NACCHO Aboriginal Women’s Health #IWD17 : Five myths about the new cervical screening program that refuse to die

 ” With the burden of cervical cancer being much greater for Indigenous women (the incidence of cervical cancer is twice, and mortality four times, as high than non-Indigenous Australians), it’s important that Aboriginal and Torres Strait Islander communities stay informed of the new national cervical screening program.”

Terri Foran, Lecturer in the School of Women’s and Children’s Health, UNSW

This article was originally published on The Conversation. Read the original article.

For information on pap tests or the cervical screening program, contact Pap Test Register infoline on 13 15 56, talk to your GP or look up your nearest ACCHO

Picture above : The Free NACCHO App contains a geo locator, which will help you find the nearest Aboriginal Community Controlled Health Organisation (302 Clinics ) in your area and

 Provides heath information online and telephone on a wide range of topics and where you can go to get more information or assistance should you need urgent help

Download details HERE

Women are confused about what changes to the cervical screening program will mean for their sexual health.

The online petition against changes to Australia’s cervical cancer screening program has revealed more than 70,000 people (most of whom we could assume are women) are deeply concerned about what the upcoming changes mean. The Conversation

Their comments also reveal a number of misconceptions about the new screening program, which will now be rolled out in December 2017, rather than in May as planned.

It seems that in concentrating on the science behind shifting away from Pap smears every two years to testing for the human papillomavirus (HPV) every five years, our medical authorities have failed to convince many Australian women this move will save lives.

Convincing women to come on board is, of course, critical to the success of the new screening program, which is forecast to improve cervical cancer detection rates by at least 15 per cent and is good news for women.

So let’s have a look at some common misconceptions and concerns about changes to the cervical cancer screening program raised by some of my patients and by the many people signing up to the change.org petition.

Myth #1: no more Pap tests means no more invasive examinations

Quite a few of my patients have thought the new screening program means the end of invasive examinations. And I say “unfortunately not”. For most women the collection procedure will be exactly the same as before. This means you will still have to lie on a couch and a doctor or nurse will still insert the dreaded speculum. This instrument is needed to hold the vaginal walls gently apart so that the cervix at the end of the vagina can be seen.

Two small brushes are used to sample cells from both the outside of the cervix and from the opening which leads up to the uterus. Rather than the specimen being smeared on a slide (as with Pap smears), the two brushes are swizzled around in a preservative liquid, which separates out most of the collected cells and any HPV, the virus responsible for at least 99.7% of cervical cancers.

But it’s not until the specimen gets to the pathology lab that the process really changes.

First, the specimen is checked for HPV and only if HPV is present will cells be examined for signs of pre-cancer or cancer.

There is also the option for women who have previously avoided having Pap tests for cultural, religious or personal reasons to collect their own HPV sample. It is estimated that even if a woman has only one self-collected test at age 30 she reduces her risk of cervical cancer by about 40%.

 

Myth #2: the new test could miss types of cervical cancer not related to HPV

Almost 85% of cervical cancers are actually skin cancers, triggered not by the sun but by HPV. This type of cervical cancer usually takes about 15-20 years to develop. So, HPV testing gives us a chance to detect potential problems long before there is anything to see on a Pap test.

In the new program, women who carry the highest risk HPV types will then have their cells examined using a more sensitive test known as liquid-based cytology. They will also be automatically referred to a gynaecologist for further tests. If other kinds of HPV are found, a check whether the cells show any changes will guide whether the woman is referred for other tests or simply monitored more closely.

 Pap Tests

Women who have previously avoided having Pap tests for cultural, religious or personal reasons can soon collect their own HPV sample.

Some 15% of cervical cancers start in glandular cells. HPV also triggers these cancers but they are often beyond the reach of the little brushes used to collect cells in a Pap test. They can hide away quietly, growing and spreading for many years before they are detected.

When you hear of someone diagnosed with cervical cancer after previously normal Pap tests it is almost always a glandular-type cancer.

The good news is that HPV testing should pick up this kind of cancer earlier and more reliably than a regular Pap test.

There are also some very rare cervical cancers (less than 1%) that start off from muscle, nerve or pigment cells deep within the cervix and are not related to HPV infection. It is true that the new screening program is not designed to detect these types of cancer but then they were also almost impossible to detect on a traditional Pap test as well.

 

Myth #3: young women will miss out on early detection if screening starts at 25

There are many online testimonies from women signing the change.org petition saying they had cervical cancer before the age of 25. It is more likely that most of these were pre-cancerous changes because cervical cancer in this age group is really rare – around 1.7 in 100,000 Australian women under 25.

Unfortunately, in the nearly 30 years our present screening program has been running there has been no significant impact on the numbers of cervical cancers reported in Australian women under 25.

Another complication in this younger age group is that cellular changes may look worse than they actually are because of a robust immune reaction to the HPV infection. Unfortunately this can lead to well-meaning advice to treat changes that are very likely to get better on their own.

 

Myth #4: less cervical testing reduces the chances of picking up other cancers such as ovarian and uterine cancer

Pap tests were designed to pick up pre-cancerous changes in the cells of the cervix. They are absolutely useless at detecting endometriosis, polyps, ovarian cancer or sexually transmitted infections other than HPV. They occasionally pick up uterine cancer if it is advanced enough for the cells to be shedding through the cervix that day.

The important point here is that screening tests are only for women with no symptoms. If a woman develops symptoms, such as irregular bleeding, pain or abnormal vaginal discharge, she needs to see her doctor for advice regardless of when she had her last cervical screening test.

 

Myth #5: the government is motivated by a cheaper option and will shift the costs of the test to the woman herself

The new tests are more expensive than a traditional Pap test, but because they are so much more sensitive there is no need to do them as frequently.

They will be funded under Medicare just as the Pap test is now. Any out-of-pocket costs depend on whether health care providers bulk bill (as they often do with screening tests) or charge the scheduled fee.

 

 

NACCHO Aboriginal #prevention Health : #ALPHealthSummit : With $3.3 billion budget savings on the table, Parliament urged to put #preventivehealth on national agenda

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 ” Recently the Federal Government has spoken in favour of investment in preventive health.

 In an address to the National Press Club in February this year, Prime Minister Malcolm Turnbull said, “in 2017, a new focus on preventive health will give people the right tools and information to live active and healthy lives”.

Health Minister Greg Hunt echoed that sentiment on 20 February announcing the Government was committed to tackling obesity.

Prevention 1st, however, argues the need for a more comprehensive, long-term approach to the problem. Press Release

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NACCHO was represented at the #ALPHealthSummit by Chair Matthew Cooke pictured above with Stephen Jones MP

Leading health organisations are calling on the Commonwealth to address Australia’s significant under-investment in preventive health and set the national agenda to tackle chronic disease ahead of Labor’s National Health Policy Summit today.

Chronic disease is Australia’s greatest health challenge, yet many chronic diseases are preventable, with one third of cases traced to four modifiable risk factors: poor diet, tobacco use, physical inactivity and risky alcohol consumption.

Adopting preventive health measures would address significant areas flagged as critical by the both major parties, including ensuring universal access to world-class healthcare, preventing and managing chronic disease, reducing emergency department and elective surgery waiting times, and tackling health inequalities faced by Indigenous Australians.

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Prevention 1st – a campaign led by the Foundation for Alcohol Research and Education (FARE), the Public Health Association of Australia (PHAA), Consumers Health Forum of Australia (CHF Australia), and Alzheimer’s Australia – is urging the ALP to adopt the group’s Pre-Budget submission recommendations as part of the party’s key health policy framework.

FARE Chief Executive Michael Thorn says it is up to federal policymakers to address Australia’s healthcare shortfalls and that Labor has the perfect opportunity to reignite its strong track record and lead the way in fixing the country’s deteriorating investment in preventive healthcare.

“Australia’s investment in preventive health is declining, despite chronic disease being the leading cause of illness in Australia. Chronic disease costs Australian taxpayers $27 billion a year and accounts for more than a third of our national health budget. The ALP has both the opportunity and a responsibility as the alternate government to set the national agenda in the preventive healthcare space. Ultimately, however, it falls to the Government of the day to show leadership on this issue,” said Mr Thorn.

Its Pre-Budget submission 2017-18, Prevention 1st identifies a four-point action plan targeting key chronic disease risk factors.

Prevention 1st has called for Australia to phase out the promotion of unhealthy food and beverages, and for long overdue national public education campaigns to raise awareness of the risks associated with alcohol, tobacco, physical inactivity, and poor nutrition. Under the proposal, these measures would be supported by coordinated action across governments and increased expenditure on preventive health.

The costed plan also puts forward budget savings measures, recommending the use of corrective taxes to maximise the health and economic benefits to the community. Taxing products appropriate to their risk of harm will not only encourage healthier food and beverage choices but would generate much needed revenue – around $3.3 billion annually.

With return on investment studies showing that small investments in prevention are cost-effective in both the short and longer terms, and the opportunity to contribute to happier and healthier communities, Consumers Health Forum of Australia Chief Executive Officer Leanne Wells urged both the Australian Government and Opposition to take advantage of the opportunity to stem the tide of chronic disease.

“There is an obvious benefit in adopting forward-thinking on preventive healthcare to reduce pressure on the health budget and the impact of preventable illness and injury on society,” Ms Wells said.

The ALP National Health Policy Summit will be held at Parliament House in Canberra on Friday 3 March.


View the submission

View media release in PDF

NACCHO Aboriginal #Healthmatters : @AustralianLabor National #HealthPolicy Summit Agenda this week and getting evidence into health policy

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Question to the Honourable Nicola Roxon, former Australian Labor Minister for Health and Ageing (2007–2011) : Can you give an example of this more courageous leadership during your time as minister?

A: One example is a cause close to my heart: Australia’s introduction of plain packaging for tobacco products. We are proud to be world leaders in introducing our shocking and ugly plain packs, and even more proud of the lively discussion and action it is generating elsewhere around the world on the future of tobacco control.

Picture above : Lessons learnt : Plain packaging for tobacco products is a great example of implementing good health policy where trusted health organisations worked across political groups, provided expert research and supported the government to take action

What’s planned for this weeks Labor National Health Policy Summit 

According to the Federal Opposition, Labour will build on a legacy as the party of health care reform by hosting a National Health Policy Summit next Friday 3 March in Canberra , led by Leader of the opposition Bill Shorten and Shadow Minister for Health Catherine King :

See interim Full day Agenda below

 “One of the most challenging aspects of the current Government is the complete lack of any vision for health in Australia. Instead of building our health system up and preparing for the future, the tenure of the Abbott/Turnbull Governments has been characterised by cuts and chaos.

Not only does our health system deserve more – it needs more. The government simply isn’t filling this space, so Labor will.”

The National Health Policy Summit will put the people who know best at the centre of health discussions – giving patients, providers, stakeholders and experts a much-needed voice in health reform.

It will give representatives the chance to not only contribute to our health debate, but to challenge the direction of our health system.

Labor has a long history of reforming Australia’s healthcare system for the benefit of all.”

 NACCHO Note : Both NACCHO and Croakey will be covering

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See Croakey Coverage

We welcome articles and press releases from all political parties

Interview with the Hon. Nicola Roxon:

Getting evidence into health policy

Editor-in-Chief of Public Health Research & Practice, Don Nutbeam spoke to the Honourable Nicola Roxon, former Australian Labor Minister for Health and Ageing (2007–2011), to gain some insight into the process, and advice on how to engage most productively with government.

Q: Often ministers and policy makers must try to make good policy decisions in areas where evidence is incomplete or contested. What strategies or processes did you employ when trying to make good public health decisions at a federal level when the evidence was insufficient? What were the main challenges involved and how did you overcome them?

A: I think it is very rare for ministers or governments to want to make decisions where evidence is incomplete or contested (provided the contest is real, not fabricated by vested interests). There are so many competing, worthy, evidence based causes – especially in health – that these will usually be given priority. However, in a crowded political agenda, having a worthy cause isn’t always enough to capture the imagination of government. The biggest single mistake I saw when I was Health Minister was repeated over and over again, by decent, hard-working researchers, medicos and advocates – and it was the naive assumption that, because they were working on something good, or had developed a worthy project, the government would therefore act on it.

As a minister, I was able to act on some fabulous ideas, and I’m proud of that. But many good ideas were not acted upon – often because of financial constraints, but also many other reasons played a role.

Just because your idea is good, even worthy, isn’t enough.

Q: So, how does evidence inform policy decisions in the real world?

A: To get real decisions and actions in your area, you must think closely and carefully about who you are putting your evidence to, their needs and priorities, and why your proposal will help them. In a world where most interventions cost money – and, in health, usually a lot of money – simply appealing to their good nature is too simplistic. You need to make it easy for decision makers to see how acting on your idea is worth taking up time, money and political energy.

Knowing what is going on in the decision maker’s portfolio, what is troubling them, what is taking up their time and giving them sleepless nights helps you find a way to fit your issue into their thinking space. Start by putting yourself in the position of the minister you want to take action. Do you know what they are trying to achieve? Have you read any of their speeches or policies or recent interviews? Demonstrating your understanding of their issues and pressures is good manners, but also helps you shape your pitch to their current interests or pressures.

For example, when the Australian Government announced health reform negotiations with the states, a few groups came to us with proposals that could be part of those discussions. Not all were successful, but it showed they were tuned in to opportunities, and ready to make the most of them in a way that might suit government.

Even a scandal or problem can sometimes be a chance to offer a helpful solution. It might help solve the problem, or detract from it! Either way, this might be welcome.

The more in tune you are with the decision maker’s pressures, the more likely you are to be agile and think laterally, to find good opportunities to raise your cause at the right time.

Q: When these opportunities present themselves, what is the best way to communicate?

A: Are you clear on what you would say and how you would say it if you got a brief chance to pitch your idea? A lot of people talk about having an ‘elevator pitch’ – this is the idea of what you would say if you were, by good luck, in an elevator with the decision maker. Could you explain your idea simply? And quickly enough?

The aim is to first capture the imagination of the decision maker – get them to be interested in your idea, impressed with your focus and your offer to help them.

I had too many meetings to recall where people tried to download 20 years of in-depth research in a 10-minute meeting – the minister needs to know it is there, to appreciate your expertise or credibility, but they don’t need to be able to present a paper on it to the next technical meeting of the World Health Organization (WHO)!

Stick to the headline message or your core thesis to support a proposal – then you can leave the detailed summary for an adviser or official to mull over.

What you want from your meeting is to spark enough interest that the minister asks for more work to be done on your issue – not that they decide to write a book on it. Worse, your clear message will be diluted or lost if you try to do too much in a short meeting.

Q: What do you say to the researchers who feel that their work is ignored?

A: I am frustrated that governments are almost universally criticised for not taking action on public health. Sometimes that criticism of governments is fair and well based. We are right to expect courage and leadership from our governments. But, in truth, criticism of governments is also sometimes lazy. It can be easier to criticise a government for not acting on your issues than to ask whether you’ve done all you can to help them take that decision.

From the perspective of a former minister, I want to urge researchers, advocates and clinicians to assess whether they have done all they can to create a fertile environment to encourage government leadership. When they do, governments will provide leadership.

Q: Can you give an example of this more courageous leadership during your time as minister?

A: One example is a cause close to my heart: Australia’s introduction of plain packaging for tobacco products. We are proud to be world leaders in introducing our shocking and ugly plain packs, and even more proud of the lively discussion and action it is generating elsewhere around the world on the future of tobacco control.

I have been very flattered, and often overwhelmed, by the recognition I get from introducing this measure. But the truth that ought to be acknowledged is that there were many people and many factors that made this courageous public health decision a good one for government, and easier than people imagine.

What made us choose this courageous path, when there were so many other competing issues on the table? It offers a good case study about advocacy.

The work of so many researchers, advocates, doctors, past governments, journalists and ordinary Australians moved this seemingly courageous decision into a political ‘sweet spot’. Ultimately, it was a good policy decision that was good politics too.

It was an inexpensive policy with high impact; a policy with lots of supporters and a disliked opponent (the tobacco industry); a highly visible policy that complemented other measures important to the government, but perhaps less ‘sexy’.

On each of these issues, advocates and supporters of the initiative sought to make the necessary links to our broader health reforms, our fresh focus on prevention and our interest in Indigenous health.

And it helped that the public had responded well in the past to tobacco control interventions, showing the huge benefits of a comprehensive approach to tobacco control measures. The research was strong, and the international treaty on tobacco (the WHO Framework Convention on Tobacco Control) supportive.

Q: What role would you expect from civil society in this process?

A: The Cancer Council and Heart Foundation in Australia were the rolled-gold best examples of this on plain packaging – they worked across political groups, and had expert research as well as highly responsive media teams. They are trusted voices for consumers and were prepared to use that voice to not just criticise, but to help government act, as well. Their expertise and advice were vital.

Their advice on potential problems was also invaluable to the government. In tobacco control, you need a good working knowledge of international tobacco control developments and global industry tactics. Being carefully prepared for attacks is smart for governments, but just as vital is for other civil society participants to be ready to explain to the media or to parliamentary committees.

Q: What of more contested issues, such as alcohol regulation and tackling obesity in the population?

A: In Australia, it has been harder to garner support for strong interventions on alcohol and obesity. On obesity in particular, the mixed approaches from advocates and researchers about what is needed to be successful have made it more difficult for governments to act decisively. When multifactorial approaches are likely to be needed, this can make the ‘ask’ confusing – governments often want a clear plan, or a clear starting point. In some public health areas, it is often hotly contested where one should start.

With alcohol, at least in Australia, it is sometimes difficult to find the lever. Do we target individuals or the community? Consumers or business? And it can be even more perplexing with food, where mixed messages make the need to improve public awareness of the risks of obesity even more complicated.

The challenge to advocates on these issues and most other public health priorities is to find that lever – the right lever, at the right time for the decision maker you are trying to convince. Be careful, of course, not to weaken the argument by going in too many directions at once.

Developing alliances across consumers, clinicians, advocates and researchers will always be very powerful. The same proposal from multiple groups gives your argument weight and depth. Instead of all asking for something slightly different, if you can agree on one major initiative or a good starting point, it is a very much more convincing request. It automatically lifts it above the 20 other meetings and requests the minister has that day. You can be confident that everyone else asking the minister for something that day will probably not have done that work – so it is a way to make your cause better and more attractive, easier to sit up and take notice.

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What’s planned for the Summit

Labor says the Summit will bring together more than 130 of Australia’s leading thinkers on health to be part of roundtable discussions via a packed program, with two blocks of four concurrent sessions, led by Shadow Ministers and leading health figures.

The event will begin with a welcome from Shadow Health Minister Catherine King and a keynote from Opposition Leader Bill Shorten and will end with a panel discussion between chairs to report back on the following policy roundtables (see also the co-chairs, some who are still to be announced).

1.Opportunities and challenges in our health sectors

Protection, prevention and promotion

Public Health Association of Australia CEO Michael Moore
Stephen Jones, Shadow Minister for Regional Services, Territories and Local Government Stephen Jones.

  • the preventable chronic disease crisis
  • risk factors
  • protective factors

Primary, secondary and community care

 Sharon Claydon, Chair, Medicare Caucus Committee

  • general practice
  • specialist primary health
  • allied health
  • pathology & imaging
  • pharmacy & medicines
  • dental

 Hospitals

Brian Owler, former President, Australian Medical Association

  • post-2020 public hospital funding
  • reducing emergency department and elective surgery waiting times
  • interaction between public and private hospitals
  • private health insurance
  • improving quality, safety and value in hospitals
  • outpatient clinics

Mental health and suicide prevention

Frank Quinlan, Mental Health Australia and Sue Murray, Suicide Prevention Australia
Julie Collins, Shadow Minister for Ageing and Mental Health

Mental health priorities

  • Mental health reform
  • Measuring outcomes
  • Stigma and awareness
  • Workforce

Suicide reduction priorities

  • Early intervention and prevention
  • Integrated services
  • Research and data collection

2.Where to for health reform?

Ensuring universal access for all Australians

Dr Stephen Duckett, Grattan Institute
Jenny Macklin, Shadow Minister for Families and Social Services

  • access, including out-of-pocket costs and waiting times
  • integration of primary care
  • coordination of primary, secondary and acute care
  • health financing

Designing our health workforce for the future

Professor Mary Chiarella, Sydney University
Tony Zappia, Shadow Assistant Minister for Medicare

  • future health service needs
  • health workforce reform
  • Commonwealth health workforce programs

Tackling health inequality and other whole-of-government challenges

 Professor Sharon Friel, Australian National University
Mark Butler, Shadow Minister for Climate Change and Energy

  • Regional, rural and remote health
  • Indigenous health
  • Other health inequalities
  • Interface with aged care
  • Interface with NDIS
  • Other social policy issues
  • Climate change and health

Innovation across our health system

Professor Christine Bennett AO, School of Medicine, Sydney, The University of Notre Dame Australia and past Chair of Research Australia
Murray Watt, Senate Community Affairs Committee

  • Health, medical and translational research
  • eHealth and digital technologies
  • Safety and quality
  • Precision medicine
  • New technologies
  • Partnerships and collaboration.

 

NACCHO Aboriginal Health and #Smoking : Pack warning labels help Aboriginal smokers butt out

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Aboriginal Community Controlled Health Services across 140 health settings are helping smokers in our communities to quit.

Pack warning labels are also an important element as smokers read, think about and discuss large, prominent and  graphic labels.

This comprehensive approach works to reduce Aboriginal and Torres Strait Islander smoking and the harm it causes in our communities,’

Matthew Cooke from the National Aboriginal Community Controlled Health Organisation (NACCHO).

Pack warning labels are motivating Aboriginal and Torres Strait Islander smokers to quit smoking according to new research released by Menzies School of Health Research (Menzies) today.

The study has shown that graphic warning labels not only motivate quit attempts but increase Indigenous smokers’ awareness of the health issues caused by smoking.

Forming part of the national Talking About The Smokes study led by Menzies in partnership with Aboriginal Community Controlled Health Services, the 642 study participants completed baseline surveys and follow-up surveys a year later.

The study found that 30% of Indigenous smokers at baseline said that pack warning labels had stopped them having a smoke when they were about to smoke.

Study leader, Menzies’ Professor David Thomas said, ‘This reaction rose significantly among smokers who were exposed to plain packaging for the first time during the period of research. The introduction of new and enlarged warning labels on plain packs had a positive impact upon Aboriginal and Torres Strait Islander smokers.’

Professor David Thomas, explained the significance of this finding, ‘Reacting to warning labels by forgoing a cigarette may not seem like much on its own. However, forgoing cigarettes due to warning labels was associated with becoming more concerned about the health consequences of smoking, developing an interest in quitting and attempting to quit. This is significant for our understanding of future tobacco control strategies.’

In addition, Indigenous smokers who said at baseline they often noticed warning labels on their packs were 80% more likely to identify the harms of smoking that have featured on warning labels.

Just under two in five (39%) Aboriginal and Torres Strait Islander people aged 15 and over smoke daily. Smoking is responsible for 23% of the health gap between Aboriginal and Torres Strait Islander people and other Australians.

In 2012, pack warning labels in Australia were increased in size to 75% on the front of all packs and 90% of the back at the same time as tobacco plain packaging was introduced.

The study was funded by the Australian Government Department of Health and published in the Nicotine & Tobacco Research journal and available at:

http://ntr.oxfordjournals.org/content/early/2017/01/08/ntr.ntw396.full.pdf+html.

Summary of findings
  • The research is part of the Talking About the Smokes study http://www.menzies.edu.au/page/Research/Projects/Smoking/Talking_About_the_Smokes/
  • A total of 642 Aboriginal and Torres Strait Islander smokers completed surveys at baseline (April 2012-October 2013) and follow-up (August 2013-August 2014)
  • At baseline, 66% of smokers reported they had often noticed warning labels in the past month, 30% said they had stopped smoking due to warning labels in the past month and 50% perceived that warning labels were somewhat or very effective to help them quit or stay quit
  • At follow-up, an increase in stopping smoking due to warning labels was found only those first surveyed before plain packaging was introduced (19% vs 34%, p=0.002), but not for those surveyed during the phase-in period (34% vs 37%, p=0.8) or after it was mandated (35% vs 36%, p=0.7). There were no other differences in reactions to warning labels according to time periods associated with plain packaging.
  • Smokers who reported they had stopped smoking due to warning labels in the month prior to baseline had 1.5 times the odds of quitting when compared with those who reported never doing so or never noticing labels (AOR: 1.45, 95% CI: 1.02-2.06, p=0.04), adjusting for other factors.
  • Smokers who reported they had often noticed warning labels on their packs at baseline had 1.8 times the odds of correctly responding to five questions about the health effects of smoking that had featured on packs (AOR: 1.84, 95% CI: 1.20-2.82, p=0.006), but not those that had not featured on packs (AOR: 1.03, 95%CI 0.73-1.45, p=0.9) when compared to smokers who did not often notice warning labels.

NACCHO Advertisement

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NACCHO has announced the publishing date for the 9 th edition of Australia’s first national health Aboriginal newspaper, the NACCHO Health News .

Publish date 6 April 2017

Working with Aboriginal community controlled and award-winning national newspaper the Koori Mail, NACCHO aims to bring relevant advertising and information on health services, policy and programs to key industry staff, decision makers and stakeholders at the grassroots level.

And who writes for and reads the NACCHO Newspaper ?

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While NACCHO’s websites ,social media and annual report have been valued sources of information for national and local Aboriginal health care issues for many years, the launch of NACCHO Health News creates a fresh, vitalised platform that will inevitably reach your targeted audiences beyond the boardrooms.

NACCHO will leverage the brand, coverage and award-winning production skills of the Koori Mail to produce a 24 page three times a year, to be distributed as a ‘lift-out’ in the 14,000 Koori Mail circulation, as well as an extra 1,500 copies to be sent directly to NACCHO member organisations across Australia.

Our audited readership (Audit Bureau of Circulations) is 100,000 readers

For more details rate card

Contact : Colin Cowell Editor

Mobile : 0401 331 251

Email  : nacchonews@naccho.org.au

 

 

NACCHO Aboriginal Health and Chronic Disease #prevention

 

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 ” The Australian Chronic Disease Prevention Alliance recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing overweight and obesity, and with revenue supporting public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia.

Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns[42].

Health levy on sugar-sweetened beverages

ACDPA Position Statement

Key messages

  •  The Australian Chronic Disease Prevention Alliance (ACDPA) recommends that the Australian Government introduce a health levy on sugar-sweetened beverages (sugary drinks)i, as part of a comprehensive approach to decreasing overweight and obesity.
  •  Sugar-sweetened beverage consumption is associated with increased energy intake and in turn, weight gain and obesity. Obesity is an established risk factor for type 2 diabetes, heart disease, stroke, kidney disease and certain cancers.
  •  Beverages are the largest source of free sugars in the Australian diet. One in two Australians usually exceed the World Health Organization recommendation to limit free sugars to 10% of daily intake (equivalent to 12 teaspoons of sugar).
  •  Young Australians are the highest consumers of sugar-sweetened beverages, along with Aboriginal and Torres Strait Islander people and socially disadvantaged groups.
  •  Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption.
  •  A health levy on sugar-sweetened beverages in Australia is estimated to reduce consumption and potentially prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years. The levy could generate revenue of $400-$500 million each year, which could support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
  •  A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

i ‘Sugar-sweetened beverages’ and sugary drinks are used interchangeably in this paper. This refers to all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks and flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks, and cordials. This term does not include milk-based products, 100% fruit juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened). 2

About ACDPA

The Australian Chronic Disease Prevention Alliance (ACDPA) brings together five leading non-government health organisations with a commitment to reducing the growing incidence of chronic disease in Australia attributable to overweight and obesity, poor nutrition and physical inactivity. ACDPA members are: Cancer Council Australia; Diabetes Australia; Kidney Health Australia; National Heart Foundation of Australia; and the Stroke Foundation.

This position statement is one of a suite of ACDPA statements, which provide evidence-based information and recommendations to address modifiable risk factors for chronic disease. ACDPA position statements are designed to inform policy and are intended for government, non-government organisations, health professionals and the community.

www.acdpa.org.au

Chronic disease

Chronic diseases are the leading cause of illness, disability, and death in Australia, accounting for around 90% of all deaths in 2011[1]. One in two Australians (i.e. more than 11 million) had a chronic disease in 2014-15 and almost one quarter of the population had at least two conditions[2].

However, much chronic disease is actually preventable. Around one third of total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet[2].

Overweight and obesity

Overweight and obesity is the second greatest contributor to disease burden and increases risk of type 2 diabetes, heart disease, stroke, kidney disease and some cancers[2].

The rates of overweight and obesity are continuing to increase. Almost two-thirds of Australians are overweight or obese and one in four Australian children are already overweight or obese[2]. Children who are overweight are also more likely to grow up to become overweight or obese adults, with an increased risk of chronic disease and premature mortality[3].

The cost of obesity in Australia was estimated to be $8.6 billion in 2011-12, comprising $3.8 billion in direct costs and $4.8 billion in indirect costs[4]. If no further action is taken to slow obesity rates in Australia, the cost of obesity over the next 10 years to 2025 is estimated to total $87.7 billion[4].

Free sugars and weight gain

There is increasing evidence that high intake of free sugarsii is associated with weight gain due to excess energy intake and dental caries[5]. The World Health Organization (WHO) strongly recommends reducing free sugar intake to less than 10% of total energy intake (equivalent to around 12 teaspoons of sugar), or to 5% for the greatest health benefits[5].

ii ‘Free sugars’ refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

In 2011-12, more than half of Australians usually exceeded the recommendation to limit free sugar intake to 10%[6]. There was wide variation in the amounts of free sugars consumed, with older children and teenagers most likely to exceed the recommendation and adults aged 51-70 least likely to exceed the recommendation[6]. On average, Australians consumed around 60 grams of free sugars each day (around 14 teaspoons)[6]. Children and young people were the highest consumers, with adolescent males and females consuming the equivalent of 22 and 17 teaspoons of sugar each day respectively [6].

Beverages contribute more than half of free sugar intake in the Australian diet[6]. In 2011-12, soft drinks, sports and energy drinks accounted for 19% of free sugar intake, fruit juices and fruit drinks contributed 13%, and cordial accounted for 4.9%[6]. 3

Sugar-sweetened beverage consumption

In particular, sugar-sweetened beverages are mostly energy-dense but nutrient-poor. Sugary drinks appear to increase total energy intake due to reduced satiety, as people do not compensate for the additional energy consumed by reducing their intake of other foods or drinks[3, 7]. Sugar-sweetened beverages may also negatively affect taste preferences, especially amongst children, as less sweet foods may become less palatable[8].

Sugar-sweetened beverages are consumed by large numbers of Australian adults and children[9], and Australia ranks 15th in the world for sales of caloric beverages per person per day[10].

One third of Australians consumed sugar-sweetened beverages on the day before the Australian Health Survey interview in 2011-12[9]. Of those consuming sweetened beverages, the equivalent of a can of soft drink was consumed (375 mL)[9]. Children and adolescents were more likely to have consumed sugary drinks than adults (47% compared with 31%), and consumption peaked at 55% amongst adolescents[9]. Males were more likely than females to have consumed sugary drinks (39% compared with 29%)[9].

Australians living in areas with the highest levels of socioeconomic disadvantage were more likely to have consumed sugary drinks than those in areas of least disadvantage (38% compared with 31%)[9]. Half of Aboriginal and Torres Strait Islander people consumed sugary drinks compared to 34% of non-Indigenous people[9]. Amongst those consuming sweetened beverages, a greater amount was consumed by Aboriginal and Torres Strait Islanders than for non-Indigenous people (455 mL compared with 375 mL)[9]. 4

The health impacts of sugar-sweetened beverage consumption

WHO and the World Cancer Research Fund (WCRF) recommend restricting or avoiding intake of sugar-sweetened beverages, based on evidence that high intake of sugar-sweetened beverages may increase risk of weight gain and obesity[7, 11]. As outlined earlier, obesity is an established risk factor for a range of chronic diseases[2].

The Australian Dietary Guidelines recommend limiting intake of foods and drinks containing added sugars, particularly sugar-sweetened beverages, based on evidence of a probable association between sugary drink consumption and increased risk of weight gain in adults and children, and a suggestive association between soft drink consumption and an increased risk of reduced bone strength, and dental caries in children[3].

Type 2 diabetes

Sugar-sweetened drinks may increase the risk of developing type 2 diabetes[3]. Evidence indicates a significant relationship between the amount and frequency of sugar-sweetened beverages consumed and increased risk of type 2 diabetes[12, 13]. The risk of type 2 diabetes is estimated to be 26% greater amongst the highest consumers (1 to 2 servings/day) compared to lowest consumers (<1 serving/month)[13].

Cardiovascular disease and stroke

The consumption of added sugar by adolescents, especially sugar-sweetened soft drinks, has been associated with multiple factors that can increase risk of cardiovascular disease regardless of body size, and increased insulin resistance among overweight or obese adolescents[14].

A high sugar diet has been linked to increased risk of heart disease mortality[15, 16]. Consuming high levels of added sugar is associated with risk factors for heart disease such as weight gain and raised blood pressure[17]. Excessive dietary glucose and fructose have been shown to increase the production and accumulation of fatty cells in the liver and bloodstream, which is linked to cardiovascular disease, and kidney and liver disease[18]. Non-alcoholic fatty liver disease is one of the major causes of chronic liver disease and is associated with the development of type 2 diabetes and coronary heart disease[18].

There is also emerging evidence that sugar-sweetened beverage consumption may be independently associated with increased risk of stoke[19].

Chronic kidney disease

There is evidence of an independent association between sugar-sweetened soft drink consumption and the development of chronic kidney disease and kidney stone formation[20]. The risk of developing chronic kidney disease is 58% greater amongst people who regularly consume at least one sugar-sweetened soft drink per day, compared with non-consumers[21].

Cancer

While sugar-sweetened beverages may contribute to cancer risk through their effect on overweight and obesity, there is no evidence to suggest that these drinks are an independent risk factor for cancer[7]. 5

A health levy on sugar-sweetened beverages

WHO recommends that governments consider taxes and subsidies to discourage consumption of less healthy foods and promote healthier options[22]. WHO concludes that there is “reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more”[23].

Price influences consumption of sugar-sweetened beverages[24, 25]. Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption[23]. While a health levy would result in lower income households paying a greater proportion of their income in additional tax, the financial burden across all households is small, with minimal differences between higher- and lower-income households (less than $5 USD per year)[26].

A 2016 study modelled the impact of a 20% ad valorem excise tax on sugar-sweetened beverages in Australia over 25 years[27]. The levy could reduce sugary drink consumption by 12.6% and reduce obesity by 2.7% in men and 1.2% in women[27]. Over 25 years, there could be 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of ischaemic heart disease and 1,100 fewer strokes[27]. In total, 1,600 deaths could potentially be prevented[27].

The 20% levy was modelled to generate more than $400 million in revenue each year, even with a decline in consumption, and save $609 million in overall health care expenditure over 25 years[27]. The implementation cost was estimated to be $27.6 million[27].

A separate Australian report is supportive of an excise tax on the sugar content of sugar-sweetened beverages, to reduce consumption and encourage manufacturers to reformulate to reduce the sugar content in beverages[28]. An excise tax at a rate of 40 cents per 100 grams was modelled to reduce consumption by 15% and generate around $500 million annually in revenue[28]. While a sugary drinks levy is not the single solution to obesity, the introduction of a levy could promote healthier eating, reduce obesity and raise revenue to combat costs that obesity imposes on the broader community.

There is public support for a levy on sugar-sweetened beverages. Sixty nine percent of Australian grocery buyers supported a levy if the revenue was used to reduce the cost of healthy foods[29]. A separate survey of 1,200 people found that 85% supported levy revenue being used to fund programs reducing childhood obesity, and 84% supported funding for initiatives encouraging children’s sport[30].

An Australian levy on sugar-sweetened beverages is supported by many public health groups and professional organisations.

 

NACCHO Aboriginal #healthyfutures and skin #cancer : Sun protection and dark skin: what you need to know

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” Australia has the highest incidence of melanoma and other skin cancers in the world, and while skin cancer is more common in people with light skin, it’s a dangerous misconception that darker skinned people aren’t at risk.

In a 2014 study, one third of Aboriginal and Torres Strait Islander participants from Northern and Central Australia had vitamin D deficiency, which carries some very negative health implications: low vitamin D levels are linked to an increased risk of diseases like diabetes and heart disease.

Given the burden of these chronic diseases in Aboriginal and Torres Strait Islander people, and their contribution to a much reduced life expectancy, more research is needed on the role of sun exposure and vitamin D.

Across all aspects of the healthcare system, overcoming the disadvantage within Indigenous heath is, and needs to be, a priority – dermatology is no exception.”

By Ellen Sima from SBS TV

Cancer Help , Resources and further information for Aboriginal people

Fair or freckled skin, red or blond hair and blue or green eyes: these are the common calling cards of skin cancer susceptibility. But while the risks in darker skinned people is generally reduced, it’s certainly not absent.

In Aboriginal and Torres Strait Islander people – a group with diverse, but commonly darker skin tones – melanoma and other skin cancers are less prevalent than in the non-Indigenous population, but still cause deaths every year.

Public health campaigns – think ‘slip, slop, slap’ – are often targeted to light skinned people, however the inequalities in the availability and appropriateness of health care can impact how different groups access diagnosis and treatment.

Some studies out of the US and UK suggest that, when people of colour (POC) do get skin cancers, they’re often diagnosed at a later stage and carry a higher mortality risk.

Combine this with the dearth of research on skin cancer in darkly pigmented people (studies on skin cancer in Aboriginal and Torres Strait Islanders are particularly sparse), and the picture for darker skinned people is pretty unclear.

In light of this, this article can’t offer any health advice on sun protection beyond that put forward by the Cancer Council.

What it can do is look at what skin cancers are, how different types of pigmentation can change a person’s risk of skin cancer, and go over some other health considerations for sun protection in dark skin that you can bring up with your doctor.

The skin you’re in, and where it could become cancerous:

Some quick human biology: your skin is your largest organ, and is made up of the epidermis (upper layer) and the dermis (lower layer). When skin is exposed to the sun, ultraviolet (UV) rays can damage its DNA, causing the uncontrolled growth of abnormal cells.

The most common types of skin cancer all begin in the epidermis (the upper skin layer), and are handily named after the types of cells they start in:

Basal cell carcinoma (BCC): the basal cells are column-shaped and form the bottom layer of the epidermis. BCC can look like a lump or scaly patch, pale, pink or dark in colour. It’s usually slow growing, rarely spreading to other parts of the body. The earlier it’s found, the easier it is to treat.

Squamous cell carcinoma (SCC): the squamous cells are in the upper layer of the epidermis. SCC can look like a thickened scaly spot or rapidly growing lump, and tends to grow quickly. If left untreated, it can spread to other parts of the body, but this isn’t very common.

Melanoma: melanocytes are located in the basal cell layer and produce melanin pigment. Melanoma are aggressive tumors, and while this cancer is less common than BCC and SCC, it’s much more likely to spread to other parts of the body (like your brain, bones and lungs) through your lymphatic system and bloodstream.

Pigmentation – what’s it got to do with skin cancer risk?

The colour of a person’s skin is strongly influenced by their skin pigments, which are determined by their genetics and lifestyles factors, like sun exposure.

Remember those melanocytes (where melanomas form)? These cells produce melanin and package it in organelles called melanosomes. The melanin in skin comes in two main types: eumelanin is black or brown protective pigment, while pheomelanin is a yellow-red colour.

The type and amount of melanin each person produces will affect their pigmentation (skin colour). Eumelanin is abundant in darker skinned people, who produce more melanin than people with light skin.

For those among us who tan in the sun, exposure to UV rays increases the production of melanin by the melanocytes; when the melanin accumulates in the epidermal layers, a tan builds up and the skin darkens.

Melanin helps protect skin against the sun’s rays by absorbing UV radiation in the surface layers, reducing the risk of cellular DNA damage that can lead to skin cancer.

This protective melanin helps reduce skin cancer risk in dark skinned people.

The flip side – dark skin and vitamin D deficiency

While this melanin barrier can protect against UV damage, it can also make it more difficult for darker skinned people to get the Vitamin D they need.

Vitamin D, known as the ‘sunshine vitamin’, is produced when our skin is exposed to ultraviolet B (UVB) light. Melanin filters this light, reducing the penetration of UVB and putting darker skinned people at a higher risk of vitamin D deficiency.

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A local perspective: sun exposure and health risks for Aboriginal and Torres Strait Islander people

While the research on skin cancer in Aboriginal and Torres Strait Islanders is pretty thin on the ground, some stats published in the Australian Institute of Health and Welfare give a general picture of melanoma incidence:

Between 2005-2009, the rate for melanoma in Indigenous Australians was 9.3 cases in 100,000 people, compared to 33 cases per 100,000 in non-Indigenous Australians.

For BCC and SCC cancers, the data is extremely limited, as, unlike melanoma, these cancers aren’t mandatory to report in state and territory registries.

To gain a better understanding of what skin cancer risks are at play for the diverse Aboriginal and Torres Strait Islander population, more research is needed.

For more information on how to stay safe in the sun this Summer, contact Cancer Council Australia

 

NACCHO Aboriginal Health ” Tackling Indigenous Smoking ” : New Year #healthyfutures #quit message from Tom Calma

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 ” I want to say some more about New Year Eve resolutions or pledges.  Common among smokers around the world is the pledge they make to give up.  

This is great, but the common experience is that within a couple of months the pledge is put on the back burner and old habits re-emerge.  Now is a good time to mount a campaign to talk to your constituents about the “give up the smokes pledge” and encourage them to call Quitline or visit their doctor to talk about developing a strategy and getting support to quit and stay quit.

It would be great for colleagues to get on the Yarning Place and share successful strategies and to post success stories.  We might even want to host a pledge board and to monitor people’s pledges in three and six months’ time.

It has been a big year of learning and successes; please stay safe and healthy over the festive period and enjoy quality family time, drink alcohol responsibly and be smoke free of course “

Professor Tom Calma, National Coordinator for Tackling Indigenous Smoking, in his final Monthly Message of the year : Included in the National Best Practice Unit for Tackling Indigenous Smoking Update of the 12 December 2016 see below , is urging all Aboriginal organisations to take control and resolve in 2017 to implement smoke free workplaces.

  ‘Our mob have the right to work in a smoke free environment just like everyone else in this country.’
 
Visit the Tackling Indigenous Smoking portal on Australian Indigenous HealthInfoNet to access resources to help you achieve smoke free workplaces,homes, cars and events:
 asite
 
For those individuals who are thinking of making a ‘give up smokes pledge’ this New Year, there are several supports available, including:
·         Quitline – 13 78 48
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·         The QuitNow website: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/home for other resources
·         Your Aboriginal Community Controlled Health Organisation and /or Tackling Indigenous Smoking regional team can provide you with smoking cessation support.
naccho-app

 Download the NACCHO APP

Hi colleagues,

 

Tackling smoking in the workplace is often put in the ‘too hard basket’.  In 2016 this is no longer excusable.

 
If we want to make significant inroads into tackling our smoking rates, we must have the courage and will to take control of our workplaces and have Board members, CEOs and Managers and staff step up and set an example to their communities.  Our mob have the right to work in a smoke free environment just like everyone else in this country.

On the 30 November this year, the Commonwealth Department of Health celebrated 30 years of being smoke free.    Think of the benefits to all those working in this Department over these three decades.   Health lead the way in the Commonwealth, with all other Departments becoming smoke free by 1988.  Public and private sector offices implemented their own smoke free policies in the mid-1990s.  Why is it that Aboriginal and Torres Strait Islander organisations, corporations and workplaces are either not smoke free, or do not enforce smoke free policies?
 
The Smoke Free Workplace Policy currently operating in the Department bans smoking and use of e-cigarettes/personal vaporisers within 15 metres of all health buildings at all time.  There may be elements of this Policy that you can draw on, including ideas on the assistance available to staff to quit.   So when you work with or interact with an Aboriginal and Torres Strait Islander organisation or group encourage them to develop a smoke free policy and give them some guidance on how to do it.

The TIS Portal includes resources on smoke free spaces: 
http://www.aodknowledgecentre.net.au/aodkc/aodkc-tobacco/tackling-indigenous-smoking/resources-that-work/tools-and-resources-to-support-activities-that-work.    I encourage you to engage with colleagues on the Yarning Place to share strategies and ideas for smoke free workplace success.

The 30 November was also the fourth anniversary of commencement of Australia’s world-leading tobacco plain packaging measures.  If we can be world leading on tobacco control for all Australians, we can become leaders in Indigenous tobacco control to save our people, our culture and our languages.

As this is my last message for 2016 I would urge you to place at the top of your New Year resolutions list adopting and enforcing smoke free workplace policies in your organisation and encouraging and helping our Aboriginal and Torres Strait Islander organisations to also realise these goals.
 
I want to say some more about New Year Eve resolutions or pledges.  Common among smokers around the world is the pledge they make to give up.  This is great, but the common experience is that within a couple of months the pledge is put on the back burner and old habits re-emerge.  Now is a good time to mount a campaign to talk to your constituents about the “give up the smokes pledge” and encourage them to call Quitline or visit their doctor to talk about developing a strategy and getting support to quit and stay quit.   It would be great for colleagues to get on the Yarning Place and share successful strategies and to post success stories.  We might even want to host a pledge board and to monitor people’s pledges in three and six months’ time.
 
It has been a big year of learning and successes; please stay safe and healthy over the festive period and enjoy quality family time, drink alcohol responsibly and be smoke free of course. J  
 
Regards TOM
 
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NACCHO Aboriginal Health Alert #GetonTrack Report : The ten things we need to do to improve our health

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” Australia’s Health Tracker reports that 25.6% of children and 29.5% of young people are overweight or obese, with even higher prevalence reported in Aboriginal and Torres Strait Islander communities.

Over-consumption of discretionary or junk foods contributes to Australia’s inability to halt the rise of diabetes and obesity. Australia’s Health Tracker also reports that junk foods contribute, on average, to approximately 40% of children and young people’s daily energy needs.

These foods and drinks tend to have low levels of essential nutrients and can take the place of other, more nutritious foods. They are associated with increased risk of obesity and chronic disease such as heart disease, stroke, type 2 diabetes, and some forms of cancer.

Obesity during adolescence is a risk factor for chronic disease later in life and can seriously hinder children’s and young people’s physical and mental development. ”

From the Getting Australia’s Health on Track

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Download the report here getting-australias-health-on-track-ahpc-nov2016

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NACCHO Aboriginal Health #Newspaper What Works Part 3 : Healthy Futures for our Aboriginal Community Controlled Health Services the 2016 Report Card will say

Report from the Conversation

In Australia, one in every two people has a chronic disease. These diseases, such as cancer, mental illness and heart disease, reduce quality of life and can lead to premature death. Younger generations are increasingly at risk.

Crucially, one-third of the disease burden could be prevented and chronic diseases often share the same risk factors.

A collaboration of Australia’s leading scientists, clinicians and health organisations has produced health targets for Australia’s population to reach by the year 2025.

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These are in line with the World Health Organisation’s agenda for a 25% global reduction in premature deaths from chronic diseases, endorsed by all member states including Australia.

Today the collaboration is announcing its top ten priority policy actions in response to a recent health report card that identifies challenges to meeting the targets.

The actions will drive down risk factors and help create a healthier Australia.

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1. Drink fewer sugary drinks

One in two adults and three out of four children and young people consume too much sugar. Sugary drinks are the main source of sugar in the Australian diet and while many other factors influence health, these drinks are directly linked to weight gain and the risk of developing diabetes.

Putting a 20% tax on sugary drinks could save lives and prevent heart attacks, strokes and diabetes. The tax would also generate A$400 million each year that could be spent on much needed health programs.

2. Stop unhealthy food marketing aimed at kids

Almost 40% of children and young people’s energy comes from junk food. Children are very responsive to marketing and it is no coincidence almost two-thirds of food marketing during popular viewing times are unhealthy products.

Restricting food marketing aimed at children is an effective way to significantly reduce junk food consumption and Australians want action in this area. Government-led regulation is needed to drive this change.

3. Keep up the smoking-reduction campaigns

Smoking remains the leading cause of preventable death and disease in Australia, although the trends are positive.

Campaigns that highlight the dangers of smoking reduce the number of young people who start smoking, increase the number of people who attempt to quit and support former smokers to remain tobacco free.

4. Help everyone quit

About 40% of Aboriginal people and 24% of people with a mental illness smoke.

To support attempts to quit, compliance with smoke-free legislation across all work and public places is vital. Media campaigns need to continue to reach broad audiences. GPs and other local health services that serve disadvantaged communities should include smoking cessation in routine care.

5. Get active in the streets

More than 90% of Australian young people are not meeting guidelines for sufficient physical activity – the 2025 target is to reduce this by at least 10%.

Active travel to and from school programs will reach 3.7 million of Australia’s children and young people. This can only occur in conjunction with safe paths and urban environments that are designed in line with the latest evidence to get everyone moving.

6. Tax alcohol responsibly

The Henry Review concluded that health and social harms have not been adequately considered in current alcohol taxation. A 10% increase on the current excise, and the consistent application of volume-based taxation, are the 2017 priority actions.

Fortunately, the trends suggest most people are drinking more responsibly. However approximately 5,500 deaths and 157,000 hospital admissions occur as a consequence of alcohol each year.

7. Use work as medicine

People with a mental illness are over-represented in national unemployment statistics. The 2025 target is to halve the employment gap.

Unemployment and the associated financial duress exerts a significant toll on the health of people with a mental illness, and costs an estimated A$2.5 billion in lost productivity each year.

Supported vocational programs have 20 years of evidence showing their effectiveness. Scaling up and better integrating these programs is an urgent priority, along with suicide prevention and broader efforts.

8. Cut down on salt

Most Australian adults consume in excess of the recommended maximum salt intake of 5 grams daily. This contributes to a high prevalence of elevated blood pressure among adults (23%), which is a major risk factor for heart diseases.

Around 75% of Australian’s salt intake comes from processed foods. Reducing salt intake by 30% by 2025, via food reformulation, could save 3,500 lives a year through reductions in heart disease, stroke and kidney disease.

9. Promote heart health

Heart disease is Australia’s single largest cause of death, and yet an estimated 970,000 adults at high risk of a cardiovascular event (heart attack or stroke) are not receiving appropriate treatment to reduce risk factors such as combined blood pressure and cholesterol-lowering medications. Under-treatment can be exacerbated by people’s lack of awareness about their own risk factors.

National heart risk assessment programs, along with care planning for high-risk individuals, offer a cost-effective solution.

10. Measure what matters

A comprehensive Australian Health Survey must be a permanent and routine survey every five years, so Australia knows how we are tracking on chronic disease.

All of these policies are effective, affordable and feasible opportunities to prevent, rather than treat, Australia’s biggest killer diseases

 

NACCHO Aboriginal Health and Smoking :Facebook could help lower Indigenous smoking rates,health researchers say

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“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,”

Marita Hefler from the Menzies School of Health Research in Darwin.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,”

After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

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Articles are from Page 8  NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

Indigenous people have the highest rates of smoking in the country, but researchers in the Top End believe Facebook could be the most effective way of helping them quit.

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As reported the ABC

Aboriginal people living in remote communities smoke at three times the rate of other Australians, according to research fellow Marita Hefler from the Menzies School of Health Research in Darwin.

Preliminary research into the role of Facebook in helping smokers to quit has found that although the living situations of Indigenous Australians differs widely across the Northern Territory, even those who lack food or clothing may still own a smartphone.

“We know that Aboriginal people use social media at very high rates; it’s been taken up even in remote communities, particularly where people have limited communication through other means,” Ms Hefler said.

Researchers believe Indigenous people use Facebook at higher rates than the overall population, making it one of the most effective ways to reach out.

“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,” Ms Hefler said.

Early findings show that when friends and family talk about quitting smoking on social media, it has a greater effect than traditional hardline anti-smoking ads.

“The people in your Facebook networks influence you the most,” Ms Hefler said.

“In the past, anti-smoking advertising has relied heavily on having a captive audience; we know that smokers don’t like the content they are seeing, but they can’t get away. Now with the advent of Facebook, all you have to do is swipe and the message is gone.”

Cigarettes more popular than fruit in outback stores

Customers in remote Australia spent roughly four and a half times more on cigarettes than fruit and vegetables in 2015-16, said Stephen Bradley, chairman of Outback Stores, a government-owned company which manages 37 businesses in some of the remotest parts of the country.

An incentive program run by Outback Stores to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales, but Mr. Bradley admits more needs to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” he said.

The Federal Government is aiming to close the gap between Indigenous and non-Indigenous life expectancy within a generation.

Indigenous deaths caused by heart disease and strokes have been dropping but on average Indigenous people are still dying 10 years younger than non-Indigenous Australians.

“Smoking in Aboriginal communities looks quite different to what it does in the rest of Australia,” Ms Hefler said.

“There’s historical reasons why the smoking rate is higher: it’s tied up in inter-generational trauma, and we also know the stolen generations are more likely to smoke.”

Using Facebook to quit

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After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

Ms Lowah has been a smoker for more than half her life and agrees the tough traditional anti-smoking ads are too easy to ignore.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,” she said.

The preliminary research findings from Menzies have been welcomed by NT Territory Labor MP Chansey Paech, whose central Australian electorate of Namatjira has a high Indigenous population.

“Both the Territory and Federal Governments have made significant contributions over the last several years to reduce the rates of smoking, so I’m looking forward to reading the report and seeing what the recommendations are, and hopefully reducing the smoking rate in the Northern Territory, which we know is too high,” he said.

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NACCHO Overcoming Indigenous Disadvantage #Smoking and Healthy Lives report : Cigarettes favoured over fruit in Outback stores

 

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” Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

  A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016). “

The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians. Download Chapter 8 or see below

naccho-download-nov-2016-chapter8-healthy-lives

Read 90 NACCHO articles about Tackling Indigenous Smokes

Or Articles page 8 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

” Tobacco turnover had remained “consistently high” with 8.34 million sticks sold over the year and tobacco accounting for 19 per cent of all food and grocery sales.

Customers spent 4.4 times more on cigarettes than fruit and vegetables in 2015/16.”

Chairman Stephen Bradley revealed in the annual report of Outback Stores Pty Ltd, the government-owned company which manages 37 businesses in some of the remotest parts of Australia.

Lung cancer is the highest-ranked cancer type among Indigenous people, but the fourth-ranked for non-indigenous Australians.

An incentive program to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales.

 Location of Outback stores across Australia.

Location of Outback stores across Australia.

But the company admitted more needed to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” Mr Bradley wrote.

The government is aiming to close the gap between Indigenous and non-indigenous life expectancy within a generation, halving the gap in mortality rates for under-fives within a decade and halving the gap in employment outcomes.

The company reported 297 Indigenous staff were employed in Outback Stores businesses, which turned over $82.5 million in 2015/16.

Overcoming Indigenous Disadvantage: Key Indicators 2016

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–>The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians. Chapter 8.4

Tobacco consumption and harm[1]

Things that work

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016).

A systematic review of 73 interventions in indigenous communities globally found that there was no single intervention that was more likely to result in a reduction in tobacco use, but rather that more successful programs:

  • use a comprehensive approach inclusive of multiple activities
  • centre Aboriginal leadership
  • make long-term community investments
  • provide culturally appropriate health materials and activities to produce desired changes (Minichiello et al. 2016).

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

Box 8.4.1      Key messages
·      Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

·      A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

 

Box 8.4.2      Measures of tobacco consumption and harm
There is one main measure for this indicator (aligned with the associated NIRA indicator), rates of current daily smokers, measured by the proportion of people aged 18 years and over who are current daily smokers (all jurisdictions; remoteness; age; sex).

Smoking rate data are available from the ABS Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS)/National Aboriginal and Torres Strait Islander Social Survey (NATSISS), with the most recent data available from the 2014‑15 NATSISS. Data for the non‑Indigenous population are sourced from the ABS Australian Health Survey (AHS)/National Health Survey (NHS), with the most recent data available from the 2014-15 NHS.

Previous editions of this report included a supplementary measure on tobacco-related hospitalisations. This is no longer included as the measure only related to conditions directly attributable to tobacco — not most conditions, where tobacco may be a contributing factor but the link is not immediate. Data are also difficult to interpret as they represent less than one per cent of all Aboriginal and Torres Strait Islander hospitalisations and are therefore highly volatile over time.

Tobacco consumption is a subsidiary performance measure for COAG’s target of ‘closing the life expectancy gap (between Indigenous and non-Indigenous Australians) within a generation’ (COAG 2012).

In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking (AHMAC 2015). Among Aboriginal and Torres Strait Islander Australians, tobacco use is the leading risk factor contributing to disease and death (Vos et al. 2007). Studies have found that smoking tobacco increases the risk of developing numerous cancers, heart and vascular diseases, and depression (AHMAC 2012; Cunningham et al. 2008; Pasco et al. 2008). Smoking in pregnancy can lead to miscarriage, stillbirth or premature birth (Graham et al. 2007). Section 6.2 includes information on women reporting smoking during pregnancy.

Compared to non-Indigenous people, Aboriginal and Torres Strait Islander Australians who smoke generally commence at an earlier age and smoke for longer (CEITC 2010, 2014). Recent research (Knott et al. 2016) suggests also there may be fundamental differences in the determinants of smoking and the reasons for quitting, between Aboriginal and Torres Strait Islander men and women.

Research has found that the proportion of Aboriginal and Torres Strait Islander adults who want to quit smoking and those who have made a quit attempt in the past year, are similar to the general population. However fewer Aboriginal and Torres Strait Islander adults have made a sustained quit attempt for at least a month and a lower proportion agree that social norms disapprove of smoking, compared to the general population (Thomas et. al 2015).

Tobacco use is often associated with other lifestyle related health risk factors, such as excessive alcohol consumption and poor diet. Long term risky/high risk drinkers (both males and females) were more likely to be current smokers than those who drank at a low risk level (ABS 2006). Section 11.1 examines alcohol consumption and harm.

In Australia and many other countries smoking behaviour is inversely related to socioeconomic status, with those in disadvantaged groups in the population more likely to start and continue smoking. In addition to long-term health risks, low income groups (such as some Aboriginal and Torres Strait Islander families and communities) are affected by the financial strain associated with tobacco use (Greenhalgh 2015). A recent study in NSW found that more disadvantaged areas were significantly more likely to have higher tobacco outlet densities, with this density significantly and positively associated with smoking status (Marashi-Pour 2015).

Tobacco consumption

Current daily smokers are people who smoked one or more cigarettes (or pipes or cigars) per day at the time of survey interview.

The COAG performance measure and the data presented in this section focus on the proportion of people aged 18 years and over who are current daily smokers. However, as noted, Aboriginal and Torres Strait Islander Australians tend to start smoking at an earlier age than non‑Indigenous people — for 2014-15, in non-remote areas around one in six (16.2 per cent) Aboriginal and Torres Strait Islander 15 to 17 year olds were current daily smokers, compared with one in thirty (3.3 per cent) non‑Indigenous 15 to 17 year olds (table 8A.4.12).

Nationally in 2014-15, the crude daily smoking rate among Aboriginal and Torres Strait Islander adults was 41.4 per cent, a decline from 50.7 per cent in 2001 (table 8A.4.1). Rates varied across states and territories in 2014-15, from 38.8 per cent in SA to 46.2 per cent in the NT (table 8A.4.1). Smoking rates were higher in remote and very remote areas (49.3 per cent and 48.9 per cent) than in major cities (36.3 per cent) (table 8A.4.2). In non-remote areas in 2014-15, smoking was most prevalent among those aged 25–54 years (between 45.4 and 46.5 per cent), with smoking rates much lower for older people (31.3 per cent for those aged 55 years and over). A similar pattern was observed for non‑Indigenous Australians, although the daily smoking rates were consistently lower across all age groups (table 8A.4.12).

After adjusting for different population age structures, in 2014-15 the current daily smoking rate for Aboriginal and Torres Strait Islander Australians was 2.8 times the rate for non-Indigenous Australians (table 8A.4.7). The gap in smoking rates was widest in remote areas (table 8A.4.8).

 

Figure 8.4.1   Current daily smokers aged 18 years and over, 2001 to 2014-15a, b
a Error bars represent 95 per cent confidence intervals around each estimate. b Rates are age standardised.
Sources: ABS (unpublished) National Health Survey 2001; ABS (unpublished) National Health Survey and National Aboriginal Torres Strait Islander Health Survey 2004-05; ABS (unpublished) National Aboriginal Torres Strait Islander Social Survey 2008; ABS (unpublished) National Health Survey 2007-08; ABS (unpublished) Australian Aboriginal Torres Strait Islander Health Survey 2012-13 (core component); ABS (unpublished) Australian Health Survey 2011–13 (2011-12 core component); ABS (unpublished) National Aboriginal and Torres Strait Islander Social Survey, 2014-15; ABS (unpublished) National Health Survey, 2014-15; table 8A.4.7.

Between 2001 and 2014-15, after adjusting for differences in population age structures, the daily smoking rate declined for both Aboriginal and Torres Strait Islander adults and non‑Indigenous adults, leaving the gap relatively unchanged at around 26 percentage points (figure 8.4.1).

Data for smoking rates reported by State and Territory are available by remoteness in tables 8A.4.2–6 and 8A.4.8−10 and by sex in tables 8A.4.11-12.

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

[1]    The Steering Committee notes its appreciation to the National Health Leadership Forum, which reviewed a draft of this section of the report.