NACCHO Aboriginal Health supports @fam_matters_au campaign #WeBelieveFamilyMatters @IndigenousX Every child has the right to be safe : Plus @SNAICC Submission: #ClosingtheGap ‘Refresh’ Process

 

”  I am a proud advocate for change – because things need to change. Change can be uncomfortable and it can cause anxiety.

 But I see a near future where change can bring positive outcomes to our nation. I play a small role at SNAICC – National Voice for our Children, the national advocacy body fighting for the rights of Aboriginal and Torres Strait Islander children.

I say only small because there are plenty of stronger and louder voices in the national conversation speaking up about the changes that need to happen for our people. So I will only speak for myself and the changes that I dream of.”

Maylene Slater-Burns is Kamilaroi/Wiradjuri/Djungan/Gangalidda woman. Seeker of some real change : Continued Part 2 below

Or Read in full HERE

Hosting this week IndigenousX : Guardian Australia is proud to partner with IndigenousX to showcase the diversity of Indigenous peoples and opinions from around the country

Read over 300 Aboriginal Children’s Health articles published by NACCHO over past 6 years

 Part 1 SNAICC Submission: Closing the Gap ‘Refresh’ Process – April 2018 ( added by NACCHO )

SNAICC put it simply in its recent submission to the Closing the Gap “refresh”:

“We have a shared responsibility to ensure the right of every Aboriginal and Torres Strait Islander child to be safe and thrive in family, community and culture.”

It has been 10 years since COAG’s Closing the Gap strategy began.

In that time, only three of the seven national targets are reported as being on track and four are due to expire in 2018. COAG is currently undertaking the Closing the Gap ‘refresh’ process.

This process is a unique opportunity to influence the next phase of the CTG agenda, which will form the framework over the next 10 years for all Australian governments to advance outcomes for Aboriginal and Torres Strait Islander people. It will also provide the framework for how government funding is prioritised to meet the targets.


SNAICC’s Key Calls

We have a shared responsibility to ensure the right of every Aboriginal and Torres Strait Islander child to be safe and thrive in family, community and culture. To achieve this:

  • an additional Closing the Gap target should be included to eliminate the overrepresentation of our children in out-of-home care by 2040, with sub-targets that address the underlying causes of child protection intervention; and
  • the current Closing the Gap target on early childhood education should be  strengthened to encompass early childhood development and  expanded to close the gap in outcomes for all Aboriginal and Torres Strait Islander children from birth to 4 years by 2030

Download the SNAICC Submission HERE

SNAICC_Brief-CTG_Refresh-Apr._2018

Part 2 Every child has the right to be safe. Will you speak up with me?

Upon the delivery of the federal budget last week, it is clear that change for our people is not a priority for the federal government – but the government of the day has never scared me into thinking change is impossible. I, in tune with how I was raised by my family in Naarm, believe that real change happens from within community, by community and for community.

My mum, Sharon Slater, and my dad, Mel Burns, have lived and worked in the Melbourne Aboriginal community for decades. As I grew up, it was a normal part of life to be at work with them. My parents were foster carers, youth workers, basketball coaches, community drivers, fundraisers, and health workers – and completed their own admin at the end of the day. I am proud to follow in their footsteps. All I’ve ever known is my community from within.

SNAICC has been part of my life since early childhood, as Mum worked in administration and bookkeeping. Family was always centre at SNAICC – the best memory I have is my twin Marjorie and I mucking around with the photocopier.

In the late 1980s, following the first child survival seminar held in Naarm, community leaders called for the establishment of a national peak body to represent Aboriginal child care agencies, which led to the creation of SNAICC. Despite the ongoing harsh climate of constant political change that impacts a great number of our Aboriginal community-controlled organisations, SNAICC continues to be the voice of its members and the voice for our children.

For me, SNAICC’s work answers a natural calling in this journey to realise the changes that our children, families and communities deserve.

Today, Aboriginal and Torres Strait Islander children are over-represented in the child protection system at a rate of more than 10 times that of other children. We are losing our children and we must speak up right now, because enough is enough.

The Family Matters campaign is the coming together of organisations and individuals across the nation to reduce the over-representation of our children removed from family.

Family Matters is an approach that trusts Aboriginal people to deal with Aboriginal business, one that includes genuine collaboration and partnership, empowers communities and involves long-term, all-of-government support across the country.

It all comes down to trusting in the legacy of my role models, family members and past leaders who have paved the way before us. Our community knows what works best for our community, and the best way forward when it comes to reunifying the 17,664 Aboriginal and Torres Strait Islander children living away from home with their community, heritage and culture.

Community is bringing the Family Matters campaign to the doorstep of Australia.

SNAICC put it simply in its recent submission to the Closing the Gap “refresh”: “We have a shared responsibility to ensure the right of every Aboriginal and Torres Strait Islander child to be safe and thrive in family, community and culture.”

Now is the time for healing and restoration through connecting with other dreamers and change-makers to move forward together. Will you walk with me? Will you speak up with me? Our children are trusting us with their futures. Our work starts now.

NACCHO #HealthBudget18 Coverage 3/5 Read and Download the Top 10 Peak Health Organisation Press Release responses to #Budget2018NACCHO

1.NATSIHWA welcomes the 2018 budget announcements of additional funding to Aboriginal and Torres Strait Islander Peak Health Workforce Professional Bodies

2. IAHA : Allied health undervalued in 2018 Federal Budget

3.AIDA funded to continue our work in improving health outcomes for Indigenous Australians

4.1 AMA : SAFE AND STEADY HEALTH BUDGET, BUT BIGGER REFORMS ARE STILL TO COME

5.NRHA :RURAL HEALTH BUDGET $$ WELCOME – BUT NOT ENOUGH

6.AHHA : Health data boost right step on the road to reform

7. PHAA : Budget 2018 – prevention focus goes missing

8.RACGP : Signs Federal Government beginning to recognise vital role of specialist GPs in Australia’s healthcare system

9.CHF Health budget includes welcome consumer focus

10. Vision 2020 Australia welcomes the Australian Government’s investment to target major causes of vision loss in Aboriginal and Torres Strait Islander communities.

Post 1 of our NACCHO Posts on #Budget2018 NACCHO

Post 2 will be the NACCHO Chair Press Release

Post 3 will be Health Peak bodies Press Release summary

Post 4 will be Government Press Releases

Post 5 Opposition responses to Budget 2018 (Monday )

ALL NACCHO BUDGET COVERAGE HERE

1.NATSIHWA welcomes the 2018 budget announcements of additional funding to Aboriginal and Torres Strait Islander Peak Health Workforce Professional Bodies

“Today’s budget announcement presents an important opportunity for NATSIHWA. It will enable us to progress key strategic priorities, including the development of a National Mentor program to support Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners. This is a very exciting time for our members”

Mr Karl Briscoe, NATSIHWA CEO.

Download full Press Release

1.NATSIHWA BUDGET Media Release 2018

The National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) welcomes the 2018 Australian Government budget announcement that signal growth in funding for Aboriginal and Torres Strait Islander workforce organisations.

These organisations (NATSIHWA, CATSINaM, IAHA and AIDA) work togetherto support the Aboriginal and Torres Strait Islander health workforces and improve health outcomes for Aboriginal and Torres Strait Islander people.

“We thank the Australian government for the continued support of NATSIHWA. This funding will not only enhance the sustainability of our profession, but will also lead to opportunities that promote the recognition and professionalism of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners” said Ms Josslyn Tully, NATSIHWA Chairperson.

In particular, the budget announcement support the progression of NATSIHWA’s strategic plan 2017-2020. Key strategic priorities for NATISHWA over the next 12 months, include the:

  • Development of a National Mentoring Program for Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners;
  • Implementation of the National Professional Development Symposium which will bring together over 100 Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners in Alice Springs in October 2018;
  • Continuation of Regional forums to support professional development and networking of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners in regions across Australia;
  • Development of further educational resources to support individuals and services in defending Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners’ Scope of Practice; and,
  • Enhanced influence of national policy and program that improve Aboriginal and Torres Strait Islander health and health workforce outcomes that support a culturally safe work environment.

“NATSIHWA looks forward to progressing these initiatives with our membership, which includes over 750 full members who are qualified Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners across Australia”, said Ms Josslyn Tully

2. IAHA : Allied health undervalued in 2018 Federal Budget

Improving Aboriginal and Torres Strait Islander health and wellbeing must remain a national priority. Action is needed to improve outcomes for Aboriginal and Torres Strait Islander people.

Download full Press Release

2. Media-Release_allied-health-undervalued-in-2018-Federal-Budget

Those actions must involve: a coherent strategy to tackle the causes of disadvantage and enable our people to achieve their potential; governments showing the stamina to address issues that come from generations of trauma and disadvantage; and commitment to work with, hear and respect Aboriginal and Torres Strait Islander people and the knowledge they bring to issues that shape their lives.

IAHA now has a commitment of funding for a further four years. We also have a commitment of $1.55M per year in additional funding to share with our fellow Aboriginal and Torres Strait Islander health workforce peak organisations: AIDA, CATSINAM and NATSIHWA. We have proven our approaches deliver results and build the Aboriginal and Torres Strait Islander health workforce.

IAHA has a significant advocacy role and interest in several other initiatives announced in the 2018-19 Budget, including measures responding to urgent needs across Australian communities, including:

  • $105M over four years to improve access to aged care for Aboriginal and Torres Strait Islander people
  • $30M over four years for ear health assessment in pre-schools
  • $34.3M over four years for eye health and
  • Extra commitment to suicide prevention, additional mental health care.

IAHA CEO Donna Murray said “For initiatives to deliver for Aboriginal and Torres Strait Islander people, community must be involved in how those measures are developed and implemented. This applies to new measures and to addressing existing acute allied health shortages in health, disability, aged care and other social services.”

A culturally safe and responsive skilled workforce, is critical in working with Aboriginal and Torres Strait Islander people and communities. To ensure the workforce has the skills needed to deliver results, strategies and solutions need to be developed and delivered in partnership with IAHA, our members and communities.

“IAHAs success thus far in developing and implementing innovative allied health career pathway programs and supports, providing leadership opportunities and development, mentoring, in partnering and in promoting person-centred, multidisciplinary care needs to be leveraged further. We, therefore, welcome a stronger partnership with Government to enable this success to continue and grow”, said Ms Murray.

IAHA chairperson, Nicole Turner, commented “By leading and facilitating inter-professional approaches that fit with Aboriginal and Torres Strait Islander notions of health and wellbeing, we’ve supported and enabled rapid growth in the Aboriginal and Torres Strait Islander health workforce. But we still represent less than 1 percent of the allied health workforce. Our workforce must continue to grow. Continued funding for IAHA is a vital step in the right direction.”

IAHA welcomes the $550M allocated to the Stronger Rural Health Strategy and the aim of ensuring the right health professionals are available when and where they are needed. However, IAHA remains concerned and disappointed that acute shortages in rural and remote allied health services have been largely ignored, and particularly that there appears to be almost no gain for Aboriginal and Torres Strait Islander communities who have little or no access to allied health services at present.

CEO, Donna Murray, added “IAHA will continue to advocate for the National Aboriginal and Torres Strait Islander Health Plan and Implementation Plan to be fully funded. IAHA will continue to seek opportunities to work constructively with Government to achieve this result.”

3.AIDA funded to continue our work in improving health outcomes for Indigenous Australians

This week the Australian Government announced the 2018/2019 Budget to the Australian public. The Australian Indigenous Doctors’ Association (AIDA) welcomes the news of increased government investment into Aboriginal and Torres Strait Islander peak workforce organisations of $33.4 million over four years from 2018-2019.

Download full Press Release

3.AIDA-budget-response_MEDIA-RELEASE-9-May-2018

We take this as a tangible measure of the genuine commitment of the Turnbull Government to work with us to build the Aboriginal and Torres Strait Islander health workforce.

As the only professional association for both Aboriginal and Torres Strait Islander doctors and medical students, AIDA is committed to improving the health of our people and enriching the health profession by growing the numbers of Indigenous doctors.

This renewed funding certainty will allow AIDA, through our strong relationships with key stakeholders, to keep supporting efforts to increase the cultural safety of mainstream medical education and health care systems.

This continued financial support from the government means job security for our employees, increased resourcing for emerging issues and the ability to continue to implement our long-term strategic agenda.

This includes:

  •  Development of our 2018 policy priorities
  •  Further investment in Indigenous-led health research
  • The delivery of a cultural safety program for doctors, by Indigenous doctor
  • Ongoing support to our student and doctor member base

Doing things with, not to Aboriginal and Torres Strait Islander Peoples

AIDA encourages the Turnbull Government to maintain its stated commitment to work in a consultative and collaborative way with Aboriginal and Torres Strait Islander Peoples.

We remain concerned that there is no commitment in the 2018/19 Budget to adequately resource the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

AIDA maintains that this is the roadmap for the government to work with us to genuinely redress health disparity and deliver culturally appropriate and needs-based health care to Aboriginal and Torres Strait Islander Peoples.

We encourage the government to commit to implementing the social determinants of health framework into future Indigenous health policy development.

AIDA also remains concerned about the lack of targeted funding commitment around Closing the Gap.

We maintain that measureable targets, accountability mechanisms and appropriately funded policy design and program delivery are essential to closing the gap on Indigenous disadvantage.

With this renewed funding certainty, AIDA will continue working towards our vision for an Australian health care system that is free of racism, and one that affords Aboriginal and Torres Strait Islander Peoples the health care they have a right to expect and receive.

4.1 AMA : SAFE AND STEADY HEALTH BUDGET, BUT BIGGER REFORMS ARE STILL TO COME

VIEW NACCHO TV HERE

The Government has tonight delivered a safe and steady Health Budget, which outlines a broad range of initiatives across the health portfolio – but some of the bigger reforms and the biggest challenges are yet to come.

AMA President, Dr Michael Gannon, said the Government has provided some necessary funding to aged care, mental health, rural health, the PBS, and medical research, with many decisions directly responding to AMA policy.

Download full Press Release

4.1 Safe and Steady Health Budget, But Bigger Reforms Are Still to Come

4.2 AMSA Rural

AMSA Rural enthusiastically supports the changes to rural bonding and the opportunities presented by the Junior Doctor Training Program and the National Rural Generalist Pathway.

While the MDMS network may represent an expensive mis-step in addressing rural health workforce shortages, with funds better spent on rural Specialty Training Places, the announcement of better targeting, monitoring and planning for future rural workforce needs is encouraging.

Overall, AMSA Rural welcomes the government’s renewed focus on health equity for rural and regional communities, and looks forward to hearing more details of the Stronger Rural Health Strategy.

Download full Press Release

4.2 AMSA RH MR-  RURAL HEALTH IN FOCUS

5.NRHA :RURAL HEALTH BUDGET $$ WELCOME – BUT NOT ENOUGH

New funding to attract more doctors to country areas has been welcomed by the National Rural Health Alliance, Australia’s peak body for rural and remote health.

“We are pleased tonight’s Federal Budget allocates $550 million over 10 years to help fill the health workforce gaps that exist in so many parts of country Australia,” said Alliance CEO Mark Diamond.

The government says it will deliver 3,000 new specialist GPs, and 3,000 additional nurses over ten years mainly through providing end to end training in country areas.

“It’s not only doctors and nurses that are missing outside major cities. Equally there are not enough allied health professionals. Some areas have no psychologists, no physiotherapists, no occupational therapists,” Mr Diamond said.

A new Workforce Incentive Program will provide some funds to general practices to employ more nurses, doctors and, for the first time, allied health workers.

Download full Press Release

5. National Rural Health Alliance

6.AHHA Health data boost right step on the road to reform

‘The lack of any concrete action on preventive health is concerning—it has been allowed to slip down health budget priorities, despite its proven benefits in preventing big health bills later. This particularly applies to dental health, which once again has been overlooked.

‘In terms of Closing the Gap in Aboriginal and Torres Strait Islander health, we note some modest investments, including the commitment of $5 million per year for the next 3 years to address trachoma in Aboriginal communities’, Ms Verhoeven said.

‘It is disappointing that the government didn’t take the opportunity to address one of our pre-Budget recommendations to make the administrative changes to ensure patients discharged from hospital have access to Closing the Gap prescriptions.

This would have been a practical and relatively inexpensive measure to improve health outcomes for Aboriginal and Torres Strait Islander peoples.’

7.1 PHAA : Budget 2018 – prevention focus goes missing

Tonight’s national Budget continues to fund the health care systems, but is woefully short on preventative health measures to keep Australians from becoming sick in the first place, according to Public Health Association Australia (PHAA) Chief Executive Michael Moore AM.

“Despite repeated advice – and repeated commitments in principle – the Government is still not developing a preventative health focus for our health system,” said Mr Moore.

“It’s true there are a few modest measures tonight – including additional vaccinations funded, very welcome measures to promote mental wellbeing, and the Good Sports Program to reduce alcohol consumption in sporting contexts.”

“But Australia’s people will continue to experience avoidable chronic disease in the years ahead. People who should be destined to live healthy lives will not because of the preventable diseases they will suffer. While we need to look after the aged populations and those requiring medical treatment, we need to focus even more heavily on the younger generation we are failing,” Mr Moore said.

“The inevitable cost to Budgets far into the future will be greater than the investments that might have been funded.”

“What is also noticeable is that there are no preventive measures in this budget which impact negatively on industry.”

“Just last week we saw Australia’s first ever dedicated conference of preventative health professionals, with 300 expert Australians gathering in Sydney to debate the way forward to a more preventive approach to health and wellbeing.

“Yet tonight, preventive health has again been relegated to a low priority.”

“Future Health Ministers and Treasurers will rue the mistakes of this generation, including tonight’s Budget, in failing to invest in preventive health.”

Mr Moore also acknowledged Minister for Aged Care and Indigenous Health Ken Wyatt for securing a number of important initiatives in Indigenous health, Australia’s most agonizing continuing health crisis.

The Public Health Association welcomed a number of specific initiatives in tonight’s Budget:

  • Improving physical activity with a $50.4m investment to get people moving and expanding other physical activity.
  • Funding to expanding four forms of vaccinations, including Pertussis, and a targeted program to address low vaccination rate areas.
  • A National Injury Prevention Strategy for children and older people, including a program to prevent water and snow sport injuries
  • Additional funding for suicide prevention

Download 2 full Press Release

7.1 PHAA Prevention

7. 2 PHAA

NACCHO would also wish Michael a healthy future

8.RACGP Signs Federal Government beginning to recognise vital role of specialist GPs in Australia’s healthcare system

 

The Federal Government’s commitment to fund training for general practice is a sign political leaders are finally beginning to understand the vital role of specialist GPs in Australia’s healthcare system.

Royal Australian College of General Practitioners (RACGP) President Dr Bastian Seidel commended the government for investing to fund a world class, contemporary postgraduate training program for medical graduates through Australian medical colleges and in particular through the RACGP.

“We are cautiously optimistic that the penny has finally dropped,” Dr Seidel said.

“A commitment to unconditionally fund postgraduate GP training will ensure that all Australians have access to a doctor with specialist qualifications in general practice, and this has not always been the case.

Additionally, the commitment to support 3,000 international medical graduates (IMGs) to attain Fellowship as a specialist general practitioner is welcomed.

“Far too often, doctors without any postgraduate qualifications were placed in so called ‘areas of need’ and ‘district workforce shortages’.

“They were asked to work there with little or no professional support or continuous professional training.

“The funding made available in this year’s Federal Budget will finally start to rectify this shortcoming.”

Dr Seidel said while Australian GPs would be pleased with the Federal Government’s commitment to improving general practice training, there were still significant issues that needed to be addressed before the next Federal election. The indexation of general practice consultation item numbers, whilst welcome, does not go far enough.

Dr Seidel said he would like to see the Federal Government show its commitment to general practice by increasing the Medicare rebate for GP attendances by 18.5% to bring specialist GPs into line with other medical specialist attendance items.

“We must see coherent and cohesive funding for general practice that reflects the expertise of all specialist GPs.

“Appropriate investment in general practice has been proven, repeatedly, to be the most cost-effective way to deliver effective healthcare to the Australian population, particularly as the numbers of patients with chronic conditions continue to increase.

“Patients want to spend more time with their GP, and the evidence shows that time with your GP is good for patients,” Dr Seidel said.

“The Federal Government can really make a difference to the quality of care GPs are able to provide Australians by increasing this rebate before the Federal election and as a matter of urgency

 

9.CHF Health budget includes welcome consumer focus

The #digitalhealth slides from @CHFofAustralia #HealthBudget18 response. Note : Funding for things where digital health is a big part. Especially interesting is the work happening with Healthy Active Beginnings.Thx @deanhewson ‬

All 23 slides here:

Record funding for hospitals from 2020 and a $5 billion rise for aged care are contained in a Federal Budget which also provides for more consumer-focused approaches to care and research.

Download full Press Release

9. CHF Federal Health Budget

10. Vision 2020 Australia welcomes the Australian Government’s investment to target major causes of vision loss in Aboriginal and Torres Strait Islander communities.

Vision 2020 Australia welcomes the Australian Government’s investment to target major causes of vision loss in Aboriginal and Torres Strait Islander communities.

Download full press release

10. Vision Australia welcomes Eye Health Funding

The Government’s 2018-19 budget allocated $34.3 million to the eye health issues that disproportionately impact on Aboriginal and Torres Strait Islander people.

Vision 2020 Australia CEO Carla Northam said “Our members consistently tell us that the three major causes of vision loss for Aboriginal and Torres Strait Islander people are eye problems associated with diabetic retinopathy, uncorrected refractive error and the length of time people wait for cataract surgery.

“With the right amount of funding, we can address these debilitating eye conditions.”

Dr Dawn Casey, Acting CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO) welcomed the focus on providing eye health checks, especially for Aboriginal and Torres Strait Islander people who have diabetes. “We need to do all we can to make sure all Aboriginal people with diabetes have an annual eye test. At the moment, only around half are getting their eyes checked every year.”

Professor Hugh Taylor from Indigenous Eye Health, the University of Melbourne identified access to cataract surgery as needing serious attention. He said “Vision loss from cataract is twice as common in Indigenous Australians and they have to wait almost twice as long for surgery.”

Professor Taylor added “Eye care services at the local and regional levels must be planned and resourced to meet population-based needs.”

While the details on how the Government will spend the $34.3 million are unclear, Vision 2020 Australia believes that activity must focus on cutting cataract surgery wait times, making sure everyone with diabetes has an annual eye test and getting glasses to people who need them. Through these measures the Government will meet its commitment to address the major causes of vision loss in Aboriginal and Torres Strait Islander communities.

 

NACCHO Aboriginal Health and Teenage #Pregnancy #maternalMHmatters : Download @AIHW Report : Indigenous teenage mothers almost twice as likely to smoke during pregnancy as non-Indigenous mothers. @sistaquit #Prevention2018

 

” Indigenous teenage mothers are over-represented One in 4 (24%) teenage mothers identified as Aboriginal and/or Torres Strait Islander in 2015.

This means that Indigenous women were over-represented amongst teenage mothers, given Indigenous women aged 15–19 account for only 5.3% of the overall population of Australian females of the same age.

The proportion of Indigenous mothers in Australia is higher in Remote and Very remote areas, and teenage Indigenous mothers also follow this pattern

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were 1.5 times as likely to smoke in the first 20 weeks of pregnancy (43% compared with 28%) “

Read Part 2 Below or Download :

NACCHO Download aihw-per-93.pdf

Babies of teenage mothers are more likely to be premature and experience health issues in the first month than babies born to women just a few years older, a new report has revealed.

Teenage mums are also more likely to live in Australia’s lowest socio-economic areas (42 per cent) compared to mums aged 20-24 years (34 per cent), according to the report by the Australian Institute of Health and Welfare (AIHW).

The report, published today , showed the numbers of teenage mothers had dropped from 11800 in 2005 to 8200 in 2015, with nearly three-quarters of teenage mothers aged 18 or 19.

Compared to babies born to mothers aged 20-24 years, more babies born to teenage mothers were premature, had a low birth weight and needed admission to special care nursery.

Despite the negative outcomes for babies, the report showed positive trends for teenage mothers including more spontaneous labours, lower caesarean section rates and less diabetes for teenage mothers.

“The difference between teenage mothers and those in the slightly older age group is due in part to a large number of teenage mothers living in low socio-economic areas,” says AIHW report author Dr Fadwa Al-Yaman.

Dr Al-Yaman said the differences could also be due to the higher smoking rates in pregnancy, with a quarter of teenage mothers smoking after 20 weeks of pregnancy compared to 1 in six of those aged 20 to 24.

A quarter of teenage mothers identified as Aboriginal or Torres Strait Islander, with Indigenous teenage mothers almost twice as likely to smoke during pregnancy as non-Indigenous mothers.

Dr Al-Yaman said risk factors were highly interlinked, with issues such a smoking, low levels of education and employment being concentrated in remote areas.

The teenage birth rate in metro areas is less than half that of regional areas, she said.

“There is a strong link between socio-economic disadvantage and living in remote areas,” she told AAP.

“You need to have access to transport, access to health services and if you have to pay for your transport, sometimes over an hour’s worth, it’s going to take more of your welfare money.”

SISTAQUIT Trial Recruiting Services Now

The SISTAQUIT™ trial aims to improve health providers’ skills and when offering smoking cessation care to pregnant Aboriginal and Torres Strait Islander women.

Pregnancy is an important window of opportunity for GPs and health providers to help smokers quit, however they often lack the confidence and skills to address their patients’ smoking.

This intervention provides webinar-based training in evidence based and culturally competent smoking cessation care for providers working within Aboriginal Medical and Health Services.

The SISTAQUIT™ Team are currently recruiting Aboriginal Medical Services (AMS) and GP practices in NSW, WA, QLD, SA and NT for this study.

To find out more about your service being involved in the SISTAQUIT™ trial please contact Dr Gillian Gould or Joley Manton at the University of Newcastle.

Website

Download the trial brochure here

Download an information sheet here

Part 2 Indigenous Mothers

Indigenous teenage mothers are over-represented One in 4 (24%) teenage mothers identified as Aboriginal and/or Torres Strait Islander in 2015.

This means that Indigenous women were over-represented amongst teenage mothers, given Indigenous women aged 15–19 account for only 5.3% of the overall population of Australian females of the same age.

Indigenous mothers are younger than average

The average age of Indigenous teenage mothers (17.8 years) was lower than for non- Indigenous mothers (18.1 years). Indigenous teenage mothers were 4.5 times as likely to be aged under 15 (1.8%; 35) as non-Indigenous teenage mothers (0.4%; 27) and less likely to be aged 19 (37.4%; 744 compared with 49.1%; 3,048).

More likely to live in remote areas

The proportion of Indigenous mothers in Australia is higher in Remote and Very remote areas, and teenage Indigenous mothers also follow this pattern.

In 2015, the Indigenous population rate for 15–19 year old mothers living in Remote and Very remote areas was 84.9 per 1,000 females, which was 5.5 times the non-Indigenous rate (15.2 per 1,000).

The population rate for 15–19 year old Indigenous mothers was also higher for women living in Major cities at 40.7 per 1,000 for Indigenous women compared with 7.1 per 1,000 for non-Indigenous women.

Fewer and later antenatal visits

Indigenous teenage mothers generally attended fewer antenatal visits than non-Indigenous teenage mothers, with higher proportions of 1 visit (1.5% compared with 0.9%) and 2–4 visits (9.5% compared with 6.1%) and lower proportions of 5 or more visits (86% compared with 91%).

They were 1.1 times as likely to attend their first antenatal visit at 20 weeks gestation or more (25% compared with 23%).

More likely to smoke

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were:

• 1.5 times as likely to smoke in the first 20 weeks of pregnancy (43% compared with 28%)

• 1.7 times as likely to smoke after 20 weeks (36% compared with 21%).

Higher rates of diabetes

Indigenous teenage mothers were 1.2 times as likely as non-Indigenous teenage mothers to have diabetes (6.0% compared with 4.9%) and gestational diabetes (5.1% compared with 4.2%).

Onset of labour, method of birth and perineal status

In 2015, Indigenous teenage mothers were more likely than their non-Indigenous counterparts to have spontaneous labour (66% compared with 62%), and less likely to have induced labour (28% compared with 32%), but equally likely to have no labour (both 6.1%).

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were slightly more likely to:

• have a caesarean section (19% compared with 18%)

• have an intact perineum (27% compared with 26%).

 

NACCHO Aboriginal Health and #Sugartax : @4Corners #Tippingthescales: #4corners Sugar, politics and what’s making us fat #rethinksugarydrinks @janemartinopc @OPCAustralia

On Monday night Four Corners investigates the power of Big Sugar and its influence on public policy.

“How did the entire world get this fat, this fast? Did everyone just become a bunch of gluttons and sloths?”  Doctor

The figures are startling. Today, 60% of Australian adults are classified as overweight or obese. By 2025 that figure is expected to rise to 80%.

“It’s the stuff of despair. Personally, when I see some of these young people, it’s almost hard to imagine that we’ve got to this point.”  Surgeon

Many point the finger at sugar – which we’re consuming in enormous amounts – and the food and drink industry that makes and sells the products fuelled by it.

Tipping the scales, reported by Michael Brissenden and presented by Sarah Ferguson, goes to air on Monday 30th of April at 8.30pm. It is replayed on Tuesday 1st of May at 1.00pm and Wednesday 2nd at 11.20pm.

It can also be seen on ABC NEWS channel on Saturday at 8.10pm AEST, ABC iview and at abc.net.au/4corners.

See Preview Video here

 ” In 2012-13, Aboriginal and Torres Strait Islander people 2 years and over consumed an average of 75 grams of free sugars per day (equivalent to 18 teaspoons of white sugar)1. Added sugars made up the majority of free sugar intakes with an average of 68 grams (or 16 teaspoons) consumed and an additional 7 grams of free sugars came from honey and fruit juice. “

NACCHO post – ABS Report abs-indigenous-consumption-of-added-sugars 

Amata was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

The thing that I say in community meetings all the time is that, the reason we’re doing this is so that the young children now do not end up going down the same track of diabetes, kidney failure, dialysis machines and early death, which is the track that many, many people out here are on now,”

NACCHO Post : Mai Wiru, meaning good health, and managed by long-time community consultant John Tregenza.

See Previous NACCHO Post Aboriginal Health and Sugar TV Doco: APY community and the Mai Wiru Sugar Challenge Foundation

4 Corners Press Release

“This isn’t about, as the food industry put it, people making their own choices and therefore determining what their weight will be. It is not as simple as that, and the science is very clear.” Surgeon

Despite doctors’ calls for urgent action, there’s been fierce resistance by the industry to measures aimed at changing what we eat and drink, like the proposed introduction of a sugar tax.

“We know about the health impact, but there’s something that’s restricting us, and it’s industry.”  Public health advocate

On Monday night Four Corners investigates the power of Big Sugar and its influence on public policy.

“The reality is that industry is, by and large, making most of the policy. Public health is brought in, so that we can have the least worse solution.”  Public health advocate

From its role in shutting down debate about a possible sugar tax to its involvement in the controversial health star rating system, the industry has been remarkably successful in getting its way.

“We are encouraged by the government here in Australia, and indeed the opposition here in Australia, who continue to look to the evidence base and continue to reject this type of tax as some sort of silver bullet or whatnot to solve what is a really complex problem, and that is our nation’s collective expanding waistline.” Industry spokesperson

We reveal the tactics employed by the industry and the access it enjoys at a time when health professionals say we are in a national obesity crisis.

“We cannot leave it up to the food industry to solve this. They have an imperative to make a profit for their shareholders. They don’t have an imperative to create a healthy, active Australia.”  Health advocate

NACCHO post – 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 

BACKGROUND

 ” This campaign is straightforward – sugary drinks are no good for our health. It’s calling on people to drink water instead of sugary drinks.’

Aboriginal and Torres Strait Islander people in Cape York experience a disproportionate burden of chronic disease compared to other Australians.’

‘Regular consumption of sugary drinks is associated with increased energy intake and in turn, weight gain and obesity. It is well established that obesity is a leading risk factor for diabetes, kidney disease, heart disease and some cancers. Consumption of sugary drinks is also associated with poor dental health.

Water is the best drink for everyone – it doesn’t have any sugar and keeps our bodies healthy.’

Apunipima Public Health Advisor Dr Mark Wenitong

Read over 48 NACCHO articles Health and Nutrition HERE

https://nacchocommunique.com/category/nutrition-healthy-foods/

Read over 24 NACCHO articles Sugar Tax HERE  

https://nacchocommunique.com/category/sugar-

NACCHO Aboriginal Health @VACCHO_org @Apunipima join major 2018 health groups campaign @Live Lighter #RethinkSugaryDrink launching ad showing heavy health cost of cheap $1 frozen drinks

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

NACCHO Aboriginal Health and #closingthegap Download @AIHW report summarises evidence on progress towards the seven #CTG targets . These include: child mortality, school attendance, literacy and numeracy, employment, and life expectancy.

 

” This report provides detailed information and analyses on the Closing the Gap targets, including the key drivers of change underpinning these targets.

This report provides context for policy debate and discussion for the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG).

Today’s report summarises evidence on progress towards the seven Closing the Gap targets. These targets include: child mortality, school attendance, literacy and numeracy, employment, and life expectancy. Read the full report:

Download the 300 Page report HERE

AIH W Closing the Gap Targets Report

Information on this COAG initiative, and additional resources with updated data on the COAG targets are available at the Department of Prime Minister and Cabinet website.

  • Contents
  • Acknowledgments
  • Abbreviations
  • Symbols
  • Chapter 1: Overview
    • 1.1 Closing the Gap targets and progress
    • 1.1.1 About the targets
    • 1.1.2 Current picture and progress
    • 1.2 Key drivers of change
    • 1.3 Key themes across the targets
      • 1.3.1 Social determinants are critical
      • 1.3.2 Remoteness has a relatively large impact
      • 1.3.3 Improved access to services is needed
      • 1.3.4 Investment is needed across the lifecourse
      • 1.3.5 Interactions between outcomes are important
      • 1.3.6 Need more evidence on ‘what works’
    • 1.4 Data limitations
    • 1.5 Future target setting
    • 1.6 References
  • Chapter 2: Child mortality target
    • Summary
    • 2.1 Background
    • 2.2 Current picture and progress
      • 2.2.1 National data on child mortality
      • 2.2.2 Child mortality by state and territory
      • 2.2.3 Age of childhood death
      • 2.2.4 Causes of death
    • 2.3 Key drivers of child mortality
      • 2.3.1 Evidence from the literature
      • 2.3.2 Evidence from new AIHW analyses
    • 2.4 Data limitations and measurement issues
      • 2.4.1 Child deaths data
      • 2.4.2 Population and births data
      • 2.4.3 Cause of death classifications
      • 2.4.4 Data on key determinants
    • 2.5 Bringing it together
      • 2.5.1 An overview
      • 2.5.2 Examples of opportunities for further progress
    • 2.6 References
  • Chapter 3: Early childhood education target
    • Summary
    • 3.1 Background
    • 3.2 Current picture and progress
      • 3.2.1 National data on enrolment and attendance
      • 3.2.2 Enrolment and attendance by state and territory
      • 3.2.3 Attendance by remoteness
    • 3.3 Key drivers of participation in ECE
      • 3.3.1 Evidence from the literature
      • 3.3.2 Evidence from AIHW analysis of the LSIC
    • 3.4 Data limitations and measurement issues
      • 3.4.1 Comparable enrolment and attendance rates
    • 3.5 Bringing it together
      • 3.5.1 An overview
      • 3.5.2 Examples of opportunities for further progress
    • 3.6 References
  • Chapter 4: School attendance target
    • Summary
    • 4.1 Background
    • 4.2 Current picture and progress
      • 4.2.1 National data on school attendance
      • 4.2.2 School attendance by state and territory
      • 4.2.3 School attendance by remoteness
      • 4.2.4 Patterns of student attendance
    • 4.3 Key drivers of school attendance
      • 4.3.1 Evidence from the literature
      • 4.3.2 Evidence from new AIHW analysis
    • 4.4 Data limitations and measurement issues
      • 4.4.1 Reporting on days of attendance
      • 4.4.2 Measuring student attendance rates
      • 4.4.3 Measuring students achieving 90% or more attendance
      • 4.4.4 Survey and longitudinal data sets
    • 4.5 Bringing it together
      • 4.5.1 An overview
      • 4.5.2 Examples of opportunities for further progress
    • 4.6 References
  • Chapter 5: Literacy and numeracy target
    • Summary
    • 5.1 Background
    • 5.2 Current picture and progress
      • 5.2.1 National data on literacy and numeracy
      • 5.2.2 Literacy and numeracy outcomes by state and territory
      • 5.2.3 Literacy and numeracy outcomes by remoteness
      • 5.2.4 Progress towards the literacy and numeracy target
      • 5.2.5 Improvements in mean NAPLAN scores
    • 5.3 Key drivers of literacy and numeracy
      • 5.3.1 Conceptual framework on influences on child development
      • 5.3.2 Drivers based on analysis of NAPLAN data
      • 5.3.3 Drivers based on other literature
      • 5.4 Data limitations and measurement issues
    • 5.4.1 Use of the NMS
      • 5.4.2 Participation in NAPLAN testing
    • 5.5 Bringing it together
      • 5.5.1 An overview
      • 5.5.2 Examples of opportunities for further progress
    • 5.6 References
  • Chapter 6: Year 12 or equivalent attainment target
    • Summary
    • 6.1 Background
    • 6.2 Current picture and progress
      • 6.2.1 National data on Year 12 or equivalent attainment
      • 6.2.2 Year 12 or equivalent attainment by geographic area
      • 6.2.3 Patterns of Year 12 or equivalent attainment
    • 6.3 Key drivers of Year 12 attainment
      • 6.3.1 Evidence from literature
      • 6.3.2 Evidence from new AIHW analysis of NATSISS data
    • 6.4 Data limitations and measurement issues
      • 6.4.1 Frequency of data
      • 6.4.2 Census data (main data source)
      • 6.4.3 Survey data (supplementary data source)
      • 6.4.4 Apparent retention rates
      • 6.4.5 Identifying drivers of Year 12 attainment
      • 6.4.6 Administrative data on educational attainment
      • 6.4.7 Components of Year 12 or equivalent attainment
    • 6.5 Bringing it together
      • 6.5.1 An overview
      • 6.5.2 Examples of opportunities for further progress
    • 6.6 References
  • Chapter 7: Employment target
    • Summary
    • 7.1 Background
    • 7.2 Current picture and progress
      • 7.2.1 National data on employment
      • 7.2.2 Patterns of employment
    • 7.3 Key drivers of Indigenous employment
      • 7.3.1 Key drivers in the literature
      • 7.3.2 Evidence from new AIHW analysis
      • 7.3.3 Trends in Indigenous employment drivers
    • 7.4 Data limitations and measurement issues
      • 7.4.1 Frequency of Indigenous employment data
      • 7.4.2 Use of employment rates
    • 7.5 Bringing it together
      • 7.5.1 An overview
      • 7.5.2 Examples of opportunities for further progress
    • 7.6 References
  • Chapter 8: Life expectancy target
    • Summary
    • 8.1 Background
    • 8.2 Current picture and progress
      • 8.2.1 National life expectancy
      • 8.2.2 Life expectancy by jurisdiction and remoteness
      • 8.2.3 Mortality patterns and trends
      • 8.2.4 Fatal burden of disease
    • 8.3 Key drivers of mortality and life expectancy
      • 8.3.1 Social determinants and risk factors
      • 8.3.2 Contribution of risk factors to the fatal burden
      • 8.3.3 Health system interventions
    • 8.4 Data limitations and measurement issues
      • 8.4.1 Deaths and population data
      • 8.4.2 Frequency of Indigenous life expectancy estimates
    • 8.5 Bringing it together
      • 8.5.1 An overview
      • 8.5.2 Examples of opportunities for further progress
    • 8.6 References

 

NACCHO Aboriginal Youth Health News @KenWyattMP launches Aboriginal Youth Health Strategy 2018-2023, Today’s young people, tomorrow’s leaders at @TheAHCWA

“ The youth workshops confirmed young people’s biggest concerns are often not about physical illness, they are issues around mental health and wellbeing, pride, strength and resilience, and ensuring they can make the most of their lives

Flexible learning and cultural and career mentoring for better education and jobs were highlighted, along with the importance of culturally comfortable health care services.

While dealing with immediate illness and disease is crucial, this strategy’s long-term vision is vital and shows great maturity from our young people.”

Federal Minister for Health and Aged Care Ken Wyatt, AM launched AHCWA’s Western Australia Aboriginal Youth Health Strategy 2018-2023, Today’s young people, tomorrow’s leaders at AHCWA’s 2018 State Sector Conference at the Esplanade Hotel in Fremantle. Read the Ministers full press release PART 2 Below

See Previous NACCHO Post

NACCHO Aboriginal Health @TheAHCWA pioneering new ways of working in Aboriginal Health :Our Culture Our Community Our Voice Our Knowledge

“If we are to make gains in the health of young Aboriginal people, we must allow their voices to be heard, their ideas listened to and their experiences acknowledged.

Effective, culturally secure health services are the key to unlocking the innate value of young Aboriginal people, as individuals and as strong young people, to become our future leaders.”

AHCWA Chairperson Vicki O’Donnell said good health was fundamental for young Aboriginal people to flourish in education, employment and to remain socially connected.

Download the PDF HERE

The Aboriginal Health Council of Western Australia (AHCWA) has this launched its new blueprint for addressing the health inequalities of young Aboriginal people.

“The Turnbull Government is proud to have supported this ground-breaking work and I congratulate everyone involved,” Minister Wyatt said.

“Young people are the future, and thinking harder and deeper about their needs and talking to them about how to meet them is the way forward.”

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

The strategy considered feedback from young Aboriginal people and health workers during 24 focus groups hosted by AHCWA across the Kimberley, Pilbara, Midwest-Gascoyne, Goldfields, South-West, Great Southern and Perth metropolitan areas last year.

In addition, two state-wide surveys were conducted for young people and service providers to garner their views about youth health in WA.

During the consultation, participants revealed obstacles to good health including boredom due to a lack of youth appropriate extracurricular activities, sporting programs and other avenues to improve social and emotional wellbeing.

Of major concern for some young Aboriginal people were systemic barriers of poverty, homelessness, and the lack of adequate food or water in their communities.

Significantly, young Aboriginal people shared experiences of how boredom was a factor contributing to violence, mental health problems, and alcohol and other drug use issues.

They also revealed that racism, bullying and discrimination had affected their health, with social media platforms used to mitigate boredom leading to issues of cyberbullying, peer pressure and personal violence and in turn, depression, trauma and social isolation.

Ms O’Donnell said the strategy cited a more joined-up service delivery method as a key priority, with the fragmentation and a lack of coordination in some areas making it difficult for young Aboriginal people to find and access services they need.

“The strategy provides an opportunity for community led solutions to repair service fragmentation, and open doors to improved navigation pathways for young Aboriginal people,” she said.

Ms O’Donnell said the strategy also recognised that culture was intrinsic to the health and wellbeing of young Aboriginal people.

“Recognition of and understanding about culture must be at the centre of the planning, development and implementation of health services and programs for young Aboriginal people,” she said.

“AHCWA has a long and proud tradition of leadership and advocacy in prioritising Aboriginal young people and placing their health needs at the forefront.”

Under the strategy, AHCWA will establish the Aboriginal Youth Health Program Outcomes Council and local community-based Aboriginal Youth Cultural Knowledge and Mentor Groups.

The strategy also mandates to work with key partners to help establish pathways and links for young Aboriginal people to transition from education to employment, support young Aboriginal people who have left school early or are at risk of disengaging from education; and work with local schools to implement education-to-employment plans.

More than 260 delegates from WA’s 22 Aboriginal Community Controlled Health Services are attending the two-day conference at the Esplanade Hotel Fremantle on April 11 and 12.

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

The conference agenda can be found here: http://www.cvent.com/events/aboriginal-health-our-culture-our-communities-our-voice-our-knowledge/agenda-d4410dfc616942e9a30b0de5e8242043.aspx

Part 2 Ministers Press Release

A unique new youth strategy puts cultural and family strength, education, employment and leadership at the centre of First Nations people’s health and wellbeing.

Indigenous Health Minister Ken Wyatt AM today launched the landmark Western Australian Aboriginal Youth Health Strategy, which sets out a five-year program with the theme “Today’s young people, tomorrow’s leaders”.

“This is an inspiring but practical roadmap that includes a detailed action plan and a strong evaluation process to measure success,” Minister Wyatt said.

“It sets an example for other health services and other States and Territories but most importantly, it promises to help set thousands of WA young people on the right path for healthier and more fulfilling lives.”

Produced by the Aboriginal Health Council of WA (AHCWA) and based on State wide youth workshops and consultation, the strategy highlights five key health domains:

    • Strength in culture – capable and confident
    • Strength in family and healthy relationships
    • Educating to employ
    • Empowering future leaders
    • Healthy now, healthy future

Each domain includes priorities, actions and a “showcase initiative” that is already succeeding and could be replicated to spread the benefits further around the State.

Development of the strategy was supported by a $315,000 Turnbull Government grant, through the Indigenous Australians Health Program.

“I congratulate AHCWA and everyone involved because hearing the clear voices of these young Australians is so important for their development now and for future generations,” the Minister said.

NACCHO Aboriginal Health : Download @KenWyattMP speech to @CISOZ : The question of leadership and responsibility in Aboriginal health – addressing the Centre for Independent Studies

 ” Last year, we led a massive group listening program – the My Life My Lead consultations involved 600 people at 13 forums across Australia, plus more than 100 written submissions were received.

Seven priority areas were identified, and are informing the current Closing the Gap refresh agenda.

The priorities we heard from First Australians are:

  • Putting culture at the centre of change
  • Success and wellbeing for health through employment
  • Foundations for a healthy life
  • Environmental health
  • Healthy living and strong communities
  • Health service access, and
  • Health and opportunity through education

We need to be fully committed to sitting down and listening; hearing what’s being said, and continuing to invest in programs that do their work from the ground up.

Policies and services that reflect local voices and wisdom are more closely owned by the people they serve.”

Minister Ken Wyatt MP speaking at Centre for Independent Studies in Sydney yesterday

Download full address or read below

FINAL Wyatt CIS speech 10 April 2018

Family the key to Indigenous health, says Ken Wyatt

Executive summary from the The Australian Stephen Fitzpatrick 

Good parenting rather than increased funding for programs and services is key to improving Indigenous health, the federal minister responsible for the sector has ­declared.

Warning that “doing more of the same is an option we can no longer afford”,

Aboriginal Liberal MP Ken Wyatt said the successes and the failures in indigenous health demonstrated that “responsible parents and families provide the most consistent and enduring interventions”.

“Funding for health programs and services, from public or private sources, will only ever be part of the currency of change,” Mr Wyatt said at a speech to the Centre for Independent Studies in Sydney. “By far the greatest value will come from every mother, father, uncle, aunt and elder every day, taking responsibility for and contributing to better health.”

Calling for a declaration of “non-negotiable standards to be met from the bottom up”, Mr Wyatt said these standards must “reflect the pride of the oldest continuous culture on the planet” but should also extend “far beyond families, to health and community groups and organisations too”.

He said there had for too long been a “piecemeal approach” to indigenous health, with “inadequate accountability” for repeated programs and yet “every time there’s been a new issue or challenge, ­people say we need more money”.

Efforts to close the gap between indigenous and non-indigenous health outcomes would not succeed “until we eliminate the mindset that Aboriginal Australians could be, and even should be on occasions, dealt with differently”.

The current syphilis epidemic in northern Australian indigenous communities, which has prompted the Turnbull government to commit $8.8 million in an attempt to turn its tide seven years after it began, was a case in point.

“If this outbreak had occurred on Sydney’s north shore, in ­Cottesloe in Perth or Toorak in Melbourne — in any city or major town, in fact — there would have been a rapid response years ­earlier,” Mr Wyatt said.

However, he cautioned that there must also be a greater focus on strategies that clearly work, calling for governments and NGOs to “hear the voices of families, of mothers, fathers and community elders, not just the voices of those who are the strongest ­advocates for the establishment of organisations or services”.

He cited the work of Fitzroy Crossing women including Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar in curbing the spectre of ­fetal alcohol spectrum disorder, saying it had “turned the town around and you now see strong families there, bound by the glue of love and caring”.

He had ordered his department to overhaul a Medicare provision designed for indigenous Australians that provides physical, psychological and social wellbeing assessments as well as preventive healthcare, education and other options to improve health.

He said only 217,000 people ­accessed this provision last year but he wanted this number to rise because “what I want to see is all First Nations people accessing all relevant (Medicare) items in the same way other Australians do”.

He praised the growing number of indigenous health professionals at all levels, “as doctors and nurses, in allied health, administration and management (and) in policy planning and research”.

Mr Wyatt said this was likely to be the best hope for the future, with more than 40 per cent of the 720,000-strong indigenous population aged under 24, so that many of this group were “set to make a big impact across many fields that may help to close the gap”.

Full Speech Minister Ken Wyatt


Download FINAL Wyatt CIS speech 10 April 2018

Thank you Tom, [Switzer, Executive Director, Centre for Independent Studies] for your introduction.

In West Australian Noongar language, I say kaya wangju – hello and welcome.

At the same time, I acknowledge the traditional owners of the land on which we meet, the Gadigal people of the Eora Nation, and pay my respects to Elders past and present.

Today, I want to pose the question: “What is the currency of positive change for the health of First Nations people?”

Is it government or private investment; is it determination; is it personal motivation?

To begin, I’d like those of us who can remember, to think back to 1972.

Australia’s Helen Reddy was topping the international charts and we were getting out of Vietnam.

The Tent Embassy went up at Parliament House in Canberra on Australia Day that year, a symbolic foreign mission erected in the fight for land rights, after years of dashed hopes – an embassy that continues today in the fight for equality.

1972 was a potentially life-changing year for thousands of Aboriginal and Torres Strait Islander Australians.

Prime Minister Gough Whitlam established the Commonwealth Department of Aboriginal Affairs, ushering in an era of bold new promise, building on changes implemented by previous governments following the 1967 referendum.

Looking back – in so many different ways since then – we have come so far.

Yet, since 1972, we have not seen the broad, wholesale change that we would expect, especially given the significant funding and vast amount of good intentions that have been invested in Aboriginal affairs.

Yes, for the first time in several years, we are on track to reach three of the seven Closing the Gap targets – but what lies behind the statistics that still highlight health inequities today?

What have we got right – and wrong – since 1972?

As I travel our nation, I see and hear more and more inspiring stories of First People’s achievement and the journey to equality, from almost every corner of the country.

Perhaps I’m a bit old-fashioned, but I like to call these “jewels in the crown” – because they shine so brightly, and they exemplify the things that work.

One of these is a university college for Aboriginal students I recently launched in Perth.

Now doubling in size six years after it began, it boasts a 90 per cent retention rate, with almost 80 percent of students passing all their exams.

Head to remote communities in the Kimberley and the Pilbara and you’ll find the EON program, literally teaching children how to grow vegetables and good health.

This is especially close to my heart, because I approved the initial, modest, funding to help start the project 10 years ago.

Since then, EON’s employed scores of local Aboriginal people, worked with students and families to create dozens of school vegetable gardens and has run countless cooking classes, including bush tucker, too.

The compelling taste and health benefits of home grown food are one thing; but it’s the ownership, the healthy habits, the skills learned, and the pride that are also helping change young lives.

The EON program’s now in high demand, extending further south in WA and into the Northern Territory this year.

In the Western Desert, the Pintupi Luritja people saw the tragedy of kidney failure and decided it wasn’t going to be a one-way ticket off their beloved country, to being hooked up to dialysis in Alice Springs.

They took control, famously painted and sold precious artworks – and raised a million dollars to start realising their dream.

Eighteen years on, the Purple House project has treatment centres across their vast lands, a mobile dialysis truck and, just as important, a growing primary and preventive health care network.

Not surprisingly, the wraparound approach – from the ground and the street up – most often shows the common denominator of success.

This local impetus is being strongly supported, and replicated with careful community consultation, through significant Turnbull Government programs.

Better Start to Life and its care and family partnerships begin a child’s health journey before conception. We have funded 124 sites nationwide, and counting.

The results are showing fewer low birth weight babies, higher rates of breastfeeding and, in our Australian Nurse Family Partnership Program sites, 100 per cent immunisation rates, the highest in the nation.

At the same time, from Alice Springs to Port Augusta and from Doomadgee to Canberra, the Connected Beginnings program links parents, health care and education, so children are ready to start school, learn and grow into healthy teenagers and adults.

As Nelson Mandela rightly said: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”

But sometimes, I go into communities and I meet with organisations that tell me they are meeting their health targets — the key performance indicators.

I then get permission from Elders to walk around and chat with locals.

On one particular occasion, in the Kimberley, I met a significant Aboriginal artist.

We were walking along and a friend was talking with this painter and I noticed that her eyes looked opaque, so I asked her: How much can you see?

She said: “I can’t see very much at all, I’m hoping for my cataract surgery.”

At that time, it had been a two-year wait – yet the health organisation’s KPIs were being met. How could this be?

In a country as rich and advanced as Australia, how can this happen?

This is not an isolated incident.

Improving overall Aboriginal and Torres Strait Islander health is, first and foremost, critical for the well-being and dignity of hundreds of thousands of First Australians.

But it is also fundamental to our nation’s commitment to equality, and our global health status.

The health of First Nations Australians is everyone’s business.

We must continually celebrate with Aboriginal communities and families the many milestones in health, education, careers and cultural achievement.

At the same time, it is crucial we look carefully at where poorer aspects of health and wellbeing remain.

In these cases, doing more of the same is an option we can no longer afford – the high cost in lives and lost futures is incalculable, and budgets are also under intense pressure.

First Nations knowledge is embedded in the memories of the living – knowledge that is imparted through teaching, storytelling, music, art and dance.

They are our living libraries and losing each individual means a precious book of knowledge is lost forever.

It is imperative that we enable people to be healthy and live longer.

For far too long in Aboriginal health there was a piecemeal approach; series upon series of programs, often with inadequate accountability.

Every time there’s been a new issue or challenge, people say we need more money.

Currently, there are two evaluations underway to identify opportunities to improve; access to quality and effective primary health care services; assess health gains; and identify the social returns and the broader economic benefits of the Indigenous Australians’ Health Program.

While Government investment in the program will continue to grow over the forward estimates, it is imperative – especially for those in greatest need – that we maximise the health value in every dollar.

To illustrate this point I want to look at the current challenges of Sexually Transmitted Infections and Blood Borne Viruses.

Recently, I was asked to approve significant special funding for a targeted program to tackle the increasing prevalence of STIs, particularly the alarming rise of syphilis in northern areas.

When I asked ‘What are the States and Territories doing about this?’ I was disturbed to find too little had been invested and too little done when the first warning signs appeared, almost seven years ago – certainly not to the extent I would have expected from the responsible jurisdictions.

There was still an overwhelming reliance on Commonwealth leadership and funding in order to address the spread of STIs across the Top End.

I committed $8.8 million dollars, to provide a surge approach that is currently ramping up, aiming to turn the tide of infection.

I also make the point that these First Nations people now struggling under the burden of this deadly disease are, first and foremost, citizens of Australia.

If this outbreak had occurred on Sydney’s North Shore, in Cottesloe in Perth, or Toorak in Melbourne – in any city or major town, in fact – there would have been a rapid response years earlier.

I believe there will not be complete success, in terms of Closing the Gap, until we eliminate the mindset that Aboriginal Australians could be, and even should be on occasions, dealt with differently.

Ensuring awareness and respect for First Nations people and culture throughout our health system may be critical to equality of access – but above all, there is a fundamental human right we must accord every one of our citizens, and that is the right to good health.

Picture this scenario.

A doctor based in Kintore – around 2,000 kilometres South-West of Darwin visited the community of Kiwirrkurra located in Western Australia’s sandhill country — the Gibson Desert.

This doctor reports meeting a group of nine nomadic Aboriginal people, and he says:

“…They were the most healthy people I have ever seen…They were literally glowing with health – not an ounce of superfluous fat. They were extremely fit…”

The year was 1984.

Today, we hear a different narrative too often: There is an alarming rise in obesity and diabetes, suicide levels are high, there is alcohol and drug misuse and the impacts of poverty leave many people with a sense of powerlessness.

Too often, First Nations people’s achievements are overshadowed by health and welfare stories of deep, and understandable, concern.

We’re seeing laudable improvements because of interventions, but they’re not always consistent enough, and they’re often not equivalent to results achieved by other sectors within multicultural Australia.

I’m strongly focussed on where we need to improve; on why – even after accounting for the social and environmental impacts on health – we’re still seeing better outcomes for non-Aboriginal people.

For almost 20 years now, the Medicare Benefits Schedule (MBS) has included Item number 715 – a health assessment especially designed to ensure Aboriginal and Torres Strait Islander people receive primary care matched to their needs.

A 715 looks at a patient’s health — physical, psychological and their social wellbeing.

It also assesses what preventative health care, education and other assistance should be offered to improve health and wellbeing.

It’s holistic. Not body part, by body part. The whole body.

Australia’s Aboriginal and Torres Strait Islander population is around 720,000.

Yet only 217,000 people in 2016-17 have been assessed under MBS Item 715.

At the same time, I see organisations such as the Institute for Urban Indigenous Health, that according to their 2016-17 Annual Report have over 33,000 active patients, of which approximately 60 per cent have had their 715 health check.

In 2016-17, the organisations Members’ Network of 19 Aboriginal Community Controlled Health Care Clinics generated more than $14.3 million in Medicare income, with all funds re-invested in the delivery of comprehensive health care for Aboriginal and Torres Strait Islander people in South East Queensland.

What I see here are significantly better results, through completion of a “cycle of care”, comprising the range of chronic disease and other MBS items.

The Institute has grown its clinics from 5 to 19 in the past nine years, with their 20th soon to open in the Moreton Bay region.

I’m excited by this work – the innovation and capacity to change, and the resolve not to accept the status quo of poorer health outcomes.

I look at some of the health disparities and think, why aren’t we as a nation case managing, fundamentally, 720,000 people in a way that would make a difference to so many chronic conditions?

I have asked my department for an overhaul of 715s – what I want to see is all First Nations people accessing all relevant MBS items in the same way that other Australians do.

A key Government focus is on the health of our children, from conception right through to their late teens, so they can grow into strong and healthy men and women who can be the best mentors for their own children.

With more than 1700 First Australians receiving kidney dialysis, and rheumatic heart disease affecting another 6,000 mainly younger people, this year I’ve also prioritised renal health and RHD, along with eye and ear health.

From four national roundtables, we’re now charting Australia’s first roadmaps to coordinate efforts to combat these debilitating and deadly conditions.

It’s absolutely intolerable that RHD among our First Nations people is happening at more than 50 times the rate of other groups in Australian society.

In parts of the Northern Territory, those horrific rates of RHD are doubled again.

And Aboriginal and Torres Strait Islander people under the age of 55 are starting dialysis at twice the rate of non-Aboriginal Australians, with many showing danger signs in their teens.

The unfinished business of today is disappointing because we should be celebrating more successes.

And are community-controlled health organisations and other community groups established to service great need, sitting down enough and asking families and individuals what they know, what they want and what they think would work best?

They must ask: Where is the continuity of service for anyone who requires an intervention to prolong their life or to circumvent an illness?

Minor ailments like skin sores or strep throats, if treated consistently and effectively, won’t develop into early onset renal failure or rheumatic heart disease.

In the same way, neither will ear infections become impaired hearing, that can stunt a child’s learning capacity and their chances of a good job, or any job at all.

There is a need for a holistic approach to the health of each individual.

Some of the benefits flowing from Australia’s recent mining boom have been great employment opportunities, close to country, for thousands of First Nations people.

But the job hopes of many were hampered by deafness contracted in childhood, much to the frustration of mining companies committed to hiring keen local staff.

Hearing and communication are fundamental to fulfilling our life’s potential.

They’re also two of the most valuable commodities for sustainable change in Aboriginal and Torres Strait Islander health.

Governments and non-government organisations across the board must listen to and hear the voices of families, of mothers, fathers and community Elders.

Not just the voices of those who are the strongest advocates for the establishment of organisations or services that, theoretically, should make a difference on the ground.

I say this with no political overtones – the Prime Minister and the Turnbull Government are committed to doing things with Aboriginal and Torres Strait Islander people, not to them.

Last year, we led a massive group listening program – the My Life My Lead consultations involved 600 people at 13 forums across Australia, plus more than 100 written submissions were received.

SEE NACCHO report

Seven priority areas were identified, and are informing the current Closing the Gap refresh agenda.

The priorities we heard from First Australians are:

Putting culture at the centre of change

Success and wellbeing for health through employment

Foundations for a healthy life

Environmental health

Healthy living and strong communities

Health service access, and

Health and opportunity through education

We need to be fully committed to sitting down and listening; hearing what’s being said, and continuing to invest in programs that do their work from the ground up.

Policies and services that reflect local voices and wisdom are more closely owned by the people they serve.

People are empowered, because they’ve been heard, and take responsibility because they’re respected and proud.

Around the nation there are many things that are working and I have seen programs and services where Aboriginal organisations, Aboriginal people and non-Aboriginal people are highly successful in the most difficult of circumstances.

I see June Oscar and her community’s work in Fitzroy Crossing, which has changed the whole dynamic of buying alcohol and curbed the local tragedy of Foetal Alcohol Spectrum Disorder.

Together, they have turned the town around and you now see strong families there, bound by the glue of love and caring.

Alcohol and the bad behaviour of a few no longer defines Fitzroy Crossing, the strength and the story of the community does.

When I think about the successes, as well as the failures, I know that responsible parents and families provide the most consistent and enduring interventions.

Funding for health programs and services, from public or private sources, will only ever be part of the currency of change.

By far the greatest value will come from every mother, father, uncle, aunt and Elder every day, taking responsibility for and contributing to better health.

For over 65,000 years, First Nations people survived and thrived without a plethora of organisations – individual families and communities pulled together, to ensure the health and wellbeing of all.

Working and walking together with local communities, we collectively need to declare non-negotiable standards to be met, from the bottom up.

Standards that also reflect the pride of the oldest continuous culture on the planet.

This individual responsibility extends far beyond families, to health and community groups and organisations, too.

Everyone working to close the gap in health equality must look at themselves and say: Together, we have outcomes to achieve – what difference are we really making today and how can we do better?

We must constantly walk around the communities we serve and look for patterns of disparity.

If that’s what we’re seeing, the question should be: Are we fighting our own people? Are we listening enough?

Fortunately for the future, increasing numbers of young First Nations people are hearing the call to lead the next wave of change.

With more than 40 per cent of our Aboriginal and Torres Strait Islander population aged under 24, large groups – like the undergraduates I met recently at the university college – are set to make a big impact across many fields that may help close the gap.

Through concerted programs around the country, there’s also a growing number of First Nations health professionals at all levels – as doctors and nurses; in allied health, administration and management; in policy, planning and research.

My message to them and to all Aboriginal and Torres Strait Islander people, in communities across this nation, is that we are proud descendants of those who came here at least 65,000 years ago.

We have proven incredibly resilient, and we’ll continue that tradition of resilience, and respect for our country and for all Australians.

But the strength of our cultural identity will always remain the basis for our health – and what we strive for and live for.

Thank you.

 

NACCHO Aboriginal Women’s Health #SocialDeterminants #RedfernStatement : The impact of political determinants of health must be recognised for Aboriginal and Torres Strait Islander women

 

 ” Western culture remains the dominant culture in Australian society.

Its worldview has shaped Australian society and is constantly in conflict with the cultural identity and knowledge of Aboriginal and Torres Strait Islanders, including that of women.

Recently, Australian Indigenous leaders have set out a blueprint for action in the Redfern Statement. 

This blueprint acknowledges that Aboriginal people have provided viable, holistic solutions.

Without a change in leadership attitudes, governance and administration, Aboriginal and Torres Strait Islander women will continue to be disadvantaged, and their health will continue to suffer.

It is high time that Australian policymaking recognized the above issues and acted with integrity on the deficits because we will not have equality until Australia recognizes the impact of the political determinants of health as identified throughout this paper.

Australia will never be a whole, functioning society until institutionalised oppression ceases. ” 

Originally published here Power and Persuasion

Read over 340 Aboriginal Women’s Health articles published by NACCHO over past 6 years

Read over 100 Aboriginal Health and Social Determinants published by NACCHO over past 6 years

The role of government policy is to support its citizenry to thrive. By this measure, Australian policy is failing Aboriginal and Torres Strait Islander communities, and women are bearing the brunt of failed policy through seriously compromised health and wellbeing. “

In this analysis, Vanessa Lee from the University of Sydney applies a lens of political determinants of health to illuminate policy failure for Indigenous women and their communities, and calls for the government to be held accountable to the outcomes of generations of harmful policy.

 This piece is drawn from an article that ran in the Journal of Public Health Policy in 2017.

Paternalism is compromising the health of Indigenous women

When it comes to Australian policy, Aboriginal and Torres Strait Islander women are not being supported. Rather, a long history of paternalistic government decisions created barriers towards Indigenous women achieving equivalent health and wellbeing measures when compared to non-Indigenous women.

The manifestation of colonisation has included a displacement of Aboriginal and Torres Strait Islander people, a history of segregation and apartheid, and a breakdown of culture and cultural values through the impact of missionaries and government legislation, Acts and policies.

These political determinants of health breech human rights conventions, lack an evidence base, and are profoundly damaging across generations. Better policy could be and should be implemented but there appears to be a lack of political will.

Aboriginal and Torres Strait Islander women experience poorer health and reduced social and emotional wellbeing when compared to non-Indigenous women, and this is due to generational life circumstances. Aboriginal and Torres Strait Islander women take a holistic world view that intrinsically connects family and culture with everything else that they connect with.

What this means is that Indigenous women have a cultural and family relationship with their social and economic world.

The breakdown in life circumstances are evident today across employment and education where 39 per cent of the Indigenous females were employed compared to 55 per cent of the non-Indigenous females; and 4.6 per cent overall of the Indigenous compared to 20 per cent of the non-Indigenous people have completed a bachelor degree or higher degree.[1]

Educational attainment and employment are intrinsically linked to economic opportunity, with higher levels of education reducing societal disadvantage. Failure to address these fundamental social determinants in early life contributes to life-long disadvantage.

When the British colonized Australia, they did so under a paternalistic ideology that remains evident today as Australian federal, state, territory and local governments continue to implement paternalistic policies. Paternalistic policies are those that restrict choices to individuals, ostensibly in their ‘best interest’ and without their consent.

The justification of such policies is often to change individuals’ damaging behaviours; for example gambling, smoking, consumption of drugs and alcohol, or the reliance on welfare payments. Given the etymology of the word ‘paternalism’, it is little wonder that Aboriginal and Torres Strait Islander women have been the victims of extraordinarily high levels of sexism, domestic violence, marginalization, work-place lateral violence and racism.

Especially since the policies were developed and implemented from colonisation, with little or no evidence to support the need to change behaviours of the First Nations women of Australia.  The response to the impact of these paternalistic policies has resulted in an increase in prevalence in pain and trauma based behaviours such as substance abuse.

Social determining factors

Social determinants of health are about “the cause of the cause.” Poorer health outcomes are not narrowed to individual lifestyle choice or risky behaviour. Understanding the social determinants of health requires looking at the relationship between cause, social factors and health outcomes. Social factors are those societal factors that influence health throughout life and include housing, education, access to healthcare and family support.

The diagram below highlights an example of the circular relationship between the causes of the social factors and the social factors themselves across a person’s life stages. The unborn Aboriginal and/or Torres Strait Islander child of parents with high drug and/or alcohol intake, low income and low education will be born into an environment influenced at the macrosocial level by history, culture, discrimination and the political economy.

This first stage of inequality can manifest in increasing risky behaviours such as smoking, drinking, unhealthy eating, and lack of exercise or imprisonment. These behaviours have been associated with intellectual impairment that continues through all life stages.[ii] Quite often the continuous exposure to drugs and alcohol from adults becomes part of the child’s assumption of the normality of risk-taking behaviour and the cycle continues.

Tragically, at times the child born into this situation may commit suicide. Indigenous young people are as much as five times more likely to commit suicide as their non-Indigenous peers. Or the child may end up in prison, and although Indigenous women make up 2% of the adult female population 2% of the adult female populationin Australia they make up 27 to 34% of the female prison population across jurisdictions (see also here). T

he imprisonment of women causes an upheaval in their lives and that of their families and for Indigenous women it also creates a breakdown in their world view and to all that is connected to their world view.

Diagram 1: Relationship between ‘the cause’ and life stages

Relationship between causes, social factors and life stages

Social and economic circumstances have a profound impact on individual experiences of inequity, yet within a neoliberal framework the individual is blamed for making poor choices. The government’s failure to acknowledge or address the causes which shape the social factors that in turn underpin individual lifestyle “choices” reveals a disinterest in addressing the socio-structural causes of illness and health.

When governments invest long-term resources and time into understanding the socio-structural causes of illness and health, they will recognize that Aboriginal and Torres Strait Islander women are constantly subjected to unnecessary inequalities that mitigate against making positive lifestyle choices for future generations.

Structured inequities within society are based on unequal distribution of power, wealth, income and status. A woman’s ability to move up and down the class system is directly impacted by socioeconomic position or status – including education, employment and income.

This truth epitomizes the gross inequalities that continue to exist in Australian society. Inequities in health are heightened because social class not only includes education, employment and income but also differential access to power. Social class structures are characterized by factors including race, sex/gender, ethnicity, Indigeneity and religion. Fundamentally, it is structural issues of class and political disadvantage that place Aboriginal and Torres Strait Islander women close to the bottom of the socioeconomic ladder.

Political determinants

From colonization of Australia until the present day, the policy decisions for Aboriginal and Torres Strait Islander people made by National, State and Territory governments, churches and other institutions have had dire effects on Indigenous peoples’ health and well-beingInequitable policies contributed to inequalities in health resulting from unequal distribution of power and resources between Indigenous and non-Indigenous people.

The impact of policies which fail to take a holistic view on Indigenous population health reflects a political failure of the system with regard to the basic human rights of Aboriginal and Torres Strait Islander people and their good health and well-being.

Denial of a human right directly violates a person’s right to self-determination. These rights should be protected by a covenant to which Australia is a signatory—The International Covenant on Civil and Political Rights (1966) (The Covenant). It states that “all peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development” (Article 1 Section 1).

The level of Australia’s commitment to this covenant became questionable with the implementation of The Northern Territory National Emergency Response (the Intervention) in 2007. This was a federal government action that ignored one of its own government-funded reports highlighting the critical importance of working with Aboriginal and Torres Strait Islander people in the design and implementation of initiatives for their communities. In less than six months, following the politically motivated “Intervention” that was introduced just prior to an election, the Australian parliament introduced a complex legislative package consisting of five Bills, all 450 pages long and passed in parliament on the same day.

The bills were primarily associated with welfare reform. In 2008, a national emergency response by the Australian government took effect and was administered across all of the Northern Territory using the political rationale ‘to protect Aboriginal children’. This appeared to be an excuse to further erode Indigenous self-determination rather than to address the safety of children; as one critic pointed out, “we have witnessed the abandonment of consultation with Indigenous people, diminishing use of available statistical and research evidence and increased marginalization of the experts – especially if their views diverge from national leadership.” (p. 7)

The impact on health outcomes

Welfare data published in 2016 show that Indigenous children in the Northern Territory were being removed from families at 9.8 times more often than that of non-Indigenous children based on ‘reforms’ in the five new ‘welfare reform’ Bills.

The Northern Territory Indigenous death rates are still 2.3 times higher than those of non-Indigenous people, and Indigenous people experience assault victimization at six times the rate of non-Indigenous people (see here).

The 2014/2015 Social Survey found that fewer than half of Aboriginal and Torres Strait Islander people aged 15 years and over were employed, and males were more than twice as likely as females to be working full time.

The deplorable outcomes of these politically motivated policies are most clearly illustrated by the understanding that Aboriginal and Torres Strait Islander women between the ages of 20 and 24 years are four times more likely to commit suicide than are the other woman and between 70-60% of Indigenous women in prisons are due to them being victims of domestic violence.

Holding government accountable to policy outcomes

These outcomes demonstrate the political failure of Australian governments at national, state, territory and local levels to work with the Aboriginal and Torres Strait Islander people, and the lack of integrity surrounding equitable policy administration, leadership and governance.

Many policies developed for Aboriginal and Torres Strait Islanders over a long period of time have contributed to the shameful inequity in Australian society between Indigenous and non-Indigenous people. This level of inequity is even more dramatic with regard to Indigenous women.

The Covenant is neither the first Human Rights Charter that Australia has signed nor the first it has violated to the disadvantage of Aboriginal and Torres Strait Islander women, their health and well-being (and of the entire Indigenous population). Australia played a key role as one of eight nations involved in developing the United Nations’ Universal Declaration of Human Rights, when Australian Dr HV Evatt was the President of the United Nations General Assembly.

Until a referendum allowed Aboriginal and Torres Strait Islander people to become citizens, there was scant regard to Article 2: “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status”. The Australian government is disregarding its own stated ideals when it disregards the rights of Indigenous Australians.

The gap in health outcomes between Aboriginal and Torres Strait Islanders and other Australians is becoming more apparent, leading to calls for a new and more effective response. The effects of discriminative policies are now being exposed more often – thus, they become more visible. Non-Indigenous services account for 80 per cent of Indigenous expenditure, and there is a lack of transparency and clarity evaluating how these organizations address policies developed by government for Aboriginal and Torres Strait Islander people.

Fifty per cent of the Indigenous Australian population is under the age of 22and their health, as that of their elders, remains dire. Without understanding their cultural ways of doing and knowing and without working with Aboriginal and Torres Strait Islander women in making policy decisions, there will be no progress in achieving health equality for this population group.

Major changes needed

Western culture remains the dominant culture in Australian society. Its worldview has shaped Australian society and is constantly in conflict with the cultural identity and knowledge of Aboriginal and Torres Strait Islanders, including that of women. Recently,

Australian Indigenous leaders have set out a blueprint for action in the Redfern Statement.

This blueprint acknowledges that Aboriginal people have provided viable, holistic solutions. Without a change in leadership attitudes, governance and administration, Aboriginal and Torres Strait Islander women will continue to be disadvantaged, and their health will continue to suffer.

It is high time that Australian policymaking recognized the above issues and acted with integrity on the deficits because we will not have equality until Australia recognizes the impact of the political determinants of health as identified throughout this paper. Australia will never be a whole, functioning society until institutionalised oppression ceases.

References

[1] Burns, J., MacRae, A., Thomson, N., Anomie., Catto, M., Gray, C., Levitan, L., McLoughlin, N., Potter, C., Ride, K., Stumpers, S., Trzesinski, A. and Urquhart, B. (2013) Summary of Indigenous women’s health. http://www.healthinfonet.ecu.edu.au/population-groups/women/reviews/our-review.

[ii] Carson, B., Dunbar, T., Chenhall, R. and Bailie, R. (Eds.). (2007). Social determinants of indigenous health. Sydney, Australia: Allen & Unwin.

NACCHO #ClosingTheGap Aboriginal Health : @congressmob and #RedfernStatement Alliance leaders express dismay over last minute changes to high-level #Aboriginal peak body meeting for @pmc_gov_au #CTGRefresh consultations

 ” National Congress and Redfern Statement Alliance leaders meeting in Canberra yesterday  have expressed dismay over last minute changes to a high-level Aboriginal peak body meeting for the Closing the Gap Refresh consultations.

Co-Chair Rod Little expressed his frustration, saying ‘it is critical that the government respects the need for Aboriginal peak bodies to share their expert views without having to accommodate other powerful voices such as NGOs.”

Download full Press Release : National Congress – Closing the Gap Refresh Rejigged – Final pdf Media Release Final 4th April 2018 (1)

The Closing the Gap Refresh agenda stated: ‘Australian governments acknowledge they need to work differently with Aboriginal and Torres Strait Islander Peoples.

Our Redfern Statement called for the government to ‘commit to better engagement with Aboriginal and Torres Strait Islander peoples through their representative national peaks.’ More specifically, the recommendation focused on ‘convening regular high level ministerial and departmental meetings and forums with the National Congress and the relevant peak organisations and forums.’

Read 15+ NACCHO articles about the Redfern Statement

National Congress has only recently learnt that no longer will Aboriginal peak bodies be given the much-anticipated exclusive opportunity to voice their views on the Refresh project.

Now we understand that the government organisers have opened the doors to a range of non-indigenous NGOs to participate on the same day.

Whilst these organisations have valuable contributions to make, this may not be the appropriate forum.

The consultation process is already compressed enough without our organisations having to abbreviate our important contributions.”

What is potentially being overlooked by consultation organisers is how having NGOs present might impact on critical evaluations of the influence of NGOs themselves on Aboriginal and Torres Strait Islander affairs.

It should not be taken for granted that NGOs and Aboriginal peak bodies see eye to eye on a range of issues, and the sensitive issue of setting targets for Closing the Gap may well be such an issue.

National Congress reminds the government that the Redfern Statement Alliance is an excellent framework with which to engage Aboriginal peak bodies.

No member of this alliance wants to see its perspectives on Closing the Gap Refresh watered down or diminished by competing organisations.

Our peak organisations are calling for the full attention of the government and an exclusive opportunity to have our voices heard.

The government is not meeting its own expectations and working ‘differently’ by having powerful NGO representatives share this key consultation.

We would like this to be addressed as a matter of urgency.

Background to #CTGRefresh

Another step in this process is to consider how governments can improve program implementation. Six implementation principles have been developed to guide the new Closing the Gap agenda.

The principles are:

  • Funding prioritised to meet targets
  • Evidence-based programs and policies
  • Genuine collaboration between governments and communities
  • Programs and services tailored for communities
  • Shared decision-making
  • Clear roles, responsibilities and accountability

How you can get involved ?

We want your views on the future of Closing the Gap. What is important, what worked and how can we do better?

“We have to be there to be part of the conversation, so let’s get with it.” – Chris Sarra, Co-Chair Indigenous Advisory Council, and Founder and Chair, Stronger, Smarter Institute

We’re interested in getting your thoughts on a few questions below. You don’t need to answer every question.

Alternatively, you may prefer to upload a submission.

Once you’ve completed your response, click ‘Next’ and we will ask you a few questions about yourself.

Read the discussion paper for more information on the Closing the Gap Refresh.

Submissions close 5pm AEDT 30 April  2018.

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

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

See 2 SkyNews Broadcasts below

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

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

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

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

Above Editorial Daily Telegraph 3 April

Firstly those in favour of this cultural safety policy include

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

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

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

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

1.Dr Michael Gannon President AMA

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

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

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

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

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

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

2. AMA (NSW) President, Prof Brad Frankum

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

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

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

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

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

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

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

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

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

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

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

6.NSW Health deputy secretary Susan Pearce

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

7.NSW Health spokeswoman .

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

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

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

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

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

Part 1 NSW Policy

Download The Policy document in full

NSW Policy Doc

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

Strategies to address issues identified should be implemented and evaluated

2.1.3 Considerations for Aboriginal patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 3 : Culturally safe healthcare starts in the waiting room

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

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

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

 

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

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

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

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

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

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

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

 

Part 4 Racism and the hospital system : Donna Ah Chee

 Read in full here

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

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

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

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

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

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

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

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

References

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

 

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

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

Martin Laverty, Dennis R McDermott and Tom Calma

Originally published by MJA here

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

MJA Cultural Safety

Read 20 + previous NACCHO articles Cultural Safety  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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