NACCHO Aboriginal Health Pharmacy News : #ACCHO Pharmacy skills will help #closethegap in #heart disease

ACCHOs have a strong history in doing this effectively and appropriately for their communities,

Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

Deputy NACCHO CEO Dr Dawn Casey

With new research showing current cardiovascular disease screening guidelines are missing younger at-risk Aboriginal people, a leading Aboriginal health specialist has highlighted the role pharmacists can play in preventative cardiac care.

The statement Dr Dawn Casey comes following research finding up to half of older Australian Aboriginal and Torres Strait Islander people are at high risk of cardiovascular disease (CVD), and that significant numbers of those in their 20s were also at risk.¹

Continued below

Read over 50 NACCHO Aboriginal Heart Health articles published over past 6 years

Read 8 NACCHO Aboriginal Health and Pharmacy articles

Featured article 

 Read above report HERE : NACCHO Aboriginal Heart Health

From Australian Pharmacist 

Australian National University researchers found 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high absolute primary risk of CVD. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.¹

The study of 2820 people from a 2012-13 health survey² revealed many Aboriginal and Torres Strait Islander people are not aware of their risk and most not receiving currently recommended therapy to lower their cholesterol, and are hospitalised for coronary heart disease at a rate up to eight times higher than that of other Australians.¹

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the high-risk category starts much earlier than this, and indicates the affected group needs to start receiving CVD checks earlier in life, the study authors said.

Dr Casey echoed the positive results of the study, allowing the entire ACCHS sector to better deliver preventative and holistic care.

‘ACCHOs have a strong history in doing this effectively and appropriately for their communities,’ she told Australian Pharmacist.

‘Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

‘Embedded ACCHO pharmacists can use their skills and knowledge work with a range of clinicians in the ACCHO to conduct holistic risk screening and overall management strategy.

NACCHO is currently actively advocating for enhanced integration of pharmacists into ACCHOs models of care.’

NACCHO and PSA are currently working as part of a broader team on two projects to enhance the broader roles that pharmacists’ skills and training can deliver – Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) and Indigenous Medication Review Service (IMeRSe).

‘Pharmacists have a broad range of clinical skills and are often very suitable additions to multidisciplinary clinical teams, especially where chronic disease is prevalent and many medicines required,’ Dr Casey said.

‘Community pharmacists may identify risks within normal client care, for example through a pharmacy-based MedsCheck or an HMR. Where team-based care is working effectively, pharmacies and ACCHOs will liaise and work together to ensure care is optimised across these settings.

‘Pharmacists’ understanding of medicines also involves understanding how medical conditions and risk factors for these conditions apply. Unfortunately there is still sometimes a misconception across Australia that pharmacists really just supply medicines and manage retail businesses. Enhancing professional and clinical services is a key trend across the whole pharmacy sector and NACCHO is an active participant in these developments.’

PSA and NACCHO have collaboratively produced guidelines to support pharmacists caring for Aboriginal and Torres Strait Islander people available at:

http://www.psa.org.au/wp-content/uploads/guide-to-providing-pharmacy-services-to-aboriginal-and-torres-strait-islander-people-2014.pdf

References

1 Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks, E. Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209 (1): 35-41. DOI: 10.5694/mja17.00897

NACCHO Aboriginal Health News : Download @aihw Aboriginal health organisations : Online Services Report—key results 2016–17 : Part 2 Is the Closing the Gap ‘too focused on prosperity debate

 ” The National Congress of Australia’s First Peoples has also warned that a focus on “economic prosperity” in the current Close the Gap review “is misguided and should not serve as an overarching focus for government policy”.

The Lowitja Institute has called for “prosperity” to be ­removed as a criteria, saying it “has strong monetary connotations and does not adequately speak to the health and education sectors”, and warns that the ­review will fail “if effective partnerships and engagement, not consultation, with Aboriginal and Torres Strait Islander leaders and communities is not undertaken from the start to the end of the process”.

From the Australian 14 July see Part 2 Below

Part 1 : Download Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17

This ninth national report provides information on 266 organisations funded by the Australian Government to deliver health services to Aboriginal and Torres Strait Islander people. These organisations contributed to the 2016–17 Online Services Report. Information is presented on the characteristics of these organisations; the services they provide; client numbers, contacts and episodes of care; staffing levels; and service gaps and challenges.

Some changes were made to the 2016–17 data collection, aimed at ensuring consistency in episode of care reporting between the different data collection systems. This resulted in a decrease in primary health episode of care counts in 2016–17. These are not comparable with previous collections, so comparisons are not presented in this report. See Chapter 2 for more information about the data collection, data quality and the impacts of these changes.

Download the full report 120 Page HERE

aihw-ihw-196

Key messages

1.A range of services are provided to Aboriginal and Torres Strait Islander people

Of the 266 organisations in 2016–17:

  • 196 (74%) provided a range of primary health-care services to around 444,700 clients through 3.2 million episodes of care. Just over two-thirds of these organisations (136) were Aboriginal Community Controlled Health Organisations. Services provided include: health promotion; clinical care; substance-use treatment and prevention; and social and emotional wellbeing support. These organisations also provided access to specialist, allied health and dental services, either on site or by facilitating off-site access. For example, most provided access to cardiologists (90%); renal specialists (87%); ophthalmologists (86%); paediatricians (90%); psychiatrists (87%); diabetes specialists (90%); and ear, nose and throat (ENT) specialists (88%). They also provided access to dental services (94%) and to allied health services such as physiotherapists (89%); psychologists (93%); dieticians (95%); podiatrists (96%); optometrists (94%); and audiologists (91%).
  • Around 7,600 full-time equivalent (FTE) staff were employed by organisations providing primary health-care services and just over half of all staff (53%) were Aboriginal and/or Torres Strait Islander (see Chapter 3).
  • 213 (80%) provided maternal and/or child health services through their primary health and/or New Directions funding. Around 8,400 Indigenous women were seen through 42,200 antenatal visits—an average of 5 visits per client (see Chapter 4).
  • 88 (33%) provided social and emotional wellbeing services. The 189 counsellors in these organisations saw around 16,300 clients, through 77,100 client contacts—an average of 5 contacts per client (see Chapter 5).
  • 80 (30%) provided substance-use services to around 39,400 clients through 197,700 episodes of care. Most episodes of care (88%) were for non-residential or after-care services (see Chapter 6).

2.Many funded organisations provide services in Remote and Very remote areas

Nearly half (46%) of the organisations funded to provide primary health-care services to Aboriginal and Torres Strait Islander people did so in Remote or Very remote areas and they saw around 168,100 (38%) clients. Around 44% of employed staff (3,347 FTE) worked in Remote or Very remote areas, including a higher proportion of employed nurses and midwives (59% or 664 FTE) and a lower proportion ofemployed dental care staff (21% or 38 FTE).

There were more FTE nurses and midwives per 1,000 clients in Remote (3.5) and Very remote areas (4.4), compared with 2.6 per 1,000 clients overall. There were fewer doctors in Very remote areas (0.9 FTE doctors per 1,000 clients compared with 1.3 overall), perhaps reflecting a greater reliance on nurse-led clinics in these areas. Contacts by nurses and midwives represented half (51%) of all contacts in Very remote areas compared with 29% overall.

Over 800,000 episodes of care (25%) were provided to clients in Very remote areas. However, organisations in Very remote areas were still more likely to report staffing vacancies. Nearly one-third (31%) of reported health-staff vacancies were in organisations in Very remote areas. They also had more health-staff vacancies per 1,000 clients (1.0 compared with 0.7 overall). Organisations in Very remote areas were also more likely to report the recruitment, training and support of staff as one of the challenges they faced in providing quality care to clients (75% compared with 67% overall) as well as staff retention and turnover (75% compared with 57% overall).

3.Various group activities are run to promote health and wellbeing

Organisations delivered a range of group activities in 2016–17 to improve the health of the community:

  • Those funded to provide primary health-care services ran around 8,400 physical activity/healthy weight sessions; 4,300 chronic disease client support sessions; and 3,300 tobacco-use treatment and prevention sessions. Other common health promotion activities included campaigns to encourage immunisation services (in 81% of organisations), healthy lifestyle programs (75%) and sexual health/ education (71%).
  • With respect to maternal and child health services, around 20,300 home visits; 3,100 maternal and baby/child health group sessions; 2,100 parenting group sessions and 1,000 antenatal group sessions were provided.
  • In those funded to provide substance-use services, most (93%) provided community education, while 60% did school visits. Around 4 in 5 (80%) ran physical activity or healthy weight programs and around three-quarters ran tobacco-use treatment and prevention groups (76%),  alcohol-misuse  treatment and prevention groups (74%), living skills groups (75%), men’s groups (75%) and women’s groups (74%).

Things to note

  • Most (94%) organisations funded to provide primary health care also provided social and emotional wellbeing or mental health or counselling services, and over half (57%) had mental health promotion activities in 2016–17; however, nearly two-thirds of organisations still reported mental health and social and emotional wellbeing services as a service gap (63%). This was even higher (78%) in organisations funded to provide substance-use services, but not primary health care.
  • Some organisations indicated that clients with high needs had to wait too long for some services,   in particular to access dental services and mental health professionals. For example, 50 (27%) organisations providing on-site or off-site access to dental services still felt clients with high needs often had to wait a clinically unacceptable time for dental services. This was higher in organisations in Remote (44%) and Very remote (34%) areas.
Part 2 Is the Closing the Gap ‘too focused on prosperity debate

The Closing the Gap program aimed at reducing indigenous disadvantage has hit stasis 10 years after it began, with four of its seven measures expired, a review of the scheme still months off being completed and warnings from a range of peak organisations that some proposed criteria for replacement targets are irrelevant or unhelpful.

Some fear the 11th annual Prime Minister’s report due in February might focus more on ­details of the review and launching a reboot, rather than accounting for any actual achievements in the scheme’s aims.

Submissions to the review warn of a “dire need for greater government accountability” and say “a myopic focus on national statistics” in the past has led to the needs of individual remote communities being unmet, as well as criticising the awarding of contracts to mainstream organisations which “frequently lack the capacity, knowledge and cultural competence required to effectively deliver services to our communities”.

The National Congress of Australia’s First Peoples has also warned that a focus on “economic prosperity” in the current review “is misguided … and should not serve as an overarching focus for government policy”.

The Lowitja Institute has called for “prosperity” to be ­removed as a criteria, saying it “has strong monetary connotations and does not adequately speak to the health and education sectors”, and warns that the ­review will fail “if effective partnerships and engagement, not consultation, with Aboriginal and Torres Strait Islander leaders and communities is not undertaken from the start to the end of the process”.

It also warns of unhelpful uses of nationwide targets “which, due to data-collection protocols were unmeasurable, and secondly, did not seem to consider the distinct challenges faced at both the state and local levels”.

Of the four Closing the Gap targets that expired at the beginning of this month, just one — halving the gap in infant mortality rates — was said to be on track, ­although even that assessment has been questioned.

The other three — closing the gap on school attendance, halving the gap in reading and numeracy and halving the employment gap — expired without being on track.

Only two of the still active three targets are on track: getting 95 per cent of all indigenous four-year-olds enrolled in early childhood education by 2025 and halving the gap for Year 12 or equivalent attainment by 2020.

A third, closing the life expectancy gap by 2031, is not on track.

The Weekend Australian understands two review workshops are scheduled in Canberra for the end of this month, for peak groups in the sector and others who have made submissions.

The review, which is being conducted by the Department of Prime Minister and Cabinet as a Council of Australian Governments exercise, is then expected to report back by October 31 with a new “framework, targets and performance indicators”.

However congress co-chair Rod Little warned this might still be merely a report that requires further refining, with the outcome that by next February, when the Prime Minister’s annual report should be delivered, “that’s one year that’s gone into reshaping the framework rather than working on outcomes”.

But he said the October deadline opened the door for further consolidation.

NACCHO and @Vision2020Aus Aboriginal Eye Health Deadly Good News : #BecauseofHerWeCan #WeCan18 ! – #Indigenous women in eye health @Walgett_AMS @BADACBallarat @AHCSA_ @IEHU_UniMelb

 ” To mark NAIDOC Week 2018 and this year’s theme ‘Because of Her, We Can!’, Vision 2020 Australia is celebrating the roles and achievements of some of the incredible Aboriginal and Torres Strait Islander women working in the eye health sector.  

These women perform a range of roles across a number of areas in the sector, but they are all proud of their cultures, passionate about their work and driven to help improve health outcomes in Indigenous communities and beyond.”

Originally published HERE VISION 2020

Read over 40 Aboriginal Eye Health Articles published over the past 9 years

 ” Vision 2020 Australia’s Aboriginal and Torres Strait Islander Committee Chair, Dr Dawn Casey (COO, NACCHO), said it will be hard to improve Aboriginal health when funding bodies and Aboriginal service providers are “not on the same page”.

Dr Casey spoke at the Close the Gap for Vision by 2020: Striving Together National Conference in March about the longevity of ACCHOs delivering clinically effective health outcomes for over 40 years: “Our mob trust us”. While medical professionals have a role to play in closing the gap, sustainable approaches must be embedded in ACCHOs ”

Read full report here Aboriginal-led solutions key to closing the vision gap

1.Robyn Bradley, Aboriginal Health Liaison Officer – Royal Victorian Eye and Ear Hospital

Robyn’s father’s ancestors emigrated from England and Scotland in the early 1800s and her mother’s family are from the Dhauwurd Wurrung peoples more commonly known as Gunditjmara in Western Victoria.

“I am proud to belong to this beautiful and ancient land. If you listen quietly you can still hear the dreamtime stories of our elders rustling through the bush, whispered over the dessert country and swirling around our brilliant coastlines. I am proud I come from this perfectly crafted tapestry of ancient first nation peoples, emigrants, convicts, pioneers, bushrangers and first fleeters.

“I am also proud to share my passion for my culture and beliefs as an Aboriginal Health Liaison Officer at the Eye and Ear. I get to meet with community and act as a steward to help them receive the highest possible level of care – care that considers what is culturally appropriate and meets their unique needs.”
Robyn Bradley, Aboriginal Health Liaison Officer at the Royal Victorian Eye and Ear Hospital

2. Aboriginal women of the Aboriginal Health Council of South Australia

Since its inception, the Aboriginal Health Council of South Australia (AHCSA) has looked to the leadership of Aboriginal and Torres Strait Islander Women as trailblazers and advocates for better health outcomes for their communities.

Currently there are seven Aboriginal Women working in various roles within the AHCSA Secretariat. The women’s kinship ties extend all over the country and all are united in their efforts to contribute to improving health for their communities, acting as advocates for increased and improved access to Hospital and Health Services and creating opportunities for their communities, particularly the next generation.

Image (L-R): Sarah Betts (Sexual Health Coordinator), Ngara Keeler (Tackling Indigenous Smoking Programme Coordinator), Jessica Koncz (Student Services Officer), Jenaya Hall, (Tackling Indigenous Smoking Project Officer), Amanda Mitchell (Deputy CEO), Debra Stead (Senior Finance Officer),
Absent from photo, Hannah Keain, (Junior Project Officer)
7 Aboriginal women who work at the Aboriginal Health Council of South Australia

3.Keearny Maher, Occupational Therapist – VisAbility

Keearny Maher is a Wiradjuri woman who specialises in vision impairment at VisAbility WA. Her cultural ties originate in Narrandera, NSW through her mother and Wiradjuri woman Ann-Maree Bloomfield.

“One rewarding aspect of my role is helping people find independence again after vision loss, particularly in the simple activities we all take for granted, like making a hot cuppa.”

Keearny’s role takes her all over WA, with some of her career highlights extending overseas, including volunteer work as an occupational therapist in Ukraine and India with children with varying disabilities.

Occupational Therapist at VisAbility, Keearny Maher

Rosamond Gilden, Research Assistant – Indigenous Eye Health at the University of Melbourne and member of Orthoptics Australia

Upon completing a Masters in Orthoptics, Rosamond worked in the private and public sector. To pursue her interest in research, Rosamond joined the Centre for Eye Research Australia as Clinical Coordinator of the National Eye Health Survey. It was during this time she became aware of the poor eye health outcomes for Indigenous Australians and wanted to make a difference.
In 2016, Rosamond commenced work with Indigenous Eye Health and is part of the Roadmap team whose goal is to Close the Gap for Vision by 2020.  Rosamond has used her experiences as a clinician to inform the current work that she is now undertaking and is grateful for the opportunity she has each day to contribute to a sector that has a sincere interest in improving eye health outcomes for Aboriginal people.
Rosamond Gilden

4. Jenny Hunt, Eye Health Worker – Walgett Aboriginal Medical Service in partnership with Brien Holden Vision Institute

Jenny is a proud Gamilaraay woman who has been providing eye care services in partnership with the Brien Holden Vision Institute Aboriginal Vision Program for the past 10 years to the Walgett community.

“I find the eye program rewarding when I see the relief and smile on my people’s faces when they first put their glasses on. I feel proud. Also, if they do not attend their optometrist or ophthalmologist appointments, I will chase them up and take them there myself because I know how important it is for them.
“I have excellent communication with the outreach location workers and they do a wonderful job getting the patients in for our clinics. I travel to Narrabri, Collarenebri, Goodooga, Pilliga and Lightning Ridge for clinics as well as the one we run in Walgett. Without the help from these workers, there would be no eye clinics.”
Jenny Hunt standing in front of a sign for Walgett Aboriginal Medical Service

5.Faye Clarke, Diabetes Educator/Care Co-ordinator – Ballarat and District Aboriginal Co-operative in partnership with Indigenous Eye Health at the University of Melbourne

Faye is a Gunditjmara, Wotjobaluk and Ngarrindjeri woman who works with Aboriginal communities in the Ballarat and wider Grampians region of Victoria to help promote eye health and help those living with diabetes. Faye is passionate about working in Indigenous eye health and was excited to work with the IEH team on the Roadmap to Close the Gap for Vision.

“Vision is such an essential part of our life and when it is threatened it makes all the difference to someone’s quality of life. My dual role as a Care Co-ordinator means I can take on roles in both education and co-ordinating their path in the health care system.

“I am passionate about Indigenous eye health because of the work I do but also because of the clients I work with who are affected by threats to their vision.”

Faye Clarke from Ballarat and District Aboriginal Co-operative

6.Simone Kenmore, Manager of South Australian Trachoma Elimination Program – Country Health South Australia

Simone is a Yankunytjatjara woman from the Anangu Pitjantjatjara Yankunytjatjara Lands in remote South Australia. Simone works with Indigenous communities and health professionals across Australia to inform a model of best practice to work towards the elimination of trachoma in South Australia, and is passionate about improving health outcomes for Indigenous communities.
“I have always been passionate about working in programs that contribute to improved outcomes for Indigenous communities. My work in trachoma is driven by the fact that it is a preventable disease. By sharing what we know about eye health, building the capacity of our communities and working in partnership across health, education and housing we can eliminate trachoma and prevent blindness for future generations.”
(Image and content provided by Indigenous Eye Health at University of Melbourne)
Simone Kenmore

7.Emma Robertson, ITC Care Coordinator – Karadi Aboriginal Corporation

Emma is a Palawa woman working in a health promotion role at Karadi Aboriginal Corporation in Tasmania, encouraging people to come in for regular eye checks. Emma believes this year’s NAIDOC Week is a great chance to honour the women who have influenced her and her work in Indigenous health.

“I thinks this year’s theme is one of the best yet. I get to honour the women who were before my time that set the path that now enables me to work in my areas of passion around Indigenous health. It also makes me feel proud as an Aboriginal mum and the role I am playing in setting what I hope is a great role model for my daughters – that with hard work, determination and good people around you, you can make a profound difference in the lives of others.”

(Image and content provided by Indigenous Eye Health at University of Melbourne)
Emma Robertson from Karadi Aboriginal Corporation

NACCHO partners with @Mayi_Kuwayu and key Indigenous peak bodies to survey 200,000 Aboriginal and Torres Strait Islander people in national Wellbeing study

“The Aboriginal-led and governed study will be larger than any previous study of Aboriginal and Torres Strait Islander adults.

It aims to provide information for communities, services and policy makers to improve Aboriginal and Torres Strait Islander health and wellbeing.”

Dr Mark Wenitong, study co-investigator from the Apunipima Cape York Health Council.

In an Australian first, the Australian National University will partner with key Aboriginal and Torres Strait Islander peak bodies to conduct a national study of Aboriginal and Torres Strait Islander wellbeing.

The study name, ‘Mayi Kuwayu’ means ‘to follow Aboriginal people over time’ in Ngiyampaa language, the family language of the study’s director, Associate Professor Ray Lovett from the National Centre for Epidemiology and Population Health at ANU.

Download Mayi Kuwayu Study_Protocol

“The survey includes questions that people have told us matter to them as Aboriginal and Torres Strait Islander people.

Those things include connection to country, cultural beliefs and knowledge, language, family, kinship and community, cultural expression and continuity and self-determination and leadership, along with health”, Associate Professor Ray Lovett said.

 

The study will be rolled out in the second half of 2018 and will provide much needed evidence on Aboriginal and Torres Strait Islander culture and its impact on health and wellbeing.

The team has developed the survey questions with Aboriginal and Torres Strait Islander people from across the country over the last three years.

An Aboriginal and Torres Strait Islander governance committee will oversee the study, and ensure that it adheres to principles of Indigenous data sovereignty and governance.

All Aboriginal and or Torres Strait Islander people aged 16 years or older can be part of the study.

 

Potential participants can contact the team at mkstudy@anu.edu.au, at the study website www.mkstudy.com.au, or by free call on 1800 531 600.

The study received funding from the Lowitja Institute and the National Health and Medical Research Council.

A protocol paper describing the study has recently been published in the journal BMJ Open: https://bmjopen.bmj.com/content/8/6/e023861.share.

Our study partners include:

NACCHO Aboriginal Heart Health : @ourANU @Mayi_Kuwayu Report high levels of risk of heart disease and #stroke for young and old #Indigenous Australians can be prevented : Plus @strokefdn Response

Recognising the risk will help save and improve lives and contribute to Closing the Gap in life expectancy.

Heart checks may need to start earlier in order to protect Aboriginal and Torres Strait Islander people but the good news is most heart attacks and strokes can be prevented.

Critical to this is knowing who is at risk and encouraging lifestyle changes, including quitting smoking, and lowering blood pressure and cholesterol levels.

The study also found that many people at high risk of heart attacks or strokes are not aware of it and most are not receiving currently recommended therapy to lower their cholesterol.”

Indigenous Health Minister Ken Wyatt releasing the study

Ken Wyatt Heart study press release

 ” Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.

The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke.

Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk ‘

Download the Report here Heart Stroke Report

OR Read online HERE

ANU researchers have met with Minister for Indigenous Health Ken Wyatt, Aboriginal woman and heart health researcher Vicki Wade and to launch new study on First Nations people heart health.

Aboriginal and Torres Strait Islander people were twice as likely to be hospitalised with stroke and 1.4 times as likely to die from stroke than non-indigenous Australians. 

Stroke can be prevented, it can be treated and it can be beaten. We must act now to stem the tide of this devastating disease

Steps must be taken immediately to increase stroke awareness and access to health checks through targeted action. Federal and state government must come together to address this issue.”

Stroke Foundation Chief Executive Officer Sharon McGowan said the research results were frightening. See Full Press Release Part 2 below

” Australian’s national guidelines currently say heart health screening should begin at age 35 for Aboriginal and Torres Strait Islander people.

However, new research has found there’s a high risk of Indigenous people under 35 developing cardiovascular disease.

The study also shows Indigenous people have a higher risk of developing cardiovascular disease in older age.

Researchers say this information will be important to help identify risks earlier, and prevent disease from developing ”

Dr Norman Swan radio interview LISTEN HERE

Professor Emily Banks

Professor of Epidemiology and Public Health, National Centre for Epidemiology and Population Health, Australian National University, Canberra

Associate Professor Ray Lovett

Head of Aboriginal and Torres Strait Islander Health Program, National Centre for Epidemiology and Population Health, Australian National University, Canberra

Most heart attacks and strokes can be prevented with appropriate treatment. Yet heart disease, including heart attacks, causes 13% of deaths among Australia’s Aboriginal and Torres Strait Islander peoples and is a major contributor to the gap in life expectancy with non-Indigenous Australians.

New findings from a study published today in the Medical Journal of Australia show vast room for improvement in heart health among Aboriginal and Torres Strait Islander peoples.

Who is at risk?

This new research found 10% of Aboriginal and Torres Strait Islander people aged 35-74 years old have heart disease (compared to 9% aged 45-74 in the general population). Another 16% are at high risk of getting heart disease (compared to 11% aged 45-74 in the general population), defined in Australia as a greater than 15% chance of getting heart disease in the next five years.

A heart check involves calculating how likely a person is to develop heart disease over a specific time period (five years in Australia). This involves gathering information from multiple factors including a person’s age, sex, smoking status, whether they have diabetes and their blood pressure and cholesterol levels.

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the “high risk” category starts much earlier than this.

Around 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high risk of heart disease. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.

Too few Indigenous peoples are having heart checks. from http://www.shutterstock.com

Potential to prevent events through medication

Heart disease risk can be lowered through lifestyle changes, including giving up smoking, losing weight and exercising more, as well as using medications that lower blood pressure and cholesterol levels. Generally, all people who have heart disease and those at high risk should be prescribed preventative medications.

Yet this latest evidence shows only 53% of Aboriginal and Torres Strait Islander peoples with existing heart disease and 42% of those at high risk were using cholesterol-lowering medications. We don’t know the exact reasons for this. It could be due to a number of things including people not getting a heart check in the first place, and not continuing to use medications when they have been prescribed.

We don’t know the exact number of Aboriginal and Torres Strait Islander people receiving a heart check, but we do know overall numbers are low and it varies by region. Estimates among Aboriginal and Torres Strait Islander people with diabetes found rates of heart checks ranged from about 3% of people in participating health centres in Queensland, South Australia and Western Australia to around 56% in the Northern Territory.

This highlights the huge potential to prevent future heart attack and stroke in these communities by improving treatment in people at high risk.

What can we do?

These findings highlight multiple actions that can be taken to improve heart disease prevention. First, this new evidence suggests the age to start doing heart checks should be lowered in Australian guidelines. This decision would need to be jointly undertaken with Aboriginal and Torres Strait Islander communities.

GPs and nurses should be proactive in identifying Aboriginal and Torres Strait Islander patients, providing heart and overall health checks, and following up with patients.

The Northern Territory is a good example. There, the number of Aboriginal and Torres Strait Islander peoples receiving a heart check more than doubled after improvements in reporting, monitoring and follow-up. Improving the rate of health checks for adolescents and young adults is particularly important so discussions and treatment decisions can take place early.

Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.

The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke.

Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk.

Part 2 Stroke Foundation  Press Release

 

Stroke Foundation has backed a call for urgent action to prevent stroke in Australia’s Aboriginal and Torres Strait Islander community.

This follows today’s release of a world-first study by the Australian National University (ANU), highlighting the harrowing reality of stroke and heart attack risk in Aboriginal and Torres Strait Islander people.

The research found around one-third to a half of Aboriginal and Torres Strait Islander people in their 40s, 50s and 60s were at high risk of future heart attack or stroke. It also found risk increased substantially with age and starts earlier than previously thought.

Stroke Foundation Chief Executive Officer Sharon McGowan said the research results were frightening.

“We knew the Aboriginal and Torres Strait Islander community had a greater risk of stroke and cardiovascular disease, but the rate was well above the non-indigenous population,” Ms McGowan said.

“Alarmingly, the study also found high levels of risk were occurring in people younger than 35.

“Steps must be taken immediately to increase stroke awareness and access to health checks through targeted action. Federal and state government must come together to address this issue.”

National guidelines currently recommend heart health and stroke risk screening be provided to Aboriginal and Torres Strait Islander people 35 and over. This study highlights the need for screening in much younger people.

Ms McGowan said there was one stroke every nine minutes in Australia and Aboriginal and Torres Strait Islander people were overrepresented in stroke statistics.

Aboriginal and Torres Strait Islander people were twice as likely to be hospitalised with stroke and 1.4 times as likely to die from stroke than non-indigenous Australians.

“Stroke can be prevented, it can be treated and it can be beaten. We must act now to stem the tide of this devastating disease,’’ she said.

“Federal and State Government must do more to empower our Aboriginal and Torres Strait Islander communities to take control of their health and prevent stroke and heart disease – we must deliver targeted education on what stroke is, how to prevent it and the importance of accessing treatment at the first sign of stroke.”

Ms McGowan said stroke could be prevented by managing your blood pressure and cholesterol, eating healthily, exercising, not smoking and limiting alcohol consumption

NACCHO Aboriginal Health : Download the ANAO Report : Primary Healthcare Grants under the IHAP Indigenous Australians’ Health Program : Effective high quality, comprehensive, culturally appropriate, primary healthcare services in urban, regional, rural and remote locations

” The bulk of IAHP expenditure is via grants. Since 2015, IAHP primary healthcare grants totalling approximately $1.44 billion have been awarded with 85 per cent of this funding going to Aboriginal Community Controlled Health Organisations.

The audit objective was to assess the effectiveness of the Department of Health’s design, implementation and administration of primary healthcare grants under the IAHP.”

Download the report HERE

ANAO Report PHC Grants Under IAHP – DoH

Summary and recommendations

Background

1. The Indigenous Australians’ Health Program (IAHP) was established in 2014 through the consolidation of four existing Indigenous health funding streams administered by the Department of Health (the department).

The IAHP aims to provide Aboriginal and Torres Strait Islander people with access to effective high quality, comprehensive, culturally appropriate, primary healthcare services in urban, regional, rural and remote locations across Australia.1

Primary healthcare services are usually the ‘entry point’ for persons into the broader health system and can be contrasted to services provided through hospitals or when people are referred to specialists.

The IAHP access to effective high quality, comprehensive, culturally appropriate, primary healthcare services in urban, regional, rural and remote locations

2. The bulk of IAHP expenditure is via grants. Since 2015, IAHP primary healthcare grants totalling approximately $1.44 billion have been awarded with 85 per cent of this funding going to Aboriginal Community Controlled Health Organisations.

3. As at March 2018, a total of 164 organisations are receiving IAHP primary healthcare grant funding. In 2016–17, IAHP-funded services provided primary healthcare services to an estimated 352,000 Indigenous Australians. This represents 54.2 per cent of the estimated total Indigenous population.

Rationale for undertaking the audit

4. The IAHP was selected for audit because it is intended to contribute towards achieving the Indigenous health-related ‘Closing the Gap’ targets regarding life expectancy and infant mortality. The program represents the Australian Government’s largest direct expenditure on Indigenous primary healthcare.

Audit objective and criteria

5. The audit objective was to assess the effectiveness of the Department of Health’s design, implementation and administration of primary healthcare grants under the IAHP.

6. To form a conclusion against this objective, the ANAO adopted the following high-level criteria:

  • Did the department design the IAHP primary healthcare components consistent with the Government’s objectives in establishing the IAHP?
  • Has implementation of the IAHP primary healthcare components been supported through effective coordination with key Government and non-Government stakeholders?
  • Has the department’s approach to assessing primary healthcare funding applications and negotiating funding agreements been consistent with the Commonwealth Grant Rules and Guidelines?
  • Has the department implemented a performance framework that supports effective management of individual primary healthcare grants and enables ongoing assessment of program performance and progress towards outcomes?

Conclusion

7. The department’s design and implementation of the primary healthcare component of the IAHP was partially effective as it has not yet achieved all of the Australian Government’s objectives in establishing the program. The department has not implemented the planned funding allocation model and there are shortcomings in performance monitoring and reporting arrangements. However, the department has consolidated the program, supported it through coordination and information-sharing activities and continued grant funding.

8. The Government’s original objectives in establishing the IAHP are due to be fully achieved in 2019–20, four years later than originally planned. The majority of IAHP primary healthcare grant funding to date has been allocated in essentially the same manner as previous arrangements rather than the originally intended needs based model. Program implementation has been supported through appropriately aligning funding streams to intended outcomes and coordination and information-sharing with relevant stakeholders.

9. Most aspects of the department’s assessment of IAHP primary healthcare funding applications and negotiation of funding agreements were consistent with the Commonwealth Grants Rules and Guidelines (CGRGs). The exception to this was the poor assessment of value for money regarding the majority of grant funds. The grant funding agreements were fit for purpose, but the department has not established service-related performance benchmarks for funded organisations that were provided for in most of the agreements.

10. The department has not developed a performance framework for the Indigenous Australians’ Health Program. Extensive public reporting on Indigenous health provides a high level of transparency on the extent to which the Australian Government’s objectives in Indigenous health are being achieved. However, this reporting includes organisations not funded under the IAHP and, as such, it is not specific enough to measure the extent to which IAHP funded services are contributing to achieving program outcomes.

11. In managing IAHP primary healthcare grants, the department has not used the available provisions in the funding agreements to set quantitative benchmarks for grant recipients. This limits its ability to effectively use available performance data for monitoring and continuous quality improvement. Systems are in place to collect performance data, but systems for collecting quantitative performance data have not been effective. Issues with performance data collection limit its usefulness for longitudinal analysis.

Supporting findings

Program design and implementation

12. The design of the IAHP was consistent with the Government’s objectives of achieving budget savings and reducing administrative complexity through consolidation of existing grant programs. The objective of allocating primary healthcare grant funding on a more transparent needs basis will not be achieved until 2019–20, four years behind the timetable agreed by Government in establishing the IAHP.

13. Three outcomes were established for the program and set out in published IAHP grant guidelines. One of the outcomes does not clearly identify the desired end result. IAHP funding, including the primary healthcare component, are appropriately aligned to the outcomes.

14. The department uses a wide variety of forums and networks to share information and seek feedback about its current and planned Indigenous health activities, including the IAHP. Some coordination and joint planning activities relating to primary healthcare have also been undertaken through the Aboriginal Health Partnership Forums.

Awarding Grants

15. Ninety eight per cent of IAHP primary healthcare grant funding has been provided through non-competitive processes. The department obtained Ministerial agreement for these processes.

16. Most aspects of the assessment of funding proposals were undertaken consistently with the CGRGs and IAHP guidelines. The exception was assessment of value for money. Assessment records for some funding rounds, including the $1.23 billion ‘bulk’ round undertaken in 2015, lacked evidence of substantive analysis of value of money considerations. The department was also unable to provide evidence it had undertaken a value for money assessment regarding the $114 million grant to the Northern Territory Government. In virtually all cases, risk assessments formed part of the assessment process.

17. Departmental delegates were provided with sufficient advice to enable them to discharge their obligations under the Public Governance, Performance and Accountability Act 2014 in approving IAHP grant proposals. The timeliness of the advice varied, but was provided relatively quickly for the larger 2015 funding rounds.

18. Funding agreements are fit for purpose, using a grant head agreement and an IAHP-specific schedule. The specific services to be provided by each funded organisation are set out in separate Action Plans, which are appropriately referenced in the agreement schedule. The agreements with Aboriginal Community Controlled Health Organisations allow for the setting of individual performance targets, but no targets have been set. All agreements also clearly set out reporting requirements.

Monitoring and Reporting

19. The department has not established a performance framework for the primary healthcare component of the IAHP.

20. Systems are in place to collect performance data, but systems to collect quantitative performance data have not been effective. Several changes to data collection processes have resulted in an increased reporting burden on IAHP grant recipients and two six-monthly data collections being discarded or uncollected. These breaks in the data series limit its usefulness for longitudinal analysis of performance trends. The department has commenced projects to improve the quality of data, but has limited assurance over the quality of data collected before 2017 as it has not been validated.

21. The department relies on public reporting of a range of Indigenous health indicators to monitor achievement of program outcomes. The reporting includes data about services not funded under the IAHP. As such, it is not specific enough to measure the extent to which IAHP funded services are contributing to achieving program outcomes. The department was also unable to demonstrate how it used the data to inform relevant policy advice and program administration.

22. The department is not effectively using available performance data to monitor IAHP grant recipient performance and has not set quantitative national key performance indicator (nKPI) based benchmarks for grant recipients. The department’s ability to set performance expectations and assess actual performance is limited by the currency of data and variability in the content of Action Plans.

Recommendations

Recommendation no.1

Paragraph 3.21

The Department of Health improve the quality of IAHP primary healthcare value for money assessments, including ensuring their consistency with the new funding allocation model.

Department of Health response: Agreed.

Recommendation no.2

Paragraph 4.10

The Department of Health assess the risks involved in IAHP-funded healthcare services using various clinical information software systems to support the direct online service reporting and national key performance indicator reporting process, and appropriately mitigate any significant identified risks.

Department of Health response: Agreed.

Recommendation no.3

Paragraph 4.30

The Department of Health ensure that new IAHP funding agreements for primary healthcare services include measurable performance targets that are aligned with program outcomes and that it monitors grant recipient performance against these targets.

Department of Health response: Agreed.

Summary of entity response

23. The Department of Health (‘the Department’) notes the findings of the report and agrees with the recommendations.

It is pleasing that the report finds: the program has been consolidated and supported through coordination and information sharing activities; programme implementation has appropriately aligned funding streams to intended outcomes; and the objective of reducing administrative complexity has been achieved.

Work is already underway within the Department which aligns with the report’s recommendations, and the report provides a platform to continue these efforts. In particular, the Department has introduced more robust assessment processes for primary health care grants under the Indigenous Australians’ Health Programme and has also commenced development of enhanced performance measurements of program outcomes, supported by an outcomes-focussed policy framework. The Department’s responses to the individual recommendations provide further detail.

The report identifies that the introduction of a new funding allocation model for the distribution of primary health care funding as announced in the 2014–15 Budget is yet to be completed and finds that this deferral has contributed to a partially effective implementation of the Australian Government’s objectives in establishing the programme. The Government announced in the 2018–19 Budget that the model will be implemented from 1 July 2019 and the Department will continue to work closely with Aboriginal Community Controlled Health Services to deliver this important initiative. The Department notes that this deferral occurred in the context of extensive stakeholder engagement together with significant data improvement activities designed to support a robust and well-developed funding model.

Whilst the Department is committed to continuous improvement of the administration of the Indigenous Australians’ Health Programme, the Department wishes to acknowledge and recognise the significant contribution our network of Aboriginal Community Controlled Health Services are making to improve the health of their communities under the Australian Government’s Closing the Gap agenda

1. Background

Indigenous health and government funding

1.1 In 2008, the Council of Australian Governments set targets aimed at reducing or eliminating differences in specific outcomes between Indigenous and non-Indigenous Australians. These Closing the Gap targets covered three broad areas, of which health was one. In 2013, the Australian Government released the National Aboriginal and Torres Strait Islander Health Plan 2013–23, which set out a 10 year plan for the direction of Australian Government Indigenous health policy. This was followed in 2015 by an Implementation Plan for the Health Plan. The Implementation Plan outlines the actions to be taken by the Australian Government, the Aboriginal community controlled health sector, and other key stakeholders to give effect to the Health Plan. Progress under the Implementation Plan is measured against 20 goals and 106 deliverables that were developed to complement the existing Closing the Gap targets.

1.2 While the 2018 Prime Minister’s Closing the Gap report and the 2017 Aboriginal and Torres Strait Islander Health Performance Framework report show gains have been made in some areas, Indigenous Australians continue to experience significantly poorer health outcomes than the general population.2 Life expectancy is about 10 years lower. Rates of chronic disease are higher, with some tending to occur at a younger age in Indigenous Australians compared to the general population. The overall burden of disease3 for Indigenous Australians is also 2.3 times higher. Some factors potentially impacting on health, such as smoking and obesity, are higher: the overall smoking rate is 2.7 times higher and Indigenous Australians are 1.6 times as likely to be obese as the general population. Some health interventions can have a long lead time before measurable impacts are seen across the target population—for example, up to three decades in the case of many smoking-related diseases.

1.3 The Australian and state and territory governments all fund Indigenous health. Estimated total direct funding on Indigenous health4 has increased since the setting of the Closing the Gap targets: from $4.76 billion in 2008–09 to $6.30 billion in 2015–16.5 Of this, expenditure specifically targeted at Indigenous Australians was $1.44 billion in 2015–16. The remainder is expenditure on ‘mainstream’ services used by Indigenous Australians, notably hospitals, and the cost of various Australian Government subsidies, including the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme. Indigenous-related expenditure on public and community health services6 in 2015–16 is estimated at $1.73 billion. The Australian Government contributes 59 per cent of the total 2015–16 government expenditure on the Indigenous public and community health services category.

1.4 Measured on a per-person basis, total direct health funding on Indigenous Australians in 2015–16 by all Governments in Australia is 1.83 times greater than the direct health funding on non-Indigenous Australians. Funding on the public and community health services category of Indigenous health is 3.59 times higher.

The Indigenous Australians’ Health Program

1.5 The Department of Health (the department) has had primary responsibility for Commonwealth Indigenous health policy and funding since 1995. Since that time, the department’s role has been to improve both Indigenous Australians’ access to mainstream primary healthcare and increase the capacity of the Indigenous-specific sector to provide comprehensive primary healthcare.7

1.6 In the May 2014 Budget, the Australian Government announced the establishment of the Indigenous Australians’ Health Programme (IAHP). It was formed by consolidating four existing funding streams administered by the department, which between them included around 30 discrete funding components.8 The consolidation was intended to reduce administrative complexity and enable an improved focus on basic health needs (including clinical primary healthcare) at a local level to improve health outcomes. The stated high-level objective for the IAHP is:

to provide Aboriginal and Torres Strait Islander people with access to effective high quality, comprehensive, culturally appropriate, primary health care services in urban, regional, rural and remote locations across Australia.

1.7 A new primary healthcare grant funding allocation model was also to be developed for implementation from 2015–16. As discussed in Chapter 2, development and implementation of the new allocation model has been delayed.

1.8 With the exception of ‘social and emotional wellbeing’ activities being transferred to the Department of Prime Minister and Cabinet9, the range of activities funded by the department under IAHP are broadly similar to those under the pre-IAHP arrangements and funding levels have increased. In 2013–14, funding under predecessor grant programs was $682.3 million (excluding social and emotional wellbeing activities). The budget allocation for IAHP funding in 2017–18 is $856.1 million.

1.9 The bulk of IAHP expenditure is via grants. As at March 2018, $743.5 million of 2017–18 grant funds had been expended or committed.10 The largest component is grants to provide primary healthcare services to Indigenous Australians, which account for $461.5 million (62 per cent) of total IAHP 2017–18 expended and committed grant funding.11 Other significant grant funding areas under the IAHP relate to activities intended to increase Indigenous Australians’ access to mainstream services12 ($108 million, or 15 per cent) and funding for various maternal/early childhood health and anti-smoking activities (about five per cent each).

1.10 As at March 2018, 164 organisations are receiving IAHP primary healthcare grant funding. Around 140 of these organisations are Aboriginal Community Controlled Health Organisations (ACCHOs), which collectively account for 85 per cent of total IAHP core primary healthcare grant funding in 2017–18. The remaining primary healthcare grant recipients include the Northern Territory Government, various public sector regional health bodies across several states, and a small number of private sector providers and non-government organisations.

1.11 The geographical distribution of the healthcare facilities receiving IAHP primary healthcare funding is shown in Figure 1.1.

Figure 1.1: Distribution of IAHP primary healthcare funded facilities

Source: Department of Health.

1.12 The 2017–18 primary healthcare grant funding amounts according to jurisdiction and remoteness index is shown in Table 1.1.

 

NACCHO Aboriginal Health : Some big improvements but challenges remain says the @aihw 2018 Report : The report card is in—and here’s what we can learn

 ” There have been some big improvements in the health of Australia’s Aboriginal and Torres Strait Islander population—but challenges remain.

Life expectancy for Indigenous Australians has improved over time and with higher education attainment closely associated with better health outcomes, rising year 12 completion rates among Indigenous Australians are a positive sign.

There have also been reductions in smoking rates and alcohol use, as well as a significant improvement in child death rates.

While the improvements seen in recent years are positive, the report shows that social factors are key to making further progress—social factors such as employment, education and income are responsible for about one-third of the health gap between Indigenous and non-Indigenous Australians.

By comparison, health risk factors such as smoking and obesity account for one-fifth of the health gap.

In 2015–16, Indigenous primary health care services were delivered across nearly 370 sites, more than two-thirds of which were in Very remote (33%), Remote (13%) and Outer regional (23%) areas.”

From Executive summary see Part 1 Below

Or See Pages 305 -357 in report for more detail

Download Here

 ” Australia is generally a healthy nation but there are some key areas where we could do better, according to the latest report from the Australian Institute of Health and Welfare (AIHW).

The two-yearly report card, Australia’s health 2018, was launched today by the Hon. Greg Hunt MP, Minister for Health.”

See Part 2 Below

Download Brief aihw-aus-222.pdf

Part 1 Overview Indigenous Health

Aboriginal and Torres Strait Islander people are the Indigenous peoples of Australia. Indigenous Australians can be of Aboriginal origin, Torres Strait Islander origin, or both.

There were an estimated 787,000 Indigenous Australians in 2016—3.3% of the total Australian population, with an estimated growth in their population size of 19% since 2011.

This chapter presents information on the health status of the Indigenous population, as well as the determinants of health and access to health services that are specific to the Indigenous population.

For Indigenous Australians, good health is more than the absence of disease or illness; it is a holistic concept that includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for both the individual and the community.

This concept of good health emphasises the connectedness of these factors and recognises how social and cultural determinants can affect health.

As a group, Indigenous Australians experience widespread disadvantage and health inequality. In 2014–15, Indigenous Australians were at almost half as likely as non-Indigenous Australians to rate their health as ‘fair’ or ‘poor’, and much less likely to rate their health as ‘excellent’ or ‘very good’.

Compared with non-Indigenous Australians, Indigenous Australians are 1.7 times as likely to have disability or a restrictive long-term health condition and 2.7 times as likely to experience high or very high levels of psychological distress.

The gap in life expectancy between Indigenous and non-Indigenous Australians in 2010–2012 was around 10.6 years for males and 9.5 years for females. Health inequality can start early for Indigenous people—reflected in infant and child mortality rates being generally higher in their communities.

Further, although rates have declined in recent years, Indigenous children are 2.1 times as likely as non-Indigenous children to die before the age of 5.

Indigenous children and adolescents are also far more likely than non-Indigenous children to be affected by ear infections and hearing loss. Although the proportion of Indigenous children with poor ear health and hearing loss has decreased in the last 15 years, the rate of long-term ear/hearing problems in children aged 0–14 is still almost 3 times that for non-Indigenous children (8.4% compared with 2.9%). Poor ear and hearing health can profoundly affect a child’s life, impeding cognitive development, auditory processing skills and speech and language development.

Hearing loss can lead to social isolation and problems with school attendance, which, in turn, can have life-long negative social consequences. For many Indigenous children, hearing loss and the associated aftermaths further compound many of the disadvantages already facing Indigenous Australians.

Much of the understanding of the ‘health gap’ between Indigenous and non-Indigenous Australians is based on factors generally recognised as contributing to good health, including:

  • differences in the social determinants of health—Indigenous Australians, on average, have lower levels of education, employment, income, and poorer quality housing than non-Indigenous Australians
  • differences in health risk factors—Indigenous Australians, on average, have higher rates of risk factors that can lead to adverse health outcomes, such as tobacco smoking, risky alcohol consumption and insufficient physical activity for good health
  • differences in access to appropriate health services—Indigenous Australians are more likely than non-Indigenous Australians to report greater difficulty in accessing affordable health services that are close by.

Socioeconomic factors account for more than one-third (34%) of this health gap—household income is the largest individual contributor to the overall gap (14%), followed by employment status (12%).

Health risk factors contribute 19% of the gap—with differences in smoking rates between Indigenous and non-Indigenous Australians being the largest contributor, at 10%. While the Indigenous smoking rate has fallen substantially in recent years—from 51% in 2002 to 42% in 2014–15—it is still 2.7 times as high as that for non-Indigenous Australians.

Access to appropriate, high-quality and timely health care can help to improve health outcomes. Indigenous Australians can use mainstream or Indigenous-specific primaryhealth care services.

In 2015–16, Indigenous primary health care services were delivered across nearly 370 sites, more than two-thirds of which were in Very remote (33%), Remote (13%) and Outer regional (23%) areas.

The geographic distribution of the Indigenous population can pose substantial challenges for workforce recruitment and delivery of health services. For example, access to midwives is critical for the health of Indigenous women, who are less likely to attend antenatal care in the first trimester of pregnancy, and have higher levels of social disadvantage.

These factors contribute to the higher likelihood that babies born to Indigenous mothers will be premature, of low birthweight and/or will die before their first birthday. Looking at the supply of midwives across Australia, 15% of Indigenous women of child-bearing age live in areas likely to pose the highest challenges for supply of a midwife workforce.

This percentage is 8 times as high as that for non-Indigenous women of child-bearing age (1.8%).

Part 2 AIHW Press Release

Australia is generally a healthy nation but there are some key areas where we could do better, according to the latest report from the Australian Institute of Health and Welfare (AIHW).

The two-yearly report card, Australia’s health 2018, was launched today by the Hon. Greg Hunt MP, Minister for Health.

Download Brief aihw-aus-222.pdf

The report shows that Australia sits squarely in the best third of OECD countries when it comes to life expectancy, with girls born in 2016 likely to live 84.6 years, while boys can expect to live to 80.4 years.

Fewer of us are smoking or putting ourselves at risk from long-term alcohol use than in the past. More of our children have been immunised and we’re doing well in terms of preventing avoidable deaths.

At an individual level, we’re feeling the effects of these good results, with more than 4 in every 5 Australians grading their own health to be at least ‘good’—if not ‘very good’ or ‘excellent’.

But with a population that is living longer, we are now experiencing higher rates of chronic and age-related conditions. For example, we know that older Australians use a higher proportion of hospital and other health services and 75% of all PBS medicines were dispensed to people aged 50 and over.

And with health spending continuing to rise—reaching $170 billion in 2015–16 and outstripping population growth—we see the important role our health system plays in both prevention and treatment.

Long-term health conditions are common—often underpinned by lifestyle factors

Half of Australians have a common chronic health condition, such as diabetes, heart disease, a mental illness, or cancer. Importantly, almost a quarter of us have two or more of these conditions, often making our experiences of health and healthcare particularly complex.

Many chronic health conditions share common preventable risk factors, such as smoking, excessive alcohol consumption, and not getting enough exercise—in fact, around one-third of our nation’s ‘disease burden’ is due to preventable risk factors.

Our expanding waistlines are a notable example: about 6 in 10 adults—or 63%—are either overweight or obese, while carrying too much weight is responsible for 7% of our total disease burden.

Over the past two decades, the proportion of Australians who have a healthy body weight fell, while the proportion who are obese increased. Over the same period, the proportion who are ‘severely obese’ nearly doubled.

AIHW CEO Barry Sandison said that when it comes to obesity, it is not just a case of poor diet or exercise habits. Rather, a range of factors—biological, behavioural, social and environmental—contribute to our likelihood of becoming obese, including the walkability of our cities, rising work hours and increasingly sedentary jobs, larger portion sizes and food advertising.

‘Understanding why someone may be obese—or in good or poor health generally—is complex and it’s important to look at the raft of factors across a person’s life that may be at play,’ he said.

Tackling the ‘why’ of poor health

Mr Sandison said that through data, we are able to better understand how a diverse array of social and other factors contribute to our health.

For example, the report shows a clear connection between socioeconomic position and health—compared with people living in Australia’s highest socioeconomic areas, those in the lowest group are almost 3 times as likely to smoke or have diabetes and twice as likely to die of potentially avoidable causes.

Those in the lowest group are also more likely to have cost barriers preventing them from accessing health services—more than twice as likely to avoid seeing a dentist or filling a prescription due to the cost.

The impact of socioeconomic position on health can also be thought of in terms of disease burden, with those in the lowest socioeconomic group experiencing disease burden 1.5 times higher than those in the highest group.

Mr Sandison noted a similar pattern was seen among people living in remote areas, while certain groups—such as veterans—experience higher rates of mental health conditions such as depression. LGBTI Australians, people with a disability, prisoners and people of cultural and linguistically diverse backgrounds also experience specific health challenges.

As well as social factors, our natural environment is connected to our health and wellbeing—with air and water quality, exposure to extreme weather, and other events such as bushfires and drought all playing a role.

‘There is more to learn about the connections between health and the natural world—and in turn, the interplay between these and other risk factors,’ Mr Sandison said.

Employment and income key factors in improving Indigenous health

The value of data and looking forward

Mr Sandison noted that in a digital age, there is enormous potential to fill data gaps through new sources of health information.

‘Health data is collected for a variety of reasons—in hospitals, at our GP and through the prescriptions we receive, while new sources of information are emerging, such as through the Australian Government’s My Health Record.’

Despite the breadth of health and welfare information available, there are gaps in our knowledge and opportunities to make better use of existing data.

By bringing together data, we can gain important insights into people’s pathways through the health system and experiences of their own health, such as the relationship between different chronic conditions and the services and treatments yielding the greatest improvements in health outcomes and quality of life.

‘With a structured, strategic approach to health information and leadership from agencies like the AIHW, Australia’s health data assets can be built and improved to fill gaps in our knowledge and understanding—to drive better health outcomes for all Australians,’ Mr Sandison said.

Media coverage

Indigenous Australians are more than twice as likely to die before their fifth birthday than non-Indigenous Australians.

Australia’s Health 2018, a report released by the Australian Institute of Health and Welfare today , says Indigenous Australians have a shorter life expectancy than non-indigenous Australians and are at least twice as likely to rate their health as fair or poor.

On average, indigenous Australians have lower levels of education, employment and income and poorer quality housing than non-indigenous Australians.

However there have been improvements in child mortality rates, smoking rates and drinking rates for those over the age of 15.

Factors in the health gap include higher rates of smoking and risky alcohol consumption, less exercise, a greater risk of high blood pressure and difficulty accessing affordable health services.

The report states that if indigenous adults were to have the same household income, employment rates, hours worked and smoking rate as non-indigenous Australians, the health gap would be reduced by more than a third.

Levels of health vary within the indigenous population, with those employed in 2014-15 less likely to smoke and use illicit substances and more likely to have an adequate daily fruit intake.

IMPROVEMENTS IN INDIGENOUS HEALTH

– Child mortality rates (zero to four) decreased from 217 deaths per 100,000 in 1998 to 140 deaths per 100,000 in 2016

– Between 2005-2007 and 2010-2012, the gap in life expectancy at birth between indigenous and non-indigenous Australians decreased from 11.4 to 10.6 years for males and 9.6 to 9.5 years for females

– Smoking rates declined from 51 per cent in 2002 to 42 per cent in 2014-15, concentrated in non-remote areas.

– In 2014-15, 17 per cent of indigenous Australians aged between 15-17 smoked, compared to 30 per cent in 1994

INDIGENOUS HEALTH COMPARED TO NON-INDIGENOUS HEALTH

– 2.1 times as likely to die before their fifth birthday

– 2.7 times as likely to experience high or very high levels of psychological distress

(Source: Australia’s Health 2018, Australian Institute of Health and Welfare

NACCHO Aboriginal Health and #Obesity : Contributions to the Select Committee into the #obesity epidemic in Australia close 6 July

” More than two-thirds (69%) of Aboriginal and Torres Strait Islander adults were overweight or obese (29% overweight but not obese, and 40% obese). Indigenous men (69%) and women (70%) had similar rates of overweight and obesity (ABS 2014a).

One-third (32%) of Indigenous men and more than one-quarter (27%) of Indigenous women were overweight but not obese, while 36% of Indigenous men, and 43% of Indigenous women were obese ”

See NACCHO Aboriginal Health article

There is clear and robust evidence that children’s exposure to unhealthy food advertising influences their food choices, influences their diets, and can contribute to poor diets, overweight and obesity.

Despite Australian children’s high rates of overweight and obesity, there are few controls on advertising practices targeting advertisements for unhealthy foods and beverages to children in Australia and much is left up to self-regulation by the food and beverage industry.

The Obesity Policy Coalition advocates for improved regulatory controls to reduce children’s exposure to this type of harmful advertising

SEE OPC Page

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 90 Aboriginal Health Obesity articles published over the past 6 years

The Senate is currently holding a Select Committee into the Obesity Epidemic in Australia, with a focus on childhood obesity. The Committee will be exploring the prevalence, causes, harm and economic burden of childhood obesity. They will also be exploring the effectiveness of existing policies and programs to address childhood obesity and role of the food industry in contributing to childhood obesity.

The Select Committee provides a valuable opportunity for us to show that there is an urgent need for action to prevent obesity, particularly among children. It also comes at a critical time when pressure is mounting on the Australian Government to act.

Submissions to the Inquiry are due by Friday 6 July 2018. Submissions can be made to Committee Secretary at obesitycommittee.sen@aph.gov.au. You can also find out more about the Committee here.

If you want to put in a submission please use one of the following:

Please use this opportunity to encourage others to make a submission on this important issue, the more submissions the better.

If you want to share this with your colleagues through your website or bulletins, here is some material to use.

Tipping the Scales report

In September 2017 more than 35 leading community, public health, medical and academic groups united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking report, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required.

Tipping the Scales: Australian Obesity Prevention Consensus

This consensus document delivers a rigorous and evidence-based agenda to our Federal Government and establishes the key elements to include in a national strategy, as well as the basis for an ongoing dialogue, about the best ways to address the obesity epidemic.

Tipping the Scales: summary sheet

Summary document of the Tipping the Scales eight key points.

 

 

 

NACCHO Aboriginal Health and Chronic Disease : #NCDForum @Prevention1stAU Report : Government is ignoring our chronic disease time bomb

  ” One in every two Australians suffer from chronic disease but experts say Commonwealth and State Governments appear blind to the country’s greatest health challenge.

The latest assessment of the country’s chronic disease prevention policy has found that while our health measures in tobacco policy are world leading, Australia has fallen well short in its preventive health efforts in the key areas of alcohol consumption, nutrition, and physical activity.”

A scorecard released today by Prevention 1st found that while government anti-smoking policies are ‘good’, efforts to address alcohol consumption, physical activity and nutrition all rate poorly.

Download report HERE

Prevention-in-Australia-online

Prevention 1st invited experts in tobacco, alcohol, nutrition and physical activity to rate Commonwealth and state government action against the World Health Organization’s (WHO) ‘Best Buys’ and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases.i

Chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, accounts for 66 per cent of the burden of disease, and costs our economy an estimated $27 billion annually.

According to the Australian Institute of Health and Welfare, one-third of chronic disease cases are preventable and can be traced to four modifiable risk factors: tobacco use, alcohol consumption, poor diet, and physical inactivity.

FARE Chief Executive Michael Thorn says that while Australia has been a world leader in preventive health, past glories count for little, when the Prevention 1st Scorecard released today makes clear that our governments are not presently doing enough.

Mr Thorn says a framework already exists around evidence-based, short-term wins and that those World Health Organization recommendations, if implemented, would immediately improve Australians’ health.

“Effective policies are essential and we have those, but those solutions become worthless if government is not prepared to translate those policies into action,” Mr Thorn said

The Prevention 1st Scorecard recommends the implementation of four simple evidence-based measures to address tobacco use, alcohol consumption, nutrition and physical activity.

• The renewal of mass media anti-smoking campaigns that are population-wide and engage effectively with disadvantaged groups.

• The abolition of the Wine Equalisation Tax (WET) and introduction of a volumetric tax for wine and cider.

• Legislated time-based restrictions on exposure of children (under 16 years of age) to unhealthy food and drink marketing on free-to-air television until 9.30pm.

• The implementation of a whole-of-school program that includes mandatory daily physical activity.

Prevention 1st is 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 Dementia Australia.

ENDS

 

NACCHO Aboriginal Health and #ElderCare : @KenWyattMP launches @genrontologyau #ATSIAAG Report : Assuring equity of access and quality outcomes for older Aboriginal peoples: What needs to be done

“This report details valuable recommendations to improve aged care access for our First Peoples and I commend the Australian Association of Gerontology and its special Aboriginal and Torres Strait Islander Ageing Advisory Group.

It highlights the importance of respect for culture, to instill confidence in older First Nations people, and I look forward to its findings helping guide the development of effective pathways to quality aged care.”

The report was launched by Minister for Aged Care and Indigenous Health Ken Wyatt at Parliament House on Wednesday.

A new report is calling for an expansion of specialist targeted services for older Aboriginal and Torres Strait Islander people and more work to embed cultural safety in mainstream care to improve the aged care system for Indigenous Australians.

Photo above : From left: Graham Aitken, Ken Wyatt, Ros Malay and James Beckford Saunders at the launch of a report focused on improving aged care access and quality for Aboriginal and Torres Strait Islander people

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ASSURING EQUITY OF ACCESS FOR OLDER Aboriginal people

Elder Facts

In the 2016 Census, 649,171 people identified as Aboriginal and/or Torres Strait Islander, representing 2.8% of the population – up from 2.5% in the 2011 Census, and 2.3% in 2006.

Although the Aboriginal and Torres Strait Islander population has a much younger age profile and structure than the non-Indigenous population, the median age of Aboriginal and Torres Strait Islander people is gradually rising.

The proportion of Aboriginal and Torres Strait Islander people aged 65 years and over is only 4.8%, much smaller than for non-Indigenous people at 16%.

However, the number of Aboriginal and Torres Strait Islander people aged 55 years and over is increasing, and is projected to more than double from 59,400 in 2011 to up to 130,800 in 2026.

Aboriginal and Torres Strait Islander Elders need access to culturally appropriate services, and they generally want to be cared for in their communities where they are close to family, and where they can die on their land.

Aboriginal and Torres Strait Islander people face ongoing challenges finding services that are appropriate to their needs and circumstances, and often have problems accessing services where they exist.

Press Release

The Australian Association of Gerontology report also recommends strategies to improve the ability of the aged care workforce to provide more appropriate care, an expansion of advocacy services and a more appropriate needs assessment process.

The report was developed by the AAG’s Aboriginal and Torres Strait Islander Ageing Advisory Group (ATSIAAG) with findings from its national workshop in Perth in November 2017 that explored barriers to equity in access and outcomes in aged care for Aboriginal and Torres Strait Islander peoples.

A lack of service connectivity, the challenges vulnerable groups experience with consumer directed care and My Aged Care, high costs and gaps in policy, education and advocacy are among roadblocks to access and equity outlined in the report.

The report was launched by Minister for Aged Care and Indigenous Health Ken Wyatt at Parliament House on Wednesday.

“This report details valuable recommendations to improve aged care access for our First Peoples and I commend the Australian Association of Gerontology and its special Aboriginal and Torres Strait Islander Ageing Advisory Group,” Minister Wyatt said.

“It highlights the importance of respect for culture, to instil confidence in older First Nations people, and I look forward to its findings helping guide the development of effective pathways to quality aged care.”

ATSIAAG co-chair Graham Aitken said he was delighted Minister Wyatt gave the report the prominence it deserved.

“We are looking forward to seeing a response from government to the suggestions put forward in the report,” he said.

 

Fellow ATSIAAG co-chair Ros Malay said the report was timely given the work underway to develop an action plan for Aboriginal and Torres Strait Islander people under the Aged Care Diversity Framework, which was launched in December.

“The report has some great ideas that could be picked up in the action plan,” Ms Malay said.

The report was launched during a ATSIAAG roundtable of key stakeholders from government agencies, academia, aged care, and Aboriginal and Torres Strait Islander organisations who discussed how better data would drive improved aged care for older Aboriginal and Torres Strait Islander people.

A greater uptake of evidence from research and data to ensure greater understanding of the aged care service and support needs of older Aboriginal and Torres Strait Islander people and how they can best be met is another strategy proposed in the report.

Mr Wyatt said understanding how better data could build a better aged care system for the nation’s First Peoples was a priority for the Turnbull Government.

“Following last year’s Australian National Audit Office report into Indigenous aged care, we have taken steps to improve data,” he said.

AAG CEO James Beckford Saunders said a report from this week’s roundtable would be published within the next few months.

Access the report, Assuring equity of access and quality outcomes for older Aboriginal and Torres Strait Islander peoples: What needs to be done, here

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