan outlines five key areas where Governments and other stakeholders must focus their policy efforts:

·         Encourage students from rural areas to enrol in medical school, and provide medical students with opportunities for positive and continuing exposure to regional/rural medical training;

·         Provide a dedicated and quality training pathway with the right skill mix to ensure doctors are adequately trained to work in rural areas;

·         Provide a rewarding and sustainable work environment with adequate facilities, professional support and education, and flexible work arrangements, including locum relief;

·         Provide family support that includes spousal opportunities/employment, educational opportunities for children’s education, subsidies for housing/relocation and/or tax relief; and

·         Provide financial incentives to ensure competitive remuneration.

“Rural workforce policy must reflect the evidence. Doctors who come from a rural background, or who spend time training in a rural area, are more likely to take up long-term practice in a rural location,” Dr Gannon said.

“Selecting a greater proportion of medical students with a rural background, and giving medical students and graduates an early taste of rural practice, can have a profound effect on medical workforce distribution.

“Our proposals to lift both the targeted intake of rural medical students and the proportion of medical students required to undertake at least one year of clinical training in a rural area from 25 per cent to 33 per cent are built on this approach.

“More Indigenous people must be encouraged to train and work in health care, as there is a strong link between the health of Indigenous people in rural areas and their access to culturally appropriate health services.

“Fixing rural medical workforce shortages requires a holistic approach that takes into account not only the needs of the doctor, but also their immediate family members.

“Many doctors who work in rural areas find the medicine to be very rewarding, but their partner may not be able to find suitable employment, and educational opportunities for their children may be limited.

“The work environment for rural doctors presents unique challenges, and Governments must work collaboratively to attract a sustainable health workforce. This includes rural hospitals having modern facilities and equipment that support doctors in providing the best possible care for patients and maintaining their own skills.

“Finally, more effort must be made to improve internet services in regional and rural areas, given the difficulties of running a practice or practising telehealth with inadequate broadband.

“All Australians deserve equitable access to high-speed broadband, and rural doctors and their families should not miss out on the benefits that the growing use of the internet is bringing.”

The AMA Position Statement – Rural Workforce Initiatives is available at https://ama.com.au/position-statement/rural-workforce-initiatives-2017

Background:

·         Most Australians live in major cities (70 per cent), while 18 per cent live in inner regional areas, 9 per cent in outer regional areas, and 2.4 per cent in both remote and very remote areas.

·         Life expectancy is lower for people in regional and remote Australia. Compared with major cities, the life expectancy in regional areas is one to two years lower, and in remote areas is up to seven years lower.

·         The age standardised rate of the burden of disease increases with increasing remoteness, with very remote areas experiencing 1.7 times the rate for major cities.

·         Coronary heart disease, suicide, COPD, and cancer show a clear trend of greater rates of burden in rural and remote areas.

·         The number of medical practitioners, particularly specialists, steadily decreases with increasing rurality. The AIHW reports that while the number of full time workload equivalent doctors per 100,000 population in major cities is 437, there were 272 in outer regional areas, and only 264 in very remote areas.

·         Rural medical practitioners work longer hours than those in major cities. In 2012, GPs in major cities worked 38 hours per week on average, while those in inner regional areas worked 41 hours, and those in remote/very remote areas worked 46 hours.

·         The average age of rural doctors in Australia is nearing 55 years, while the average age of remaining rural GP proceduralists – rural GP anaesthetists, rural GP obstetricians and rural GP surgeons – is approaching 60 years.

·         International medical graduates (IMGs) now make up over 40 per cent of the medical workforce in rural and remote areas.

·         There is a health care deficit of at least $2.1 billion in rural and remote areas, reflecting chronic underspend of Medicare and the Pharmaceutical Benefits Scheme (MBS) and publicly-provided allied health services.

Part 2 Update

THREE WEEKS LEFT TO APPLY FOR 2018 AMA INDIGENOUS MEDICAL SCHOLARSHIP
 
Indigenous medical students have three weeks left to apply for the 2018 AMA Indigenous Medical Scholarship.
Applications close on 31 January for the Scholarship, a program that has supported Aboriginal and Torres Strait Islander students to study medicine since 1994.
The successful applicant will receive $10,000 each year for the duration of their course.
Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.
 
“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community,” AMA President, Dr Michael Gannon, said today.
 
“It’s evident that Indigenous people have a greater chance of improved health outcomes when they are treated by Indigenous doctors and health professionals.
 
“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances
“The AMA strongly encourages Indigenous students to apply for the Scholarship, which, along with the AMA’s annual Report Card on Indigenous Health and the work of the AMA Taskforce on Indigenous Health, is part of the AMA’s commitment to improving the health of Aboriginal and Torres Strait Islander Australians.”
 
Previous winners have gone on to become prominent leaders in health and medicine, including Associate Professor Kelvin Kong, Australia’s first Aboriginal surgeon.
 
Applicants must be currently enrolled at an Australian medical school, be in at least their first year of medicine, and be of Aboriginal and/or Torres Strait Islander descent. Further information, including the application form, can be found at https://www.ama.com.au/indigenous-medical-scholarship-2018
 
The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.
 
More information is available at https://ama.com.au/donate-indigenous-medical-scholarship. For enquiries, please contact the AMA via email at indigenousscholarship@ama.com.au or phone (02) 6270 5400.

 

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

 

 ” Poor nutrition has been linked to the reduced health outcomes experienced by Aboriginal and Torres Strait Islander people, contributing to conditions known to disproportionately affect this population, including type 2 diabetes, kidney disease and some cancers.

Twenty two per cent of Aboriginal and Torres Strait Islander people live in a household that has, in the past 12 months, run out of food and not been able to purchase more. Food insecurity increases for Aboriginal and Torres Strait Islander people who live in remote areas.

Efforts to Close the Gap must recognise the potential impacts of improved nutrition on health outcomes, as well as the implications of food insecurity “

AMA Position Statement on Nutrition 2018

Download AMA Position Statement on Nutrition 2018

Advertising and marketing of junk food and sugary drinks to children should be banned, and a tax on sugar-sweetened beverages should be introduced as a matter of priority, the AMA says.

Releasing the AMA Position Statement on Nutrition 2018, AMA President, Dr Michael Gannon, said today that eating habits and attitudes toward food are established in early childhood.

“Improving the nutrition and eating habits of Australians must become a priority for all levels of government,” Dr Gannon said.

“Governments should consider the full complement of measures available to them to support improved nutrition, from increased nutrition education and food literacy programs through to mandatory food fortification, price signals to influence consumption, and restrictions on food and beverage advertising to children.

“Eating habits and attitudes start early, and if we can establish healthy habits from the start, it is much more likely that they will continue throughout adolescence and into adulthood.

“The AMA is alarmed by the continued, targeted marketing of unhealthy foods and drinks to children.

“Children are easily influenced, and this marketing – which takes place across all media platforms, from radio and television to online, social media, and apps – undermines healthy food education and makes eating junk food seem normal.

“Advertising and marketing unhealthy food and drink to children should be prohibited altogether, and the loophole that allows children to be exposed to junk food and alcohol advertising during coverage of sporting events must be closed.

“The food industry claims to subscribe to a voluntary code, but the reality is that this kind of advertising is increasing. The AMA calls on the food industry to stop this practice immediately.”

The Position Statement also calls for increased nutrition education and support to be provided to new or expecting parents, and notes that good nutrition during pregnancy is also vital.

It recognises that eating habits can be affected by practices at institutions such as child care centres, schools, hospitals, and aged care homes.

“Whether people are admitted to hospital or just visiting a friend or family member, they can be very receptive to messages from doctors and other health workers about healthy eating,” Dr Gannon said.

“Hospitals and other health facilities must provide healthy food options for residents, visitors, and employees.

“Vending machines containing sugary drinks and unhealthy food options should be removed from all health care settings, and replaced with machines offering only healthy options.

“Water should be the default beverage option, including at fast food restaurants in combination meals where soft drinks are typically provided as the beverage.”

NACCHO Campaign 2013 : We should health advice from the fast food industry !

Key Recommendations:

·         Advertising and marketing of unhealthy food and beverages to children to be prohibited.

·         Water to be provided as the default beverage option, and a tax on sugar-sweetened beverages to be introduced.

·         Healthy foods to be provided in all health care settings, and vending machines containing unhealthy food and drinks to be removed.

·         Better food labelling to improve consumers’ ability to distinguish between naturally occurring and added sugars.

·         Regular review and updating of national dietary guidelines and associated clinical guidelines to reflect new and emerging evidence.

·         Continued uptake of the Health Star Rating system, as well as refinement to ensure it provides shoppers with the most pertinent information.

Aboriginal and Torres Strait Islander people

Food insecurity

Food insecurity occurs when people have difficulty or are unable to access appropriate amounts of food.13

It has been estimated that four per cent of Australians experience food insecurity,14 though it is likely the extent of the problem is much higher.

Food insecurity is associated with a range of factors, including unstable living situations, geographic isolation and poor health.

It is more prevalent in already disadvantaged communities. In households with limited incomes, food budgets can be seen as discretionary and less of a priority.

This can result in disrupted eating habits and an over-reliance on less nutritious foods.

Food insecurity can have significant health implications, such as increased hospitalisation and iron deficiency anemia (in children) and increased kidney disease, type 2 diabetes and mental health issues (among adolescents and adults).

Poor nutrition has been linked to the reduced health outcomes experienced by Aboriginal and Torres Strait Islander people, contributing to conditions known to disproportionately affect this population, including type 2 diabetes, kidney disease and some cancers.16

Twenty two per cent of Aboriginal and Torres Strait Islander people live in a household that has, in the past 12 months, run out of food and not been able to purchase more. Food insecurity increases for Aboriginal and Torres Strait Islander people who live in remote areas.17

Efforts to Close the Gap must recognise the potential impacts of improved nutrition on health outcomes, as well as the implications of food insecurity. The development and implementation of potential solutions must be led by Aboriginal and Torres Strait Islander people.

The nutrition of Aboriginal and Torres Strait Islander people living in remote communities may be heavily dependent on Outback Stores. The 2009 Parliamentary Inquiry ‘Everybody’s Business: Remote Aboriginal and Torres Strait Community Stores’ resulted in a number of practical recommendations to increase the availability and affordability of healthy foods in Outback Stores, many of which have not been implemented.

Recommendation

These Stores, in consultation with local communities, should prioritise and facilitate access to affordable nutritious foods.

The AMA Position Statement on Nutrition 2018 is available at https://ama.com.au/position-statement/nutrition-2018

 

NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 

 ” It is unacceptable that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting Aboriginal and Torres Strait Islander people, who comprise just three per cent of the population. Funding for Aboriginal and Torres Strait Islander Health is inadequate to meet the burden of illness.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health ”

Extract from

AMA Budget Submission 2018-19

AMA President, Dr Michael Gannon, said today that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Releasing the AMA’s Pre-Budget Submission 2018-19, Dr Gannon said the key for the Government is to look at all health policies as investments in a healthier and more productive population.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.

“There is now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner … or vote loser.

“Our Submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make,” Dr Gannon said.

The AMA Pre-Budget Submission 2018-19 covers:

·         General Practice and Primary Care;

·         Public Hospitals;

·         Private Health Insurance;

·         Medicare Benefits Schedule (MBS) Review;

·         Preventive Health;

·         Diagnostic Imaging;

·         Pathology;

·         Mental Health and the NDIS;

·         Medical Care for Older Australians;

·         My Health Record;

·         Rural Health;

·         Indigenous Health;

·         Medical Workforce;

·         Climate Change and Health; and

·         Veterans’ Health.

 The AMA Pre-Budget Submission 2018-19 is at https://ama.com.au/ama-pre-budget-submission

This Submission was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

Part 2 The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite a decade of commitments to closing the gap.

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

The AMA values the progress being made in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. But if the Government is serious about building on this early but slow progress, it must create sustainable, long-term improvements by increasing funding and resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people. It must also increase and properly resource the health workforce.

Many of the chronic health conditions experienced by Aboriginal and Torres Strait Islander people should not be endemic in a highly-developed country like Australia. Chronic diseases are known to be the main cause of the life expectancy gap between Indigenous and non- Indigenous Australians.

Despite some recent health gains for Aboriginal and Torres Strait Islander people, awareness and political will is frustratingly slow-moving. There is an urgent need for the Commonwealth to deliver on the well-documented research and national strategies showing how to tackle health inequalities and the social determinants of health.

Closing the gap in health outcomes means addressing: poverty; unhygienic, overcrowded conditions; poor food security and access to potable drinking water; lack of transport; and an absence of health services.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health.

AMA POSITION

The AMA calls on the Government to:

• prioritise Indigenous health funding in the 2018-19 Budget and fund Aboriginal and Torres Strait Islander health services according to need;

• support measures to increase the uptake of MBS and PBS items;

• fund and implement the National Aboriginal and Torres Strait Islander Health Plan;

• adopt the recommendations in the AMA’s Report Cards on Indigenous Health, in particular the recommendations in the 2016 Report Card calling for a target to eradicate new cases of Rheumatic Heart Disease (RHD); and the recommendations in the 2017 Report Card to address ear health (otitis media);

• given the strong link between health and incarceration, support the justice reinvestment approach to health by appropriately funding services that divert Aboriginal and Torres Strait Islander people from prison;

• commit to the principles of the Redfern Statement, which calls on all political parties to make Aboriginal and Torres Strait Islander affairs a key election priority;

• meaningfully address the disadvantage experienced by Aboriginal and Torres Strait Islander people by reversing cuts to the Indigenous Affairs portfolio;

• reinvest in health, justice, early childhood, and disability services, as well as services to prevent violence;

• increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations to build their capacity to be sustainable over the long term;

• recognise that chronic disease in Indigenous communities is inextricably connected to the social determinants of health such as: poverty; inappropriately designed, unhygienic, overcrowded housing conditions; inadequate access to affordable food and potable water supplies; and an absence of health services;

• acknowledge the wealth of existing reports, Parliamentary inquiries, strategies, and plans to improve Indigenous health and close the gap, and start to fund and implement them; and

• fund national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce.

 

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

 

 

” The Aboriginal and Torres Strait Islander population is reported to suffer the highest rates of otitis media in the world.  This unacceptably high prevalance has been known for at least 60 years.

The 2017 Report Card on Indigenous Health identifies chronic otitis media as a ‘missing piece of the puzzel for Indigenous disadvantage’ and calls for an end to the preventable scourge on the health of Indigenous Australians.”

Download AMA Indigenous Health Report Card 2017: A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities

2017 Report Card on Indigenous Health

“ This is a disease of poor people in poor countries as well as other indigenous minorities. These unacceptably high rates have been known for at least 60 years,

Chronic otitis media has lifelong impacts for health and wellbeing just like cardiovascular disease or diabetes – its effects are often ‘life sentences’ of disability and are linked to high rates of Indigenous incarceration.”

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Mr. John Singer said Indigenous children experience some of the highest rates of chronic otitis media in the world.

Download NACCHO Press Release

NACCHO Press Release response AMA release Indigenous Report card.doc

NACCHO welcomes the 2017 AMA Report Card on Indigenous Health: A national strategic approach to ending chronic otitis media See Part 2 below

  ” Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.’

The Hon Ken Wyatt launch speech see in full Part 5

Part 1 AMA Background

Otis media is a build up of fluid in the middle ear cavity, which can become infected.  While the condition lasts, mild or moderate hearing loss is experienced.

Otitis media is very common in children and for most non-Indigenous children, is readily treated. But for many Indigenous people, otitis media is not adequately treated.  It persists in chronic forms over months and years.

As this Report Card identifies, the peak prevalence for otitis media in some Indigenous communities is age five months to nine months; with up to one-third of six-month-old infants suffering significant hearing loss.  The effects of long periods of mild or moderate hearing loss at critical developmental stages can be profound.  During the first 12 or so months of life, a person’s brain starts to learn to make sense of the sounds it is hearing.  This is called ‘auditory processing’.  If hearing is lost during this critical period, and even if normal hearing returns later, life-long disabling auditory processing disorders can remain.

Chronic otitis media is a disease in communities with poorer social determinants of health.  It is a disease of the developing world.  It should not be an endemic ‘massive health problem’ in Australia – one of the healthiest and wealthiest countries in the world.  However the chronic otitis media crisis is occurring in too many of our Indigenous communities.

This Report Card calls for a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia, and a response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population.

Part 2 NACCHO welcomes the 2017 AMA Report Card on Indigenous Health: A national strategic approach to ending chronic otitis media 

The peak body for Aboriginal controlled medical services today welcomed the release of the AMA’s 2017 Report Card on Indigenous Health and joined its call for a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous children in Australia. This disease has long term disabling effects and social impacts in the Indigenous adult population.

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Mr. John Singer said Indigenous children experience some of the highest rates of chronic otitis media in the world.

“This is a disease of poor people in poor countries as well as other indigenous minorities. These unacceptably high rates have been known for at least 60 years,” Mr. Singer said.

Chronic otitis media has lifelong impacts for health and wellbeing just like cardiovascular disease or diabetes – its effects are often ‘life sentences’ of disability and are linked to high rates of Indigenous incarceration.

NACCHO calls on Australian governments to adopt the recommendations of the Report including embedding chronic otitis media and hearing loss in the Closing the Gap Strategy. However in addition to these principles specialist ear disease and hearing services must be provided to all Aboriginal children if this disease is to be tackled.

Like many chronic diseases impacting on the gap in life expectancy, otitis media is linked to poorer social determinants. “If we are serious about improving health outcomes for Indigenous people, governments at all levels must do more to improve education, housing and employment outcomes.” Mr. Singer said.

Indigenous led solutions must be at the center of any approach. Aboriginal people are more likely to access the care and support they need from an Aboriginal controlled organisation. The community controlled sector has the experience, history and expertise in working with Aboriginal communities and are best placed to work with governments on the report recommendations. Our members should be the preferred model for investment in comprehensive primary health care services.

Our members across the country are keen to work with governments on a systematic approach to the prevention, detection, treatment and management of otitis media,” Mr. Singer said.

NACCHO, its Affiliates and members will continue to work with the AMA in the hope that the report will be a catalyst for coordinated, sustainable government action to improve ear health among Aboriginal and Torres Strait Islander people.

Part 3 INDIGENOUS EAR HEALTH – AMA CALLS FOR ACTION TO END A ‘LIFE SENTENCE’ OF HARM

AMA Indigenous Health Report Card 2017: A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities

The AMA today issued a challenge to all Australian governments to work with health experts and Indigenous communities to put an end to the scourge of poor ear health – led by chronic otitis media – affecting Aboriginal and Torres Strait Islander Australians.

At the launch of the 2017 AMA Indigenous Health Report Card in Canberra today, AMA President, Dr Michael Gannon, said the focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique and tragic health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

The Report Card – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – was launched by the Minister for Indigenous Health, The Hon Ken Wyatt AM.

“It is a tragedy that, in 21st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that, for most non-Indigenous Australian children, otitis media is readily treated.

“The condition in the non-Indigenous population passes within weeks, and without long-term effects.

“But for many Aboriginal and Torres Strait Islander children, otitis media is not adequately treated. It persists in chronic forms over months and years. At worst, it is there for life.”

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

“We urge our political leaders at all levels of government to take note of this Report Card and be motivated to act to implement solutions.”

The AMA calls on Australian governments to act on three core recommendations:

Recommendation 1:

That a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG). This should build on and incorporate existing national and State and Territory level responses and include:

  •  a critical analysis of current approaches, and to identify the range of reasons that current chronic otitis media crisis persists;
  •  the development of a COAG Closing the Gap target about new cases of chronic otitis media and hearing loss in Indigenous infants and children under 12 years of age;
  •  a national otitis media surveillance program to monitor prevalence and support a targeted and cost-effective national response;
  •  a significantly increased focus on prevention – both primordial prevention with a focus on the social determinants of the disease, and primary prevention including family and community health literacy about otitis media;
  •  a central, adequately funded and supported role for primary health care and Aboriginal Community Controlled Health Services (ACCHS) in a systematic approach to the prevention, detection, treatment, and management of otitis media; and
  •  access to ear, nose and throat (ENT) specialists, particularly within ACCHS and other Indigenous-specific primary health care services, based on need

Recommendation 2:

That the national approach proposed in Recommendation 1 include addressing the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required. This includes:

  •  a national approach to supporting Indigenous students with hearing loss that aims to remove disadvantage that they may face in educational settings;
  •  a national approach to developing hearing loss-responsive communication strategies in all government and non-government agencies providing services to Indigenous people including – but not limited to – health, mental health, justice, and employment services; and
  •  exploring the support role of the National Disability Insurance Scheme (NDIS) to Indigenous people with hearing loss

Recommendation 3:

That attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues (including otitis media and related hearing loss and developmental impacts), with the expectation of appropriate action. The health issues to be addressed include mental health problems, cognitive disabilities, alcohol and drug problems, hearing loss, and developmental impacts associated with otitis media. 3

Part 4 : Background

  •  Indigenous children experience some of the highest rates of chronic suppuratives otitis media (CSOM) in the world.
  •  Chronic otitis media in infancy and childhood can affect Indigenous peoples’ adult health and wellbeing as much as cardiovascular disease or diabetes, and its effects are significant ‘life sentences’ of disability.
  •  Chronic otitis media has life-long impacts that bring greater risk of a range of adult social problems, not the least of which is incarceration. The association of chronic otitis media-related hearing loss and the high rates of Indigenous imprisonment has been noted for over 25 years now – but with little action evident

The AMA Indigenous Health Report Card 2017 – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – is at https://ama.com.au/article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

Part 5 Ken Wyatt Speech

I’d like to acknowledge the traditional custodians of the land on which we meet – the Ngunnawal and Ngambri people – and pay my respects to their Elders, past and present.

I thank AMA President Dr Michael Gannon and Associate Professor Kelvin Kong of the Royal Australasian College of Surgeons for their words, and acknowledge:

  • AMA Secretary-General Anne Trimmer
  • Representatives from the College,
  • the AMA’s Indigenous Health Taskforce,
  •  the National Aboriginal Community Controlled Health Organisation (NACCHO), and Aboriginal medical centre

My Parliamentary colleagues, and distinguished guests.

Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.

Over the past 15 years, this annual Report Card has highlighted priority issues such as low birth weight babies, institutionalised inequities and racism, government funding, medical workforce, rheumatic heart disease, and best practice in primary care.

I welcome this year’s Report Card, with its focus on ear health and hearing loss, which can have devastating impacts.

Compounding this is the fact that the most common ear afflictions are almost entirely preventable.

For all the wrong reasons, ear disease is highly prevalent in Indigenous children and repeated episodes can lead to hearing loss and deafness, if not treated early.

The impact of this can have lifelong effects on education, employment and wellbeing.

Nowhere have these consequences been more evident than in my home State of Western Australia, where significant numbers of hearing-impaired Aboriginal people have been unable to secure mining boom jobs, despite their best efforts and support from major companies.

While I agree with Dr Gannon that this Report Card can be ‘a catalyst for government action to improve ear health among Aboriginal and Torres Strait Islander people’, I would like to point out that the Turnbull Government has much work under way aimed at improving Indigenous ear health.

We are resolutely committed to turning this problem around.

The AMA’s Report Card calls for a national, systematic and strategic approach to address chronic otitis media and its impacts in Indigenous communities, and for this approach to be reflected in the Council of Australian Governments Closing the Gap targets.

I note the AMA recommends that any such national response be developed for COAG by a National Indigenous Hearing Health Taskforce, importantly under Indigenous leadership, and that it should build on and incorporate existing national, State and Territory-level responses.

In March, the COAG Health Council agreed to explore the feasibility of such a national approach to reducing the burden of middle ear disease.

The Queensland Department of Health has leadership of this proposal, and plans to take it to the Australian Health Ministers’ Advisory Council next week, when it is scheduled to consider the matter on 8 December.

Alongside this, the House of Representatives Standing Committee on Health, Aged Care and Sport Inquiry into Hearing Health and Wellbeing of Australia is calling for a national strategy to be developed and additional funding provided.

The recommendations of the committee’s report – titled ‘Still waiting to be heard’ – are currently being given detailed consideration by the Turnbull Government, as are the findings of the Department of Health’s independent examination of Commonwealth ear health initiatives.

The AHMAC work and the ‘Still waiting to be heard’ report will inform the way forward on Indigenous ear health.

It’s also pertinent to note a number of other initiatives that will contribute directly to improved ear health.

The Turnbull Government has committed to incorporating a social determinants and cultural determinants of health approach in the next iteration of the five-year Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan, due to be released in 2018.

As Dr Gannon has pointed out, ‘social determinants of health contribute to the development of ear disease …. and act as barriers to treatment and prevention.’

The release of the Cultural Respect Framework 2016–2026, which was endorsed by AHMAC early this year, will underpin the delivery of culturally competent health service delivery.

A culturally competent approach by health professionals is critical to the health and wellbeing of Aboriginal and Torres Strait Islander people who, like all Australians, have the right to safe, culturally comfortable care of the highest clinical standard.

Further, COAG is currently working to refresh the Closing the Gap targets, including the health targets.

Initiatives like these demonstrate the commitment of good minds and good people to tackling our nation’s most confronting health issue – Indigenous health.

That commitment is also reflected in Commonwealth funding. To improve ear health, a total of $76.4 million, from 2012–13 to 2021–22, is being provided through the Indigenous Australians’ Health Programme, and the National Partnership on Northern Territory Remote Aboriginal Investment.

This funding is increasing access to clinical services, including surgery. It is providing equipment, training health professionals and raising awareness of otitis media symptoms and the need for early treatment.

In the past year, this has resulted in around 47,000 patient contacts in more than 300 locations across Australia.

More than 200 surgeries were provided, and over 1000 health professionals received training in 80 locations.

More than 1000 pieces of diagnostic equipment were available across 170 sites; and clinical guidelines were made available nationally.

As well, under the Australian Hearing Specialist Program for Indigenous Australians, the Australian Government provides hearing services in more than 200 Aboriginal and Torres Strait Islander communities across Australia each year to help overcome distance, culture and language barriers.

Successful initiatives, such as Children’s Health Queensland’s Deadly Ears program, are making a difference. Deadly Ears has helped almost halve the rate of Chronic Otitis Media, working at 11 outreach services in rural and remote areas.

So, clearly, there is a large body of work underway at local, State and national levels – but just as clearly, we must continue our focus, build our partnerships and broaden our approach.

While primary care is fundamental to ear health solutions, we must work together with Aboriginal communities to advance other areas of life which impact on health and wellbeing.

The Turnbull Government understands this, and this is the basis for our whole-of-government policies, including housing, education, employment and health service delivery.

We are focussed on what works, so efficient and successful models of care can be shared and replicated.

We are concentrating on grassroots empowerment, to support local responsibility, and in turn, to grow personal commitment.

Finding ear health solutions is a shared responsibility – for all governments, the medical profession, health workers, and parents and their children.

Reducing ear problems is one of my top Indigenous health priorities, and I’m confident we can start to make real gains in this critical area.

While there is undoubtedly a way to go, evidence-based Report Cards like this will help ensure we are on the right track.

The Turnbull Government is listening.

I commend the AMA for its work, and look forward to continuing our shared dedication to better hearing for Indigenous people.

Thank you.