NACCHO Aboriginal Health #CloseTheGap : DOWNLOAD @AIHW 5 new Aboriginal Health Performance Framework 2017 reports #NSW #VIC #QLD #SA #WA

“As we come to the tenth anniversary of Closing the Gap, we have an opportunity to redouble our efforts in the areas where we need to do better and develop a truly national, collaborative approach to improving the lives of First Australians.

We are committed to co-designing the Closing the Gap refresh and that is why the Council will hear from the National Congress of Australia’s First Peoples and discuss priorities and objectives for each state and territory over the next 12 months.

I’m looking forward to working together to strengthen relationships, collaborate and demonstrate accountability across and within jurisdictions.”

Minister for Indigenous Affairs Nigel Scullion said that the previous Closing the Gap process had little buy in from states and territories.

The Turnbull Government understands that states and territories play a critical role in improving the lives of Aboriginal and Torres Strait Islander peoples and that’s why it’s so important all governments come together if we are genuine about Closing the Gap.

Ministers from federal, state and territory governments will meet in Canberra today 23 October to focus national efforts on Indigenous policy.

This is the first meeting of the Council of Australian Governments (COAG) Ministerial Council on Indigenous Affairs.

The Ministerial Council supports collaboration and all governments’ efforts in Indigenous Affairs across Australia, with a focus on the Closing the Gap Refresh, and engagement between Aboriginal and Torres Strait Islander peoples and governments.

 The Australian Institute of Health and Welfare has released five new Aboriginal and Torres Strait Islander Health Performance Framework 2017 reports (#NSW #VIC #QLD #SA #WA )

Which can be download below.

These reports give the latest information on how Aboriginal and Torres Strait Islander people in each state are faring according to various measures of health status and outcomes, determinants of health, and health system performance.

Tier 1—Health status and outcomes

Tier 2—Determinants of health

Tier 3—Health system performance

Indicators are based on the Aboriginal and Torres Strait Islander Health Performance Framework.

The reports highlight the main areas of improvement, and continuing concern. Example below New South Wales

Summary

The Aboriginal and Torres Strait Islander Health Performance Framework 2017 report for New South Wales finds both areas of improvement and areas of concern in the health of Aboriginal and Torres Strait Islander people living in New South Wales (Table S1).

Areas of improvement for New South Wales include:

  • Deaths due to circulatory diseases—the leading cause of death for Indigenous Australians—fell by 27% between 2006 and 2015 (Table 1.23.28).
  • Medicare-recorded health assessments for Indigenous Australians rose significantly between 2006–07 and 2015–16, from 30 to 247 per 1,000 (Table 3.04.3).
  • A decrease in the infant mortality rate, from 11.7 per 1,000 live births in 1998–2000 to5.2 per 1,000 live births in 2013–2015 (Table 1.20.9). The gap in the low birthweight rate for babies born to Indigenous mothers, compared with non-Indigenous mothers fell from 7.3% in 2001 to 5.0% in 2014 (Table 1.01.3).

Areas of concern for New South Wales include:

  • The age-standardised proportion of Indigenous women smoking during pregnancy (45%) was 4 times the rate for non-Indigenous women (11%) in 2014 (Table 2.21.1).
  • Death rates from chronic diseases in 2011–2015 were much higher for Indigenous Australians than for non-Indigenous Australians—more than 3 times as high for diabetes (50 compared with 15 per 100,000), and almost twice as high for respiratory diseases (90 compared with 51 per 100,000) (Table 1.23.2).
  • Death rates for some cancers in 2011–2015 were much higher for Indigenous Australians than for non-Indigenous Australians—more than 3 times as high for cervical cancer (3.1 compared with 0.9 per 100,000), and almost twice as high for lung cancer (56 compared with 31 per 100,000) (Table 1.23.2).
  • The incidence of end-stage kidney disease for Indigenous Australians rose from 6.5 per 100,000 in 1996 to 14 per 100,000 in 2014 (Table 1.10.15).
  • Indigenous Australians had higher rates of hospitalisation for injury than non-Indigenous Australians (38 compared with 25 per 1,000) between July 2013 and June 2015. The most common injuries were falls, assault, exposure to inanimate mechanical forces, complications of medical and surgical care, and transport accidents (tables 1.03.3 and 1.03.7 NSW).
  • Indigenous Australians had lower rates of hospital procedures than non-Indigenous Australians (63% compared with 80%) between July 2013 and June 2015 (Table 3.06.1).
  • The unemployment rate for people aged 15–64 continued to be higher for Indigenous than non-Indigenous Australians (15% compared with 6% in 2014–15) (Table 2.07.5).

Table of contents in each report

  • Acknowledgments
  • Abbreviations
  • Symbols
  • Summary
  • Introduction
  • Demographic information
  • Structure of this report
  • Interpreting the data in this report
  • Data improvement activities

Tier 1—Health status and outcomes

  • 1.01 Low birthweight
  • 1.02 Top reasons for hospitalisation
  • 1.03 Injury and poisoning
  • 1.04 Respiratory diseases
  • 1.05 Circulatory diseases
  • 1.06 Acute rheumatic fever and rheumatic heart disease
  • 1.07 High blood pressure
  • 1.08 Cancer
  • 1.09 Diabetes
  • 1.10 Kidney disease
  • 1.11 Oral health
  • 1.12 HIV/AIDS, hepatitis and sexually transmissible infections
  • 1.13 Community functioning
  • 1.14 Disability
  • 1.15 Ear health
  • 1.16 Eye health
  • 1.17 Perceived health status
  • 1.18 Social and emotional wellbeing
  • 1.19 Life expectancy at birth
  • 1.20 Infant and child mortality
  • 1.21 Perinatal mortality
  • 1.22 All causes age-standardised death rates
  • 1.23 Leading causes of mortality
  • 1.24 Avoidable and preventable deaths

Tier 2—Determinants of health

  • 2.01 Housing
  • 2.02 Access to functional housing with utilities
  • 2.03 Environmental tobacco smoke
  • 2.04 Literacy and numeracy
  • 2.05 Education outcomes for young people
  • 2.06 Educational participation and attainment of adults
  • 2.07 Employment
  • 2.08 Income
  • 2.09 Index of disadvantage
  • 2.10 Community safety
  • 2.11 Contact with the criminal justice system
  • 2.12 Child protection
  • 2.13 Transport
  • 2.14 Indigenous people with access to their traditional lands
  • 2.15 Tobacco use
  • 2.16 Risky alcohol consumption
  • 2.17 Drug and other substance use, including inhalants
  • 2.18 Physical activity
  • 2.19 Dietary behaviour
  • 2.20 Breastfeeding practices
  • 2.21 Health behaviours during pregnancy
  • 2.22 Overweight and obesity

 

Tier 3—Health system performance

  • 3.01 Antenatal care
  • 3.02 Immunisation
  • 3.03 Health promotion
  • 3.04 Early detection and early treatment
  • 3.05 Chronic diseases management
  • 3.06 Access to hospital procedures
  • 3.07 Selected potentially preventable hospital admissions
  • 3.08 Cultural competency
  • 3.09 Discharge against medical advice
  • 3.10 Access to mental health services
  • 3.11 Access to alcohol and drug services
  • 3.12 Aboriginal and Torres Strait Islander people in the health workforce
  • 3.13 Competent governance
  • 3.14 Access to services compared with need
  • 3.15 Access to prescription medicines
  • 3.16 Access to after-hours primary health care
  • 3.17 Regular GP or health service
  • 3.18 Care planning for chronic diseases
  • 3.19 Accreditation
  • 3.20 Aboriginal and Torres Strait Islander people training for health-related disciplines
  • 3.21 Expenditure on Aboriginal and Torres Strait Islander health compared with need
  • 3.22 Recruitment and retention of staff
  • Appendix A: Data sources
  • Glossary
  • References
  • List of tables
  • List of figures
  • Related publications

Download Reports HERE

1.Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: New South Wales
Download NSW Report
 
 2.Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: Victoria
Download VIC Report   
3.Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: Queensland
Download QLD Report
4.Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: Western Australia  
Download WA Report
5.Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: South Australia
Download SA Report

 

NACCHO Aboriginal Health Evaluation Alert : Minister @KenWyattMP engages consultants to evaluates the #IAHP Indigenous Australians’ Health Program

Independent consultants have been engaged to conduct evaluations of the Australian Government’s Indigenous Australians’ Health Program (IAHP).

Our focus is on closing the gap and, while we are making gains, we need to accelerate progress and in some cases, just doing more of the same is not going to achieve that,

We need to know what is working well so we can best target our investment in, and support of, health programs.

The consultants will work closely with Aboriginal and Torres Strait Islander communities and key consumer, primary health care and government organisations, The subsequent implementation of the agreed evaluation design will be a separate, four-year project.”

The Minister for Indigenous Health, Ken Wyatt AM, said the two projects were part of a wide ranging approach to monitor and examine the IAHP.See NACCHO background below Part 2 and 3

1.A longer term evaluation of comprehensive primary health care will be co-designed with stakeholders over 9 months, by consultants Allen and Clarke.

2.In addition, a health economics analysis will be undertaken by Deakin University.

This project will consider the IAHP’s return on investment and the relative costs of providing comprehensive primary health care to Aboriginal and Torres Strait Islander people through Indigenous specific and non-Indigenous health care services.

“Improved health results, social returns and broader economic benefits will be assessed,” said Minister Wyatt.

“This economic evaluation will inform future IAHP investments, to improve efficiency and drive better health outcomes.

“Both studies will be supported by an Evaluation Advisory Group comprised of key stakeholders and health experts, to ensure a wide range of perspectives are taken into account.

“This work aligns with the Turnbull Government’s commitment to a more strategic, long-term approach to Indigenous health and Indigenous affairs as a whole.”

Part 2 NACCHO Background : IAHP Indigenous Australians’ Health Programme

The Indigenous Health Division is responsible for the Indigenous Australians’ Health Programme, which commenced on 1 July 2014.

This Programme consolidated four Indigenous health funding streams: primary health care base funding; child and maternal health activities; Stronger Futures in the Northern Territory (Health); and the Aboriginal and Torres Strait Islander Chronic Disease Fund.

The following themes comprise the Programme:

  • Primary Health Care Services;
  • Improving Access to Primary Health Care for Aboriginal and Torres Strait Islander People;
  • Targeted Health Activities;
  • Capital Works; and
  • Governance and System Effectiveness.

The Guidelines for the Programme provide an overview of the arrangements for the administration of, and activities that may be funded under, the Programme.

PDF version: Indigenous Australians’ Health Programme Guideline – PDF 501 KB

Part 3 NACCHO background history February 2016

NACCHO $ Aboriginal Health Funding alert :Federal Goverment’s Indigenous Australians’ Health Programme

1.Indigenous Australians’ Health Programme – Tackling Indigenous Smoking Innovation Grants

The Australian Government has made available $6.3 million over three financial years from June 2016 to June 2018 for innovation grants. These projects will offer innovative and intense activities for Aboriginal and Torres Strait Islander people to reduce smoking prevalence in remote areas, for pregnant women and for young people vulnerable to entrenched cultural norms of smoking.

It is expected that successful grant recipients will work in collaborative partnerships of research organisations and service providers to seek solutions to reduce rates of smoking that have been resistant to reduction. This arrangement will improve the evidence on how to reduce smoking rates in areas or groups of high need and interventions will be evaluated in context to add to existing understanding of what works and what does not work in what circumstances.

This will be a competitive, open process for which various health service providers and research organisations may apply

2.Indigenous Australians’ Health Programme – Service Maintenance Programme

The Indigenous Australians’ Health Programme’s Service Maintenance Programme (SMP) is providing Commonwealth funded Aboriginal Community Controlled Health Services (ACCHSs) a total of up to $2 million (GST exclusive) in grant funding in 2015-16. SMP grants will provide for the priority repair and upgrade of clinics and staff housing facilities run by organisations which aim to improve access to services and improve health outcomes for Indigenous Australians.

3.Indigenous Australians’ Health Programme – Primary Health Care Activity

The Department of Health has released two Invitations to Apply for the continuation of Primary Health Care and New Directions: Mothers and Babies Services under the Indigenous Australians’ Health Programme (IAHP) in selected communities and regions across Australia for two years from 2016-17. IAHP Primary Health Care Activity aims to improve access for Aboriginal and Torres Strait Islander people to effective and high quality health care services essential to improving health and life expectancy, and reducing child mortality. New Directions: Mothers and Babies Services Activity aims to improve the health of Indigenous Australians by improving access to antenatal care and maternal and child health services by Indigenous children, their mothers and families.

4.Indigenous Australians’ Health Programme – New Directions: Mothers and Babies Services Activity

The Department of Health has released two Invitations to Apply for the continuation of Primary Health Care and New Directions: Mothers and Babies Services under the Indigenous Australians’ Health Programme (IAHP) in selected communities and regions across Australia for two years from 2016-17. IAHP Primary Health Care Activity aims to improve access for Aboriginal and Torres Strait Islander people to effective and high quality health care services essential to improving health and life expectancy, and reducing child mortality. New Directions: Mothers and Babies Services Activity aims to improve the health of Indigenous Australians by improving access to antenatal care and maternal and child health services by Indigenous children, their mothers and families

 

NACCHO Aboriginal Children’s Health #F1000DA17 : International @First1000DaysOz Movement gets Aboriginal Make-Over

“We work to support parents in taking responsibility for our children, providing them with the best start in life and ensuring that the protective factors inherent in our culture and our strong family structures are evident in our work with families.

The work of First Thousand Days Australia is aimed at reducing chronic stressors for mums and dads, so that the focus is on healthy pregnancies and giving our parents the opportunity to provide their children the best start in life.

We welcome the support of Congress and note that both the recent Redfern and Uluru statements from the national Aboriginal and Torres Strait Islander leadership highlighted early childhood development and health as a major priority for Indigenous communities “

Professor Kerry Arabena, Chair of Indigenous Health (Pictured above ) at the University of Melbourne, who heads up the Australian initiative says her group is unique in that it’s an Indigenous designed and managed intervention.

“Some of our people are kept apart from us –by politics and power— and forced to live away from the people who care most about them,” she told the audience of child care workers, educationalists, health workers and researchers. “They are in prisons and in out-of-home care.

“As long as they exist separated from us, from their families, from our communities and from our society, we remain a people who are unable to exercise the right of self-determination.

Dr Huggins, Co-Chair of the National Congress of First Peoples, said that the lack of success in improving the outcomes for Indigenous infants and children was a source of deep anxiety for all Indigenous families see Part 2 Below

Read over 270 NACCHO Aboriginal Children’s Health Articles published over the pat 5 Years

International First Thousand Days Movement got an  ” Aboriginal Make-Over ” when national summit began in Brisbane this week

Brisbane  hosted one of Australia’s most significant gatherings of Aboriginal and Torres Strait Islander child and maternal health experts and community leaders when the First Thousand Days Australia national summit convened this week .

The first 1,000 days of life – the time spanning roughly between conception and one’s second birthday – is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.

In Australia this international movement has been broadened out, by a group of Aboriginal and Torres Strait islander health researchers and practitioners, from the original nutrition-focused international initiative to include child protection, early life literacy, the role and contribution of men and the range of other issues which impact on Indigenous parents and infants in Australia.

Professor Arabena said the Queensland Government had supported the initiative with a $1.5m grant to establish two trial sites in the state and other funds have been made available for ongoing research and evaluation.

“There is a sense of desperation in many of our communities and organisations that current efforts to give our kids the best possible opportunities in life are not having the impact we’d like; our children are being put into out-of-home-care at unprecedented rates and the COAG targets to close the gap on child mortality, school attendance and literacy and numeracy haven’t been met this year.

“It’s clear that we need new initiatives that give Aboriginal and Torres Strait Islander communities more control over developing strategies and First Thousand days Australia is aiming to do just that,” said Professor Arabena.

The First Thousand Days Australia National Summit will run from tomorrow until Friday 20 October

View the Summit program including abstracts and presenters’ bios here.

 Part 2 Australian Government has historic opportunity to build safety and health of Aboriginal and Torres Strait Islander children  

Aboriginal leader, Dr Jackie Huggins, has told a child and maternal health summit In Brisbane that Australia’s elevation to the UN Human Rights Committee should cause the Australian Government to ensure its domestic actions matches its international rhetoric on Aboriginal and Torres Strait Islander children and families.

Speaking at the First Thousand Days Summit in Brisbane today Dr Huggins, Co-Chair of the National Congress of First Peoples, said that the lack of success in improving the outcomes for Indigenous infants and children was a source of deep anxiety for all Indigenous families.

“Some of our people are kept apart from us –by politics and power— and forced to live away from the people who care most about them,” she told the audience of child care workers, educationalists, health workers and researchers. “They are in prisons and in out-of-home care.

“As long as they exist separated from us, from their families, from our communities and from our society, we remain a people who are unable to exercise the right of self-determination.

The first 1,000 days of life – the time spanning roughly between conception and one’s second birthday – is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.

In Australia this international movement has been broadened out, by a group of Aboriginal and Torres Strait islander health researchers and practitioners, from the original nutrition-focused international initiative to include child protection, early life literacy, the role and contribution of men and the range of other issues which impact on Indigenous parents and infants in Australia.

Dr Huggins said the Turnbull Government had an historical opportunity to engage with the Indigenous community on child health and safety through the Aboriginal-led First Thousand Days Australia initiative.

“Indigenous people are the experts when it comes to taking responsibility for, and looking after our children,” Dr Huggins said. “We have the right to develop and provide services which address inter-generational trauma. We have the right to teach our children in their languages and ensure they have a culturally appropriate education and have the right to deliver pre-natal services according to the needs of our communities.”

First Thousand Days Australia CEO, Professor Kerry Arabena, welcomed the support of Congress and said that both the recent Redfern and Uluru statements from the national Aboriginal and Torres Strait Islander leadership highlighted early childhood development and health as a major priority for Indigenous communities.

“We all need to start focusing on the strengths and resilience of our families and work with them to build on these strengths rather than the continued emphasis on the perceived weaknesses,” said Professor Arabena.

 

NACCHO Aboriginal Healthy Futures #closethegap #socialdeterminants @pmc_gov_au Debate : Where to from here?

 

” Federal Indigenous affairs bureaucrats have released a draft of their new evaluation framework, eight months after the Commonwealth committed $40 million over four years to evaluate policies in the portfolio and put a highly regarded university professor in the driving seat.

The draft sets out processes to look more objectively at national policies to support Aboriginal and Torres Strait Islander communities and contribute to Closing the Gap, which have been led by the Department of the Prime Minister and Cabinet for the past few years.”This is intended to align with the role of the Productivity Commission in overseeing the development and implementation of a whole of government evaluation strategy of policies and programs that effect Indigenous Australians,”

PM&C sets high standards for Indigenous affairs evaluation see PART 1 Below

 ”  It’s been widely known for fifty years that the health of Aboriginal people lags far behind that of other Australians. Despite that and the expenditure of billions of taxpayers’ dollars, serious gaps persist between Indigenous versus non-Indigenous health and wellbeing.

There is compelling evidence that social factors are potent determinants of the health of populations. In the simplest of terms these are (a) social disadvantage, and (b) the relationship of Indigenous Australians to mainstream society. Associated with these are basic issues already mentioned; these include education, housing standards, employment and socio-economic status. These must be addressed if health disadvantages are to be overcome. Until this happens the poor health outcomes of Indigenous Australians will persist.

It’s easy to identify medical problems, perhaps because they can be classified and measured. It is tempting then to decide that these problems are ‘medical’ and, therefore, should respond to ‘medical’ interventions or approaches in isolation. This is dangerously misleading.

It’s time for clinicians to realise and publicly acknowledge that most of the important issues which determine the health status of Indigenous people have ‘non-medical’ roots and need vigorous ‘non-medical’ approaches in order to be corrected.

 MICHAEL GRACEY. Aboriginal health: An embarrassing decades-long saga See Part 2 Below

Part 1

Around the same time as the new evaluation funding was announced, Malcolm Turnbull sought out indigenous health expert Ian Anderson to take over as deputy secretary leading the PM&C indigenous affairs group, which is also the only group within the central department overseen by an associate secretary, Andrew Tongue.

FROM The Mandarin

Anderson’s first major task was a review of the Closing the Gap target framework, which focuses attention on particular indicators of disadvantage. A few months into the job he set out some of his thoughts in a public speech at a special event marking 50 years since the referendum that effectively created this area of federal policy.

The framework notes good evaluation is “planned from the start, and provides feedback along the way” (referencing the audit office’s 2014 better practice guide to public sector governance).

“Good evaluation is systematic, defensible, credible and unbiased. It is respectful of diverse voices and world-views.

“Evaluation is distinct from but related to monitoring and performance reviews. Evaluation may use data gathered in monitoring as one source of evidence, while information obtained through monitoring and performance reviews may help inform evaluation priorities.”

The credibility of future evaluations depends on demonstrating their independence. To this end, the framework says a new external advisory committee, membership so far unknown, will “support transparency and ensure the conduct and prioritisation of evaluations is independent and impartial” by overseeing how the new framework is applied, checking the annual evaluation plan and with “ongoing advice, quality assurance and review”.

A “commitment to transparency” is also included. The committee will publish “all high priority evaluations” and reviews of them. Others will be randomly reviewed and summarised in an annual report.

“At the three year mark an independent meta-review of IAG evaluations will be undertaken to assess the extent to which the Framework has achieved its aims for greater capability, integration and use of robust evaluation evidence against the standards described under each of the best practice principles.”

All the actual evaluation reports will be published as well, at least in summary form, including “where ethical confidentiality concerns or commercial in confidence requirements” apply. Indigenous communities that have participated in evaluations will get to see the results too and additional “knowledge translation” efforts are proposed:

“Evaluation findings will be of interest to communities and service providers implementing programs as well as government decision-makers. Evaluation activities under the Framework will be designed to support service providers in gaining feedback about innovative approaches to program implementation and practical strategies for achieving positive outcomes across a range of community settings.”

The draft framework says it aims to:

  • generate high quality evidence that is used to inform decision making,
  • strengthen Indigenous leadership in evaluation,
  • build capability by fostering a collaborative culture of evaluative thinking and continuous learning across the IAG and more broadly across communities and organisations, and
  • place collaboration and ethical ways of doing high quality evaluation at the forefront of evaluation practice in order to inform decision making.

Higher quality evaluation that is “ethical, inclusive and focused on improving outcomes” is more likely to have impact, the draft points out. “It aims to pursue consistent standards of evaluation of Indigenous Advancement Strategy (IAS) programs but not impose a ‘one-size-fits-all’ model of evaluation.”

The guide calls for best-practice evaluation to be “integrated into the cycles of policy and community decision-making” in a way that is “collaborative, timely and culturally inclusive.”

“Our approach to evaluation, as outlined in this Framework, reflects a strong commitment to working with Indigenous Australians.

“Our collaborative efforts centre on recognising the strengths of Aboriginal and Torres Strait Islander peoples, communities and cultures.

“Fostering leadership and bringing the diverse perspectives of Indigenous Australians into evaluation processes helps ensure the relevance, credibility and usefulness of evaluation findings. In evaluation, this means we value the involvement of Indigenous Australian evaluators in conducting all forms of evaluation, particularly using participatory methods that grow our mutual understanding.”

Indigenous Advancement Strategy evaluations will look at how well programs meet three criteria:

Do they build on strengths to make a positive contribution to the lives of current and future generations of Indigenous Australians?

Are they designed and delivered in collaboration with Indigenous Australians, ensuring diverse voices are heard and respected?

Do they demonstrate cultural respect towards Indigenous Australians?

Four elements of good evaluation

The draft framework lists four elements of good evaluations — they are robust, relevant, credible and appropriate, which is to say they are “fit for purpose” and done in a timely fashion — and explains in detail how each of these ideals is to be achieved in Indigenous affairs through higher standards.

“Evaluation needs to be integrated into the feedback cycles of policy, program design and evidence-informed decision-making,” explains a chapter on relevance. “Evaluation feedback cycles can provide insights to service providers and communities to enhance the evidence available to support positive change. This can occur at many points in the cycle.”

While not being too prescriptive, the framework aims to set a high standard for the evidence that is used to judge the impact of programs.

“A range of evaluation methodologies can be used to undertake impact evaluation. Evaluations under the Framework will range in scope, scale, and in the kinds of questions they ask. Measuring long-term impact is challenging but important. We need to identify markers of progress that are linked by evidence to the desired outcomes.

“The transferability of evaluation findings are critical to ensure relevant and useful knowledge is generated under the Framework. High quality impact evaluations use appropriate methods and draw upon a range of data sources both qualitative and quantitative.

“Evaluation design should utilise methodologies that produce rigorous evidence and make full use of participatory methods. Use of participatory approaches to evaluation is one example of demonstrating the core values of the Framework in practice.”

Perhaps the moves to take a more academic approach at the federal level will allow for more open discussion of what works, in a portfolio where this year the minister has seen fit to publicly attack researchers in the field, and blast the independent audit office for doing its job instead of helping him attack the opposition.

Part 2 :  Aboriginal health: An embarrassing decades-long saga

It’s been widely known for fifty years that the health of Aboriginal people lags far behind that of other Australians. Despite that and the expenditure of billions of taxpayers’ dollars, serious gaps persist between Indigenous versus non-Indigenous health and wellbeing.

Recognition of an Aboriginal Health Problem

When these inequities were recognised in the 1960s the very high rates of Aboriginal childhood malnutrition and infections and high death rates of infants and young children brought home the unpalatable fact that Australia had a so-called ‘Third World’ health problem. This is a feature of poverty-stricken nations. This was clearly unacceptable in our otherwise affluent and healthy country. There was a public outcry which stirred the federal government into attempts to remedy this embarrassing state of affairs.

In 1979 the Commonwealth Parliamentary Committee on Aboriginal Affairs found that . . .

‘the appalling state of Aboriginal health’ . . . ‘can be largely attributed to the unsatisfactory environmental conditions in which Aboriginals live, to their low socio-economic status in the Australian community, and to the failure of health authorities to give sufficient attention to the special needs of Aboriginals and to take proper account of their social and cultural beliefs and practices’ . . .

The Committee criticised governments for their lack of recognition of these factors and commented on the need for Aboriginal people to be much more closely involved in all stages of planning and delivering their own health care. Notwithstanding some improvements in Indigenous health which occurred over the almost forty years that followed, many of that Committee’s findings and criticisms are still valid.

Efforts to Improve Indigenous Health

In 1981 a $50 million Aboriginal Health Improvement Program was launched with the aim of upgrading environmental health standards, such as better housing and community and family hygiene conditions. Government funds were allocated and State and Territory health departments implemented strategies and programs and deployed clinical and allied staff in order to achieve better Indigenous health.

An important objective was to provide more accessible services for Indigenous people. Some positive health gains followed; for example, better pregnancy outcomes, fewer maternal deaths, fewer infant and young child infections, suppression of vaccine-preventable illnesses through immunisation, and lower infant death rates.

This should have helped Indigenous youngsters to negotiate the rough ride through early life that would otherwise have been their lot. However, health and disease statistics for Indigenous Australians generally stayed well behind those of other citizens in the years that followed.

Strategies to ‘Close the Gap’

The persisting poor standards of Indigenous health prompted the Federal Government in 2008 to ‘Close the Gap’ for Indigenous Australians in a range of health outcomes and other facets of life and wellbeing so that they and other Australians would have ‘equal life chances’. The then Prime Minister Rudd anticipated within a decade halving the widening gap in literacy, numeracy and employment opportunities for Indigenous people. The Statement of Intent also anticipated better opportunities for Indigenous children so that within a decade . . . “the appalling gap in infant mortality rates between Indigenous and non-Indigenous children would be halved and, within a generation, the equally appalling 17-year life gap between Indigenous and non-Indigenous when it comes to overall life expectancy” . . .  would be gone.

These aspirations seemed commendable and were well received by the public. However, their feasibility was questioned soon after they were announced. The target of closing the gap in life expectancy was said to be “probably unattainable” and the capacity to extinguish the risk of chronic diseases (like heart disease, diabetes and kidney disease) and related deaths was considered publicly by a renowned medical expert to be “implausible” in the 22-year timetable set out by the government. This is pertinent because those chronic diseases are the main contributor to the discrepancy in Indigenous versus non-Indigenous deaths. Those reservations were well founded.

Obstructions to Closing the Gap

Indigenous Australians now have very high rates of chronic diseases, as already mentioned. These are aggravated by smoking- and drug-related disorders. These conditions are long-term and have permanent complications, such as visual loss or blindness, or severe limitations on mobility. These cannot be reversed and, therefore, restrict prospects for longevity. In many Aboriginal communities a third or half of adults 35 years or over have one or more of these problems. Nationally, these diseases and accidental or intentional injuries, including suicide and homicide, are several times more prevalent in Indigenous Australians than in the total Australian population.

This well-documented and widespread heavy burden of illnesses, disabilities and related excess premature deaths among Indigenous Australians makes it virtually impossible to remove, within a generation, the inequalities between this pattern and the better outcomes which prevail in the rest of the population. This is made more difficult because some of these problems are trans-generational and can have their origins during intra-uterine development.

There are practical impediments in bringing better health to the Indigenous population. Inadequate access and maldistribution of facilities, personnel and services can be serious drawbacks, particularly in rural and remote areas. Of course, improving access to services does not necessarily lead to their appropriate utilisation.

And compliance with treatments and follow-up supervision and medications can be problematic. Similarly, altering health knowledge and modifying risky personal lifestyles are difficult among many people whether they are Indigenous or not. There have also been serious problems with management and governance of clinical services for Indigenous people whether they are Indigenous-specific or mainstream services.

This has tended to weaken their impact on health service delivery and waste limited financial and other resources. Collectively, all of these factors have diluted the much-needed positive outcomes of efforts to close the gaps in Aboriginal health standards and statistics.

Indigenous Health: the current situation

Some indicators of the current situation are revealing: death rates of Indigenous children under five years are more than double the national rates; their low birth weight rate is about double the overall national rate; hospitalisation rates are almost three times the national rates; hospital admission rates for potentially preventable conditions are almost four times higher; deaths from complications of diabetes at 35 to 55 years are approximately twenty times higher; and dementia rates are about five time higher than in non-Indigenous Australians and the  condition starts earlier in life. The Australian Institute of Health and Welfare estimated that among Indigenous Australians born from 2010 to 2012 life expectancy would be about nine to ten years shorter than for other Australians. These indicators of health status, illness patterns and life expectancy are disgraceful and require urgent attention.

Where to from here?

 The targets set to be met by the Close the Gap Strategy are reported publicly each year. Regrettably, the goals are falling short in many of the government’s nominated areas. These include several of the health-related areas which have been mentioned.
Tellingly, the targets are not being met in many other facets of Indigenous life which have significant impacts on physical, emotional and mental health and wellbeing.

These include, for example, early childhood schooling rates, closing the gaps in literacy and numeracy for older Indigenous schoolchildren, achieving equity in employment rates and the economic benefits which should follow, having Indigenous people housed in adequate and hygienic living conditions, and being more engaged with the wider Australian community in various day-to-day activities. These failures have been publicly acknowledged by successive Prime Ministers including Abbott and Turnbull.
In the health arena itself there is a need for closer cooperation and collaboration between the three main sectors which provide curative and health promotion activities for Indigenous people. These sectors are: (a) mainstream services provided by governments; (b) Indigenous-specific services from Aboriginal or Indigenous Health or Medical Services; and (c) privately funded clinical and allied services. There is often overlapping of these sectors and, sometimes, issues of territoriality which detract from their effectiveness and, potentially, add to the financial costs involved.
As mentioned by that Parliamentary Committee as far back as 1979, there is a pressing need for more Indigenous involvement and responsibility for decision-making and delivery of their own health services. Although this is improving slowly, there is a long way to go before those people who need the services have the power to help control their own future health. This is particularly so in remote areas where local communities and their committees are often sidelined from this important function.

Social Dimensions which affect Health

There is compelling evidence that social factors are potent determinants of the health of populations.

In the simplest of terms these are (a) social disadvantage, and (b) the relationship of Indigenous Australians to mainstream society. Associated with these are basic issues already mentioned; these include education, housing standards, employment and socio-economic status.

These must be addressed if health disadvantages are to be overcome. Until this happens the poor health outcomes of Indigenous Australians will persist.

It’s easy to identify medical problems, perhaps because they can be classified and measured. It is tempting then to decide that these problems are ‘medical’ and, therefore, should respond to ‘medical’ interventions or approaches in isolation. This is dangerously misleading. It’s time for clinicians to realise and publicly acknowledge that most of the important issues which determine the health status of Indigenous people have ‘non-medical’ roots and need vigorous ‘non-medical’ approaches in order to be corrected. This means, of course, that non-medical sectors of governments must accept more responsibility and become more actively involved in issues which ultimately determine the health of populations which they are expected to serve. This will require a major shift in thinking within Federal and State governments and bureaucracies and wider acceptance among the Australian community.

The challenges are daunting but the need is urgent. Surely it is within our collective capabilities to turn around this sad and long-standing saga into a success story.

Michael Gracey AO is a paediatrician who has worked with Indigenous children, their families and communities for more than forty years. He was Australia’s first Professor of Aboriginal Health and for many years was Principal Medical Adviser on Aboriginal Health to the Western Australian Department of Health. He is a former President of the International Paediatric Association.

NACCHO Aboriginal Health : Pat Anderson AO 17 th Vincent Lingiari Lecture ” Our Hope for the Future: Voice. Treaty. Truth “

 

” When delegates from the Dialogues assembled at Uluru in May this year, the exhaustive deliberations and informed participation through the Regional Dialogues led to a broad consensus, as articulated in the Uluru Statement from the Heart which was adopted by the Convention.

Specifically, Australia’s First Peoples overwhelmingly rejected any purely symbolic changes to the Constitution, such as through a ‘statement of recognition’.

……..Dialogue participants and the Uluru Convention showed significant agreement.

There was overwhelming consensus around three proposals.

First, for a constitutionally established representative body that would give First Nations a Voice directly to the Federal Parliament.

Second, for the establishment of a Makarrata Commission to supervise the making of Treaties with us.

Third, for a process of local and regional Truth-telling which could form the basis for genuine reconciliation.”

Ms Pat Anderson AO  delivered the 17th Annual Vincent Lingiari Memorial Lecture at Charles Darwin University on Wednesday, 16 August.Full Text and video below

The lecture commemorated the historic walk-off from Wave Hill Station by Indigenous stockmen and their families, planting the seeds for Aboriginal land rights in Australia.

For her lecture titled: “Our Hope for the Future:  Voice. Treaty. Truth” Ms Anderson reflected on her personal history and experience as an advocate for social justice during the last half-century of struggle for the recognition of the rights of Aboriginal and Torres Strait Islander people.

Chair of the Lowitja Institute and co-chair of the former Prime Minister’s Referendum Council, former Chair of NACCHO and CEO of Danila Dilba ACCHO and AMSANT ,  Ms Anderson is a campaigner for advancing the rights of Aboriginal and Torres Strait Islander people in education, health, early childhood development, and violence against women and children. She is an Aboriginal advocate for social justice and winner of the 2016 Human Rights Medal.

Watch NACCHO TV Video of full speech

Or full speech transcript download in 16 Page PDF or read below

patanderson-lingiari-lecture-final2-16-august-2017

Ms Pat Anderson AO delivered the 17th Annual Vincent Lingiari Memorial Lecture at Charles Darwin University on Wednesday, 16 August, which commemorated the historic walk-off from Wave Hill Station by Indigenous stockmen and their families, planting the seeds for Aboriginal land rights in Australia.

Good evening everyone,

I acknowledge and pay respects to the Larrakia people, traditional custodians of the land on which we are meeting tonight.

I want to thank Charles Darwin University for asking me to deliver this Lecture. This is huge honour for me. It’s always hard presenting in your home town.

I was feeling a bit anxious about that because you all know everything about me.

I would like to acknowledge Wendy Ludwick who I think put my name forward for this honour.

We are here to honour the memory of Vincent Lingiari and his leadership in the 1966 Wave Hill strike.

I will return to that story, and to the place of the Gurindji in the contemporary struggle for the rights of Australia’s First Peoples shortly.

But first, I’d like to share another story with you, a personal story.

This story is from the 1950s, a decade before the Wave Hill Walk Off, and is set at Parap Camp a few miles from here (in the suburb now called Stuart Park), where I and my sisters grew up with our mum and dad.

For those who don’t know the history, Parap Camp was home to many Aboriginal and some Torres Strait Islander families in those harsh post-War years.

Many of those families had a Stolen Generations heritage, with the parents of Parap camp families having grown up in the nearby Kahlin Compound. Kids were rounded up from all over the Territory.

My mother was one of those, taken as a young girl sometime in the 1930s by white men on horseback from her Alyawarre family north east of Alice Springs.

She was brought here to the Compound, fifteen hundred kilometres away.

After growing up at Kahlin, she was sent to work as a young teenager on a farm on the other side of the Darwin harbour, near Belyuen.

Later, she met my dad, a Swedish merchant seaman who had jumped ship in Fremantle, and made his way to Darwin.

They married and settled at Parap Camp.

My story is from when I was about 9 or 10 years old, when I was in Grade 3 or 4 – like almost all children from Parap Camp, I and my sisters attended school without fail.

School attendance was non-negotiable in those days – we all just went.

Every year the class would have a Christmas Party at the end of the final term, and the idea was that all the kids would bring food from home for the party.

I was excited because I knew my mum made the best sponge cakes ever: great high, fluffy things.

I pictured myself taking one of these cakes into school – I was a bit vain, and wanted to show off what a great cook mum was.

But when I asked her to make the cake, she flatly refused.

No matter what I said, how I nagged at her, she just said no.

Finally, in frustration, I just burst out: “But why mum? Why won’t you make one of your cakes and let me take it to the school party?”.

She hesitated for a moment.

And then she said quietly: “I don’t like white people eating my food”.

I knew immediately from the way she said it that not only was this the end of the argument, but also that she was telling me something more.

I can still see her face and hear her voice.

I haven’t forgotten this: although I didn’t understand how at the time, it was clearly important.

And so I had to trudge off to my Christmas party with a packet of store bought biscuits, while all the other kids brought scones, cakes and biscuits baked by their mothers – none of which, I might add, were as good as what my mum could have made.

This sounds like an ordinary domestic, family event.

And it is.

But like so many stories that are part of every Aboriginal family in this country, there is a lot packed into this little scenario.

For a start, how did my mum get to be so good a cook?

I see now that her skill with cooking was something she had learnt from the white women she worked for as domestic, unpaid labour.

Her ability to cook a beautiful sponge cake was a direct consequence of the policy of assimilation by which all Australian governments aimed to eradicate us as distinct cultural groups.

At the same time, there were other skills that were withheld from her and so many other Stolen Generations.

Most importantly, growing up in Kahlin Compound she was never taught to read or write.

Despite the rhetoric about Aboriginal children being taken away to improve their chances in life, literacy was one skill that the administration clearly thought was of no use to a young Aboriginal woman.

That much is clear from our history.

However, on a personal level, much about my mother’s motivations in the story about the cake remains curious to me.

Did she not want white people to eat her food as an act of defiance?

Was it a reluctance – or a refusal – to place herself in a situation of being judged by them?

Was it her own brand of passive resistance?

I don’t know.

However, I do know it was a profound moment in our relationship as she revealed something of herself to me.

This moment has stayed with me over all these years.

And I believe this little incident points to the great gulf in experience between Aboriginal and non-Aboriginal Australia.

It points towards an experience carried by so many of our families: the experience of having been treated unjustly, but of that injustice not being acknowledged.

This experience has been analysed by Jill Stauffer in her 2015 book, Ethical loneliness: the injustice of not being heard1.

Stauffer describes the profound isolation and loneliness that arises as a consequence of such an experience.

Calling it ‘ethical loneliness’ she says that it is a condition undergone by persons who have been unjustly treated … who emerge from that injustice only to find that the surrounding world will not listen to or cannot properly hear their testimony. … ethical loneliness is the experience of having been abandoned by humanity, compounded by the experience of not being heard.

There is something of this ethical loneliness in my mother’s experience, and even in the story of the cake she would not make.

I believe that experience is common to many if not all Aboriginal and Torres Strait Islander families.

It stems from the complex, often damaged and damaging relationship between our First Nations and those who colonised this place from 1788 onwards.

Much of that damage remains embedded in the relationship between black and white Australia.

This nation has never properly dealt with that damage.

It has never properly acknowledged it, and acted upon that acknowledgement.

I believe we now, in 2017, all of us over the age of 18, this generation, have an historic opportunity to do that, to begin the process of repair, to re-set that relationship on a foundation of equality, justice and truth.

That opportunity is presented by the prospect of genuine and substantive reform to the Australian Constitution, and that is the topic I want to talk to you about this evening.

I would like to take you on the journey that I have been recently on as a member of the Referendum Council, which was tasked with making recommendations to the Federal Government on constitutional reform.

I would like to share with you our experience of the unique regional Dialogues with First Peoples and communities, and what we heard in them, culminating in the National Convention of First peoples at Uluru in May this year, and the Uluru Statement from the Heart.

And most importantly I want to describe the three essential demands to come from this process, which I summarise with these three words:

Voice.

Treaty.

Truth.

Before we trace that journey from the world of the Parap Camp in the 1950s, to where we stand today in 2017, I would like to acknowledge the importance of the Wave Hill Walk Off in 1966 in our history.

Mr Lingiari and the other Gurindji men and women first walked off their jobs on the Wave Hill station to demand fair pay and conditions, but ended up sitting down at Wattie Creek and demanding the return of their traditional lands.

They were demanding proper acknowledgment of the injustice done to them, and proper restitution of the harms done.

In doing so, they began the modern land rights movement.

But they were also re-asserting the struggle for self-determination, as summed up so elegantly by Mr Lingiari himself when he said:

“We want to live on our land, our way”

In those nine words, he captured the essence of what have been and continue to be the central demands of our First Nations since 1788.

First, recognition of our sovereignty, never ceded, of the land, of Country.

Second, acceptance of our right to continue in our unique and diverse cultures.

The Gurindji and Mr Lingiari powerfully re-asserted those demands, just as our First Nations have done since the beginning of the colonisation of Australia, and just as we have continued to do since.

This year, 2017, is a year of anniversaries of events which built upon and extended the rights of First Peoples as so clearly stated by the Gurindji.

It is

• 50 years since the 1967 Referendum;

• 25 years since the Mabo decision overturned the lie of ‘terra nullius’ in 1992; and

• 20 years since the Bringing Them Home Report in 1997.

It is also, crucially, 10 years since the Intervention was unleashed on our communities here in the Northern Territory.

The Intervention was the counter-revolution, the attempt to turn back the clock to the times before the Gurindji and Wave Hill, and the 1967 Referendum, and all the other achievements.

The Intervention was the attempt to take us back to the world of Parap Camp in the 1950s, when the powers of the nation-state reached into every aspect of how we lived our lives.

Now, ten years on, it is clear how profoundly and utterly the Intervention and the thinking behind it has failed.

It continues, however, to create much heartache and pain.

As John Lawrence in his recent Castan Centre Address3 has stated, tem years on, the Northern Territory gaols more people per capita than any country in the world.

The overwhelming majority of those incarcerated are Aboriginal.

The number of children being removed from their families is soaring: it rose by an average of 16% per year between 2011 and 2015.

This frightening increase is entirely due to the removal of Aboriginal children from their families4.

Family violence is out of control.

These figures – which many of you will know – are profoundly disturbing.

They demonstrate the tsunami of anger, frustration, despair and sadness that is engulfing our communities and families.

These type of figures are echoed across the country.

They reflect the kind of Intervention-thinking that has informed policy making over the last ten years, based on the idea that the nation-state knows best what is good for us.

Let us remember that the Intervention was trumpeted by its instigators as necessary to protect Aboriginal women and children.

It marked a shift in policy-making not just here but across the country.

Intervention-thinking sees self-determination as a failed idea, and blames us for the situation in which we find ourselves.

It believes that we do not have anything to offer, that we are at best ‘risks’ to be managed.

It ignores or condones or covers up the abuse of young people in detention, or our lack of housing or access to education.

I say again: it has utterly failed.

We can see this through the statistics, but more importantly through visiting many of our communities and listening to the experience of Aboriginal and Torres Strait Islander peoples over these last few months.

I’ve been working in this field all of my adult life, and I can say honestly say that I have never seen things so bad.

This has to change.

We now sit in 2017 at what I believe is a critical junction in our history, not just for the First Nations of this country, but for the nation-state as a whole.

Six weeks ago, the Referendum Council of which I was Co-Chair handed a report to the Prime Minister, recommending what constitutional change should look like if it is to be acceptable to our First Peoples.

The report documents what we were told in a series of regional dialogues with Aboriginal and Torres Strait Islander people and communities across the country.

Going out and talking to Aboriginal and Torres Strait Islander people was our first priority under our terms of reference.

These twelve regional Dialogues were held from Thursday Island to Hobart, from Perth, to Ross River outside Alice Springs, to Sydney and Melbourne. People from across the regions came to these centres.

We also held a one-day information session in Canberra.

Each Dialogue was attended by around one hundred people, including Traditional Owners, representatives of local organisations, and individuals.

Each was held over three days to allow full consideration of a number of proposals for Constitutional reform. It was the same format and same agenda for each Dialogue. We needed a methodology which could, in some way, be empirically measured.

The reforms that each Dialogue considered had been inherited by the Referendum Council from the work of the Expert Panel on the Recognition of Aboriginal and Torres Strait Islander Peoples in the Constitution (co-chaired by Patrick Dodson and Mark Leibler) and the Joint Select Committee on Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples (co-chaired by Senators Ken Wyatt and Nova Peris).

They were:

• first, a statement acknowledging us as the First Australians, either inside or outside the Constitution;

• second, amending or deleting that part of the Constitution which empowers the Commonwealth to make laws for Aboriginal and Torres Strait Islander peoples;

• third, inserting a guarantee against racial discrimination into the Constitution; and

• fourth, deleting that part of the Constitution which contemplates the possibility of a state government excluding some Australians from voting on the basis of their race.

The Dialogues also considered a fifth option, that of a First Peoples’ Voice to be heard by Parliament, and the right to be consulted on legislation and policies that affects us.

The Dialogue process was unprecedented in Australia’s history: never before have we as First Nations sat down across the nation in such an intensive, structured manner to deliberate on constitutional matters.

It was a passionate process.

Delegates grappled with the technical and legal implications of these proposals, as well as with their political viability.

There were disagreements, there were even arguments: how could it be otherwise when 1,200 people from all the diversity of our Nations were brought together to talk about matters so closely connected with the experiences and history of their families, clans and communities?

But there was also an extraordinary level of agreement on some matters.

When delegates from the Dialogues assembled at Uluru in May this year, the exhaustive deliberations and informed participation through the Regional Dialogues led to a broad consensus, as articulated in the Uluru Statement from the Heart which was adopted by the Convention.

Specifically, Australia’s First Peoples overwhelmingly rejected any purely symbolic changes to the Constitution, such as through a ‘statement of recognition’.

There were two reasons behind the rejection of this narrow model of Constitutional recognition.

First, there was a concern that formal recognition in the Constitution might interfere with sovereignty – and all Dialogues were steadfast in asserting the fact that we as First Nations had never ceded our sovereignty.

In re-asserting the fact of sovereignty, the delegates echoed the conclusions of the Expert Panel on Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples five years ago, which stated that5:

The … occupation of the country … proceeded on the fiction of terra nullius. It follows that ultimately the basis of settlement in Australia is and always has been the exertion of force by and on behalf of the British Crown. No-one asked permission to settle. No-one consented, no-one ceded. Sovereignty was not passed from the Aboriginal peoples by any actions of legal significance voluntarily taken by or on behalf of them.

Second, and more simply, participants in the Dialogues and at Uluru simply did not trust the likely process for drafting a constitutional statement of recognition

The concern was that by the time the lawyers were through with it, such a statement would end up being so bland as to be incompatible with the duty to recognise the difficult truths of Australia’s past.

Instead, our mob wanted substantive change, structural reform, for their communities on the ground.

And if it didn’t fit that criteria, they weren’t interested.

And this is where Dialogue participants and the Uluru Convention showed significant agreement.

There was overwhelming consensus around three proposals.

First, for a constitutionally established representative body that would give First Nations a Voice directly to the Federal Parliament.

Second, for the establishment of a Makarrata Commission to supervise the making of Treaties with us.

Third, for a process of local and regional Truth-telling which could form the basis for genuine reconciliation.

These three things – Voice – Treaty – Truth – were the key consensus demands that arose from the Dialogues, were captured in the Uluru Statement from the Heart, and form the core of the Referendum Council’s report.

I’d now like to turn to each of these three crucial concepts and unpack them, give you my view why they are important, what they might mean, and how they might provide a pathway out of our current situation.

These are not abstract notions, or intellectual constructs.

Changing the Constitution, many of us believe, is the only place left for us to go.

We have sat on the Committees, we have set up our own organisations, we have changed national policy agendas, but we still haven’t been able to achieve the substantive change demanded by our communities.

As Marcia Langton said at Garma recently, we have been Royal Commission-ed out, we have been committee-ed out, and we have been panel-ed out.

We still have to rely on other people’s good will.

And that is not good enough anymore.

We need more than that.

We need once and for all for our sovereignty to be recognised and our voices to be heard.

The recommendation for substantive constitutional change was for the establishment of a “representative body that gives Aboriginal and Torres Strait Islander First Nations a Voice to the Commonwealth Parliament”.

We believed – following the consensus at Uluru – that this is the only constitutional reform which would accord with the wishes of Aboriginal and Torres Strait Islander peoples.

Why is this important?

Establishing such a body in the Constitution has both substantive and symbolic value.

Symbolically, it recognises the unique place of First Peoples in Australian history and in contemporary Australian society.

It formally acknowledges our place here.

In asking Australians to vote ‘yes’ to such a proposal we would be asking us all to reflect on who we are, on what values and principles we hold dearest.

It would establish a significant national narrative about working together – about a genuine two-way conversation.

But such a body will also provide substantive benefits.

A constitutionally entrenched Voice to Parliament could address Australia’s poor history of consultation with our Peoples by government.

All too often we have been excluded from the key decisions that are made about our lives.

The Intervention itself is a key example, designed over three days6, in some offices in Canberra by people who took little account of the evidence, had no understanding of the realities of our lives and most significantly didn’t talk to any of us.

(No wonder it has failed!)

The Voice to Parliament would ensure we have input at the highest level into the policy-making that affects us.

It could also play a valuable monitoring role.

Properly resourced, it could hold Government to account, regularly reviewing and reporting on the implementation of recommendations from the host of inquiries and reports from the Royal Commission Into Aboriginal Deaths In Custody onwards.

It could also monitor the use of the Constitution’s ‘race power’ or attempts to suspend racial discrimination legislation so that measures like the Intervention could be properly scrutinised before their implementation.

Embedding the establishment of the Voice to Parliament in the Constitution is vital because the body’s existence would not then be at the whim of whichever government was in power in Canberra.

You know, every time there is a change of government, or a new Minister, or even a Head of Department, we all have to troop down to Canberra yet again and justify our existence. Pretty much, start all over again.

The Voice to Parliament would be a permanent and enduring feature of the nation’s body-politic.

It could only be abolished by going back to you, the people, in a new referendum.

To date, all our national organisations have disappeared with the stroke of a Minister’s pen.

We would be, at last, in the main building, not in the demountable out the back.

Of course, the details of how to establish such a body would need to be carefully negotiated with Parliament once its establishment was agreed through Referendum.

My vision – and that of many people we spoke to during the dialogues and at Uluru – is for a body that include representation from all the diversity of First Nations across Australia.

It would be a place for dialogue, a meeting place for us and with us.

And in my opinion, it is this diversity that would enrich the body-politic.

After 65,000 years or more on this continent, with all our different languages, histories and cultures, I think we would have something powerful and unique to offer the nation-state through such a body.

Let me turn to second proposal to come from the Dialogues and from Uluru: Treaty.

Australia is one of the few liberal democracies around the world which still does not have a treaty or treaties or some other kind of formal acknowledgement or arrangement with its Indigenous minorities.

It is something we have demanded since at least the mid-nineteenth century.

Despite the hard-won gains, such as through the Land Rights Act following the Gurindji Walk Off, and the Native Title Act sparked by Eddie Mabo, there is unfinished business that we need to resolve.

We used the word ‘Makaratta’ to describe this process of agreement or Treaty-making.

Makaratta is the process that guides the Yolngu Nation in North East Arnhem Land through difficult disputes, and its workings have been recently described by Galarrwuy Yunupingu in this way7:

… each party, led by their elders, must speak carefully and calmly about the dispute. They must put the facts on the table and air their grievances … The leaders must always seek a full understanding of the dispute: what lies behind it; who is responsible; what each party wants, and all things that are normal to peacemaking efforts. When that understanding is arrived at, then a settlement can be agreed upon.

Following the Uluru Statement, this means the establishment of a ‘Makarrata Commission’ to set up a national Framework and principles for negotiating treaties, and a possible a national settlement document.

A Treaty is a pathway to the recognition of sovereignty and to the achievement of self-determination.

It is an agreement between equals.

Such treaties could be regional or State-wide, and it would be the Makarrata Commission’s job to provide a national framework for, and supervise, these two-way processes.

Critically, treaties are inseparable from the third demand from the Dialogues and Uluru: Truth.

You cannot make a lasting and effective agreement unless you have a shared, truthful understanding of the nature of the dispute, of the history, of how we got to where we stand.

The true story of colonisation must be told, must be heard, must be acknowledged.

Because, this is still not the case.

This is difficult and painful territory – for us as well as for mainstream Australia.

It can be hard to hear.

As Jill Stauffer says in her book ‘Ethical Loneliness’ that I quoted from at the beginning of tonight:

Responding well to others, especially survivors of wrongdoing, may require that we open ourselves to hearing something other than what we expect or want to hear

But hearing this history is necessary before we can come to some true reconciliation, some genuine healing for both sides..

I was reminded of this just last month when I read media stories about an online digital map of more than 150 massacres developed by Professor Lyndall Ryan at the University of Newcastle8.

Through meticulous examination of the records, the map seeks to provide the evidence for those who still question whether massacres happened.

Professor Ryan has started documenting these facts for the eastern coast of Australia but plans to extend this to the rest of the country.

This is important work.

But I question how it is that we have had to wait until 2017 for this?

Why is this not part of the national conversation?

Our communities know about the massacres.

Our families know about the children being forcibly removed from their families.

But it seems that there is a need for many in mainstream Australia to pretend that all this didn’t happen, that it’s all just part of a ‘black armband’ view of history, made up to make you feel guilty.

One of the most moving episodes in the regional dialogues for me personally came at Ross River near Alice Springs.

There the Elders spoke of the distress they felt at the recent placement of a statue of the explorer John McDouall Stuart in Alice Springs to mark the the 150th anniversary of his attempt to reach the Top End from Adelaide.

The statue was shown holding a gun.

The Elders felt legitimately that this showed a painful lack of respect, given the fact that Stuart’s journey led directly to a series of massacres in the region as control of the land was wrested from the traditional owners.

Let me be clear: this process of truth–telling is not about guilt.

Guilt is a debilitating emotion that stops us moving forward or doing anything.

What I’m talking about is respect and acknowledgment.

As one participant in the Regional Dialogues in Broome said:

[We are] people who worked as stockmen for no pay, who have survived a history full of massacres and pain. We deserve respect.

And of course, this is not just the history of our First Peoples – it is the history of all of us, of all of Australia, and we need to own it.

Then we can move forward together.

The Dialogues opted for the development of a ‘Declaration of Recognition’ to be passed by all Australian Parliaments.

This declaration – outside the Constitution – would be free to articulate that difficult shared history.

It could provide a unifying statement about the three waves of people who make up the Australian story:

• our ancient First Peoples (65,000 years or more),

• those people who came in 1788 and after,

• the peoples who have come from out of Europe and Asia and who continue to try to come us today, often fleeing persecution and seeking a better life.

Three waves of people.

So, this where we stand now in 2017.

The unprecedented process of deliberation by Australia’s First peoples, through the regional Dialogues and at Uluru, led to the formulation of three clear demands:

Voice.

Treaty.

Truth.

Some commentators and others have expressed concern that these are new proposals, the examination of which will need yet more new processes to consider.

I respectfully disagree.

None of these issues are new.

We have been talking about these things for a long time.

Other commentators believe that these are impractical, left-field proposals.

Again, I respectfully disagree.

I believe these changes are challenging but achievable, and are proportionate to the level of distress, anger and powerlessness being felt in our communities.

In the international landscape of recognising Indigenous peoples, what we are asking for is modest, conservative even.

Many of our First Nation communities and families are plagued by a myriad of challenges including poverty, suicide, youth detention, family breakdown, and all kinds of health problems.

Worse, in my view, than any of this, is that too many of us feel hopeless.

To reverse this and to take our rightful place in this country, we need to create new places, new ways by which we can speak and get things done to deal with our complicated 21st century lives.

At the same time we will strongly and even fiercely guard who we are and our right to be different.

We need to create a future when we, and our children and grandchildren, are recognised as having something powerful and unique to offer this nation.

This needs to happen now, and not just for us as First Nations.

This is about the social and emotional wellbeing of the country as a whole.

It is a time of reflection, a time for all Australians to consider what kind of a society we are today, what are our values and our principles.

Surely, we are not the same people as we were in 1901 when the Constitution was drawn up.

Eventually we will have to sit down together, black and white in this nation, and deal with this.

For the truth is that this is our place.

We, the First Nations, are not going anywhere.

They can put it off for another ten years, twenty years fifty years.

But eventually you will have to sit down with as respectful equals and sort out this relationship.

But right now, we have an opportunity, a roadmap for doing that.

Simply this:

Voice.

Treaty.

Truth.

And I want to add:

Justice.

Hear us. Acknowledge us.

Thank you all for coming.

 

NACCHO Aboriginal Health and @sistaquit Smoking : Smoking rates among pregnant Indigenous women tackled in major research project

 ” In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.”

Smoking rates among pregnant Indigenous women tackled in major research project 

See full ABC report here or Part 2 below

Part 1 Project update 26 September

Currently we have received EOIs from about 20 ACCHS in 5 states that we are targeting for the SISTAQUIT study. These states are NSW, QLD, SA, WA and NT.

These sites will now undergo a two-way discussion for mutual interest, and to find out what protocols we need to go through to get their communities signed up.

We are aiming for 30 services to be signed up to SISTAQUIT by end of the year.

We will have a trade table at the NACCHO AGM, so interested CEOs and managers of ACCHS can get more information,  meet with Joley Manton face-to-face, and sign up their interest or consent.

Our pilot study “ICAN QUIT in Pregnancy” has been successful wrapped up, and we are applying our learnings to go forward to this larger SISTAQUIT trial.

We would like to thank pilot ACCHS services in NSW, SA and QLD for their tremendous support in making this happen.

What does the SISTAQUIT™ in Pregnancy study aim to do?

Our study aims to improve the provision of timely, evidence-based smoking cessation support to pregnant women attending Aboriginal Medical Services (AMS), by training health providers such as GPs, Aboriginal Health Workers and midwives in culturally appropriate smoking cessation care.

The SISTAQUIT intervention (culturally appropriate smoking cessation training for health providers) has been developed over a decade. We most recently explored the feasibility and acceptability of the SISTAQUIT intervention through the ICAN QUIT in Pregnancy pilot study with six Aboriginal Community Controlled Health services.

We aim to increase the proportion of health providers offering assistance in quitting to pregnant smokers and to improve the quit rates of pregnant smokers, measured by carbon monoxide testing during pregnancy and after birth. We also aim to improve birth weights and respiratory outcomes of the babies in the first six months of life.

We are currently seeking EOIs from AMS interested in participating in the trial. Funding is available to cover AMS trial participation costs, and pregnant mothers will be offered a voucher for their time for each study visit.

Contact Details

School of Medicine and Public Health, University of Newcastle:

Assoc. Prof. Gillian Gould: gillian.gould@newcastle.edu.au

Ms Joley Manton: sistaquit@newcastle.edu.au;  Phone: (02) 4033 5720

Website: www.newcastle.edu.au/SISTAQUIT

Part 2

 

SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

 “We want to show that SISTAQUIT works, and that women are able to quit with our approach.

We wanted to be able to reach out eventually to any service in Australia through the internet, so we decided to do that through interactive webinars.

We know now that quite a few chronic diseases are set up by babies being exposed to smoking when they’re in the womb,”

Associate Professor Gould said

It is hoped a large-scale research project will help provide clearer solutions for tackling smoking rates among pregnant Indigenous women across the country.

In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.

“From that point of view, it is important.

“We know that one of the problems is that women are not given enough help to quit smoking.”

Associate Professor Gould has been working on the multi-phase research project for a number of years.

In the first phase of the study, the research team worked with Indigenous communities in the NSW Hunter Valley to develop a suite of resources to train health providers in supporting women while they quit smoking.

Many of those resources have been digitally focused.

Phase two involved a pilot project using those resources, and was implemented in NSW, South Australia and Queensland.

“We had trained all of the health providers at those services,” Associate Professor Gould said

Project aiming to give health workers effective tools

With the pilot study finished, the research is now expanding into 30 Aboriginal medical centres around the country, with the SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

“We will link up with the services, and we’re conducting three one-hour webinars, which will be live and interactive,” Associate Professor Gould said.

“We [also] have this booklet that women receive, and within that booklet are embedded different videos.

“The women can use an app on their phone, and when they scan the little screenshot of the video that’s in the booklet, they can hear [information] from Aboriginal and Torres Strait Islander health professionals which is going to help them quit smoking.

“We’re mainly aiming it at the health professionals — GPs, midwives, Aboriginal health workers — to give them training, and then they have these resources that are going to, in consultation with women, help them quit.

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

Hopes smoking rates will drop

The study is set to last until 2021, and Associate Professor Gould was optimistic the approach would help reduce rates of smoking.

“This is the real world; it’s a real-world study, so this is what life is like,” she said.

“In our pilot study so far, we’ve had four women quit out of 22, which means we’ve already got a quit rate of almost 25 per cent. The usual quit rate is about 3 per cent. So, we think we’re doing pretty good.

“We’re aiming in the bigger trial to improve the quit rate from the baseline of 3 per cent up to 11 per cent, but already in our pilot we’ve exceeded our aim.

“You never know if this is going to work or not, and that’s why [we’re] doing the study

 

NACCHO Aboriginal Health and #Obesity : Download #TippingtheScales Report Leading health orgs set out 8 urgent actions for Federal Government

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

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

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

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 30 + NACCHO Obesity articles published last 5 years

Read over 30+ NACCHO Nutrition and Healthy foods published last 5 years

Thirty-four leading community, public health, medical and academic groups have today united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

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

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

  1. Time-based restrictions on TV junk food advertising to kids
  2. Set clear food reformulation targets
  3. Make the Health Star Rating mandatory by July 2019
  4. Develop a national active transport strategy
  5. Fund weight-related public education campaigns
  6. Introduce a 20% health levy on sugary drinks
  7. Establish a national obesity taskforce
  8. Develop and monitor national diet, physical activity and weight guidelines.

OPC Executive Manager Jane Martin said the eight definitive policy actions in Tipping the Scales addressed the elements of Australia’s environment which set individuals and families up for unhealthy lifestyles, rather than just focusing on treating the poor health outcomes associated with obesity.

Watch video HERE : How does junk food marketing influence kids

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese. This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult,” Ms Martin said.

“The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 But Australia still has no strategy to tackle our obesity problem. It just doesn’t make sense.

“Without action, the costs of obesity and poor diet to society will only continue to spiral upwards. The policies we have set out to tackle obesity therefore aim to not only reduce morbidity and mortality, but also improve wellbeing, bring vital benefits to the economy and set Australians up for a healthier future.”

Professor of Epidemiology and Equity in Public Health at Deakin University, Anna Peeters, said the 34 groups behind the report were refusing to let governments simply sit back and watch as growing numbers of Australians developed life-threatening weight and diet-related health problems.

“For too long we have been sitting and waiting for obesity to somehow fix itself. In the obesogenic environment in which we live, this is not going to happen. In fact, if current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by diseases linked to overweight and obesity, such as type 2 diabetes, cancer heart disease, between 2011-20501,” Professor Peeters said.

“Obesity poses such an immense threat to Australia’s physical and economic health that it needs its own, standalone prevention strategy if progress is to be made. There are policies which have been proven to work in other parts of the world and have the potential to work here, but they need to be implemented as part of a comprehensive approach by governments. And they need to be implemented now.

“More than thirty leading organisations have agreed on eight priorities needed to tackle obesity in Australia. We would like to work with the Federal Government to tackle this urgent issue and integrate these actions as part of a long-term coordinated approach.”

In addition to the costs to society, the burden of obesity is felt acutely by individuals and their families.

As a Professor of Women’s Health at Monash University and a physician, Professor Helena Teede sees mothers struggle daily with trying to achieve and sustain healthy lifestyles for themselves and their families, while having to deal with the adverse impact of unhealthy weight, especially during pregnancy.

“As a mother’s weight before pregnancy increases, so does the substantive health risk to both the mother and baby. Excess weight gain during pregnancy further adds to these risks and is a key driver of infertility, long-term obesity, heart disease and type 2 diabetes, while for the child, their risk of becoming overweight or obese and developing chronic diseases in later life greatly increases,” Professor Teede said.

“The women I see are generally desperate for help to improve their lifestyle and that of their families. They want to set themselves and their families up for healthy, long lives.

“Currently, there is a lot of blame placed on individuals with unhealthy diets and lifestyles seen as being due to individual and family discipline. Women from all backgrounds and walks of life struggle with little or no support to achieve this. It is vital that we as a community progress beyond placing all responsibility on the individual and work towards creating a policy context and a society that supports healthy choices and tips the scales towards obesity prevention to give Australian families a healthy start to life.”

The calls to action outlined in Tipping the Scales are endorsed by the following organisations: Australian Chronic Disease Prevention Alliance (which includes the Heart Foundation, Cancer Council Australia, Kidney Health Australia, Diabetes Australia and the Stroke Foundation), Australian Health Policy Collaboration (AHPC), Australian Medical Students’ Association (AMSA), Australian & New Zealand Obesity Society (ANZOS), Australasian Society of Lifestyle Medicine, Baker Heart & Diabetes Institute, CHOICE, Consumers Health Forum of Australia, Deakin University’s Global Obesity Centre (GLOBE), Institute For Physical Activity and Nutrition (IPAN), Monash Centre for Health, Research and Implementation (MCHRI), LiveLighter, Menzies School of Health Research, The University of Melbourne’s Melbourne School of Population & Global Health, Melbourne Children’s (which includes The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute and the University of Melbourne), the National Rural Health Alliance Inc, Nutrition Australia, Obesity Australia, Obesity Policy Coalition, Obesity Surgery Society of Australia & New Zealand, Parents’ Voice, Public Health Association of Australia and Sugar By Half.

Download the Tipping the Scales action plan and snapshot at opc.org.au/tippingthescales


1. Obesity Australia. Obesity: Its impact on Australia and a case for action. No time to Weight 2. Sydney, 2015.

NACCHO Aboriginal Health : #Indigenous groups say work for the dole scheme racially discriminatory and “unhealthy “

“ Aboriginal Peak Organisations of the Northern Territory (APONT ), and our members have received widespread concerns about the debilitating impacts that CDP is having on its participants, their families and communities.

Financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry.

Such consistent and strong concerns expressed by those at the coalface must be taken seriously and acted upon,

Onerous and discriminatory obligations applied to remote CDP work for the dole participants mean they have to do significantly more work than those in non-remote, mainly non-Indigenous majority areas, up to 670 hours more per year.”

The chief executive of Aboriginal Medical Services Alliance Northern Territory, John Paterson, said the program was causing significant harm to communities. He said financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry (see Guardian article in full below Part 2 )

In press conference picture below

  • John Paterson, CEO, Aboriginal Medical Services Alliance NT (APO NT)
  • David Ross, Director, Central Land Council (APO NT)
  • Rod Little, Co-Chair, National Congress
  • David Thompson, CEO, Jobs Australia
  • Ged Kearney, President, Australian Council of Trade Union
  • Maria Harvey, CEO, Tiwi Islands Training & Employment Board
  • Dickie Bedford, CEO, Marra Worra Worra

 

Part 1 Fair work and strong communities

Aboriginal Peak Organisations NT Proposal for a Remote Development and Employment Scheme

NACCHO is one of the many organisations that has endorsed this scheme

Download the brochure and full list of organisations endorsing

RDES-Summary_online

All Australians expect to be treated with respect and to receive a fair wage for work. But the Australian Government is denying these basic rights to people in remote communities through its remote work for the Dole program – the “Community Development Programme”.

Around 84 per cent of those subject to this program are Aboriginal and Torres Strait Islander people.

Most people in remote communities have to do more work than people in non-remote non Indigenous majority areas for the same basic social security payment.

In some cases, up to 760 hours more per year.

There is less flexibility and people are paid far below the national minimum wage.

Aboriginal and Torres Strait Islander people are also being penalised more because of the onerous compliance conditions.

In many cases, people are receiving a basic social security payment for work they should be employed to do.

The Government’s program is strangling genuine job opportunities in remote communities.

The Government’s remote Work for the Dole program is racially discriminatory and must be abandoned. Better outcomes will be achieved if Aboriginal and Torres Strait Islander people are given the opportunity to determine their own priorities and gain greater control over their own lives.

A Fair Wage for Work

There is an opportunity for the Australian government to meaningfully partner with remote communities, rather than impose a “one size fits all” model from Canberra.

Aboriginal and Torres Strait Islander people in remote communities want to take up the reins and drive job creation and community development initiatives.

Remote communities need a program that sees people employed to work on projects the community needs.

And to do so with decent pay and conditions, and the right to earn more for extra effort. The current program keeps people in the welfare system and excessive penalties see people just disengage. It provides no reward for effort and does not address the need to support people into the workforce.

Remote communities need a program that encourages school leavers to move straight into employment or training.

Not one that leaves young people trapped in a welfare cycle or disengaged.

Tailored community-led approaches are needed that reflect the diverse cultural, economic and social aspirations of Aboriginal and Torres Strait Islander peoples and the realities of the remote job market.

A Fair and Positive Scheme for waged work and strengthening communities

Five Aboriginal organisations in the Northern Territory, working with Aboriginal and Torres Strait Islander remote service providers, have developed a new, fair and positive model for job creation and community building – the Remote Development and Employment Scheme.

The Scheme will see people placed into part time work with award wages and conditions.

People will be protected by the workplace rights so many Australians take for granted. It would reduce the role that the welfare system plays in people lives. It will see more time and money spent creating new opportunities for jobs, enterprise and community development and less on pointless administration.

The Scheme is a place-based and community-driven model.

It will establish long term collaboration across governments, employers and Aboriginal and Torres Strait Islander organisations to increase opportunities in remote communities.

Critically, the Scheme provides incentives to encourage people into work, training and other activities, rather than punishing people already struggling to comply.

Keys features of the Remote Development and Employment Scheme :

  • Establish a wages fund to empower Aboriginal and Torres Strait Islander and other local organisations to create 10,500 part time jobs on award wages and conditions, working on services and projects important to their communities, with the ability to “top up” these wages from other funds when extra work is done.
  • Create 1,500 paid work experience and training places for young people, supported by locally driven youth development strategies.
  • Remove the discriminatory requirement for people in remote communities who remain on social security payments to work more hours than people in non- remote areas.
  • Create Remote Job Centres, with local governance bodies, focused on long term support to help people get into work, stay in work, and progress into better jobs based on their skills and aspirations.
  • Retain activity obligations for people who can work and receive social security but aren’t in a job. Obligations will be based on their capabilities and the needs and views of communities.
  • Support people with disabilities and family responsibilities to meet their gaols and contribute to their communities in a manner appropriate to their capabilities and aspirations.
  • Maintain and improve access to government services in remote communities, including Centrelink, and help people with disabilities access the right payment through the support of Remote Job Centres.
  • Ensure the Scheme is managed with Aboriginal and Torres Strait Islander people, through shared learning and evidence, by establishing an independent body with an Aboriginal and Torres Strait Islander led board.

Part 2 from The Guardian

Indigenous groups say work for the dole scheme racially discriminatory

An alliance of Indigenous groups has called the government’s remote work for the dole scheme a racially discriminatory, onerous and debilitating program that is causing children to go hungry.

The community development program was introduced in 2015, aiming to reduce welfare dependency in rural and remote areas.

The scheme relies heavily on private job service providers, and places more onerous requirements on jobseekers, who are required to work or engage in related activities for 25 hours a week across 46 weeks of the year.

Its 35,000 participants, who are 83% Indigenous, earn about $11 an hour, and those who fail to meet their obligations face financial penalties.

Witnesses told a Senate inquiry on Friday that a lack of job opportunities in remote communities made it unworkable and impractical.

Participants have been left to engage in “activity for activity’s sake” with little prospect for learning new skills or gaining a job.

If they fail to comply with rigid requirements, jobseekers face financial punishment. The government issued 35,122 financial penalties in the final quarter of last year, mostly through no show no pay penalties, usually of about $53.

An Australian National University study showed Indigenous people were 27 times more likely to be penalised by a loss of income than those on a similar program in a largely white area.

On Friday the Aboriginal Peak Organisations of the Northern Territory (Apont), an alliance of five groups, gave evidence to a Senate inquiry into the program.

One of the members, the chief executive of Aboriginal Medical Services Alliance Northern Territory, John Paterson, said the program was causing significant harm to communities. He said financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry.

“Apont and our members have received widespread concerns about the debilitating impacts that CDP is having on its participants, their families and communities. Such consistent and strong concerns expressed by those at the coalface must be taken seriously and acted upon,” Paterson said.

“Onerous and discriminatory obligations applied to remote CDP work for the dole participants mean they have to do significantly more work than those in non-remote, mainly non-Indigenous majority areas, up to 670 hours more per year.”

Apont, which was created to end the top-down approach of Indigenous policy, has proposed a new model, which focuses on increasing jobs, boosting community development, and lessening the welfare system’s intrusion into people’s lives.

“The CDP is racially discriminatory, and Apont believes it must be abandoned. In seeking this we are not just coming here armed with criticisms, but with a solution, an alternative.”

Cassandra Goldie, the chief executive of the Australian council of social service (Acoss), said the significant resources being spent on the CDP – about $268m in 2015-16 – would be better directed to creating employment in rural communities.

“When the term ‘welfare dependency’ is used, it’s often understood that it’s the social security payment that’s the problem,” Goldie said.

“But … the very important task of generating local employment, real employment opportunities, that is where the significant capabilities of the commonwealth, institutionally, should be coming in behind the deep desire by Atsi [Aboriginal and Torres Strait Islander] leadership, and also Indigenous people locally, to drive this agenda,” she said.

That was a position backed by non-profit job service providers, represented by the chief executive of Jobs Australia, David Thompson. “There’s been nothing done, nothing of any significant note, to actually increase the stock of jobs in those communities,” he said.

The Department of Social Services was questioned about why it imposed stricter requirements on participants of the CDP.

Labor senator Malarndirri McCarthy asked, “If there are less jobs in a remote and rural region and less opportunities, why would there be a higher expectation of the hours?”

The DSS’s Bronwyn Field said the government had heard significant concerns from community leaders about sit-down welfare. To resolve that, it had decided daily activities from participants would be required.

“The government, when they started consultation prior to introducing the CDP, spent a lot of time with communities. One of the clear pieces of feedback was the fact that many Indigenous community leaders were concerned about people … doing sit-down welfare,” Field said.

McCarthy responded, “So you’re saying that was a result of government consultations to have those hours – 25 in the community, and 15 in town?”

NACCHO #Aboriginal Health and #Diabetes @theMJA the @NHMRC #Indigenous guidelines need update

Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening.

Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable “

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

Originally published MJA

Read over 120 diabetes related posts by NACCHO over past 5 years

MORE can be done to increase diabetes screening rates among Indigenous Australians and enable earlier intervention, say experts who are calling for a greater focus on young adults.

A study published in the MJA found enormous variation in diabetes screening rates between different Aboriginal Community Controlled Health Services (ACCHSs).

The proportion of Indigenous adults screened for diabetes at least once in 3 years – as per the Royal Australian College of General Practitioners and Diabetes Australia (RACGP/DA) guidelines – ranged from 16% to 90% between different services.

Overall, 74% of Indigenous adults received a screening test for diabetes at least once between 2010 and 2013, the study found, based on de-identified data on 20 978 patients from 18 ACCHSs.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable.

Extract Overview provided by NACCHO

Download a full copy of 2 nd edition

http://www.racgp.org.au/download/documents/AHU/2ndednationalguide.pdf

Type 2 diabetes is most commonly found in obese adults who develop increasing insulin resistance over months or years. For these patients there is a substantial ‘prediabetic’ window period of opportunity to offer preventive interventions. Screening for diabetes is safe, accurate and cost effective, and detects a substantial proportion of people who may not otherwise have received early intervention.1 This chapter discusses type 2 diabetes in adults who are not pregnant.

The prevalence of type 2 diabetes in Aboriginal and Torres Strait Islander populations is 3–4 times higher at any age than the general population, with an earlier age of onset.2 The precise prevalence is hard to pinpoint; a 2011 systematic review of 24 studies showed prevalence estimates ranged from 3.5–31%, with most lying between 10% and 20%. Diabetes prevalence in remote populations is approximately twice that of urban populations and is higher among Aboriginal and Torres Strait Islander people.3

Aboriginal and Torres Strait Islander men and women die from diabetes at 23 and 37 times the rate of non-Indigenous Australian men and women respectively, in the 35–54 years age group.4 Large scale clinical trials have demonstrated that appropriate management of diabetes can prevent the development or delay the progression of complications such as myocardial infarction, eye disease and renal failure.5

Obesity is a very strong predictor for diabetes; a body mass index (BMI) ≥30 kg/m2 increases the absolute risk of type 2 diabetes by 1.8–19-fold, depending on the population studied. A cohort study of non-diabetic Aboriginal adults aged 15–77 years in central Australia found that those with a BMI of ≥25 kg/m2 had 3.3 times the risk of developing diabetes over 8 years of follow up compared to those with a BMI <25 kg/m2.1 The AusDiab study found that three measures of obesity: BMI, waist circumference and waist-to-hip ratio, all had similar correlations with diabetes and CVD risk.6 Waist circumference performed slightly better than BMI at predicting diabetes in a remote Aboriginal community

The study defined screening tests to include glycated haemoglobin (HbA1c) testing as well as the oral glucose tolerance test and venous glucose level testing.

Barriers to screening included being aged under 50 years, being transient rather than a current patient and attending the service less frequently, the study found. The authors concluded that particular attention should be given to increasing the screening rate in these groups.

The finding that young people were less likely to be tested was “intuitively reasonable”, the authors said, given that the risk of developing diabetes rises with age. However, they suggested that it was still best practice to test Indigenous adults from the age of 18 years, as it provided a “substantial opportunity for limiting the impact of type 2 diabetes”.

Indigenous Australians aged 25–34 years are five times more likely to have diabetes or high blood sugar levels than non-Indigenous Australians of the same age, they noted.

Despite this difference between Indigenous and non-Indigenous people, the National Health and Medical Research Council (NHMRC) only recommends screening Indigenous people for diabetes once they are aged over 35 years, and doing it every 3 years.

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

“Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening,” she told MJA InSight.

“Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent,” she said.

Professor O’Dea said that more widespread use of HbA1c testing could increase the screening rate in Aboriginal communities, particularly among younger people and those who were more transient.

“If screening for diabetes was just a simple opportunistic HbA1c test, you wouldn’t have so many problems getting people to have it done,” she said. “HbA1c testing will give you a good idea of the mean glucose level, and unlike the glucose tolerance test, you don’t have to ask the patient to return in the fasting state.

“If it does turn out that the patient has borderline diabetes, then you can ask if they are prepared to do a glucose tolerance test,” she added.

Study co-author, Associate Professor Christine Paul, said that there was significant variation in the use of HBA1c testing across sites and across time in the study.

“I think it is possible that increasing the use of HbA1c as a screening test may help [to increase screening rates]; however, I don’t think it’s the main answer,” she said. “Clearly some health services need support to get systems in place, regardless of which test they use.”

 

NACCHO Aboriginal Health #Strokeweek : #Fightstroke Aboriginal people are up to three times more likely to suffer a stroke than non-Indigenous

 

” Aboriginal and Torres Strait Islander people are up to three times more likely to suffer a stroke than non-Indigenous Australians and almost twice as likely to die, according to the Australian Bureau of Statistics. It’s an alarming figure and one that  prompted the National Stroke Foundation in 2016 to urge the Federal Government to fund a critical $44 million awareness campaign in a bid to close the gap .

The good news is most strokes are preventable and treatable.

However communities need to be empowered to protect themselves from this insidious disease.”

Sharon McGowan, Stroke Foundation CEO ( see full Aboriginal Stroke statistics part 2 below

Download the 48 Page support guide :

journeyafterstroke_indigenous_0

Read over 75 Stroke related articles published by NACCHO over past 5 years

“Never had I ever come across one ( stroke ) or heard much about them. I had nothing to do with them,”

When I woke up, I didn’t know what was going on. I couldn’t communicate. I couldn’t tell anyone I was still here. It was really scary. I’d never seen the effects of a stroke.

First, I lost my voice, then my vision, my [ability to] swallow and my movement of all my body parts. I lost all my bowel and bladder function. I’ve still got bad sight but I can see again. My speech took about six months.

With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home “

For Tania Lewis, an Awabakal woman, stroke was something that only happened to older people. But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Board Member Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )

Part 1 Stroke Foundation in 2016 called on government to close the gap

Originally published here

A stroke occurs when supply of blood to the brain is disturbed suddenly. The longer it remains untreated, the heightened the risk of stroke-related brain damage.

Medical treatment during the first onset of symptoms can significantly improve a sufferer’s chance of survival and of successful rehabilitation.

In Australia, stroke is the leading cause of long-term disability in adults, accounting for 25 per cent of all chronic disability. The NSF reports that roughly 50,000 strokes occur per year with over 437,000 people living with stroke across the country. While severity varies, two thirds of victims, like Tania, are left with impeding disabilities

But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

The burden of stroke doesn’t just fall on the patient, but can take a significant toll on family and carers.

“The doctor at the hospital tried to take Power of Attorney and Guardianship away from me and give it to the Guardianship Board, because he didn’t believe that [my husband] Len or anyone could look after me,” Tania recalls.

“I was put through hell. I figured life wasn’t worth living anymore because they took everything away from me. I couldn’t go home to my family. So I tried to off myself.

“Then all of a sudden, one day the doctor said, ‘You can go home. We can’t rehabilitate you anymore’. At home, I was having seizures for a while. My hubby wouldn’t sleep. He and his mum would take shifts looking after me. We tried to get assistance but there was nothing for young people. So one day, my husband collapsed on the lounge room floor from exhaustion. It was just a nightmare. That’s how I ended up in aged care.”

Tania spent the next two and a half years between three aged care facilities.

“I wouldn’t wish it upon nobody,” she says.

It was during her nightly ritual of chatting with her daughter via Facebook that Tania typed “young people in nursing homes” into Google. The search engine’s results would lead to her life-changing encounter with the YPINH.

“With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home. Whatever I need, physio, OT – they’ve got my back. I can’t thank them enough for what they’ve done for me.”

Today, Tania is working with the Aboriginal Disability Network, helping Indigenous Australians navigate their way through the National Healthcare System.

It has long been recognised that Aboriginal and Torres Strait Islander people have a life expectancy that is approximately 20 years less than non-Indigenous Australians (Australian Bureau of Statistics). Recent data from the ABS shows that up to 80 per cent of the mortality gap can be attributed to chronic diseases such as heart disease, stroke, diabetes and kidney disease.

For many Aboriginal communities, especially those in remote regions, socio-economic factors play an important role. Kerin O’Dea from Darwin’s Menzies School of Health Research cites unemployment, poor education outcomes and limited access to fresh foods as key factors in her paper, Preventable chronic diseases among Indigenous Australians.

Lifestyle related risks such as smoking, alcohol misuse, stress, poor diet, and inadequate physical activity also need to be addressed, according to the Australian Institute of Health and Welfare .

But the first step, McGowan says, is for indigenous stroke sufferers to recognise the signs of a stroke in themselves and their family members. The NSF recommends the F.A.S.T. test as the most effective way to remember the most common signs of a stroke.

Face: Check their face. Has their mouth drooped?
Arms: Can they lift both arms?
Speech: Is their speech slurred? Do they understand you?
Time: Is critical. If you see any of these signs call 000 straight away.

“If I had known that because I’d lost my vision I had suffered a stroke, I could’ve put two and two together and got help, but I didn’t know anything,” Tania says.

“I was a heavy smoker, but not anymore – no way. Life’s too important. I didn’t ever know anything about a stroke – I was more thinking when you smoke, you can have lung problems and lose your fingers, like on the packets. But they don’t say anything about a stroke – they don’t advertise that stuff.”

The Stroke Foundation called on the Federal Government to fund an urgent $44 million campaign to address the gap in stroke care. For more information on stroke and the campaign, visit strokefoundation.com.au.

Part 2 Aboriginal Stroke Facts

From here

  • The incidence rate of stroke for Aboriginal and Torres Strait Islander Australians has been found to be 2.6 times higher for men and 3.0 for women (Australian Institute of Health and Welfare, 2008; Katzenellenbogan et al. 2010) compared to non-Aboriginal and Torres Strait Islander Australians and many suggest that these figures may in fact be underestimates (Thrift et al 2011).
  • Aboriginal and Torres Strait Islander Australians are known to experience stroke at a younger age than their non-Aboriginal and Torres Strait Islander counterparts, (Katzenellenbogen et al., 2010; Australian Institute of Health and Welfare, 2004) with 60% of Aboriginal and Torres Strait Islander non-fatal stroke burden occurring in the 25-54 year age-group compared to 24% in the non-Aboriginal and Torres Strait Islander group (Katzenellenbogen et al., 2010).
  • The prevalence of stroke is similarly significantly higher at younger ages among Aboriginal and Torres Strait Islander people (Katzenellenbogen 2013), with a significantly higher prevalence of co-morbidities among Aboriginal and Torres Strait Islander patients under 70 years of age, including heart failure, atrial fibrillation, chronic rheumatic heart disease, ischaemic heart disease, diabetes and chronic kidney disease. This reflects the increased clinical complexity among Aboriginal and Torres Strait Islander stroke patients compared with non-Aboriginal/Torres Strait Islander patients.
  • Aboriginal and Torres Strait Islander stroke patients aged 18–64 years have a threefold chance of dying or being dependent at discharge compared to non-Aboriginal and Torres Strait Islander patients (Kilkenny et al., 2012).