NACCHO Aboriginal Health and Health Literacy Research : Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care.

” Enhancing health literacy can empower individuals and communities to take control over their health as well as improve safety and quality in healthcare.

However, Indigenous health studies have repeatedly suggested that conceptualisations of health literacy are confined to Western knowledge, paradigms, and practices. The exploratory qualitative research design selected for this study used an inductive content analysis approach and systematic iterative analysis.

Publicly available health literacy-related policy and practice documents originating from Australia, Canada, and New Zealand were analysed to explore the extent to which and the ways in which Indigenous knowledges are recognised, acknowledged, and promoted.

 Findings suggest that active promotion of Indigenous-specific health knowledges and approaches is limited and guidance to support recognition of such knowledges in practice is rare.

Given that health services play a pivotal role in enhancing health literacy, policies and guidelines need to ensure that health services appropriately address and increase awareness of the diverse strengths and needs of Indigenous Peoples.

The provision of constructive support, resources, and training opportunities is essential for Indigenous knowledges to be recognised and promoted within health services.

Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care. “

Gordon Robert Boot and Anne Lowell Charles Darwin University, Australia

Download full copy of research 

Health Literacy

Image above from Menzies study : The aim of this study was to understand the interplay between health literacy, gender and cultural identity among young Aboriginal and Torres Strait Islander males living in the Northern Territory.

The health promotion sector is increasingly recognising that developing and improving individual, population, and provider health literacy (HL) is an important and effective strategy to enhance health and wellbeing, as well as to improve safety and quality in healthcare (Australian Commission on Safety and Quality in Health Care [ACSQH], 2014; Centre for Literacy, 2011; Johnson, 2014).

Integral to HL is the capability of individuals and the wider community to take active control and participate in addressing their healthcare needs (ACSQH, 2014, Johnson, 2014, Nutbeam, 2008).

Health outcomes can be improved through HL competencies that enable self-care and self-advocacy, development of mutual trusting relationships with health professionals, more effective access to and navigation of the healthcare system, as well as the ability of service providers to communicate effectively (Paasche-Orlow & Wolf, 2007, Sørensen et al., 2012).

Recent studies have highlighted that inclusion and promotion of Indigenous health knowledges within health promotion practices can enhance overall Indigenous health outcomes through mutual recognition of differing worldviews (Smylie, Kaplan-Myrth, McShane & Métis Nation of Ontario-Ottawa, 2008; Vass, Mitchell, & Dhurrkay, 2011), improved health communication (Lowell et al., 2012), and through strengthening cultural safety within culturally diverse healthcare systems (Rowan et al., 2013; Nielsen, Alice Stuart & Gorman, 2014).

However, representation of Indigenous health knowledges and practices within health literacy-related policy and practice documents does not appear to have been investigated in previous research.

The overall purpose of this paper is to present selected findings of a larger study (Boot, 2016), which has sought to address this knowledge gap by exploring the extent and means by which Indigenous knowledges, paradigms, and practices are recognised, acknowledged, and promoted within HL-related documents across Australia, Canada, and New Zealand.

This article focuses on two themes from the findings that have particular relevance: acknowledging cultural beliefs, practices, and norms, and promotion of Indigenous cultural health knowledges, paradigms, and practices (Boot, 2016).

The next section of this article explores definitions and context encompassing Indigenous health and health literacy. The Methods section describes in detail the exploratory research approach, document selection, and content analysis process.

The Findings section illustrates prominent examples from within the two themes that are represented within this article. The relevance and implications of these findings are further explored in the concluding discussion, and recommendations for future research are presented.

Background

Many countries, including Australia, Canada, and New Zealand, are considered to have world-class healthcare systems (Organisation for Economic Co-operation and Development, 2017).

Extensive efforts are made by governments and the health promotion sector to improve overall health and quality of life outcomes within these populations (Organisation for Economic Co-operation and Development, 2017).

The majority of people living within these countries have reasonably good health and enjoy an average life expectancy of 78 to 82 years of age (Australian Bureau of Statistics [ABS], 2015b; Statistics Canada, 2015; Statistics New Zealand, 2015).

All three countries have a similarly rich history of Indigenous cultures, knowledges, and languages, but life expectancy for many Indigenous people within these countries remains significantly lower, ranging from 69 to 80 years of age, in comparison with the national average (ABS, 2015a; Statistics Canada, 2015; Statistics New Zealand, 2015).

The health inequities Indigenous people experience today are predominantly linked to the effects of colonisation and persistently unfavourable social determinants (Dudgeon, Milroy & Walker, 2014; Griffiths, Coleman, Lee & Madden, 2016; Sherwood, 2013).

Governments and frontline health services aim to overcome these inequities by developing and implementing a variety of policies, strategies, and evidence-based approaches.

Defining Health Literacy 

The concept of health literacy originates from the field of education and has in recent years expanded to include a wide range of skills and knowledges. Health literacy is commonly defined as the abilities and skills of an individual or community to access, appraise, and communicate health-related information, to navigate and engage with the healthcare system, and to advocate and maintain personal and community health and wellbeing (Centre for Literacy, 2011; Nutbeam, 2000; Sørensen et al., 2012; World Health Organisation, 2016a).

Governments and scholars advocate that developing and enhancing HL within populations supports the process of empowerment thereby enabling the individual, community, and society to take control over their healthcare needs and engage in collective action to promote health (ACSQH, 2014; Estacio, 2013; Freedman et al., 2009; Johnson, 2014; Kickbusch, 2009; Ministry of Health, 2015; Mitic & Rootman, 2012; Nutbeam, 2008; Sykes, Wills, Rowlands, & Popple, 2013).

Health literacy skills develop across the lifespan, are context specific, and influenced by social, cultural, and political contexts (Centre for Literacy, 2011; Kickbusch, Wait, & Maag 2006; Mitic & Rootman, 2012; Paasche-Orlow & Wolf, 2007; Vass et al., 2011; Zarcadoolas, Pleasant, & Greer, 2005).

Zarcadoolas et al. (2005), for example, asserted that cultural health literacy needs to be inherent within health literacy models. This is defined as having “the ability to recognize and use collective beliefs, customs, world-view and social identity in order to interpret and act on health information” (p. 197).

In addition, Ewen (2011) argued that health professionals need to obtain and effectively utilise cultural literacy skills in order for them to be culturally competent in their service delivery.

Cultural literacy is considered a skill-set that encompasses awareness, respect, and responsiveness to cultural differences and needs (Ewen, 2011). These abilities become critical within culturally diverse healthcare environments where worldviews, values, approaches to communication, and conceptualisations of health and wellbeing differ significantly from those endorsed by the dominant culture.

More recent conceptualisations of HL are increasingly recognising the significance and complexity of the health literacy environment: That is, “the infrastructure, policies, processes, materials, people and relationships that make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services” (ACSQH, 2014, p. 10). The Global Conference on Health Promotion in Shanghai in 2016 also identified HL as a critical social determinant of health that needs to be developed and strengthened within populations (World Health Organisation, 2016b). Enhancing HL skills within Indigenous populations, however, requires sophisticated cultural literacy and a collaborative, comprehensive, and empathetic approach due to the diversity in worldviews, perceptions of health and wellbeing, as well as complex sociocultural factors (Ewen, 2011; Smylie, Williams & Cooper, 2006; Vass et al., 2011).

Indigenous Concepts of Health and Wellbeing

Indigenous populations across and within each of the three countries that are the focus of this article

(Australia, Canada, and New Zealand) are diverse in terms of languages and their physical environment (urban, rural, level of remoteness, and climate), as well as political and social relationships, ancestral heritage, and cultural knowledges and practices (Dudgeon et al., 2014; Greaves, Houkamau & Sibley, 2015; Stephenson, 1995). Although Indigenous Peoples share some common health beliefs, their health knowledges and healing practices are diverse due to the unique social, cultural, political, and environmental circumstances within which they have developed and continue to exist (Dudgeon et al., 2014; Durie, 1994).

Despite this diversity, Indigenous people across all three countries tend to regard health and wellbeing as a holistic, multidimensional, and interconnected concept that cannot be separated from other aspects or fragmented into distinguishable individual units (Durie, 1994; Morgan, Slade & Morgan, 1997; Stephens, Porter, Nettleton & Willis, 2006). Health and wellbeing incorporates physical, psychological, social, ecological, spiritual, and cultural aspects and is sustained by nurturing and attending to all these relational aspects regularly in an appropriate and meaningful manner (Campbell, 2002; Durie, 1994; Morgan et al., 1997; Vukic, Gregory, Martin-Misener & Etowa, 2011; Wilson, 2008). Individual studies within all three countries similarly highlight how positive strengthening and maintaining of those interrelated aspects can provide preventative and long-lasting health benefits (Colles, Maypilama & Brimblecombe, 2014; Dockery, 2010; Hopkirk & Wilson, 2014; Lambert et al., 2014; Lowell, Kildea, Liddle, Cox & Paterson, 2015; Smylie et al., 2008; Wilson, 2008).

Previous research addressing Indigenous health concerns have identified HL-related barriers and challenges including racism, communication and language barriers, poor relationships, and culturally associated misconceptions (Durey & Thompson, 2012; Lambert et al., 2014; Lowell et al., 2015; Vass et al., 2011). Such challenges can significantly obstruct access to and provision of effective primary healthcare services, inevitably influencing health outcomes (Lambert et al., 2014). The need for healthcare systems to adequately acknowledge and incorporate Indigenous health knowledges within health promotion practices has also been identified (Hopkirk & Wilson, 2014; Liaw et al., 2011; Lowell et al., 2015; Nielsen et al., 2014; Priest, MacKean, Davis, Briggs & Waters, 2012; Rowan et al., 2013; Vass et al., 2011).

Incorporating and promoting Indigenous knowledges within an Indigenous healthcare environment has the potential to strengthen culturally safe practices and opportunities for self-determination, enhance health communication, and to foster relationships that are built on trust and mutual respect (Colles et al., 2014; Dockery, 2010, Hopkirk & Wilson, 2014; Lambert et al., 2014, Lowell et al., 2015). However, the majority of current conceptualisations of HL are commonly confined to Western pedagogies and paradigms. As such, they frequently disregard the significance of Indigenous cultures, languages, and knowledges as strengths, with potential health benefits (Akena, 2012; Barwin, 2012; Durey & Thompson, 2012; Lambert et al., 2014; Priest et al., 2012; Sherwood, 2013; Smylie et al., 2006; Vass et al., 2011).

Ingleby (2012) suggested that every person has some form of HL that is intrinsic to their personal and cultural beliefs. Enhancing HL within diverse populations can therefore only be achieved when distinctive personal and cultural beliefs are taken into account and appropriately acted upon (Ingleby, 2012). Indigenous concepts of holistic health and associated knowledges and practices have developed over millennia, ensuring individual and community survival, health, and well-being prior to colonisation and beyond. For example, Indigenous-specific HL includes knowledges and practices related to bush medicines and sourcing traditional food (Ewen, 2011) and the interconnectedness of language, physical, emotional, environmental, and spiritual aspects that as a whole contribute to health and wellbeing among First Nation people (Smylie et al., 2006).

 

NACCHO Aboriginal Health #SaveADate @KidneyHealth April 8 -14 #KidneyHealthWeek #iKidneyCheck Plus @AusHealthReform Defining #culturalsafety – a public consultation. The consultation ends 15 May 2019

This weeks featured NACCHO SAVE A DATE events

15 May Cultural Safety Consultation closes

Download the 2019 Health Awareness Days Calendar 

8- 14 April Kidney Health Week

9 April Webinar : What will #Budget2019 mean for health consumers?

20 -24 May 2019 World Indigenous Housing Conference. Gold Coast

18 -20 June Lowitja Health Conference Darwin

2019 Dr Tracey Westerman’s Workshops 

7 -14 July 2019 National NAIDOC Grant funding round opens

23 -25 September IAHA Conference Darwin

24 -26 September 2019 CATSINaM National Professional Development Conference

9-10 October 2019 NATSIHWA 10 Year Anniversary Conference

16 October Melbourne Uni: Aboriginal and Torres Strait Islander Health and Wellbeing Conference

5-8 November The Lime Network Conference New Zealand 

Featured Save a dates date

15 May Cultural Safety Consultation closes 

This engagement process is important to ensure the definition is co-designed with Aboriginal and Torres Strait Islander people, health professionals and organisations across Australia.

Cultural safety is essential to improving health and wellbeing outcomes for Aboriginal and Torres Strait Islander Peoples and we are committed to a genuine partnership approach to develop a clear definition “

NHLF Chair, Pat Turner said the forum’s partnership with the Strategy Group meant that the definition is being led by Aboriginal and Torres Strait Islander health experts, which is an important value when developing policies or definitions that affect Aboriginal and Torres Strait Islander Peoples.

The NHLF has been operating since 2011 and is national representative committee for Aboriginal and Torres Strait Islander health peak bodies who provide advice on all aspects of health and well-being.

Help define this important term for the scheme that regulates health practitioners across Australia.

AHPRA, the National Boards and Accreditation Authorities in the National Registration and Accreditation Scheme which regulates registered health practitioners in Australia have partnered with Aboriginal and Torres Strait Islander health leaders and the National Health Leadership Forum (NHLF) to release a public consultation.

Together, they are seeking feedback on a proposed definition of ‘cultural safety’ to develop an agreed, national baseline definition that can be used as a foundation for embedding cultural safety across all functions in the National Registration and Accreditation Scheme and for use by the National Health Leadership Forum.

In total, there are 44 organisations represented in this consultation, which is being coordinated by the Aboriginal and Torres Strait Islander Health Strategy Group (Strategy Group), which is convened by AHPRA, and the NHLF (a list of representatives is available below).

Strategy Group Co-Chair, Professor Gregory Phillips said the consultation is a vital step for achieving health equity for Aboriginal and Torres Strait Islander Peoples. (see Picture below )

‘Patient safety for Aboriginal and Torres Strait Islander Peoples is inextricably linked with cultural safety. We need a baseline definition of ‘cultural safety’ that can be used across the National Scheme so that we can help registered health practitioners understand what cultural safety is and how it can help achieve health equity for all Australians’, said Prof Phillips.

The NHLF has been operating since 2011 and is national representative committee for Aboriginal and Torres Strait Islander health peak bodies who provide advice on all aspects of health and well-being.

The consultation is a continuation of the work by the National Scheme’s Strategy Group that has achieving health equity for Aboriginal and Torres Strait Islander Peoples as its overall goal. Members of the Group include Aboriginal and Torres Strait Islander health leaders and members from AHPRA, National Boards, Accreditation Authorities and NSW Councils.

AHPRA’s Agency Management Committee Chair, Mr Michael Gorton AM, said the far reach of this work is outlined in the Strategy Group’s Statement of intent, which was published last year.

‘The approach to this consultation is embodied in the Strategy Group’s Statement of intent, which has commitment, accountability, shared priorities, collaboration and high-level participation as its values. As a scheme, we are learning from our engagement with Aboriginal and Torres Strait Islander leaders, who are the appropriate leaders in this work. I thank these leaders, and the experts who have shared their knowledge and expertise with us, for their generosity and leadership which will lead to better health outcomes’, said Mr Gorton.

The six-week consultation is open to the public. Everyone interested in helping to shape the definition of ‘cultural safety’ that will be used in the National Scheme and by NHLF members is warmly invited to share their views.

The consultation is open until 5:00pm, Wednesday 15 May 2019.

For more information:

Download the NACCHO 2019 Calendar Health Awareness Days

For many years ACCHO organisations have said they wished they had a list of the many Indigenous “ Days “ and Aboriginal health or awareness days/weeks/events.

With thanks to our friends at ZockMelon here they both are!

It even has a handy list of the hashtags for the event.

Download the 53 Page 2019 Health days and events calendar HERE

naccho zockmelon 2019 health days and events calendar

We hope that this document helps you with your planning for the year ahead.

Every Tuesday we will update these listings with new events and What’s on for the week ahead

To submit your events or update your info

Contact: Colin Cowell www.nacchocommunique.com

NACCHO Social Media Editor Tel 0401 331 251

Email : nacchonews@naccho.org.au

Kidney Health Week: 8 – 14 April, 2019

” I’m Alice, I’m 31, and I have chronic kidney disease. When I found out my kidneys were failing, I didn’t understand what it meant or what my kidneys do, but now I do. The kidneys are one of the main organs in your body and if they aren’t well, you can get really sick, and end up in hospital on dialysis.

Before my health issues, I remember running around with my brother and cousins and doing everything kids are allowed to do. But when I turned 10, I couldn’t anymore. I felt like my freedom had been taken away from me. I asked all the time ‘why does this have to happen to me?’

Starting dialysis was terrifying. I didn’t know anything about it until I had been on it myself. It’s annoying knowing the fact that I’m going to be on it dialysis for the rest of my life. My advice is to go get your kidneys checked every 6 months. Having kidney disease is just as bad as having cancer but nobody knows about it until they get it.”

See Alice’s Webpage to donate 

This Kidney Health Week, Kidney Health Australia is asking Aboriginal and Torres Strait Islander
communities to visit their local Indigenous Health Centre to complete simple tests – blood, urine and blood pressure – to see if they are at risk of developing chronic kidney disease.

Download Kidney Health Week Supporter Kit with all the tools and resources you need to assist Kidney Health Australia to raise awareness of kidney disease. This includes social media text and images, newsletter copy, and key messages for your staff, affiliates, supporters as appropriate.

Kidney Health Week 2019 Supporter Kit – Alliances

Kidney Health Australia CEO, Chris Forbes, explained that while Aboriginal and Torres Strait Islander people represent less than 2.5 percent of the national population, they account for approximately eleven percent of people commencing kidney replacement therapy each year and the incidence of end-stage kidney disease for Indigenous peoples in remote areas of Australia is 18 to 20 times higher than that of comparable non-Indigenous peoples.

TAKE THE TEST HERE 

9 April What will #Budget2019 mean for health consumers?

What will  mean for health consumers? Join us next Tuesday for our webinar to learn more.

Register here 

20 -24 May 2019 World Indigenous Housing Conference. Gold Coast

Thank you for your interest in the 2019 World Indigenous Housing Conference.

The 2019 World Indigenous Housing Conference will bring together Indigenous leaders, government, industry and academia representing Housing, health, and education from around the world including:

  • National and International Indigenous Organisation leadership
  • Senior housing, health, and education government officials Industry CEOs, executives and senior managers from public and private sectors
  • Housing, Healthcare, and Education professionals and regulators
  • Consumer associations
  • Academics in Housing, Healthcare, and Education.

The 2019 World Indigenous Housing Conference #2019WIHC is the principal conference to provide a platform for leaders in housing, health, education and related services from around the world to come together. Up to 2000 delegates will share experiences, explore opportunities and innovative solutions, work to improve access to adequate housing and related services for the world’s Indigenous people.

Event Information:

Key event details as follows:
Venue: Gold Coast Convention and Exhibition Centre
Address: 2684-2690 Gold Coast Hwy, Broadbeach QLD 4218
Dates: Monday 20th – Thursday 23rd May, 2019 (24th May)

Registration Costs

  • EARLY BIRD – FULL CONFERENCE & TRADE EXHIBITION REGISTRATION: $1950 AUD plus booking fees
  • After 1 February FULL CONFERENCE & TRADE EXHIBITION REGISTRATION $2245 AUD plus booking fees

PLEASE NOTE: The Trade Exhibition is open Tuesday 21st May – Thursday 23rd May 2019

Please visit www.2019wihc.com for further information on transport and accommodation options, conference, exhibition and speaker updates.

Methods of Payment:

2019WIHC online registrations accept all major credit cards, by Invoice and direct debit.
PLEASE NOTE: Invoices must be paid in full and monies received by COB Monday 20 May 2019.

Please note: The 2019 WIHC organisers reserve the right of admission. Speakers, programs and topics are subject to change. Please visit http://www.2019wihc.comfor up to date information.

Conference Cancellation Policy

If a registrant is unable to attend 2019 WIHC for any reason they may substitute, by arrangement with the registrar, someone else to attend in their place and must attend any session that has been previously selected by the original registrant.

Where the registrant is unable to attend and is not in a position to transfer his/her place to another person, or to another event, then the following refund arrangements apply:

    • Registrations cancelled less than 60 days, but more than 30 days before the event are eligible for a 50% refund of the registration fees paid.
    • Registrations cancelled less than 30 days before the event are no longer eligible for a refund.

Refunds will be made in the following ways:

  1. For payments received by credit or debit cards, the same credit/debit card will be refunded.
  2. For all other payments, a bank transfer will be made to the payee’s nominated account.

Important: For payments received from outside Australia by bank transfer, the refund will be made by bank transfer and all bank charges will be for the registrant’s account. The Cancellation Policy as stated on this page is valid from 1 October 2018.

Terms & Conditions

please visit www.2019wihc.com

Privacy Policy

please visit www.2019wihc.com

18 -20 June Lowitja Health Conference Darwin


At the Lowitja Institute International Indigenous Health and Wellbeing Conference 2019 delegates from around the world will discuss the role of First Nations in leading change and will showcase Indigenous solutions.

The conference program will highlight ways of thinking, speaking and being for the benefit of Indigenous peoples everywhere.

Join Indigenous leaders, researchers, health professionals, decision makers, community representatives, and our non-Indigenous colleagues in this important conversation.

More Info 

2019 Dr Tracey Westerman’s Workshops 

More info and dates

7 -14 July 2019 National NAIDOC Grant funding round opens 

The opening of the 2019 National NAIDOC Grant funding round has been moved forward! The National NAIDOC Grants will now officially open on Thursday 24 January 2019.

Head to www.naidoc.org.au to join the National NAIDOC Mailing List and keep up with all things grants or check out the below links for more information now!

https://www.finance.gov.au/resource-management/grants/grantconnect/

https://www.pmc.gov.au/indigenous-affairs/grants-and-funding/naidoc-week-funding

23 -25 September IAHA Conference Darwin

24 September

A night of celebrating excellence and action – the Gala Dinner is the premier national networking event in Aboriginal and Torres Strait Islander allied health.

The purpose of the IAHA National Indigenous Allied Health Awards is to recognise the contribution of IAHA members to their profession and/or improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

The IAHA National Indigenous Allied Health Awards showcase the outstanding achievements in Aboriginal and Torres Strait Islander allied health and provides identifiable allied health role models to inspire all Aboriginal and Torres Strait Islander people to consider and pursue a career in allied health.

The awards this year will be known as “10 for 10” to honour the 10 Year Anniversary of IAHA. We will be announcing 4 new awards in addition to the 6 existing below.

Read about the categories HERE.

24 -26 September 2019 CATSINaM National Professional Development Conference

 

 

The 2019 CATSINaM National Professional Development Conference will be held in Sydney, 24th – 26th September 2019. Make sure you save the dates in your calendar.

Further information to follow soon.

Date: Tuesday the 24th to Thursday the 26th September 2019

Location: Sydney, Australia

Organiser: Chloe Peters

Phone: 02 6262 5761

Email: admin@catsinam.org.au

9-10 October 2019 NATSIHWA 10 Year Anniversary Conference

SAVE THE DATE for the 2019 NATSIHWA 10 Year Anniversary Conference!!!

We’re so excited to announce the date of our 10 Year Anniversary Conference –
A Decade of Footprints, Driving Recognition!!! 

NATSIHWA recognises that importance of members sharing and learning from each other, and our key partners within the Health Sector. We hold a biennial conference for all NATSIHWA members to attend. The conference content focusses on the professional support and development of the Health Workers and Health Practitioners, with key side events to support networking among attendees.  We seek feedback from our Membership to make the conferences relevant to their professional needs and expectations and ensure that they are offered in accessible formats and/or locations.The conference is a time to celebrate the important contribution of Health Workers and Health Practitioners, and the Services that support this important profession.

We hold the NATSIHWA Legends Award night at the conference Gala Dinner. Award categories include: Young Warrior, Health Worker Legend, Health Service Legend and Individual Champion.

Watch this space for the release of more dates for registrations, award nominations etc.

16 October Melbourne Uni: Aboriginal and Torres Strait Islander Health and Wellbeing Conference

The University of Melbourne, Department of Rural Health are pleased to advise that abstract
submissions are now being invited that address Aboriginal and Torres Strait Islander health and
wellbeing.

The Aboriginal & Torres Strait Islander Health Conference is an opportunity for sharing information and connecting people that are committed to reforming the practice and research of Aboriginal & Torres Strait Islander health and celebrates Aboriginal knowledge systems and strength-based approaches to improving the health outcomes of Aboriginal communities.

This is an opportunity to present evidence-based approaches, Aboriginal methods and models of
practice, Aboriginal perspectives and contribution to health or community led solutions, underpinned by cultural theories to Aboriginal and Torres Strait Islander health and wellbeing.
In 2018 the Aboriginal & Torres Strait Islander Health Conference attracted over 180 delegates from across the community and state.

We welcome submissions from collaborators whose expertise and interests are embedded in Aboriginal health and wellbeing, and particularly presented or co-presented by Aboriginal and Torres Strait Islander people and community members.

If you are interested in presenting, please complete the speaker registration link

closing date for abstract submission is Friday 3 rd May 2019.
As per speaker registration link request please email your professional photo for our program or any conference enquiries to E. aboriginal-health@unimelb.edu.au.

Kind regards
Leah Lindrea-Morrison
Aboriginal Partnerships and Community Engagement Officer
Department of Rural Health, University of Melbourne T. 03 5823 4554 E. leah.lindrea@unimelb.edu.au

5-8 November The Lime Network Conference New Zealand 

This years  whakatauki (theme for the conference) was developed by the Scientific Committee, along with Māori elder, Te Marino Lenihan & Tania Huria from .

To read about the conference & theme, check out the  website. 

NACCHO Aboriginal Health #Racism and #CulturalSafety : Has the The Ways of Thinking and Ways of Doing #WoTWoD  program designed to improve cultural respect in general practice and improve health outcomes for Aboriginal patients failed

“Cultural respect reflects the attitudes and behaviour of the entire medical practice, from reception to consulting room.

In addition, general practice organisations must work in partnership with Indigenous community-controlled organisations to reduce health care disparities, address social determinants of poor health, and increase access to safe, effective and culturally respectful care. ” 

 Professor Siaw-Teng Liaw, professor of General Practice at the UNSW Sydney and and colleagues 

A YEAR-long program designed to improve cultural respect in general practice and improve health outcomes for Aboriginal patients, has failed to either increase the rate of Indigenous health checks or improve cross-cultural behaviours, according to the authors of research published in the Medical Journal of Australia.

Download 6 page copy of research 

Cultural respect in general practice

Read full report online at MJA 

Cover : The painting created for the Ways of Thinking and Ways of Doing (WoTWoD) study by Ashley Firebrace, a Wurundjeri man from Melbourne.

With the majority of Australia’s Aboriginal population living in cities, suburban doctors’ clinics are part of the front-line effort to close the gap in health inequalities.

There are efforts to improve the way general practices treat Indigenous patients, but progress is slow.

A new study into a program designed to make GP clinics more culturally sensitive has found little improvement after 12 months.”

ABC Radio AM Interview with Janine Mohammed. interim chief executive, Lowitja Institute : Teng Liaw, professor of general practice, University of New South Wales and Dr Tim Senior, Aboriginal and Torres Strait Islander health medical advisor, Royal Australian College of General Practice and GP, Tharawal Aboriginal Medical Service

Listen HERE 3 Minutes

 

Read over 50 Aboriginal Health and Cultural Safety articles here  

The Ways of Thinking and Ways of Doing (WoTWoD) program was developed by a team led by Professor Siaw-Teng Liaw, professor of General Practice at the UNSW Sydney and the Ingham Institute of Applied Medical Research.

It was designed to “translate the systemic, organisational, and clinical elements of the Australian Health Ministers’ Advisory Council Cultural Competency Framework into routine clinical practice”.

The WoTWoD program includes “a toolkit [comprising 10 scenarios that illustrate cross-cultural behaviour in clinical practice], one half-day workshop, cultural mentor support for the practice, and a local care partnership of participating Medicare Locals/PHNs and local ACCHSs for guiding the program and facilitating community engagement”.

In evaluating the program, Liaw and colleagues introduced WoTWoD to 28 intervention general practices and compared the results after 12 months with 25 control practices.

After 12 months “the rates of MBS item 715 claims (health assessment for Aboriginal and Torres Strait Islander People) and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in cultural quotient scores, regardless of staff category and practice attribute”.

Liaw and colleagues wrote that the negative results may be attributable to “variability in the fidelity of the intervention, especially the local care partnership … the clinical and organisational reasons for low usage rate [of the MBS item 715] … and the length of the trial”.

“The length of the trial (12 months) may not have been sufficient to detect significant changes in professional practice dependent on organisational changes that require time to formulate and implement.

“Nevertheless, it is encouraging and promising that the data trends over the 12 months within each group were positive and participant perceptions of the WoTWoD were very positive.

“Further collaborative and participatory mixed methods research is required to examine the complexities of co-creating, implementing, and evaluating programs that integrate ‘thinking and doing’ cultural respect in the context of the changing needs and priorities of general practice and Indigenous communities,” Liaw and colleagues concluded.

The known: The gap in life expectancy between Indigenous and non‐Indigenous Australians remains large. Urban Indigenous Australian‐controlled health services are under‐resourced, and mainstream primary care services are often not culturally sensitive.

The new: A practice‐based cultural respect program — including a workshop and toolkit of scenarios, with advice from a cultural mentor, and guided by a care partnership of Indigenous and general practice organisations — did not significantly influence Indigenous health check rates or cultural respect levels.

The implications: Cultural respect programs may require more than 12 months to increase Indigenous health check rates and the cultural quotient scores of general practice clinic staff.

Closing the health and care gaps between Aboriginal and Torres Strait Islander (Indigenous) Australians and non‐Indigenous Australians has been a longstanding challenge.,

In 2018, a decade after Australian governments committed themselves to Closing the Gap, mortality and life expectancy for Indigenous Australians had not markedly improved, and nearly 80% of the difference in mortality between adult Indigenous and non‐Indigenous Australians was attributable to chronic disease.

The Practice Incentives Program–Indigenous Health Incentive (PIP‐IHI), introduced in May 2010, assists general practitioners undertake chronic disease care planning for their Indigenous patients. Initial uptake was poor: only 64% of general practices expected to register (1275 of 2000) did so during 2010–11. However, the proportion had increased by May 2012.

The rebate for health assessments for Aboriginal and Torres Strait Islander People (Medicare Benefits Schedule [MBS] item 715), constitutes an additional strategy for improving the access of Indigenous Australians to primary health care matched to their needs. GPs can engage suitably qualified practice nurses or Aboriginal Health Workers to assist with the assessment, including patient history‐taking, clinical examination and investigations, and with providing patients with education and resources for managing their own health.

The proportion of Indigenous Australians for whom payment for MBS item 715 was claimed increased from nearly 11% in 2010–11 to nearly 29% in 2016–17 (New South Wales, 26.8%; Victoria, 17.1%). However, the rate is still low and access to comprehensive care planning for Indigenous Australians is poor

Aboriginal Community Controlled Health Services (ACCHSs) are important providers of primary health care to Indigenous communities. However, most Indigenous Australians living in urban areas also use standard primary care and GP services.

In 2016, Indigenous Australians comprised 3% of the Australian population (744 956 people); 38% lived in New South Wales (229 951) or Victoria (53 663). About one‐third of Indigenous Australians live in major cities, but only 16 of 138 ACCHSs are in major cities; urban ACCHSs have lower staff/client ratios than regional and remote ACCHSs.

Indigenous Australians frequently encounter cultural disrespect in mainstream primary care services., The 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey reported that 16% of Indigenous Australians had experienced racism in health settings; 20% of these respondents reported that doctors, nurses and other hospital or clinic staff were discriminatory, and 7% avoided seeking health care because of unfair treatment.

Of 755 adult Indigenous Victorians surveyed in 2011, 29% had experienced racism in health settings. Lack of cultural respect in health care restricts access to and reduces the quality of care for Indigenous Australians.

We have previously identified trust, access, flexibility, time, support, outreach, and working together as key aspects of cultural respect. Although the Indigenous Chronic Disease Package (2009–2014) supported increased cultural awareness training for health workers, it did not change attitudes or behaviour sufficiently to bridge the cultural gap between health professionals and Indigenous people.

We developed the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect program with a trans‐theoretical approach, harmonising many similar conceptual frameworks and the terminology applied to Indigenous and cross‐cultural health in Australia. The theoretical underpinnings of WoTWoD were described in the article describing our pilot study. The WoTWoD framework translates the systemic, organisational, and clinical elements of the Australian Health Ministers’ Advisory Council Cultural Competency Framework into routine clinical practice. Cultural respect reflects the attitudes and behaviour of the entire medical practice, from reception to consulting room. In addition, general practice organisations must work in partnership with Indigenous community‐controlled organisations to reduce health care disparities, address social determinants of poor health, and increase access to safe, effective and culturally respectful care. This is fundamental to Indigenous Australians’ right to the highest standard of health.,

We undertook a cluster randomised controlled trial to examine whether the WoTWoD program improves clinically appropriate anticipatory care in general practice and the cultural respect of medical practice staff.

 

NACCHO Aboriginal Health and Continuous Quality Improvement (CQI): Minister @KenWyattMP announces $2.8 million national project improving people’s health through better quality control and health data collection at local ACCHO’s Aboriginal Community Controlled Health Services  

 ” Improving people’s health through better quality control and health data collection at local Aboriginal Community Controlled Health Services is the aim of a $2.8 million national project funded by the Federal Government.

Our Government recognises the importance of Aboriginal Community Controlled Health Services (ACCHS), with data showing they provide over 2.5 million episodes of care each year for more than 350,000 people.

However, to help achieve better health outcomes as our Aboriginal and Torres Strait Islander population grows, we need to support accountability, quality improvement and accurate data reporting.”

Minister Ken Wyatt Press Release Part 1 Below

” This National Framework for Continuous Quality Improvement in Primary Health Care for Aboriginal and Torres Strait Islander people, 2018-2023 booklet is designed to provide practical support for all primary healthcare organisations in their efforts to ensure that the health care they provide is high quality, safe, effective, responsive and culturally respectful.”

NACCHO Acting Chair Donnella Mills

” NACCHO is proud of the record of the Aboriginal Community Controlled Health Services (ACCHSs) in delivering primary health care to our community. We have learnt many lessons over the last 50 years about how to structure, deliver and improve care so that it best meet the needs of our communities across Australia.

This experience is used in the Framework to describe how to do, support and inform culturally respectful continuous quality improvement (CQI) in primary health care.”

Further resources including the Framework are available on our NACCHO website.

Direct link to PDF – https://www.naccho.org.au/wp-content/uploads/NACCHO-CQI-Framework-2019.pdf

Updated CQI pagehttps://www.naccho.org.au/programmes/cqi/

Pat Turner CEO of NACCHO see Press Release Part 2 below

 

Part 1 Ministers Press Release

In 2017, the Department of Health engaged KPMG to develop a national baseline quality audit at the individual service level to identify issues impacting on data quality and reporting and make recommendations for improvement. From February to May last year, 53 ACCHS volunteered to participate in the project.

The final report found that, despite reporting on national Key Performance Indicators and Online Services Report data collections since 2012-13 and 2007-08 respectively, only 30 per cent of the services visited were rated as having effective and mature processes in place to support and measure health data. The remaining 70 per cent were classified as needing support to improve.

The reports found characteristics of mature services include:

* Leadership focussed on a strong culture of Continuous Quality Improvement

* Clear workflows including induction, training and monitoring programs

* Resources and staff dedicated to recording and reporting health care activities

In Stage 2 of this project this year, KPMG will offer all health services not involved in Stage 1 the opportunity to participate, plus follow-up consultations for ACCHS in Stage 1 and the development of online training resources.

KPMG will also convene a national forum on best practice so ACCHS can share successful and effective reporting processes and practices with each other.

Part 2

The National Aboriginal Community Controlled Health Organisation (NACCHO) has just published the National Framework for Continuous Quality Improvement in Primary Health Care for Aboriginal and Torres Strait Islander people, 2018-2023.

Download the full NACCHO Press Release HERE 

al Community Controlled Health Services and Affiliates, health professional organisations and government. The project was funded by the Commonwealth Department of Health.

The CQI Framework provides principles and guidance for primary health care organisations in how to do, support and inform culturally respectful CQI.

It is designed to assist Aboriginal health services and private general practices, NACCHO Affiliates and Primary Health Networks, national and state/territory governments in their efforts to ensure that Aboriginal and Torres Strait Islander people have access to and receive the highest attainable standard of primary health care wherever and whenever they seek care.

It is relevant to clinicians, board members and practice owners, health promotion, administrative and management staff. Six case studies which illustrate how CQI has been implemented in ACCHSs are included.

NACCHO welcomes further case studies from other health services, general practice and Primary Health Networks.

Further resources including the Framework are available on the NACCHO website.

  1. Direct link to PDF – https://www.naccho.org.au/wp-content/uploads/NACCHO-CQI-Framework-2019.pdf
  2. Updated CQI page – https://www.naccho.org.au/programmes/cqi/

For further information about the CQI Framework please contact: cqi@naccho.org.au

 

NACCHO Aboriginal Health #CulturalSafety and @CATSINaM News : Minister @KenWyattMP provides $350,000 to produce an Australian-first online cultural safety training course for nurses and midwives delivering frontline care to Indigenous people.

 

“Providing culturally safe services is critical to Closing the Gap in health equality. We welcome CATSINaM’s initiative to share experiences and to learn from Aboriginal and Torres Strait Islanders to strengthen the capacity of health professionals to deliver culturally safe services for our people.

This training will not only support all nurses and midwives to meet the standards of their Codes of Practice, it will also embed cultural safety in the health system, improving healthcare and helping Close the Gap in Aboriginal and Torres Strait Islander health outcomes,” 

CATSINaM CEO Janine Mohamed said the funding would help realise a project the organisation had been working on with the Government and other partners for the past five years

Picture above : The Minister with Janine Mohamed of CATSINaM and Annie Butler of ANMF

Please note : Melanie Robinson has been appointed as the as the new CATSINAM CEO as from 4 th February See Part 2 below 

Read over 40 NACCHO Aboriginal Health and Cultural Safety articles HERE

The Federal Government will provide $350,000 to produce an Australian-first online cultural safety training course for nurses and midwives delivering frontline care to Aboriginal and Torres Strait Islander people.

Indigenous Health Minister Ken Wyatt AM made the announcement at a national roundtable in Sydney on developing and rapidly expanding the Aboriginal health workforce.

  The Minister with Aboriginal Elder Aunty Beryl and some of the staff and students from the National Centre for Indigenous Excellence in Redfern who prepared the wonderful morning tea and BBQ lunch at the Indigenous Health Workforce Roundtable

“Everyone using health services in Australia should feel valued and respected throughout their consultation and aftercare,” Minister Wyatt said.

“Our Government, through the Indigenous Australians’ Health Program, will fund the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives to develop the online cultural safety training course this year.

“The innovative use of established web technology will enable all nurses and midwives to learn about culturally safe care where they live and work, and at a time which suits them.”

The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) is the peak body representing Aboriginal and Torres Strait Islander nursing and midwifery professionals across Australia.

“The online training program will be adapted for Australia from a successful model developed by Indigenous leaders in Canada,” said Minister Wyatt.

The inclusion of cultural safety as one of the Codes of Professional Standards for nurses and midwives is driving an increase in demand for cultural safety training.

“The importance of cultural safety training is recognised across the health sector,” Minister Wyatt said.

“There is also potential for this initiative to build the cultural understanding of health professions beyond the fields of nursing and midwifery.

“The training will align with the objectives of the Cultural Respect Framework 2016-2026 for Aboriginal and Torres Strait Islander Health to include local culture in the design, delivery and evaluation of services.”

Provision of cultural safety training also supports strategies under the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, to prevent and address systemic racism and discrimination in the health system.

The Liberal National Government is providing $3.9 billion to improve the health of Aboriginal and Torres Strait Islander people over the next four years.

Part 2 Melanie Robinson has been appointed as the as the new CATSINAM CEO as from 4 th February

The Congress of Aboriginal and Torres Strait Nurses and Midwives (CATSINaM), the national peak body for Aboriginal and Torres Strait Islander Nurses and Midwives, today welcomes the appointment of Melanie Robinson as the new CEO. Ms Robinson, a nurse who has been a director of CATSINaM for three years, has worked clinically, in nurse training and policy development, most recently holding a senior position with the Western Australian Department of Health (see bio below).

She will move from Perth to Canberra to take up her new position with CATSINaM on 4 February 2019.

CATSINaM acting president, Marni Tuala, said that Melanie Robinson is a fantastic addition to the CATSINaM team given her unswerving commitment to Aboriginal and Torres Strait Islander health as well as nurse and midwife employment issues, and her profile within the national Aboriginal and Torres Strait Islander healthcare community

. “Melanie brings valuable experience and a fresh perspective to the role of CEO,” Ms Tuala said. “Melanie knows the benefits and rewards of working as a nurse and has a deep understanding of the issues that Aboriginal and Torres Strait Islander nurses and midwives face on a daily basis.” Ms Robinson said it is an honour to be a part of such a vibrant and important organisation that advocates for Aboriginal and Torres Strait Islander nurses and midwives.

Her priorities would include growing the number of Aboriginal and Torres Strait Islander nurses and midwives across Australia, and ensuring the workforce was strongly supported.

“It’s important that we look at what is working – within the universities, the vocational training sector and in terms of employment pathways – and translate these lessons more widely,” Ms Robinson said. “I am looking forward to advocating for our members, engaging with national policy development, and building strong partnerships across the government and non-government sectors, and working with the other peak bodies

. “I am also keen to continue the work of raising CATSINaM’s profile, at local, national and international levels.”

As a passionate advocate for CATSINaM, Ms Robinson said the organisation had been critical for her own journey of professional development and she wanted to ensure that others had similar opportunities.

“When I discovered CATSINaM, it opened up this whole other world as I met others with a shared history and experiences,” she said. “I will be working hard to ensure that CATSINaM offers those same opportunities to others that it has brought me.”

Ms Robinson said she hoped that the wide-ranging experience she had gained over the last 30 years would be useful for CATSINaM and its members. She commended an Aboriginal Leadership and Excellence Development program that she undertook in WA for building her confidence to take on senior roles.

Acting CATSINaM president Marni Tuala said the CATSINaM Board was keen to acknowledge the legacy of the outgoing CEO, Janine Mohamed. “CATSINaM recognises and commends the incredible achievements made by the outgoing CEO, Janine Mohamed. Her contributions during her six years in the role will not be forgotten, especially in the advocacy and implementation of cultural safety across healthcare.

Janine will continue to be a valuable member of the CATSINaM community,” Ms Tuala said.

Media Contact: Sarah Stewart: 02 62625761/ Melanie is available for interviews and profile articles.

Please contact Sarah Stewart for full information

Bio – Melanie Robinson I was born in Derby in the Kimberley region of Western Australia and grew up on the Gibb River Road in Ngallagunda community.

When I was 8 years old we moved into Derby for school and after that I went to boarding school at Stella Maris College.

I finished year 12 in 1989 and then in 1990 I commenced a Bachelor of Science (Nursing) at Curtin University completing the course in December 1993.

As a graduate I move back to Derby and completed 18 months in Derby Hospital working in paediatrics, general medical and emergency department. During this time I worked in Fitzroy Crossing hospital and the aged care facility in Derby called Numbla Nunga.

In 1996 I travelled overseas and lived in London for 6 months and then I returned to Perth and began working at Royal Perth Hospital a tertiary service where I worked for the next 2.5 years in aged care, acute medical and the intensive care unit.

In 1998 I travelled to Dublin and lived there for a year with a friend and her family, working in a local aged care unit. In 1998 I returned to Perth and commenced work in Princess Margaret Hospital where I worked in oncology, hematology and Intensive Care for the next 9.5 years.

I loved working with children and their families, which is a very specialised area and often extremely challenging.

In 2008 I decided to take a position as a nurse educator at Marr Mooditj Training and mentored and taught a number of Aboriginal students in enrolled nursing and Aboriginal Health Worker Programs. I loved this work and really enjoyed learning more about Noongar people and getting to know the local Aboriginal community.

In 2013 I took on a new position as a Senior Policy Officer in the Western Australian Department of Health.

In 2015 I managed to gain a promotion into a Senior Development Officer role and I completed a Masters in Nursing Research at the University of Notre Dame Australia in June 2018.

In 2018 for 6 months I acted as the Director Aboriginal Health in the Child and Adolescent Health Service in Western Australia. In the future I plan to return to nursing and enrol in the Masters in Midwifery Practice to gain the skills as a midwife.

NACCHO Aboriginal Male Health News : Minister @KenWyattMP will provide $1 million over 2 years to @BushTVMedia @ErnieDingo1 to deliver its Camping On Country program, to address health and wellbeing challenges in a culturally safe and meaningful way.

Ernie Dingo believes light moments are important even when talking about serious topics. In one candid exchange with a man who insisted doctors were unnecessary, Dingo shared the story of his decision to allow a doctor to examine his prostate.

“I told the men that I thought ‘Ah well, who is going to know?’ and they had a good laugh,” he said.

Dingo remains vigilant about his health. A dad of six, including three-year-old twin boys, he said being a father and grandfather made him want to encourage men to take care of themselves.

“We have to be around for our kids, and their kids,” 

Actor Ernie Dingo has created a confronting, humorous and bracingly honest reality series about Indigenous men that has captured the attention of federal Indigenous Health Minister Ken Wyatt.

Dingo, a Yamitji man from the Murchison region of Western Australia, became a household name in Australia as the presenter of lifestyle program The Great Outdoors between 1993 and 2009. But his retreat from public life coincided with a struggle against depression that he said made him want to help other Indigenous men.

From The Australian See in full Part 2 below 

Ernie Dingo’s campfire chats a dose of reality TV

 ” I’ve been in film & tv for 40 years that’s long enough! Its time for me to go bush & work with my Countrymen.

No point in having influence if you can’t use it to make the world a better place for our mob!

Follow 

A new health initiative that places culture and traditional knowledge systems at the centre of its program aims to improve the health of Aboriginal and Torres Strait Islander men and ensure they have a strong voice in health and wellbeing services in their own communities.

The Federal Government will provide $1 million over two years to Bush TV Enterprises to deliver its Camping On Country program, to address health and wellbeing challenges in a culturally safe and meaningful way.

Speaking at the launch on the Beedawong Meeting Place in WA’s Kings Park: (From left) Murchison Elder Alan Egan; Ernie Dingo; Ken Wyatt; Kununurra Elder Ted Carlton.

Respect for culture has a fundamental role in improving the health of our men, who currently have a life expectancy of 70 years, more than 10 years shorter than their non-Indigenous counterparts.

Camping On Country is based on the premise that working with local men as the experts in their own health and community is critical in Closing the Gap in health equality.

We need every Aboriginal and Torres Strait Islander man to take responsibility for their health and to be proud of themselves and their heritage — proud of the oldest continuous culture on Earth, and the traditions that kept us healthy for the past 65,000 years.

Each camp will focus on specific topics including:

  • Alcohol and drug dependency
  • Smoking, diet and exercise
  •  Mental health and suicide

A traditional healer and an Aboriginal male health worker are assigned to each camp to conduct health checks and provide one-on-one support to men, which includes supporting men through drug or alcohol withdrawals.

Traditional yarning circles are used to discuss health and wellbeing issues as well as concerns about employment, money, housing and personal relationships.

Well-known actor, television presenter and Yamatji man Ernie Dingo developed the Camping On Country program with his BushTV partner Tom Hearn, visiting 11 communities and conducting small camps with groups of men at four sites across remote Australia in 2018.

The plan is to conduct 10 camps a year, with the initial focus on communities in need in Central Australia, the Kimberley, Arnhem Land, the Gulf of Carpentaria and the APY Lands.

The program puts culture and language at the centre of daily activities and also uses the expertise and knowledge of local men’s groups, traditional owners and local Aboriginal organisations.

A video message stick will be produced during each camp and made available to all levels of government associated with Aboriginal and Torres Strait Islander health.

The message stick information will also be used by health providers to develop holistic, culturally appropriate programs with men and their communities.

The $1 million funding will also support Bush TV Enterprises to partner with a university and Primary Health Alliances to conduct research to track improvements in remote men’s health and enhance health and wellbeing services.

Bush TV Enterprises is an Aboriginal-owned community agency specialising in grassroots advocacy and producing and distributing Aboriginal and Torres Strait Islander stories.

Our Government has committed approximately $10 billion to improve Aboriginal and Torres Strait Islander health over the next decade, working together to build strong families and communities.

Part 2 From The Australian  

Ernie Dingo’s campfire chats a dose of reality TV

Dingo, a Yamitji man from the Murchison region of Western Australia, became a household name in Australia as the presenter of lifestyle program The Great Outdoors between 1993 and 2009. But his retreat from public life coincided with a struggle against depression that he said made him want to help other indigenous men.

The 62-year-old has partnered with documentary-maker Tom Hearn to make four short films from fireside yarns with indigenous men in some of Australia’s most remote towns and communities.Mr Wyatt believes the program, called Camping on Country, has the potential to change lives. He has commissioned 20 more camps around Australia over the next two years at a cost of $1 million.

“We talk about everything,” Dingo told The Australian. “You want to see the way the men sing and talk once they feel safe.”

Camping On Country could ultimately drive health policy, as Dingo listens to men talk about alcohol and drug dependency, smoking, diet, exercise, mental health and suicide. Mr Wyatt will announce his support for the camps today and hopes that they can help close the health gap between indigenous and non-indigenous men. Aboriginal men die an average 10 years earlier than other Australian men, and generally their rates of cancer, heart disease and mental illness are higher.

An Aboriginal male health worker will be at each camp providing health checks and support, including to anyone experiencing drug or alcohol withdrawals. Dingo and Hearn will make a short film of each camp through production company Bush TV. The federal funding of $1 million covers an independent assessment of the overall program, ­including whether it makes a difference to the health of men who take part.

NACCHO Aboriginal #Mentalhealth #SuicidePrevention and #RUOKday : If you ask #RUOK ? What do you do if someone says ‘no’? Plus Sponsorships for 10 #Indigenous young people to take participate #chatsafe campaign

R U OK Day today encouraging all of us to check in with others to see if they’re OK.

But what if someone says “no”? What should you say or do? Should you tell someone else?

What resources can you point to, and what help is available?

Read NACCHO Aboriginal Health articles over the past 6 Years

Mental Health 189 posts 

Suicide Prevention 124 Posts

Here is a guide 

Stop and listen, with curiosity and compassion

We underestimate the power of simply listening to someone else when they’re going through a rough time. You don’t need to be an expert with ten years of study in psychology to be a good listener. Here are some tips:

Listen actively. Pay attention, be present and allow the person time to speak.

Be curious. Ask about the person’s experience using open questions such as

what’s been going on lately?

you don’t seem your usual self, how are you doing/feeling?

Validate their concerns. See the situation from the person’s perspective and try not to dismiss their problems or feelings as unimportant or stupid. You can say things like

I can see you’re going through a tough time

it’s understandable to feel that way given everything you’ve been going through.

There are more examples of good phrases to use here.

Don’t try to fix the problem right now

Often our first instinct is wanting to fix the person’s problems. It hurts to see others in pain, and we can feel awkward or helpless not knowing how to help. But you don’t have to have all of the answers.

Instead of jumping into “fix it” mode right away, accept the conversation may be uncomfortable and allow the person to speak about their difficulties and experiences.

Sometimes it’s not the actual suggestion or practical help that’s most useful but giving the person a chance to talk openly about their struggles. Also, the more we understand the person’s experience, the more likely we are to be able to offer the right type of help.

Encourage them to seek help.

Ask:

how can I help?

is there something I can do for you right now?

Sometimes it’s about keeping them company (making plans to do a pleasant activity together), providing practical support (help minding their kids to give them time out), or linking them in with other health professionals.

Check whether they need urgent help

It’s possible this person is suffering more than you realise: they may be contemplating suicide or self-harm. Asking about suicidal thoughts does not worsen those thoughts, but instead can help ease distress.

It’s OK to ask them if they’re thinking about suicide, but try not to be judgemental (“you’re not thinking of doing anything stupid, are you?”). Listen to their responses without judgement, and let them know you care and you’d like to help.

Read more: How to ask someone you’re worried about if they’re thinking of suicide

There are resources and programs to help you learn how to support suicidal loved ones, and crisis support lines to call:

  • Contact the Social and Emotional team at your nearest ACCHO
  • Lifeline (24-hour crisis telephone counselling) 13 11 14
  • Suicide Callback Service 1300 659 467
  • Mental health crisis lines

If it is an emergency, or the person is at immediate risk of harm to themselves or others, call 000.

Encourage them to seek professional help

We’re fortunate to be living in Australia, with access to high quality mental health care, resources and support services. But it can be overwhelming to know what and where to seek help. You can help by pointing the person in the right direction.

The first place to seek help is the general practitioner (GP). The GP can discuss treatment options (psychological support and/or medication), provide referrals to a mental health professional or arrange access to local support groups. You can help by encouraging your friend to make an appointment with their GP.

There are great evidence-based online courses and self-help programseducational resources and free self-help workbooks that can be accessed at any time.

There are also online tools to check emotional health. These tools help indicate if a person’s stress, anxiety and depression levels are healthy or elevated.

What if they don’t want help?

People with mental health difficulties sometimes take years between first noticing the problem and seeking professional help. Research shows approximately one in three people experiencing mental health problems accesses treatment.

So even if they don’t want help now, your conversation may have started them thinking about getting help. You can try understanding what’s stopping them from seeking help and see if there’s anything you can do to help connect them to a professional. You don’t need to push this, but simply inviting the person to keep the options in mind and offering your ongoing support can be useful in the long run.

Follow up. If appropriate, organise a time to check in with the person again to see how they’re doing after your conversation. You can also let the person know you’re around and they are always welcome to have a chat with you. Knowing someone is there for you can itself be a great source of emotional support.

Read more: Five types of food to increase your psychological well-being

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.).

The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

SEE CONFERENCE WEBSITE

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.). The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at jo.robinson@orygen.org.au. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

Anyone seeking support and information about mental health can contact beyondblue on 1300 22 46 36. For information about suicide and crisis support, contact Lifeline on 13 11 14 or the Suicide Callback Service on 1300 659 467

 

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 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.