NACCHO Aboriginal Health #SocialDeterminants and #ClimateChange : How the @Walgett_AMS community members and market garden are at risk from high sodium in water in drought-stricken NSW town

Unfortunately in our community and particularly Aboriginal people, they have a high incidence of chronic disease,

I believe we are going to have an increase in chronic disease here, particularly from the water consumption,

In my life here in Walgett for 40 odd years, it’s the first time I’ve never drank straight from the tap.

I just worry for people who have to drink straight from the tap.”

Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, said high blood pressure, heart disease, kidney disease and diabetes were common health issues:

The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre. The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that

Salt of the earth see Part 2 below

” It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease.

For now, the garden has an exemption from the town’s level-5 water restrictions, I’m not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,

“In the long term we can’t sustain the garden.”

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people

The Garden was featured recently in our #refreshtheCTGrefresh campaign

Part 1 : Walgett has always been a river town, perched near the junction of the Barwon and the Namoi rivers.

But with the drought biting hard, the water from those rivers isn’t making it to this northern New South Wales town.

See original ABC post here

With nothing to pump from the local weir, Walgett is the latest town forced to go underground for water.

It is now on an emergency supply of bore water, and many locals are worried it is damaging their health.

PHOTO: The Barwon River at Walgett is just a series of stagnant pools at the moment. (ABC: Danielle Bonica)

Dharriwaa Elder, Thomas Morgan, said the water was no good for drinking.

“Too much salt in it,” he said. “The kids, my grandkids, they’re starting to spit it out, they don’t like it.”

Elder Rick Townsend lives near the water treatment plant.

“I get the smell of it every morning and it’s the foulest smell,” he said.

“I don’t drink it, not at all. I drink the water at the hospital, tank water. Or I’ll buy the water in the supermarkets.”

Dharriwaa Elders Clem Dodd, Thomas Morgan, Rick Townsend and Richard Lake are concerned that the town’s emergency bore water isn’t healthy for people to drink.

Another local, Chantelle Kennedy, said most people were avoiding the tap water. “Most of us go to IGA and buy packs of 24 bottles for $20. It’s dear,” she said.

“A lot of people have been buying fizzy drinks because of the water. Some of them come out and buy hot drinks, which is cheaper than buying water.”

Part 2 : Salt of the earth

The bore water is from the Great Artesian Basin, and tests have shown the sodium levels in the water exceeded Australian Drinking Water Guidelines.

Associate Professor Jacqui Webster, from the George Institute for Global Health, said the sodium levels were concerning.

“The sodium levels in the Walgett water supply are at 300 milligrams per litre and the Australian drinking water guidelines are 180 milligrams per litre, so that’s substantially higher,” she said.

Dr Webster said the guidelines for sodium in drinking water were based on taste rather than health.

But she said high sodium levels did pose serious health risks, particularly for people with underlying health problems.

“The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre,” she said.

“The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that.”

Dr Webster said those who avoided salty drinking water by drinking alternatives such as soft drinks were solving one problem and creating another.

“If they are drinking the water it’s potentially a problem but if they are substituting it with other things that is also a cause for concern,” she said.

“Indigenous communities are suffering from greater incidences of diabetes, obesity and hypertension,” she said.

“In general people get a disproportionate amount of salt from processed foods in communities where there is limited access to fresh foods, so compounding that with sodium from the water supply is a problem, and it’s something we need to be looking into.”

PHOTO: Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, says the community garden may be forced to close if the town’s water situation doesn’t improve.(ABC Western Plains: Jessie Davies)

Part 3 Community veggie garden under threat

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people.

“It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease,” she said.

For now, the garden has an exemption from the town’s level-5 water restrictions, but Ms Corby said she was not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

“The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,” she said.

“In the long term we can’t sustain the garden.”

 

‘It’s going to keep everyone alive’

Walgett’s mayor, Manuel Martinez, said the shire commissioned the town bore to provide water security in the event of shortages just like this one.

“Two years ago, we had the foresight to sink a bore. We’re drought-proofing our whole shire,” Cr Martinez said.

“This is Australia. We’re in a drought and until the drought breaks, that’s the only water supply we’ve got.”

“It’s going to keep everyone alive, and that’s what we’re here to do,” he said.

“The sodium level is a bit high, higher than normal, higher than preferred, but it’s within the guidelines and it’s the same level it is with other bores.

“I’ve lived in Lightning Ridge for the last 32 years with only bore water. Most of outback Queensland is on the Artesian Basin.”

Cr Martinez said that as soon as there was water in the rivers again, Walgett would be back on river water — or at least on a mixture of river and bore water.

He said the bore water was a short-term emergency supply.

“I’m not doubting what they say, long-term effects of anything can be harmful, especially sodium or salt in the water system,” he said.

Part 4 The upstream imbalance

PHOTO: Elders in Walgett say locals are sad and sorry that pastimes like fishing and swimming in the river are no longer possible. They’re concerned the river is dry not just because of drought but because of mismanagement and water use upstream. (ABC: Danielle Bonica)

Many residents in Walgett believe it is not just the drought that is to blame for the dry rivers.

They say the waterways have not being managed properly and that too much water is being taken out upstream.

Chairman of the Walgett Aboriginal Medical Service, Bill Kennedy, said it was hard when people saw so much water in the rivers not far up the road.

“We’ve lived through droughts before but there was always some water, and some running water,” he said.

“I guess progress has changed all that with irrigators, farming, and especially cotton further up the river.

“I was driving to Tamworth, Newcastle last week and there’s water in the rivers further up at Gunnedah, Narrabri, Wee Waa.

PHOTO: Chairperson of Walgett Aboriginal Medical Service Bill Kennedy. (ABC Western Plains: Jessie Davies )

The mayor agreed, and said it was frustrating to see so much water upstream in both rivers.

“Even in this present time now you’ll see irrigators spraying all their crops,” Cr Martinez said.

“You’ve got a town with no water supply and you go 30kms up the road and irrigators are pumping”

Cr Martinez said the last two water releases from Lake Keepit were supposed to flow down as far as Walgett but they never made it.

“It’s beyond council’s control … we can only apply to push, to get another release, and try and get water to make it down to us.”

He said there was another water release from Lake Keepit on its way and hopefully this one will make it all the way to Walgett.

Spirits at low ebb

Many people in this community were deeply saddened by the state of the two rivers here.

Elder Rick Townsend says it was the worst dry spell anyone could remember.

“It’s a pretty bad state of affairs,” he said.

“It’s the worst I’ve ever seen it in all my life that I’ve lived here.”

For countless generations, the rivers have been a place to meet, fish and swim. But locals said at the moment that was simply not possible.

“There’s no fish or anything in the river any more,” says another Elder, Thomas Morgan.

“People used to come down here and fish every day, catch heaps of fish and crayfish. [They would] come with their kids and spend a good day here with them and be happy, and now they can’t do that.”

PHOTO: Dharriwaa Elders Group chairperson Clem Dodd. (ABC Western Plains: Jessie Davies )

For Clem Dodd, a spokesman for the Dharriwaa Elders Group, the implications for the community were dire.

“This place will be a ghost town before long,” he said.

“If there’s no water, everything’s going to die. There’ll be nothing here for people — they’ll all be moving out.”

 

NACCHO Aboriginal Health #refreshtheCTGRefresh @jackietrad Queensland Minister for Aboriginal and Torres Strait Islander Partnerships : How Queensland reform will #ClosetheGAP

 ” We asked the Queensland Productivity Commission to examine how res­ources devoted to service delivery in remote Aboriginal and Torres Strait Islander communities could be best used to meet their needs. It was clear from those findings, delivered in June, that we must reform and reframe the way we work with the state’s 19 remote communities.

They have given us a clear message: “Stop consulting us. Stop engaging us. Stop doing things to us and start doing things with us. Start to hear what we’re saying, and make us equal partners and key enablers in turning around the disadvantage our people face.”

Jackie Trad is Queensland Deputy Premier, Treasurer and Minister for Aboriginal and Torres Strait Islander Partnerships. see extracts from Health Report here

Download all reports HERE

Or Download Health report here

Chapter-17-Health-and-wellbeing

This year marked 10 years since the release of the landmark report Closing the Gap, which for the first time held governments accountable for addressing the endemic inequality that exists between indigenous and non-indigenous Australians. There has been significant progress in areas such as Year 12 completion, employment and reducing infant mortality, but in some areas the gap has widened.

Does that mean we have been too ambitious? Of course not. It is incumbent on this generation to be ambitious in pursuing a better future for First Nations people and to right the wrongs of the past by tackling injustice, poverty and disadvantage. We cannot hope to achieve this unless we learn from mistakes, build on good work and acknowledge what doesn’t work.

In 2016, the Productivity Commission was scathing in its assessment of 1000 government programs to tackle indigenous disadvantage, finding that just 34 of them had been properly evaluated. It recommended more robust evaluation and publication of results.

These requests are central to achieving real change. We must stop punishing people and start empowering them. I am steadfast in my desire to make this happen. I want the Palaszczuk government’s response to be more than just a shopping list of things we are providing communities. We must throw away the bureaucratic playbook that has hampered change, and must work together to give real meaning to local authority, local decision-making and self-determin­ation.

I have tasked my director-general, Chris Sarra, to work with communities to test and work through the QPC recommendations and to put in place a framework that will enable commun­ities to thrive. It’s an agenda not devised and proselytised from Brisbane but shaped by the people who live in the unique communities across our state — communities such as Cherbourg, Yarrabah, Doomadgee and Thursday Island.

Thriving Communities will build on past successes and acknowledge failures. There is a clear place for the policy agenda advanced by Noel Pearson’s welfare reform trial and the Families Responsibilities Commission. For 10 years the FRC has been fac­ilitating behavioural change through conditional access to welfare payments in five communities in Cape York. Like Closing the Gap, the program has had mixed success.

Despite its protestations, the federal government knows this too. In June 2015, Indigenous Affairs Minister Nigel Scullion wrote to the Queensland government seeking support for a new “lower cost approach” to the FRC, citing the current model as expensive and with limitations. Consequently, for two years, all parties have been engaged in a review of the model — a fact notice­ably absent from Scullion and special envoy Tony Abbott’s recent commentary. There also has been no mention of their failure to allocate funds to the program beyond this month.

While the federal government remains distracted by internal turbulence, we are committed to working with communities to give them the self-determination they need.

About the Inquiry

In September 2016, the Queensland Government announced the Queensland Productivity Commission (QPC) would inquire into service delivery in remote and discrete Aboriginal and Torres Strait Islander communities. The Inquiry was announced in response to concerns expressed by Indigenous leaders that the level of investment in all services (federal, State and non-government) was not delivering higher outcomes for members of their communities.

The QPC was asked to consider investment in remote and discrete Indigenous communities and what works well, and why, with a view to improving outcomes for Aboriginal and Torres Strait Islander people.

The QPC has released its final report which is available on the QPC website.

The QPC Inquiry Recommendations

The QPC Inquiry final report and recommendations are based on extensive consultation with more than 500 stakeholders and remote and discrete Indigenous communities in Queensland.

The QPC Inquiry final report shows examples of good service delivery that can be built upon but most stakeholders agree that there are opportunities to improve how services are designed, funded and delivered that will work towards better outcomes for Aboriginal and Torres Strait Islander Queenslanders.

The QPC Inquiry final report provides 22 recommendations and proposes a substantial reform agenda for policy and service delivery that includes structural reform, service delivery reform and economic reform, to be supported by capacity and capability building of all stakeholders, and timely and transparent transfer of data to measure performance and evaluation.

The Queensland Government Response to the QPC Inquiry

The Queensland Government makes a long-term commitment to work with the 19 remote and discrete Aboriginal and Torres Strait Islander communities, their leaders and Mayors and other stakeholders to implement the intent of the reform agenda proposed by the QPC.

The Queensland Government has provided its response to the final report (PDF, 521 KB).

Key points Health Delivery (text added by NACCHO ) 

􀁸 Indigenous people in remote Queensland experience a burden of disease and injury 2.4 times the non-Indigenous rate—mainly chronic disease, mental disorders, cancers and intentional injuries.

􀁸 Socioeconomic determinants (education, income, overcrowding), racism and discrimination play a significant role in the health gap, along with behavioural and environmental risk factors.

􀁸 The health system is a multifaceted network of services and settings, involving a variety of public and non-government providers, funding arrangements, participants and regulatory mechanisms.

System issues

􀁸 The ‘silo’ approach to service delivery is problematic for communities. It is difficult to ensure services are adequate, appropriate, coordinated and not unnecessarily duplicated, and meet community priorities and user needs.

􀁸 Mainstream mental health services do not meet the cultural needs of Indigenous people, who view social and emotional wellbeing as incorporating individuals, their families and communities.

􀁸 Service providers and institutions are not well-equipped to respond effectively to the distress Stolen

Generations can experience when using those services—distress that arises from the role of those institutions in past injustices.

􀁸 Anecdotally, Foetal Alcohol Spectrum Disorder is prevalent, and access to diagnosis limited.

􀁸 Access to healthcare can be problematic—issues include ineffective, nil or confusing referral pathways, lower screening rates and limited access to renal care and rehabilitation centres. There are significant gaps in the Indigenous health workforce.

What is working

􀁸 Aboriginal and Torres Strait Islander community-controlled health services provide effective, culturally appropriate and multidisciplinary models of comprehensive primary healthcare.

􀁸 Family Wellbeing is an example of a cultural healing program that has been found to increase the capacity of participants to exert greater control over their health and wellbeing.

The reforms proposed by this inquiry can provide an enabling environment for stakeholders to develop collaborative and flexible solutions to these challenges.

 

NACCHO Aboriginal Health and #Obesity : #refreshtheCTGrefresh : Download the Select Committee into the #Obesity Epidemic in Australia 22 recommendations : With feedback from @ACDPAlliance @janemartinopc

The Federal Government must impose a tax on sugary drinks, mandate Health Star Ratings and ban junk food ads on TV until 9 pm if it wants to drive down Australia’s obesity rates, a Senate committee has concluded.

The Select Committee into the Obesity Epidemic, comprising senators from all major parties and chaired by Greens leader Richard Di Natale, has tabled a far-reaching report with 22 recommendations.”

See SMH Article Part 1 below

Download PDF copy of report

Senate Obesity report

Extract from Report Programs in Aboriginal and Torres Strait Islander communities

The committee heard that Aboriginal Community Controlled Health Organisations (ACCHOs) run effective programs aimed at preventing and addressing the high prevalence of obesity in Aboriginal and Torres Strait Islander communities.

Ms Pat Turner, Chief Executive Officer of National Aboriginal Community Controlled Health Organisation (NACCHO), gave the example of the Deadly Choices program, which is about organised sports and activities for young people.

She explained that to participate in the program, prospective participants need to have a health check covered by Medicare, which is an opportunity to assess their current state of health and map out a treatment plan if necessary.

However, NACCHO is of the view that ACCHOs need to be better resourced to promote healthy nutrition and physical activity.

Access to healthy and fresh foods in remote Australia

Ms Turner also pointed out that ‘the supply of fresh foods to remote communities and regional communities is a constant problem’.

From NACCHO Submission Read here 

Recommendation 21 see all Recommendations Part 2

The committee recommends the proposed National Obesity Taskforce is funded to develop and oversee culturally appropriate prevention and intervention programs for Aboriginal and Torres Strait Islander communities.

Recommendation 22

The committee recommends the Commonwealth develop additional initiatives and incentives aimed at increasing access, affordability and consumption of fresh foods in remote Aboriginal and Torres Strait Islander communities.

“Unhealthy weight is a major risk factor for cancer, diabetes, heart disease, stroke and kidney disease. Preventing obesity in children is particularly important, as it is difficult to reverse weight gain once established,” 

Chair of the Australian Chronic Disease Prevention Alliance Sharon McGowan said limiting unhealthy food marketing would reduce children’s exposure to unhealthy food and its subsequent consumption.See in full Part 3

“Obesity in this country has reached epidemic proportions, but it is not a problem without a solution. Today’s report demonstrates a willingness from representatives across all political parties to investigate the systemic causes of obesity and develop a way forward.”

A key recommendation from the Inquiry’s report is the introduction of a tax on sugary drinks; something the OPC has led calls for, and which has been supported by around 40 public health, community and academic groups in the Tipping the Scales report.

Jane Martin, Executive Manager of the Obesity Policy Coalition, said that when two thirds of Australians are overweight or obese, the Inquiry’s comprehensive report provides an acknowledgement of the scale of the problem and a blueprint for tackling it .See part 4 Below for full press release

Part 1 SMH Article 

About 63 per cent of Australian adults are overweight or obese.

In a move that will likely delight health groups and enrage the food and beverage industries, it has recommended the government slap a tax on sugar-sweetened beverages (SSB), saying this would reduce sugar consumption, improve public health and push manufacturers to reformulate their products.

“The World Health Organisation has recommended governments tax sugary drinks and, at present, over 30 jurisdictions across the world have introduced a SSB tax as part of their effort and commitment toward preventing and controlling the rise of obesity,” the report said.

While health groups, such as Cancer Council, have demanded a 20 per cent levy, the committee suggested the government find the best fiscal model to achieve a price increase of at least 20 per cent.

“The impacts of sugary drinks are borne most by those on low income and they will also reap the most benefits from measures that change the behaviour of manufacturers,” it said.

About 63 per cent of Australian adults and 27 per cent of children aged 5 to 17 are overweight or obese, which increases the risk of developing heart disease and type 2 diabetes.

At the heart of the report is the recognition of the need for a National Obesity Taskforce, comprising government, health, industry and community representatives, which would sit within the Department of Health and be responsible for a National Obesity Strategy as well as a National Childhood Obesity Strategy.

“Australia does not have an overarching strategy to combat obesity,” it said.

“Many of the policy areas required to identify the causes, impacts and potential solutions to the obesity problem span every level of government.”

The committee has also urged the government to mandate the Health Star Rating (HSR) system, which is undergoing a five-year review, by 2020.

The voluntary front-of-pack labelling system has come under fire for producing questionable, confusing ratings – such as four stars for Kellogg’s Nutri-Grain – and becoming a “marketing tool”.

“Making it mandatory will drive food companies to reformulate more of their products in order to achieve higher HSR ratings,” the report said.

“The committee also believes that, once the HSR is made mandatory, the HSR calculator could be regularly adjusted to make it harder to achieve a five star rating.”

Pointing to a conflict-of-interest, it has recommended the HSR’s Technical Advisory Group expel members representing the industry.

“Representatives of the food and beverage industry sectors may be consulted for technical advice but [should] no longer sit on the HSR Calculator Technical Advisory Group,” it said.

The government has also been asked to consider introducing legislation to restrict junk food ads on free-to-air television until 9pm.

The group said existing voluntary codes were inadequate and also suggested that all junk food ads in all forms of media should display the product’s HSR.

The committee is made up of seven senators – two  Liberals, two Labor, one each from the Greens and One Nation and independent Tim Storer.

The Liberals wrote dissenting statements, saying a taskforce was unnecessary, HSR should remain voluntary, there shouldn’t be a sugar tax, and current advertising regulations were enough.

“No witnesses who appeared before the inquiry could point to any jurisdiction in the world where the introduction of a sugar tax led to a fall in obesity rates,” they said.

Labor senators also said there was no need for a sugar tax because there isn’t enough evidence.

“Labor senators are particularly concerned that an Australian SSB would likely be regressive, meaning that it would impact lower-income households disproportionately,” they said.

Committee chair, Dr Di Natale said: “We need the full suite of options recommended by the committee if we’re serious about making Australians happier, healthier, and more active.”

Part 2 ALL 22 Recommendations

Recommendation 1

The committee recommends that Commonwealth funding for overweight and obesity prevention efforts and treatment programs should be contingent on the appropriate use of language to avoid stigma and blame in all aspects of public health campaigns, program design and delivery.

Recommendation 2

The committee recommends that the Commonwealth Department of Health work with organisations responsible for training medical and allied health professionals to incorporate modules specifically aimed at increasing the understanding and awareness of stigma and blame in medical, psychological and public health interventions of overweight and obesity.

Recommendation 3

The committee recommends the establishment of a National Obesity Taskforce, comprising representatives across all knowledge sectors from federal, state, and local government, and alongside stakeholders from the NGO, private sectors and community members. The Taskforce should sit within the Commonwealth Department of Health and be responsible for all aspects of government policy direction, implementation and the management of funding

Recommendation 3.1

The committee recommends that the newly established National Obesity Taskforce develop a National Obesity Strategy, in consultation with all key stakeholders across government, the NGO and private sectors.

Recommendation 3.2

The committee recommends that the Australian Dietary Guidelines are updated every five years.

Recommendation 6

The committee recommends the Minister for Rural Health promote to the Australia and New Zealand Ministerial Forum on Food Regulation the adoption of the following changes to the current Health Star Rating system:

  • The Health Star Rating Calculator be modified to address inconsistencies in the calculation of ratings in relation to:
  • foods high in sugar, sodium and saturated fat;
  • the current treatment of added sugar;
  • the current treatment of fruit juices;
  • the current treatment of unprocessed fruit and vegetables; and
  • the ‘as prepared’ rules.
  • Representatives of the food and beverage industry sectors may be consulted for technical advice but no longer sit on the HSR Calculator Technical Advisory Group.
  • The Health Star Rating system be made mandatory by 2020.

Recommendation 7

The committee recommends Food Standards Australia New Zealand undertake a review of voluntary front-of-pack labelling schemes to ensure they are fit-forpurpose and adequately represent the nutritional value of foods and beverages.

Recommendation 8

The committee recommends the Minister for Rural Health promote to the Australia and New Zealand Ministerial Forum on Food Regulation the adoption of mandatory labelling of added sugar on packaged foods and drinks.

Recommendation 9

The committee recommends that the Council of Australian Governments (COAG) Health Council work with the Department of Health to develop a nutritional information label for fast food menus with the goal of achieving national consistency and making it mandatory in all jurisdictions.

Recommendation 10

The committee recommends the Australian Government introduce a tax on sugar-sweetened beverages, with the objectives of reducing consumption, improving public health and accelerating the reformulation of products.

Recommendation 11

The committee recommends that, as part of the 2019 annual review of the Commercial Television Industry Code of Practice, Free TV Australia introduce restrictions on discretionary food and drink advertising on free-to-air television until 9.00pm.

Recommendation 12

The committee recommends that the Australian Government consider introducing legislation to restrict discretionary food and drink advertising on free-toair television until 9.00pm if these restrictions are not voluntary introduced by Free TV Australia by 2020.

Recommendation 13

The committee recommends the Australian Government make mandatory the display of the Health Star Rating for food and beverage products advertised on all forms of media.

Recommendation 14

The committee recommends the proposed National Obesity Taskforce is funded to develop and oversee the implementation of a range of National Education Campaigns with different sectors of the Australian community. Educational campaigns will be context dependent and aimed at supporting individuals, families and communities to build on cultural practices and improve nutrition literacy and behaviours around diet, physical activity and well-being.

Recommendation 15

The committee recommends that the National Obesity Taskforce, when established, form a sub-committee directly responsible for the development and management of a National Childhood Obesity Strategy.

Recommendation 16

The committee recommends the Medical Services Advisory Committee (MSAC) consider adding obesity to the list of medical conditions eligible for the Chronic Disease Management scheme.

Recommendation 17

The committee recommends the Australian Medical Association, the Royal Australian College of General Practitioners and other college of professional bodies educate their members about the benefits of bariatric surgical interventions for some patients.

Recommendation 18

The committee recommends the proposed National Obesity Taskforce commission evaluations informed by multiple methods of past and current multistrategy prevention programs with the view of designing future programs.

Recommendation 19

The committee recommends the proposed National Obesity Taskforce is funded to develop and oversee the implementation of multi-strategy, community based prevention programs in partnership with communities.

Recommendation 20

The committee recommends the proposed National Obesity Taskforce develop a National Physical Activity Strategy.

Recommendation 21

The committee recommends the proposed National Obesity Taskforce is funded to develop and oversee culturally appropriate prevention and intervention programs for Aboriginal and Torres Strait Islander communities.

Recommendation 22

The committee recommends the Commonwealth develop additional initiatives and incentives aimed at increasing access, affordability and consumption of fresh foods in remote Aboriginal and Torres Strait Islanders

Part 3 Protect our children chronic disease groups support calls to restrict junk food advertising

Junk food advertising to children urgently needs to be better regulated.

That’s a recommendation from the Senate report on obesity, released last night, and a message that the Australian Chronic Disease Prevention Alliance strongly supports.

Chair of the Australian Chronic Disease Prevention Alliance Sharon McGowan said limiting unhealthy food marketing would reduce children’s exposure to unhealthy food and its subsequent consumption.

“Unhealthy weight is a major risk factor for cancer, diabetes, heart disease, stroke and kidney disease. Preventing obesity in children is particularly important, as it is difficult to reverse weight gain once established,” Ms McGowan said.

Ms McGowan said one in four children are already overweight or obese, and more likely to grow into adults who are overweight or obese with greater risk of chronic disease.

“While there are multiple factors influencing unhealthy weight gain, this is not an excuse for inaction,” she said. “Food companies are spending big money targeting our kids, unhealthy food advertising fills our television screens, our smartphones and digital media channels.

“Currently, self-regulation by industry is limited and there are almost no restrictions for advertising unhealthy foods online – this has to stop.

“We need to act now to stem this tide of obesity and preventable chronic disease, or we risk being the first generation to leave our children with a shorter life expectancy than our own.”

The Australian Chronic Disease Prevention Alliance also welcomed the Report’s recommendations for the establishment of a National Obesity Taskforce, improvements to the Health Star Rating food labelling system, development a National Physical Activity Strategy and introduction of a sugary drinks levy.

“We support the recent Government commitment to develop a national approach to obesity and urge the government to incorporate the recommendations from the Senate report for a well-rounded approach to tackle obesity in Australia,” Ms McGowan said.

Part 4

Sugary drink levy among 22 recommendations

The Obesity Policy Coalition (OPC) has welcomed a Senate Inquiry report into the Obesity Epidemic in Australia as an important step toward saving Australians from a lifetime of chronic disease and even premature death.

Jane Martin, Executive Manager of the Obesity Policy Coalition, said that when two thirds of Australians are overweight or obese, the Inquiry’s comprehensive report provides an acknowledgement of the scale of the problem and a blueprint for tackling it.

“Obesity in this country has reached epidemic proportions, but it is not a problem without a solution. Today’s report demonstrates a willingness from representatives across all political parties to investigate the systemic causes of obesity and develop a way forward.”

A key recommendation from the Inquiry’s report is the introduction of a tax on sugary drinks; something the OPC has led calls for, and which has been supported by around 40 public health, community and academic groups in the Tipping the Scales report.

“Sugar is a problem in our diets and sugary drinks are the largest contributor of added sugar for Australians. Consumption of these beverages is associated with chronic health conditions including type 2 diabetes, heart disease, some cancers and tooth decay,” Ms Martin said.

“We have been calling for a 20% health levy on sugary drinks for a number of years, but Australia continues to lag behind 45 other jurisdictions around the world that have introduced levies. When sugary drinks are often cheaper than water, it’s time to take action.”

The report also calls for a review of the current rules around junk food advertising to children.

Ms Martin insisted any review should prioritise an end to the advertising industry’s selfregulated codes.

“We know industry marketing is having a negative effect; it directly impacts what children eat and what they pester their parents for. It’s wallpaper in their lives, bombarding them during their favourite TV shows, infiltrating their social media feeds and plastering their sports grounds and uniforms when they play sport,” Ms Martin said.

“With more than one in four Australian children overweight or obese, it’s time for the Government to acknowledge that leaving food and beverage companies to make their own sham rules allows them to continue to prioritise profits over kids’ health.”

While the Inquiry’s report calls for a National Obesity Strategy, a commitment announced by the COAG Health Ministers earlier this year, Ms Martin stressed that this must be developed independently, without the involvement of the ultra-processed food industry, which has already hampered progress to date.

“The OPC, along with 40 leading community and public health groups, have set out clear actions on how best to tackle obesity in our consensus report, Tipping the Scales. These actions came through strongly from many of the groups who participated in the inquiry and we are pleased to see them reflected in the recommendations.

“The evidence is clear on what works to prevent and reduce obesity, but for real impact we need leadership from policy makers. We need to stop placing the blame on individuals. The Federal and State governments must now work together to push those levers under their control to stem the tide of obesity.”

The senate inquiry report contains 22 recommendations which address the causes, control of obesity, including:

  • The establishment of a National Obesity Taskforce, with a view to develop a National Obesity Strategy
  • Introduction of a tax on sugar-sweetened beverages
  • The Health Star Rating system be made mandatory by 2020
  • Adoption of mandatory labelling of added sugar
  • Restrictions on discretionary food and drink advertising on free-to-air television until 9pm
  • Implementation of a National Education Campaign aimed at improving nutrition literacy and behaviours around diet and physical activity
  • Form a sub-committee from the National Obesity Taskforce around the development and management of a National Childhood Obesity Strategy

BACKGROUND:

On 10 May 2018, the Senate voted to establish an inquiry to examine the impacts of Australia’s obesity epidemic.

The Select Committee into the obesity epidemic was established on 16 May 2018 to look at the causes of rising levels of obese and overweight people in Australia and how the issue affects children. It also considered the economic burden of the health concern and the effectiveness of existing programs to improve diets and tackle childhood obesity. The inquiry has received 145 submissions and has published its full report today.

The Committee held public hearings from public health, industry and community groups. The OPC provided a submission and Jane Martin gave evidence at one of these sessions.

NACCHO Aboriginal Health we need to #refreshtheCTGRefresh to #closethegap : At COAG on December 12 : Which states and territories will support a formal partnership with Aboriginal and Torres Strait Islander peoples ?

“ We understand that at this stage it is intended that new Closing the Gap targets will be settled at COAG’s December meeting,

We are calling on COAG to hold off doing this and instead put in place a proper partnership mechanism with us. The new targets haven’t been published and Indigenous peaks are uncertain what the targets will be and therefore we cannot provide our support.

NACCHO and the peak bodies engaged with the process, took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year. But we can’t see how our input has been taken into account,

As a first step we propose a meeting with COAG representatives and the peak bodies to discuss a way forward that includes a genuine partnership approach.

Aboriginal people need to be at the centre of the Closing the Gap Refresh policy; the gap won’t close without our full engagement and involvement.

Having Aboriginal people involved in the design of the Refresh and proposed revised targets will lead to Aboriginal people taking greater responsibility for the outcomes. It’s been proven that Aboriginal community control is vital and delivers better outcomes for our people.” 

NACCHO Chief Executive Pat Turner AM see interview Part 3 below 

Download the NACCHO Press Release Here

NACCHO media release Refresh The CTG Refresh

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal peak bodies across Australia have written to COAG First Ministers seeking a full partnership approach between Indigenous people and governments in refreshing the Closing the Gap Strategy, scheduled to be put to COAG for consideration in Adelaide on 12 December.

The letter, signed by 13 peak bodies, proposes an urgent meeting of Aboriginal and Torres Strait Islander peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed Closing the Gap strategy.

It’s the second letter the group has written to COAG after failing to receive a response to their initial letter in early October from any government except the Northern Territory.

Part 2 Letter to Council of Australian Government First Ministers

Dear Council of Australian Government First Ministers 16/11/2018

We write again, further to our letter of 4 October 2018, concerning the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG), to seek a formal partnership mechanism between Aboriginal and Torres Strait Islander peoples and governments in the Closing the Gap Refresh policy. We have only received a response from the Northern Territory Government.

As stated in our original letter, all of us believe it is essential that agreement is reached on the Closing the Gap Refresh policy between Indigenous organisations, on behalf of communities across Australia and Australian governments. What we propose is entirely consistent with the commitment made by COAG to set a new relationship with our communities based on a partnership.

If governments alone, continue to make decisions about the Closing the Gap, without an opportunity for us to be at the table, it will not be possible to advocate with any confidence or motivate our communities to support Closing the Gap and to take joint responsibility with governments for achieving the targets.

 

Pictures above and below from our #refreshtheCTGRefresh Campaign

The evidence is strong that when Indigenous people are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. We are certain that Indigenous peoples need to be at the centre of the Closing the Gap Refresh policy: the gap won’t close without our full involvement and COAG First Ministers, who are responsible for the Closing the Gap framework, cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

We have proposed a reasonable way forward to Australian Governments in our original letter without making it public to give everyone a reasonable opportunity to consider it. However, we understand that it is the intention of Australian Governments to still settle on targets at the forthcoming meeting of COAG on 12 December 2018.

We also understand that implementation arrangements are to be left over for COAG to agree in 2019. We make the points that neither ourselves nor anyone else outside government have seen the proposed targets which we think is way short of being partners and transparent and we cannot see how the targets can be agreed without considering at the same time how they are to be achieved.

 

We assume that Australian Governments will justify agreeing to targets by referring to the consultations earlier this year. Those consultations were demonstrably inadequate. They were conducted at a very superficial level without an opportunity for Indigenous interests to be prepared for the workshops held across Australia.

They were based on a discussion paper produced by the Department of the Prime Minister and Cabinet in December 2017 and which stated that only one of the seven targets was on track which two months later was contradicted by the former Prime Minister who said that three targets were on track. Critical elements of the original Closing the Gap framework, particularly COAG’s National Indigenous Reform Agreement, were not referred to at all in the consultations and the focus was on new targets instead of how we could make sure that this time around they were achieved.

There was no independent report prepared on the outcomes of the consultations and there is no way of telling if what was said in the consultations is reflected in the proposed Refresh policy including the targets.

The consultations started far too late which has left us with 4 targets having expired in June 2018. We do not accept that we have been properly consulted let alone given the opportunity to negotiate a mechanism that allows a proper partnership to be put in place in relation to the design, delivery and monitoring of Closing the Gap.

 

There is a now a significant opportunity to put this disappointing process back on track and in particular to establish a robust Closing the Gap framework founded on a genuine partnership between Indigenous people and governments.

It is open to governments on 12 December 2018, to endorse a partnership approach and establish a mechanism to initiate negotiations between representatives of COAG and Peak organisations with a view to developing a genuine partnership as part of the Closing the Gap Refresh. This would be endorsed by the Peak Organisations across Australia.

Subject to COAG endorsing a partnership approach, we propose a meeting of Aboriginal and Torres Strait Islander Peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed closing the gap strategy.

We stand ready to do this quickly and would work with COAG on having a partnership framework in place in early 2019 with a revised approach agreed by the middle of the year.

Ms Pat Turner AM, the CEO of the National Aboriginal Community Controlled Health Organisation, is our contact for the purpose of responding to this vital matter and we ask that you contact her.

We look forward to working with you on the Closing the Gap Refresh through an established partnership mechanism.

Yours sincerely,

 

Part 3 Going backwards’: Aboriginal bodies take aim at Closing the Gap

Aboriginal peak organisations have slammed federal, state and territory governments for failing to give Indigenous leaders an effective role in re-energising the faltering Closing the Gap process.

In a letter written jointly to Prime Minister Scott Morrison, chief ministers and premiers, the leaders of the 13 peak bodies say they have been shut out of meaningful consultation about refreshed targets to overcome Aboriginal disadvantage.

By Deborah Snow SMH 19 November

Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said "it's all gone backwards".
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said “it’s all gone backwards”. CREDIT:GLENN CAMPBELL

And they want the Coalition of Australian Governments – due to consider an update to Closing the Gap next month – to defer setting new targets until a fresh pact is hammered out giving “full partnership” to Aboriginal bodies.

“I think it’s all gone backwards,” the chief executive of the National Aboriginal Community Controlled Health Organisation (NACCHO), Pat Turner,  told the Herald.

“In the last few years, governments seem to have dropped the ball a lot. I hope they are giving serious consideration to our letter. They can’t go on having two bob each-way. They are there to lead and they have to have a bit of backbone. [The state of] Aboriginal affairs is a national shame, it is something that they should be wanting to get fixed.”

Ms Turner said only one government – the Northern Territory – had bothered replying to the group when they first wrote a letter a month ago seeking better consultation over new targets and implementation strategies.

“NACCHO and the peak [Indigenous] bodies engaged with the process took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year” she said. “But we can’t see how our input has been taken into account.”

The peak bodies decided on Sunday to release a second letter they wrote to all governments at the end of last week.

The letter says the “disappointing” Closing the Gap process has to be put “back on track” with Indigenous people taking part in the design and delivery of services on the basis of “genuine partnership”.

“As a first step we propose a meeting with COAG representatives and the peak bodies to discuss [such an] approach” Ms Turner said.

The Herald sought a response from Aboriginal Affairs minister Nigel Scullion but was unable to contact his office on Sunday.

Closing the Gap was first conceived of a decade ago as a way to measure Aboriginal disadvantage and set clear targets to redress it.

Earlier this year a report from the Department of Prime Minister and Cabinet said three of seven targets were “on track”: to halve the gap in year 12 attainment and halve the gap in child mortality by 2018, and to have 95 per cent of Indigenous four-year-olds enrolled in early childhood education by 2025.

However it said that other targets, including halving the gap in reading and numeracy, and halving the gap in employment, as well as closing the gap on life expectancy, were not on track.

NACCHO Aboriginal Health #RefreshtheCTGRefresh #ClosingTheGap : @ABSStats Release : #Aboriginal and Torres Strait Islander life expectancy lowest in remote and very remote areas

“Today’s figures show that life expectancy estimates for Aboriginal and Torres Strait Islander Australians remain lower than for the non- Indigenous population.

The life expectancy at birth of Aboriginal and Torres Strait Islander men in 2015-2017 was 8.6 years lower than for non-Indigenous men, while that of Aboriginal and Torres Strait Islander women was 7.8 years lower than that of non-Indigenous women”

The life expectancy at birth for Aboriginal and Torres Strait Islander Australians in 2015-2017 was 71.6 years for men and 75.6 years for women, according to figures released today by the Australian Bureau of Statistics (ABS).

See ABS Website 

“However, life expectancy within the Aboriginal and Torres Strait Islander population varied considerably, with the lowest life expectancy experienced by those living in the more remote parts of the country” said Anthony Grubb, Director of Demography at the ABS.

“Life expectancy at birth for Aboriginal and Torres Strait Islander people living in remote and very remote areas was 65.9 years for men and 69.6 years for women, while those living in major cities had the highest life expectancy (72.1 years and 76.5 years for men and women respectively).”

“Today’s figures show that life expectancy estimates for Aboriginal and Torres Strait Islander Australians remain lower than for the non- Indigenous population. The life expectancy at birth of Aboriginal and Torres Strait Islander men in 2015-2017 was 8.6 years lower than for non-Indigenous men, while that of Aboriginal and Torres Strait Islander women was 7.8 years lower than that of non-Indigenous women”.

These differences were more marked in remote and very remote areas, where the difference in life expectancy at birth for the Aboriginal and Torres Strait Islander population compared with the non-Indigenous population was 13.8 years for men and 14.0 years for women.

Aboriginal and Torres Strait Islander people living in the Northern Territory and Western Australia had the lowest life expectancy estimates.

Today’s release suggests the differences in life expectancy between Aboriginal and Torres Strait Islander and non-Indigenous Australians narrowed slightly over the five-year period since 2010-2012.

LIFE EXPECTANCY AT BIRTH, Remoteness Areas – 2015-2017(a)

Aboriginal and Torres Strait Islander
Non-Indigenous
Difference between non-Indigenous and Aboriginal and 
Torres Strait Islander life expectancy at birth(b)

MALES


Major Cities
72.1
80.7
8.6
Inner and Outer Regional
70.0
79.1
9.1
Remote and Very Remote
65.9
79.7
13.8

FEMALES


Major Cities
76.5
83.7
7.2
Inner and Outer Regional
74.8
82.8
8.0
Remote and Very Remote
69.6
83.6
14.0

DIFFERENCE BETWEEN MALES AND FEMALES


Major Cities
-4.4
-3.0
. .
Inner and Outer Regional
-4.8
-3.7
. .
Remote and Very Remote
-3.8
-3.9
. .

.. not applicable.
(a) Based on the average number of Aboriginal and Torres Strait Islander deaths registered in 2015-2017 adjusted for under/over identification of Indigenous Status in registrations, and final Aboriginal and Torres Strait Islander population estimates for 30 June 2016 based on the 2016 Census.
(b) Differences are based on unrounded estimates. 

LIFE EXPECTANCY AT BIRTH, States and Territory – 2015-2017(a)

LIFE EXPECTANCY AT BIRTH
Aboriginal and Torres Strait Islander
Non-Indigenous
Difference between non-Indigenous and Aboriginal and
Torres Strait Islander life expectancy at birth(b)
years
years
years

MALES


NSW
70.9
80.2
9.4
Qld
72.0
79.8
7.8
WA
66.9
80.3
13.4
NT
66.6
78.1
11.5
Aust.(c)
71.6
80.2
8.6

FEMALES


NSW
75.9
83.5
7.6
Qld
76.4
83.2
6.7
WA
71.8
83.8
12.0
NT
69.9
82.7
12.8
Aust.(c)
75.6
83.4
7.8

(a) Based on the average number of Aboriginal and Torres Strait Islander deaths registered in 2015-2017 adjusted for under/over identification of Indigenous Status in registrations, and final Aboriginal and Torres Strait Islander population estimates for 30 June 2016 based on the 2016 Census.
(b) Differences are based on unrounded estimates.
(c) These life expectancy estimates are calculated taking age-specific identification rates into account. 

Further details are available in Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017 (cat. no. 3302.0.55.003).

 

NACCHO Aboriginal Children’s Health #refreshtheCTGRefresh #HOSW8 @fam_matters_au Download the #FamilyMatters Report 2018: The report 2018 urges that investment in #prevention is critical to stopping our national child removals crisis

 ” We call on all Australian Governments
 to work with Aboriginal and Torres Strait Islander communities and their representatives over the
 coming year and beyond to implement the evidence based strategies for change that this report shows are desperately needed. We hope that, as a result, next year’s report will show a changing story.

The choices that we make now go to the very heart of our shared obligation to heal our nation’s fractured past and secure our children’s future.”

– Natalie Lewis, Chair of Family Matters

At the launch of this Family Matters Report 2018, the campaign is calling upon the Council of Australian Governments to work in partnership with Aboriginal and Torres Strait Islander leaders and organisations across the country, to develop a generational Aboriginal and Torres Strait Islander children’s strategy to eliminate over-representation in out-of-home care and address the causes of child removals.

Download the Report

Family-Matters-Report-2018

The rate at which Aboriginal and Torres Strait Islander children are being removed from their families is an escalating national crisis.

The Family Matters Report 2018, which was released at the Healing Our Spirit Worldwide Conference in Sydney today, finds that Aboriginal and Torres Strait Islander children are now 10.1 times more likely to be removed from their families than non-Indigenous children. And the rate is projected to triple in the next twenty years if urgent action is not taken.

Fewer than half of Aboriginal and Torres Strait Islander children are placed with Aboriginal and Torres Strait Islander carers, following a steep decline over the last 10 years. This places Aboriginal and Torres Strait Islander children who are removed from their families at serious risk of being permanently disconnected from their families, communities and cultures.

The Family Matters Report 2018 points to a number of issues as the drivers of over-representation of Aboriginal and Torres Strait Islander children in the child protection system. Poverty is one – it was found that 25 per cent of clients accessing homelessness services were Aboriginal and/or Torres Strait Islander people, and most disturbingly, of those clients, one in four was a child under the age of 10.

Family violence was also highlighted in the report, where in 2016-17, emotional abuse, which can include exposure to family violence, was the most common child protection concern for Aboriginal and Torres Strait Islander children.

Another driver of over-representation is intergenerational trauma. Direct descendants of the Stolen Generations are 30 per cent more likely to have poor mental health than other Aboriginal and Torres Strait Islander people. All of these factors put our children at greater risk of entering the child protection system.

The report also notes with concern the strong trends in policy and legislative reform to increase the focus on permanent care and adoption. The recently released report from the Senate Inquiry into Local Adoption recommends pathways to open adoption for all children in out-of-home care, which will disproportionately impact Aboriginal and Torres Strait Islander children.

As recognised in the ALP’s dissenting report this “willfully ignores the weight of evidence from submitters, it also flies in the face of human rights conventions”. Safety for Aboriginal and Torres Strait Islander children is always the priority and this includes ensuring their connection to culture, community and kin, as recognised in the Family Matters Report.

This year’s report is solutions-focussed, highlighting the way forward for positive change. We must shift from being reactive to being proactive, invest heavily in solutions, and involve Aboriginal and Torres Strait Islander people in decision-making about their own children.

Governments are only investing 17% of child protection funding in support services for children and their families, which are critical to preventing the situations that lead to child removals. The majority of child protection funding (83%) is spent on child protection services and out-of-home care – reacting to problems once they’ve already occurred.

There must be a significant boost in funding of culturally safe preventative and early intervention measures to urgently put a stop to these high rates of Aboriginal and Torres Strait Islander child removals.

But, the pace of investment and action in prevention and early intervention is slow. Efforts to address broader community and social issues that contribute to risk for our children across areas such as housing, justice, violence and poverty, remain vastly inadequate and lack coordination… This year’s Family Matters Report puts a spotlight on primary prevention measures in the early years of children’s lives – the years that matter most to changing the storyline for our families.”

– Natalie Lewis, Chair of Family Matters

Another way forward is putting greater focus on early years services to ensure that our children have the best possible start in life. Aboriginal and Torres Strait Islander five-year-olds are 2.5 times more likely to be developmentally delayed than non-Indigenous children. And yet they are accessing early childhood education and care at half the rate of non-Indigenous children. We must facilitate greater access for Aboriginal and Torres Strait Islander children and their families to early years services.

The Family Matters Report 2018 also highlights the importance of Aboriginal and Torres Strait Islander decision-making in child protection. So far only Victoria and Queensland have a statewide program to support Aboriginal families to participate in child protection decisions. Only the same two states have agreed on a comprehensive strategy to improve outcomes for children that is overseen by Aboriginal and Torres Strait Islander representatives. Aboriginal and Torres Strait Islander family-led decision-making in child protection must be rolled out nation-wide to ensure the best outcomes for our children.

Family Matters is Australia’s national campaign to ensure Aboriginal and Torres Strait Islander children and young people grow up safe and cared for in family, community and culture. The campaign is led by SNAICC – National Voice for our Children – the national peak body for Aboriginal and Torres Strait Islander children. Our goal is to eliminate the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care by 2040.

 

NACCHO Aboriginal Health and #refreshtheCTGRefresh Campaign : 13 peak Aboriginal and Torres Strait Islander bodies propose meeting  with COAG reps to determine a framework for reaching agreement on a refreshed #ClosingtheGap strategy

We understand that at this stage it is intended that new Closing the Gap targets will be settled at COAG’s December meeting,

We are calling on COAG to hold off doing this and instead put in place a proper partnership mechanism with us. The new targets haven’t been published and Indigenous peaks are uncertain what the targets will be and therefore we cannot provide our support.

NACCHO and the peak bodies engaged with the process, took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year. But we can’t see how our input has been taken into account,

As a first step we propose a meeting with COAG representatives and the peak bodies to discuss a way forward that includes a genuine partnership approach.

Aboriginal people need to be at the centre of the Closing the Gap Refresh policy; the gap won’t close without our full engagement and involvement.

Having Aboriginal people involved in the design of the Refresh and proposed revised targets will lead to Aboriginal people taking greater responsibility for the outcomes. It’s been proven that Aboriginal community control is vital and delivers better outcomes for our people.” 

NACCHO Chief Executive Pat Turner AM see interview Part 3 below 

Download the NACCHO Press Release Here

NACCHO media release Refresh The CTG Refresh

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal peak bodies across Australia have written to COAG First Ministers seeking a full partnership approach between Indigenous people and governments in refreshing the Closing the Gap Strategy, scheduled to be put to COAG for consideration in Adelaide on 12 December.

The letter, signed by 13 peak bodies, proposes an urgent meeting of Aboriginal and Torres Strait Islander peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed Closing the Gap strategy.

It’s the second letter the group has written to COAG after failing to receive a response to their initial letter in early October from any government except the Northern Territory.

Part 2 Letter to Council of Australian Government First Ministers

Dear Council of Australian Government First Ministers 16/11/2018

We write again, further to our letter of 4 October 2018, concerning the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG), to seek a formal partnership mechanism between Aboriginal and Torres Strait Islander peoples and governments in the Closing the Gap Refresh policy. We have only received a response from the Northern Territory Government.

As stated in our original letter, all of us believe it is essential that agreement is reached on the Closing the Gap Refresh policy between Indigenous organisations, on behalf of communities across Australia and Australian governments. What we propose is entirely consistent with the commitment made by COAG to set a new relationship with our communities based on a partnership.

If governments alone, continue to make decisions about the Closing the Gap, without an opportunity for us to be at the table, it will not be possible to advocate with any confidence or motivate our communities to support Closing the Gap and to take joint responsibility with governments for achieving the targets.

Pictures above and below from our #refreshtheCTGRefresh Campaign

The evidence is strong that when Indigenous people are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. We are certain that Indigenous peoples need to be at the centre of the Closing the Gap Refresh policy: the gap won’t close without our full involvement and COAG First Ministers, who are responsible for the Closing the Gap framework, cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

We have proposed a reasonable way forward to Australian Governments in our original letter without making it public to give everyone a reasonable opportunity to consider it. However, we understand that it is the intention of Australian Governments to still settle on targets at the forthcoming meeting of COAG on 12 December 2018.

We also understand that implementation arrangements are to be left over for COAG to agree in 2019. We make the points that neither ourselves nor anyone else outside government have seen the proposed targets which we think is way short of being partners and transparent and we cannot see how the targets can be agreed without considering at the same time how they are to be achieved.

We assume that Australian Governments will justify agreeing to targets by referring to the consultations earlier this year. Those consultations were demonstrably inadequate. They were conducted at a very superficial level without an opportunity for Indigenous interests to be prepared for the workshops held across Australia.

They were based on a discussion paper produced by the Department of the Prime Minister and Cabinet in December 2017 and which stated that only one of the seven targets was on track which two months later was contradicted by the former Prime Minister who said that three targets were on track. Critical elements of the original Closing the Gap framework, particularly COAG’s National Indigenous Reform Agreement, were not referred to at all in the consultations and the focus was on new targets instead of how we could make sure that this time around they were achieved.

There was no independent report prepared on the outcomes of the consultations and there is no way of telling if what was said in the consultations is reflected in the proposed Refresh policy including the targets.

The consultations started far too late which has left us with 4 targets having expired in June 2018. We do not accept that we have been properly consulted let alone given the opportunity to negotiate a mechanism that allows a proper partnership to be put in place in relation to the design, delivery and monitoring of Closing the Gap.

There is a now a significant opportunity to put this disappointing process back on track and in particular to establish a robust Closing the Gap framework founded on a genuine partnership between Indigenous people and governments.

It is open to governments on 12 December 2018, to endorse a partnership approach and establish a mechanism to initiate negotiations between representatives of COAG and Peak organisations with a view to developing a genuine partnership as part of the Closing the Gap Refresh. This would be endorsed by the Peak Organisations across Australia.

Subject to COAG endorsing a partnership approach, we propose a meeting of Aboriginal and Torres Strait Islander Peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed closing the gap strategy.

We stand ready to do this quickly and would work with COAG on having a partnership framework in place in early 2019 with a revised approach agreed by the middle of the year.

Ms Pat Turner AM, the CEO of the National Aboriginal Community Controlled Health Organisation, is our contact for the purpose of responding to this vital matter and we ask that you contact her.

We look forward to working with you on the Closing the Gap Refresh through an established partnership mechanism.

Yours sincerely,

 

Part 3 Going backwards’: Aboriginal bodies take aim at Closing the Gap

Aboriginal peak organisations have slammed federal, state and territory governments for failing to give Indigenous leaders an effective role in re-energising the faltering Closing the Gap process.

In a letter written jointly to Prime Minister Scott Morrison, chief ministers and premiers, the leaders of the 13 peak bodies say they have been shut out of meaningful consultation about refreshed targets to overcome Aboriginal disadvantage.

By Deborah Snow SMH 19 November

Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said "it's all gone backwards".
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said “it’s all gone backwards”. CREDIT:GLENN CAMPBELL

And they want the Coalition of Australian Governments – due to consider an update to Closing the Gap next month – to defer setting new targets until a fresh pact is hammered out giving “full partnership” to Aboriginal bodies.

“I think it’s all gone backwards,” the chief executive of the National Aboriginal Community Controlled Health Organisation (NACCHO), Pat Turner,  told the Herald.

“In the last few years, governments seem to have dropped the ball a lot. I hope they are giving serious consideration to our letter. They can’t go on having two bob each-way. They are there to lead and they have to have a bit of backbone. [The state of] Aboriginal affairs is a national shame, it is something that they should be wanting to get fixed.”

Ms Turner said only one government – the Northern Territory – had bothered replying to the group when they first wrote a letter a month ago seeking better consultation over new targets and implementation strategies.

“NACCHO and the peak [Indigenous] bodies engaged with the process took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year” she said. “But we can’t see how our input has been taken into account.”

The peak bodies decided on Sunday to release a second letter they wrote to all governments at the end of last week.

The letter says the “disappointing” Closing the Gap process has to be put “back on track” with Indigenous people taking part in the design and delivery of services on the basis of “genuine partnership”.

“As a first step we propose a meeting with COAG representatives and the peak bodies to discuss [such an] approach” Ms Turner said.

The Herald sought a response from Aboriginal Affairs minister Nigel Scullion but was unable to contact his office on Sunday.

Closing the Gap was first conceived of a decade ago as a way to measure Aboriginal disadvantage and set clear targets to redress it.

Earlier this year a report from the Department of Prime Minister and Cabinet said three of seven targets were “on track”: to halve the gap in year 12 attainment and halve the gap in child mortality by 2018, and to have 95 per cent of Indigenous four-year-olds enrolled in early childhood education by 2025.

However it said that other targets, including halving the gap in reading and numeracy, and halving the gap in employment, as well as closing the gap on life expectancy, were not on track.

 

 

 

NACCHO Aboriginal Women’s Health #SistersInside #imaginingabolition : Our CEO Pat Turner address to @SistersInside 9th International Conference Decolonisation is not a metaphor’: Abolition for First Nations women

NACCHO supports the abolition of prisons for First Nations women. The incarceration of Aboriginal and Torres Strait Island women should be a last resort measure.

It is time to consider a radical restructuring of the relationship between Aboriginal people and the state.

Aboriginal and Torres Strait Islander people and their communities must be part of the design, decision-making and implementation of government funded policies, programs and services that aim to reduce – or abolish –the imprisonment of our women.

Increased government investment is needed in community-led prevention and early intervention programs designed to reduce violence against women and provide therapeutic services for vulnerable women and girls. Programs and services that are holistic and culturally safe, delivered by Aboriginal and Torres Strait Islander organisations.

NACCHO calls for a full partnership approach in the Closing the Gap Refresh, so that Aboriginal people are at the centre of decision-making, design and delivery of policies that impact on them.

We are seeking a voice to the Commonwealth Parliament, so we have a say over the laws that affect us. “

Pat Turner NACCHO CEO Speaking at  Sisters Inside 9th International Conference 15 Nov

See Pats full speaking notes below

Theme of the day: ‘Decolonisation is not a metaphor’: Abolition for First Nations women

About Sisters Inside

  • Sisters Inside responds to criminalised women and girls’ needs holistically and justly. We work alongside women and girls to build them up and to give them power over their own lives. We support women and girls to address their priorities and needs. We also advocate on behalf of women with governments and within the legal system to try to achieve fairer outcomes for criminalised women, girls and their children.
  • At Sisters Inside, we call this ‘walking the journey together’. We are a community and we invite you to be part of a brighter future for Queensland’s most disadvantaged and marginalised women and children.

Sisters Inside Website Website 

In Picture above Dr Jackie Huggins, Pat Turner, Jacqui Katona, Dr Chelsea Bond and June Oscar, Aunty Debbie Sandy and chaired by Melissa Lucashenko.

Panel: Why abolition for First Nations Women?

Panel members:

  • Dr Jackie Huggins AM FAHA (Co-Chair, National Congress of Australia’s First Peoples)
  • Pat Turner AM (CEO, National Aboriginal Community Controlled Health Organisation)
  • Dr Chelsea Bond (Senior Lecturer, University of Queensland)
  • Jacqui Katona (Activist & Sessional Lecturer (Moondani Balluk), Victoria University)
  1. Imprisonment, colonialism, and statistics
  • The Australian justice system was founded on a white colonial model that consistently fails and seeks to control and supress Aboriginal and Torres Strait Islander peoples.
  • Indigenous peoples are overrepresented in the prison system:
    • Aboriginal and Torres Strait Islander adults are 12.5 times more likely to be imprisoned than non-Indigenous Australians.[i]
    • Our women represent the fastest growing group within prison populations and are 21 times more likely to be imprisoned than non-Indigenous women.[ii]
  • Imprisonment is another dimension to the historical and contemporary Aboriginal experience of colonial removal, institutionalisation and punishment.[iii]
  • Our experiences of incarceration are not only dehumanising. They contribute to our ongoing disempowerment, intergenerational trauma, social disadvantage, and burden of disease at an individual as well as community level.
  1. Aboriginal and Torres Strait Islander women’s experiences of imprisonment
  • The Change the Record report found that most Aboriginal and Torres Strait Islander women who enter prison systems:
    • are survivors of physical and sexual violence, and that these experiences are most likely to have contributed to their imprisonment; and
    • struggle with housing insecurity, poverty, mental illness, disability and the effects of trauma.
  • Family violence must be understood as both a cause and an effect of social disadvantage and intergenerational trauma.
  • Risk factors for family violence include poor housing and overcrowding, substance misuse, financial difficulties and unemployment, poor physical and mental health, and disability.[iv]
  • Imprisoning women affects the whole community. Children are left without their mothers. The whole community suffers.
  1. Kimberley Suicide Prevention Trial
  • The Kimberley Suicide Prevention Trial, of which NACCHO is a member, provides a grim example of the link between trauma, suicide, incarceration and the social determinants of health.
  • The rate of suicide in the Kimberley is seven times that of other Australian regions.
  • Nine out of ten suicides involve Aboriginal people.
  • Risk factors include imprisonment, poverty, homelessness and family violence.
  • Western Australia has the highest rate of Aboriginal and Torres Strait Islander imprisonment.
  1. Imprisonment and institutional racism
  • The overrepresentation of Aboriginal peoples in prison systems is not simply a law-and-order issue.[v] The trends of over-policing and imprisoning of Indigenous peoples are examples of institutional racism inherent in the justice system. [vi]
  • Institutional racism affects our everyday encounters with housing, health, employment and justice systems.
  • Institutional racism is not only discriminatory; it entrenches intergenerational trauma and socioeconomic disadvantage.[vii]
  • Exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Indigenous people. We are twice as likely to die by suicide or be hospitalised for mental health or behavioural reasons.
  1. Ways forward see opening quote Pat Turner 
  2. The role of ACCHSs in supporting Indigenous women

Increasing access to the health care that people need

  • Racism is a key driver of ill-health for Indigenous people, impacting not only on our access to health services but our treatment and outcomes when in the health system.
  • Institutional racism in mainstream services means that Indigenous people do not always receive the care that we need from Australia’s hospital and health system.
  • It has been our experience that many Indigenous people are uncomfortable seeking help from mainstream services for cultural, geographical, and language disparities as well as financial costs associated with accessing services.
  • The combination of these issues with racism means that we are less likely to access services for physical and mental health conditions, and many of our people have undetected health issues like poor hearing, eyesight and chronic conditions.

Early detection of health issues that are risk factors for incarceration

  • The Aboriginal Community Controlled Health model provides answers for addressing the social determinants of health, that is, the causal factors contributing to the overrepresentation of Indigenous women’s experiences of family violence and imprisonment.
  • Aboriginal Community Controlled Health organisations should be funded to undertake comprehensive, regular health check of Aboriginal women so that risk factors are identified and addressed early.

Taking a holistic approach to health needs and social determinants of health and incarceration

  • Overall, the Aboriginal Community Controlled Health model recognises that Aboriginal and Torres Strait Islander people require a greater level of holistic healthcare due to the trauma and dispossession of colonisation which is linked with our poor health outcomes.
  • Aboriginal Community Controlled Health is more sensitive to the needs of the whole individual, spiritually, socially, emotionally and physically.
  • The Aboriginal Community Controlled Model is responsive to the changing health needs of a community because it of its small, localised and agile nature. This is unlike large-scale hospitals or private practices which can become dehumanised, institutionalised and rigid in their systems.
  • Aboriginal Community Controlled Health is scalable to the needs of the community, as it is inextricably linked with the wellbeing and growth of the community.
  • The evidence shows that Aboriginal Community Controlled organisations are best placed to deliver holistic, culturally safe prevention and early intervention services to Indigenous women.
  1. About NACCHO
  • NACCHO is the national peak body representing 145 ACCHOs across the country on Aboriginal health and wellbeing issues. In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.
  • Aboriginal Community Controlled Health first arose in the early 1970s in response to the failure of the mainstream health system to meet the needs of Aboriginal and Torres Strait Islander people and the aspirations of Aboriginal peoples for self-determination.
  • An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management. ACCHOs form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.
  • Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period. Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

[i] https://www.alrc.gov.au/publications/over-representation

[ii] Human Rights Law Centre and Change the Record Coalition, 2017, Over-represented and overlooked: the crisis of Aboriginal and Torres Strait Islander women’s growing over-imprisonment: NB: The foreword is written by Vicki Roach, a presenter in the next session of the Abolition conference

[iii] file://nfs001/Home$/doris.kordes/Downloads/748-Article%20Text-1596-5-10-20180912.pdf – John Rynne and Peter Cassematis, 2015, Crime Justice Journal, Assessing the Prison Experience for Australian First Peoples: A prospective Research Approach, Vol 4, No 1:96-112.

[iv] Australian Institute of Health and Welfare. 2018. Family, domestic and sexual violence in Australia. Canberra.

[v] https://www.theguardian.com/australia-news/2017/feb/20/indigenous-incarceration-turning-the-tide-on-colonisations-cruel-third-act

[vi] ‘A culture of disrespect: Indigenous peoples and Australian public institutions’.

[vii] https://www.theguardian.com/australia-news/2018/jul/12/indigenous-women-caught-in-a-broken-system-commissioner-says

NACCHO Aboriginal Health and #Racism #VicVotes @VACCHO_org Survey finds 86 per cent of Aboriginal and Torres Strait Islander people living in Victoria have personally experienced racism in a mainstream health setting

“Racism hinders people from actually getting good medical care, getting good health care accessing services,

The results highlight the need for government to appoint an independent health commissioner and address cultural awareness at all levels of the health system.

“There are avenues that can be taken to overcome these issues and we are here to urge they be adopted by whichever party wins government at the Victorian election later this month,

Acting CEO for VACCHO, Trevor Pearce, says incidents of racism within the mainstream health system often lead to Indigenous Australians seeking treatment much later than non-Indigenous people or avoiding it all together, contributing to the gap in health and wellbeing outcomes.

“On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.”

Pat Anderson is chairwoman of the Lowitja Institute,  (and a former chair of NACCHO) see her opinion article below link ”

This article has been read over 22,000 times in past 4 years 

Read HERE 

 

Researchers have polled Aboriginal and Torres Strait Islander Victorians about their experiences of racism at hospitals and GP clinics.

The online survey, with 120 respondents, found high levels of everyday racism in the health sector.

FROM NITV

Of those polled, 88 per cent reported incidences of racism from nurses, and 74 per cent had experienced racism when dealing with GPs.

The survey was conducted by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and designed in partnership with Royal Melbourne Institute of Technology (RMIT) students.

The results revealed 86 per cent of Aboriginal and Torres Strait Islander people living in Victoria have personally experienced racism in a mainstream health setting at least once, while 54 per cent said they experienced racism in hospitals every time they attended.

The survey responses showed fewer incidents of racism when interacting with dentists (48 per cent) and the ambulance service (46 per cent).

Mr Pearce attributed the lower figures to the cultural competency work VACCHO has done with Dental Health Services Victoria and Ambulance Victoria, and said it showed how working with the Aboriginal community could achieve beneficial results for everybody involved.

“This is going to require Aboriginal people not just being heard, but actions being taken on what we say. We know what is best for us, we have the answers. Pay attention to us and act accordingly,” he said.

Victoria’s health minister Jill Hennessy says the government is taking the issue seriously.

“We are ensuring our services are more responsive to the needs of Indigenous Australians, so they can get the high quality and safe care they need, when they need it – free from discrimination,” she said in a statement.

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

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

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

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

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

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

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

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

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

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

Minister Indigenous Health Ken Wyatt see full speech Part 2 below

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

Part 1 NACCHO Keynote by John Havnen Senior Policy Officer 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Part 2 Minister Indigenous Health Ken Wyatt keynote 

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

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

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

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

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

To form new partnerships.

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

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

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

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

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

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

But there is still much work to be done.

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

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

Alcohol and drug abuse has a broad and insidious impact.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These range from alcohol restrictions to treatment and rehabilitation.

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

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

Alcohol is a particular problem in the Northern Territory.

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

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

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

It is equally high on our Government’s agenda.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But there is one big lesson from that success.

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

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

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

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

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