NACCHO Aboriginal Research Health News : New @NHMRC project to implement and evaluate 715 annual health checks interventions designed to help Close the Gap

 “The prevalence of most chronic diseases increases with age and affects not only physical health, but also the broader contributors to the well-being of older Aboriginal people, including participation in family, community and cultural leadership roles and connection with community networks.

Aboriginal people often receive a diagnosis at a more advanced stage of chronic disease, which means there’s less opportunity to prevent their condition and health deteriorating “

Professor Sanson-Fisher said chronic diseases continue to be a major contributor to unhealthy ageing among Aboriginal and Torres Strait Islander people. Timely diagnosis and appropriate management was vital to improving health outcomes for Aboriginal and Torres Strait Islander people. See Website

Consider these facts

  • In 2016-2017 just 27 per cent of Indigenous adults aged 15 to 24 had an annual health assessment.
  • Only 30 per cent of 25-to 54-year-olds, and 41 per cent of Indigenous adults over 55 had one.
  • Around 37 per cent of the burden of disease in Aboriginal people could be prevented by reducing risk factors

Read previous NACCHO 715 Health Check Articles

Download resources to boost the rates of the 715 health check. Information available for patients and health professionals!

An intervention designed to help Close the Gap, by increasing the number of Aboriginal and Torres Strait Islander people who receive an annual health check by their GP, will be implemented and evaluated by a new National Health and Medical Research Council (NHMRC) project.

Renowned population health researcher, Laureate Professor Rob Sanson-Fisher of the University of Newcastle and Hunter Medical Research Institute, will lead a team of expert Aboriginal and non-Aboriginal researchers in the five-year research project – which was awarded $745,056 following a Targeted Call for Research** for Healthy Ageing of Aboriginal and Torres Strait Islander People.

Indigenous people die about eight years earlier than non-Indigenous Australians. For Aboriginal and Torres Strait Islander Australians born in 2015-17, the life expectancy is 71.6 years for men and 75.6 years for women – about 8.6 and 7.8 years less than non-Aboriginal men and women respectively.

Twenty-two mainstream general practice clinics within the central Coast and New England regions will participate in the research project.

The intervention package will comprise strategies such as continuing medical education, recall and reminder systems, and mailed invitations to patients.

The project will also test whether the intervention increases doctors’ adherence to best practice care and improves patient outcomes.

More than 60 per cent of Indigenous people regularly visit mainstream general practice services – a key opportunity to deliver an annual ‘715’ health assessment, which forms an integral part of the Australian Government’s Closing the Gap commitment.

The aim of the Aboriginal and Torres Strait Islander Health Assessment (Medicare Benefits Schedule item 715) is to help ensure Indigenous Australians receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early death.

The health assessment is an annual service and covers the full age spectrum..

Key contributing chronic conditions include cardiovascular diseases (19 per cent of the chronic disease prevalence gap), mental and substance use disorders (14 per cent), cancer (9 per cent), chronic kidney disease, diabetes, vision loss, hearing loss and respiratory, musculoskeletal, neurological and congenital disorders.

Around 37 per cent of the burden of disease in Aboriginal people could be prevented by reducing risk factors.

The risk factors causing the most burden are tobacco use (12 per cent of the total burden), alcohol use (8 per cent), high body mass (8 per cent), physical inactivity (6 per cent), high blood pressure (5 per cent) and high blood glucose levels (5 per cent).

“Mainstream general practice is a crucial setting to impact on prevention, timely diagnosis and appropriate management of chronic disease for Aboriginal people, which is imperative to help Close the Gap,” Professor Sanson-Fisher said.

 

NACCHO Aboriginal Health #NAIDOC2019 News 4 of 5 : New @OzProdCom Productivity Commissioner @RMokak talks about what #NAIDOC #VoiceTreatyTruth means and invites input into a new #Indigenous Evaluation Strategy

” Implementation matters, and considering likely implementation roadblocks – such as capability and culture in agencies and service delivery organisations, data availability, and knowledge translation – will be key considerations for the strategy.

We are also encountering many positive examples from outside government of how evaluation can be used to improve decision making and program implementation.

We have much to learn from Aboriginal and Torres Strait Islander organisations – such as the Institute for Urban Indigenous Health (IUIH) in South East Queensland.

IUIH has been active in commissioning and conducting research and evaluation to build the evidence base on what works, and demonstrate its impact to the community and government.

Last week, we published an issues paper, which outlines some of the key questions we’d like your help to answer.”

Commissioner Romlie Mokak delivered a speech for a NAIDOC event at the Institute of Public Administration Australia in Canberra July 2019

Download 58 page Indigenous Evaluation Strategy issues paper 

indigenous-evaluation-issues

Make a submission HERE

Today, I stand here on the lands of the Ngunnawal and Ngambri people. I am deeply grateful for the warmth and the generosity in allowing this country to be home for my family over the past 20 years. I honour your ancestors, your Elders and your young ones yet to come. I honour your sacred places and the wisdom and teachings held and shared in these places.

I aim to speak to two things today – NAIDOC and the Indigenous Evaluation Strategy.

NAIDOC theme — Voice, Treaty, Truth

This year’s NAIDOC brings into focus the theme of Voice, Treaty, Truth: let’s work together for a shared future. The NAIDOC theme, by definition, seeks for all Australians to work together to build our nation’s future. Voice, Treaty, Truth puts forward a proposition to the Australian people – not just to parliament, but to the Australian people — about a shared future.

These three elements from the Uluru Statement from the Heart speak to the call by Aboriginal and Torres Strait Islander people to have a greater say in their lives.

I quote:

When we have power over our destiny our children will flourish.

They will walk in two worlds and their culture will be a gift to their country.

We call for the establishment of a First Nations Voice enshrined in the Constitution….we seek a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history.

In 1967 we were counted, in 2017 we seek to be heard.

NAIDOC week is a time to commemorate, as well as a time to celebrate. It is a time to remember and honour those who have come before.  To honour those who have worked tirelessly and endlessly for our benefit. NAIDOC week is a time to place our — Indigenous — knowledges, our cultures, our science, our strength, our achievements – at the centre.

NAIDOC invites you into this space – beyond raising flags, beyond exhibiting art, beyond consuming native foods. NAIDOC is not just about NAIDOC week. In fact, the spirit of NAIDOC really is about what we do during those remaining weeks of the year.

25 years in policy

This week begins my 12th week at the Productivity Commission – it is still very much early days for me.

My road to the Commission has been travelled via community, state, Commonwealth and Indigenous organisations. From beginnings in the NSW public service 25 years ago as a junior policy officer in ageing and disability. To the Commonwealth Department of Health — working in Indigenous policy and program areas such as health inequality, substance use and financing.

For the past 14 years heading up national black organisations:

  • nine as CEO of the Australian Indigenous Doctors Association
  • the last five as head of the Lowitja Institute (Australia’s National Institute for Aboriginal & Torres Strait Islander Health Research).

The learning over these years – that those who are most invested and most impacted must not be assigned to policy render. They must also be designers, architects, builders and evaluators for impact and change.

Indigenous Evaluation Strategy

The Productivity Commission has been asked to develop a whole-of-government evaluation strategy to be used by all Australian Government agencies, for policies and programs affecting Aboriginal and Torres Strait Islander people.

The project will have three main components. The commission has been asked to:

  • establish a principles-based framework for the evaluation of policies and programs
  • identify priorities for evaluation
  • set out its approach for reviewing agencies’ conduct of evaluations against the strategy.

The commission has a broad remit to recommend changes to improve the use and conduct of evaluation in Australian Government agencies. This goes beyond guiding stakeholders during the commissioning and conduct of evaluations.

The evaluation strategy should also make recommendations on how evaluation and evidence-based decision making can be embedded into policy development and program delivery. The problems with existing evaluation practice that have motivated this project are not just that evaluations have been rarely or poorly conducted, but stem from the lack of influence of evaluation practice and results on policymaking.

It is clear that the value of evaluation will be limited in the absence of strong and sustainable mechanisms to feed evaluation findings, and Aboriginal and Torres Strait Islander knowledges, perspectives and priorities, into the policymaking process.

The evaluation strategy must cover both mainstream and Indigenous-specific policies and programs if it is to properly examine those that have most impact on, or potential benefit for, Aboriginal and Torres Strait Islander people.

We will make recommendations on how evaluation efforts should be prioritised, both within agencies and across the Australian Government.

Aboriginal and Torres Strait Islander peoples perspectives on what policies and outcomes matter most will be vital when identifying priorities for evaluation.

Early insights

Our project is in its early stages:

  • we will deliver a draft report in February next year
  • and a final report to government in around 12 months from now.

However early discussions around the country have provided insights into the challenges we may face when developing the strategy, and the areas where the strategy can add the most value. The dearth of evaluation of policies and programs affecting Aboriginal and Torres Strait Islander people has been well-documented. It is clear that evaluation practice in Australian Government agencies varies considerably.

Existing evaluation efforts are often narrowly focused rather than systematic, and many agencies do not publish evaluation reports in a timely manner (if at all). Aboriginal and Torres Strait Islander people and voices have been largely absent from evaluation design and conduct. Even where there has been leadership and considerable resources devoted, experience shows that changing the evaluation culture in government agencies is hard.

The then Department of the Prime Minister and Cabinet (now National Indigenous Australian agency) and the Department of Health are two agencies that have made inroads into better incorporating Aboriginal and Torres Strait Islander perspectives and priorities into their evaluation efforts.

Implementation matters, and considering likely implementation roadblocks – such as capability and culture in agencies and service delivery organisations, data availability, and knowledge translation – will be key considerations for the strategy.

We are also encountering many positive examples from outside government of how evaluation can be used to improve decision making and program implementation. We have much to learn from Aboriginal and Torres Strait Islander organisations – such as the Institute for Urban Indigenous Health (IUIH) in South East Queensland.

IUIH has been active in commissioning and conducting research and evaluation to build the evidence base on what works, and demonstrate its impact to the community and government.

Last week, we published an issues paper, which outlines some of the key questions we’d like your help to answer.

These include:

  • How can Aboriginal and Torres Strait Islander knowledges, priorities and values be better integrated into policy and program evaluation?
  • What principles should guide Australian Government agencies’ evaluation efforts?
  • What should be the priority policy areas for future Australian Government evaluation efforts?
  • How can evaluation results be better used in policy and program design and implementation?
  • What ongoing role should the Productivity Commission have in monitoring agencies’ implementation of the strategy, and in evaluating policies and programs affecting Aboriginal and Torres Strait Islander people more generally?

Further engagement

We are seeking submissions from interested parties between now and 23 August.

You can send us a written submission, make an oral submission or leave a brief comment on our website: www.pc.gov.au/indigenous-evaluation

In the second half of the year we will be engaging widely across Australia to inform the development of the strategy. We will travel to urban, regional and remote areas, to hear from individuals, groups and organisations.

We hope to hold a series of roundtable discussions on topics related to the evaluation strategy. This will be to draw on the experience and expertise of people and organisations who have been involved in evaluation or have insights into how policy making and program implementation can be improved.

In closing

As NAIDOC’s impact must surely go well beyond a single week in July.

So to a future Indigenous Evaluation Strategy must have value in a lasting way.

I invite each and every one of you to be an active part of the discussion, debate and design to make this a reality.

 

NACCHO Aboriginal Health and #ClosingTheGap @nhmrc and @UniCanberra Project : Commissioning stronger evaluations of Indigenous health and wellbeing programs

 ” Billions of dollars are spent annually on Indigenous programs, services and initiatives yet, despite the need, there is limited evidence on what programs are effective for improving Indigenous health outcomes.

The Productivity Commission has called for ‘more and better’ evaluations of Indigenous programs and commissioning processes that engage Indigenous communities, organisations and leaders.

The commissioning of evaluations plays a significant role in the way program evaluations are carried out. It is through the commissioning process that the budget is set, the evaluators are identified, the aims and objectives of the evaluation are set, and many other aspects of the evaluation are determined.” 

See University of Canberra website 

This National Health and Medical Research Council funded project (GNT1165913) responds to a call from Indigenous leaders for opportunities to influence decision-making processes within the health system and across sectors for the commissioning of health programs to reflect their needs, priorities and views on program design, delivery and evaluation.

This project aims to identify how government (federal, state/ territory) and non-government (not-for-profit, corporate, foundation, philanthropic) commissioning practices can better support Indigenous engagement and leadership in the evaluation of health and wellbeing programs in Australia.

To achieve this aim, this project will address the following objectives:

  1. To characterise the spectrum of commissioning practices of government and non-government organisations in contracting evaluations for health and wellbeing programs particularly the role of Indigenous engagement and leadership during, and resulting from, the commissioning process.
  2. To identify the issues, challenges and opportunities for Indigenous engagement and leadership across the spectrum of commissioning practices from the perspectives of: (a) commissioners/policy makers; (b) service providers; and (c) the Indigenous community.
  3. To translate the findings into resources to support Indigenous engagement and leadership in the commissioning of program evaluations.

The project will be supported by an advisory group, chaired by Professor Tom Calma AO.

The project is funded until October 2022.

Research team

Contact

For more information on the project, please contact Margaret Cargo at margaret.cargo@canberra.edu.au.

NACCHO Aboriginal #AusVotesHealth #VoteACCHO Will preventative health be on the #Election2019 agenda today at the @PressClubAust debate between health ministers @CatherineKingMP and @GregHuntMP? #npc #auspol @_PHAA_ @amapresident @CHFofAustralia @Prevention1stAU

” Labor has vowed to ramp up the Australian government’s efforts to prevent people from becoming unwell if it wins the upcoming federal election.

The pledge comes as Health Minister Greg Hunt will have the opportunity to spruik the coalition’s record on improving people’s health in a debate with Labor’s health spokeswoman Catherine King.

The pair will go head-to-head at the National Press Club today ;

You can watch the debate from 12.30 pm on ABC TV

See media report Part 1 Below

” The health of Australians is far more likely to be advanced by spending money on preventing disease than it is curing or treating illnesses.

With an aging population and chronic disease snowballing, the current focus on health through the prism of hospitals and drugs is unsustainable.

Many Australians would be shocked to learn that less than 2% of the health budget is spent on prevention. We are calling for that to change.

Most OECD countries commit around 5% of health spending to prevention. On this Australia is lagging behind.”

We have shown what can be done by driving down smoking rates. While more needs to be done on tobacco, there is an urgent and growing need to apply that lesson to obesity, physical activity and alcohol consumption. “

PHAA CEO, Terry Slevin from the Public Health Association of Australia (PHAA) who recently launched its election manifesto at its Justice Health conference in Sydney in an attempt to pivot the health conversation towards prevention. See Part 2 Below

Download the PHAA Election Priorities Here

PHAA Policy Priorities 2019

“ The AMA is calling on Health Minister, Greg Hunt, and Shadow Health Minister, Catherine King, to use today’s Health Policy Debate at the National Press Club to fill the gaps in their respective overarching visions for the future health system in Australia.

The Australian health system is one of the best in the world, if not the best. But it will take strong leadership, hard work, good policy with long-term strategic vision, and significant well-targeted funding to keep it working efficiently to meet growing community demand.

“The health system has many parts, and they are all linked. Governments cannot concentrate on a few, and neglect the others. Otherwise, patients will be the ultimate losers. Whole patient care cannot be done in silos, in parts, or in isolation.

“Health is the best investment that any government can make. We expect to hear more detail on their intended investment from the major parties at the National Press Club today,”

Dr Tony  Bartone AMA President See Part 3 Below

” We don’t need more reviews. Experience has shown stopgap health policies won’t pay in the long run. The evidence here and internationally tells us that the best overall returns for the health dollar will come from nationally co-ordinated preventive health measures to counter modern malaises of obesity and chronic illness.

Closely linked to the prevention drive should be better resourced primary health services — GP-led team care for the growing number of chronically ill and older patients. People want affordable, convenient and reliable care close to home “

Update

AMA President, Dr Tony Bartone, said today that Labor has announced a comprehensive framework to re-energise a coordinated national preventive health strategy to keep Australians fitter and healthier and out of hospital.

Dr Bartone said the broad range of initiatives is welcome, but will ultimately require significantly greater funding to be truly effective for the long term. “Investing in preventive health saves hundreds of millions of dollars in health costs and improves lives,”

See Press Release HERE

AMA Prevention

Leanne Wells is chief executive of the Consumers Health Forum of Australia. See Part 4

‘We urge Health Minister Greg Hunt and Shadow Minister Catherine King to outline how they are going to get better bang for the health buck at today’s National Press Club debate’, says Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven.

‘The Coalition, Labor, and the Greens are all promising welcome extra health dollars and reduced out-of-pocket costs for electors should they win government—but public commitment to getting better value for those dollars has been muted.

See AHHA Press Release Part 5

NACCHO has developed a set of policy #Election2019 recommendations that if adopted, fully funded and implemented by the incoming Federal Government, will provide a pathway forward for improvements in our health outcomes.

We are calling on all political parties to include these recommendations in their election platforms and make a real commitment to improving the health of Aboriginal and Torres Strait Islander peoples and help us Close the Gap.

With your action and support of our #VoteACCHO campaign we can make the incoming Federal Government accountable.

See NACCHO Election 2019 Website

NACCHO Recommendation 6.Allocate Indigenous specific health funding to Aboriginal Community Controlled Health Organisations

  • Transfer the funding for Indigenous specific programs from Primary Health Networks to ACCHOs.
  • Primary Health Networks assign ACCHOs as preferred providers for other Australian Government funded services for Aboriginal and Torres Strait Islander peoples unless it can be shown that alternative arrangements can produce better outcomes in quality of care and access to services

Part 1 Media Coverage 

Health has been a key battleground for the election campaign so far, with both major parties spending weeks trying to convince Australians they will be best placed to look after them when they’re sick.

Labor has vowed to spend $2.3 billion over four years on improving the coverage of cancer services on Medicare and wants to spend an extra $2.8 billion on public hospitals.

But the coalition says it has funded hospitals at record levels, because its strong economic management has given it the cash to do so.

Mr Hunt has also argued his government has made far more medicines affordable by listing them on the Pharmaceutical Benefits Scheme, which means they are subsidised by the government.

Improving the mental health of young and indigenous Australians is also in the coalition’s sights, with the party promising an extra $42 million for services that would do as much if it wins the national poll.

Labor has now turned its attention to stopping people from becoming ill in the first place, pledging $115.6 million worth of initiatives to promote health and prevent disease.

The prevention package includes implementing Australia’s first National Obesity Strategy.

That will involve spending $39 million over three years to roll out a national anti-obesity marketing campaign.

Smokers would be targeted by a separate $40 million anti-smoking campaign over four years to reduce cancer rates.

Money would also go toward a sun protection awareness campaign and initiatives to drive up early detection of bowel cancer.

Labor also wants to reduce harmful drinking, vowing $10 million worth of targeted campaigns, delivering warning labels on alcohol packaging and doing more to limit alcohol advertising to children.

Ms King stressed that almost a third of Australia’s burden of disease is preventable.

Every dollar spent on preventing people from becoming sick through lifestyle factors delivers almost $6 in health and productivity benefits, she said.

“Prevention is better than cure – both for our own health and the country’s.”

Part 2 PHAA

Australia invests a meagre 1.7% of the health system spending on preventative health – one of the lowest levels of the OECD economies. says we must match the world’s best practice of 5% to advance the health of Australians.

Download the PHAA Election Priorities Here

PHAA Policy Priorities 2019

The recent launch of the PHAA Immediate Priorities 5-point plan called for:

  • Setting the target of 5% of Australia’s health budget to focus on prevention
  • Protecting kids from marketing of tobacco, alcohol, junk food
  • Investing in sustained and effective community education programs on tobacco, healthy eating, alcohol and being physically active
  • Focusing on improved health for Aboriginal and Torres Strait Islander adolescents, and
  • Curbing climate change with clear and effective action to ensure a healthy planet.

This plan was launched at our Justice Health conference to emphasise the importance of focusing on the people of greatest need.

“Those who come in contact with the justice system are often the most vulnerable. People with mental health issues, drug and alcohol problems, Aboriginal and Torres Strait Islander people are all overrepresented in our jails. If we aim for a fair go for all Australians, that requires us to focus our attentions on those with the greatest need.”

“If we get this right, we can add at least five more good years to people’s lives so they can enjoy the fruits of their labour, the celebrations and successes of our families and the people we love for longer. Surely this is a goal we all must share and pursue.”

“Health experts have the solutions; parliamentarians simply need to act. ”

Part 3 AMA

The AMA is calling on Health Minister, Greg Hunt, and Shadow Health Minister, Catherine King, to use today’s Health Policy Debate at the National Press Club to fill the gaps in their respective overarching visions for the future health system in Australia.

AMA President, Dr Tony Bartone, said that the AMA has welcomed announcements from the major parties of new funding and strategies for public hospitals, cancer care, primary care, dental care for pensioners and seniors, Indigenous health, the lifting of the Medicare rebate freeze, and the Pharmaceutical Benefits Scheme (PBS), among others.

“The AMA will compare and contrast these policies and publicly rate them accordingly before election day,” Dr Bartone said.

“But we need to see the major parties announcing the missing pieces from their health care vision over the next two-and-a-half weeks, starting today.

“As the population ages and more people are living longer with multiple complex and chronic conditions, it is vital that Australia has a robust, connected, and holistic strategy to ensure improved health outcomes for patients throughout life.

“The big gaps include aged care, broad mental health strategies, comprehensive primary care and general practice investment, the private health sector, and prevention.

“The Australian health system is one of the best in the world, if not the best. But it will take strong leadership, hard work, good policy with long-term strategic vision, and significant well-targeted funding to keep it working efficiently to meet growing community demand.

“The health system has many parts, and they are all linked. Governments cannot concentrate on a few, and neglect the others. Otherwise, patients will be the ultimate losers. Whole patient care cannot be done in silos, in parts, or in isolation.

“Health is the best investment that any government can make. We expect to hear more detail on their intended investment from the major parties at the National Press Club today,” Dr Bartone said.

The AMA’s health policy wish list – Key Health Issues for the 2019 Federal Election – is available at https://ama.com.au/article/key-health-issues-2019-federal-election

The AMA will issue a health policy scorecard in the final week of the campaign.

Public Release. View in full here.

Part 4 Preventive measures the most effective health policy prescription

Health is once again a target for billions of taxpayer dollars in election promises that may soothe but never heal community concerns.

There has been no shortage of diagnoses about what ails the health system. A feature of Australia’s health policy in the past decade has been the preponderance of probes into various elements of the health sector, ranging from system-wide inquiries to more focused reviews of troubled areas.

The Coalition government, since coming to power in 2013, has instituted a clutch of reviews into key problem zones: primary care for the chronically ill, mental health, private health insurance, out-of-pocket medical costs, regulation and remuneration of pharmacies, and the efficacy of high-cost Medicare benefits.

These reviews produced various ideas for change and improvement, but community unease about health still creates a spike in public opinion surveys.

There were two recurring concerns raised by respondents to a recent survey conducted by the Consumers Health Forum. The issues were cost and uncertainty. These are worry points often reflected in the focus of the health policies announced so far in this federal election campaign.

The out-of-pocket costs dilemma confronting so many patients in Australia also is often connected to a widespread sense of uncertainty about healthcare and its co-ordination — what care is needed, its cost and where to go for appropriate treatment.

Our survey found most people were satisfied with the quality of the healthcare they received. However, a third encountered difficulties at every stage of the healthcare process, such as finding the right place to get care, deciding which provider to see and getting to see the provider they needed.

The unease about care costs and uncertain access to co-ordinated care have prompted a variety of responses from the political parties.

Labor has proposed a plan to reduce out-of-pocket costs for cancer patients; the Coalition is pledging support for streamlined access to integrated care for the over-70s and a new website detailing medical specialists’ fees. And both sides promise more hospital funding and a continuing stream of new drugs on the Pharmaceutical Benefits Scheme.

But there remains the reality that we are getting piecemeal measures when what is needed is a holistic approach with overarching strategies reflecting all of the modern world’s knowledge about the causes of ill health and our capacity to avoid ill health.

We are proposing that the next federal government give priority to three areas: childhood obesity, public dental services and primary healthcare. We don’t need more reviews. Experience has shown stopgap health policies won’t pay in the long run. The evidence here and internationally tells us that the best overall returns for the health dollar will come from nationally co-ordinated preventive health measures to counter modern malaises of obesity and chronic illness.

Closely linked to the prevention drive should be better resourced primary health services — GP-led team care for the growing number of chronically ill and older patients. People want affordable, convenient and reliable care close to home,

The political default on health is to offer more and bigger hospitals. We need to rebalance the investment to give more focus on comprehensive care in the community that reduces our dependence on hospitals.

Obesity is a dominant factor in chronic illness yet as a nation we have no coherent, effective strategy to counter poor diet and promotion to children of unhealthy food and drink, and to take other more practical measures, such as overcoming urban planning and transport obstacles to routine activities such as walking.

Modern economies and digital technology have brought new levels of consumer control and understanding to most corners of society. Yet health, despite the expertise of its practitioners and reliance on precision record-keeping elsewhere in healthcare, lags behind 21st-century potential when it comes to communications with patients. Instead, we as a wealthy country have hundreds of thousands of people each year putting off having scripts filled, seeing a specialist or living with the misery of toothache because they can’t ­afford a dentist.

Australia’s health system remains less efficient than it should be and federal-state divisions in health funding and the resistance of practitioners to change, or lack of support for practitioners to change, are significant impediments. We have seen in recent years welcome strides towards a more transparent and accountable health system. Consumers must be empowered with more government support for the development of consumer leadership and patient-centred care to improve not only health outcomes but also the working experience of clinicians.

Transforming services by encouraging consumer-influenced health services and patient engagement in healthcare can bring long-term benefits to Australia’s physical and fiscal health.

Leanne Wells is chief executive of the Consumers Health Forum of Australia.

Part 5

‘We urge Health Minister Greg Hunt and Shadow Minister Catherine King to outline how they are going to get better bang for the health buck at today’s National Press Club debate’, says Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven.

‘The Coalition, Labor, and the Greens are all promising welcome extra health dollars and reduced out-of-pocket costs for electors should they win government—but public commitment to getting better value for those dollars has been muted.

‘For example, do you really need that extra appointment with the doctor to renew a script or have a specialist referral updated? Do you really need to pay a GP to carry out a treatment or give an injection when a trained nurse can do it just as effectively? Why are some treatments still subsidised by Medicare when more effective evidence-based treatments are available? Why get that injury treated in hospital when it could be done just as well at your local primary care clinic for a fraction of the cost?

‘We need to shift the whole system to value-based healthcare—that is, better outcomes for patients relative to costs—or the right care in the right place at the right time by the right provider.

‘This will often involve teams of health professionals providing ongoing care for chronic conditions—this has been proven internationally to be more effective, more timely and better value than traditional care systems.

‘Integrated or “joined up” care driven by results is better for the patient than care driven by number of consultations attended and/or the size of the patient’s wallet.

‘To their credit, during its current term the Government initiated a review of all Medicare item numbers for relevance and effectiveness. Progress has been limited to date, but the review is ongoing.

‘The Government also initiated an inquiry into out-of-pocket costs—but included only one consumer representative in a sea of medical and private health interests. One proposed outcome of the inquiry—compelling specialists to publish their fees on a government website—while laudable, is yet to see the light of day.

‘The Government introduced the Health Care Home model of integrated care, which is a move toward value-based healthcare. But it failed to attract enough ‘buy-in’ from medical practitioners or consumers—in part because of insufficient funding and poor planning. The Coalition’s recently announced policy of rewarding GP practices for people over 70 signing up or registering with the practice for chronic disease care is a renewed step in the right direction. So is the commitment of both major parties to Primary Health Networks tasked with introducing innovative and value-based primary healthcare regimes tailored to local circumstances.

‘The $2.3 billion investment pledged by Labor to address out-of-pocket costs for people with cancer is a much-needed response to the significant and unexpected costs faced by many people with cancer. But, apart from a suggested oncology Medicare item number available only through bulk-billing of patients, there is little detail as yet on how the initiative will ensure real value for patients while sidestepping unnecessary low value care.

‘Labor’s proposed Health Reform Commission, and the Greens’ similar proposed single funding agency are encouraging signs of political will to achieve better value and less waste by ending the “blame game” between various levels of government—but we would like to see more concrete actions detailed in their policies.

‘As a nation we also need to invest in appropriate Australian research into best value care—AHHA has recently launched the Australian Centre for Value-Based Health Care to support this work.

‘We call on all parties and candidates to commit to better bang for the health buck—a revamped value-for-money health system focused on what matters to patients’, Ms Verhoeven said.

Visit the Australian Centre for Value-Based Health Care here. To follow AHHA commentary throughout the election campaign, visit www.ahha.asn.au/election. This release is also available online.

NACCHO Aboriginal Health News Alert : Download the $33.4 Billion 2017 Indigenous Expenditure Report :

 ” Australia’s failure to meet Closing the Gap targets or to design policies that help improve the lives of Indigenous Australians means that governments need to pick up the slack.

 We are spending more than we would like on reacting to disadvantage (for example, A$4.1 billion on “public order and safety”) compared to activities that reduce disadvantage (for example, only A$1.3 billion on tertiary education or A$411 million on early childhood education).

What we still don’t know (and can’t extrapolate from this report) is whether the money we are spending on Indigenous Australians is having any positive impact whatsoever. This report certainly doesn’t provide the data or the level of policy rigour to answer that much more important question.

More targeted information and higher-quality evaluations are urgently needed. Crucially, Indigenous peoples need to be involved at all stages to provide more meaningful answers.”

From the Conversation

 ” An estimated $33.4 billion of Australian, State and Territory government expenditure was spent on services provided to Aboriginal and Torres Strait Islander Australians in 2015-16, according to the 2017 Indigenous Expenditure Report.

Around 18 per cent of this expenditure was on targeted programs for Aboriginal and Torres Strait Islander Australians, and the remainder was through non-targeted, or mainstream, services.”

Download the Report HERE and read Commission press release PART 2 below

2017 Indigenous Expenditure Report $33 Billion

Share of funding to Indigenous-run groups falls over past nine years

Australian funding to other organisations earmarked as Indigenous spending has increased by one third

Reports The Guardian

The proportion of funding that goes directly to Indigenous-run organisations has fallen over the past nine years, while funding to other organisations that is earmarked as Indigenous spending has increased by one third.

The social researcher Eva Cox said the decreased portion of targeted Indigenous funding was concerning. “We do know that Indigenous-specific services do tend to deliver on outcomes,” she told Guardian Australia.

Cox said the focus should not be on how much money was spent but on where and how it was spent, and which organisations received the funding.

Indigenous expenditure accounts for 6% of total expenditure, while Indigenous Australians make up 3.2% of the population. That was an understandable and necessary concentration of funding, Cox said, because it addressed an area of higher need.

“It’s obvious if we are going to deal with a population that is isolated and has entrenched levels of disadvantage then it’s going to cost us more,” she said. “And it should cost us more money but it should be well spent.”

She said the implication from successive government reports, including a damning Australian National Audit Office report on the federal government’s flagship Indigenous advancement strategy, was that money had not been well

“Continuing to spend the money does not necessarily mean that the services are well thought out, well-placed, or well-delivered,” she said.

Melbourne University researcher Elise Klein said targeted funding was necessary to address structural disadvantages faced by vulnerable groups.

“Just to direct funds towards Indigenous programs isn’t enough,” Klein said. “It again matters the kinds of programs that are being funded – just because they say they are doing good doesn’t mean they are. It also matters about who is delivering the programs as there has been a dramatic decrease (and in some cases cessation) of funding to Indigenous community organisations.

“For example only 46% of organisations funded under the Indigenous advancement strategy are Indigenous – receiving only 55% of the total funding.”

The Northern Territory had the highest rate of targeted Indigenous funding nationally, with $20,348 of the $65,929 spent per person directed toward Indigenous-specific services. The Territory also had the highest per person spending, because of higher levels of chronic need and the greater cost of delivering services to remote areas.

Of the bigger states, New South Wales and Queensland directed the lowest proportion of funding toward Indigenous-specific services, with 12% and 15% respectively.

However, both states had the highest overall Indigenous expenditure, with NSW spending $9bn, or $38,452 per person, while Queensland spent $8.5bn or $40,350 per person.

Part 2 Productivity Commission Press Release

Since 2008-09 (and after adjusting for inflation), targeted expenditure has remained relatively constant at around $6.0 billion, while expenditure on mainstream services has increased by almost one-third (from $20.9 billion to $27.4 billion).

Per head of total population, expenditure (targeted and mainstream) equated to $44 886 per Aboriginal and Torres Strait Islander Australian, around twice the rate for non- Indigenous Australians ($22 356) and similar to ratios previously reported back to 2008 -09.

 

Around two-thirds of the higher per person expenditure for Aboriginal and Torres Strait Islander Australians is accounted for by greater intensity of service use (reflecting greater need and younger age profile), with the remaining one-third accounted for by the higher cost of providing services (such as in remote locations).

Peter Harris, Chairman of the Productivity Commission and Chair of the Steering Committee for the Review of Government Service Provision emphasised the importance of robust, public evaluations to understand the adequacy, effectiveness and efficiency of government spending, something which is outside the scope of this report.

‘Understanding which policies and programs deliver outcomes effectively is vital for Aboriginal and Torres Strait Islander

Australians, and all Australians. Without understanding what works and why, we cannot say if money is being well spent’ he said.

The full suite of information on this report, including the report, data tables and a ‘how to’ video for accessing the 2017 report data can be found at:

http://www.pc.gov.au/ier2017

The report is produced by the Productivity Commission for the Steering Committee

Background Related Productivity report

Overcoming Indigenous Disadvantage: Key Indicators 2016

The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians.

This comprehensive report card measures where things have improved (or not) against 52 indicators across a range of areas including governance, leadership and culture, early childhood, education, health, home and safe and supportive communities, and includes case studies on things that work to improve outcomes.

The report is produced in consultation with all Australian governments and Aboriginal and Torres Strait Islander Australians.

The 2016 report was released on 17 November 2016

This report measures the wellbeing of Aboriginal and Torres Strait Islander Australians, and was produced in consultation with governments and Aboriginal and Torres Strait Islander Australians. Around 3 per cent of the Australian population are estimated as being of Aboriginal or Torres Strait Islander origin (based on 2011 Census data).

Outcomes have improved in a number of areas, including some COAG targets. For indicators with new data for this report:

  • Mortality rates for children improved significantly between 1998 and 2014, particular for 0<1 year olds, whose mortality rates more than halved (from 14 to 6 deaths per 1000 live births).
  • Education improvements included increases in the proportion of 20–24 year olds completing year 12 or above (from 2008 to 2014-15) and the proportion of 20–64 year olds with or working towards post-school qualifications (from 2002 to 2014-15).
  • The proportion of adults whose main income was from employment increased from 32 per cent in 2002 to 43 per cent in 2014-15, with household income increasing over this period.
  • The proportion of adults that recognised traditional lands increased from 70 per cent in 2002 to 74 per cent in 2014-15.

However, there has been little or no change for some indicators.

  • Rates of family and community violence were unchanged between 2002 and 2014-15 (around 22 per cent), and risky long-term alcohol use in 2014-15 was similar to 2002 (though lower than 2008).
  • The proportions of people learning and speaking Indigenous languages remains unchanged from 2008 to 2014-15.

Outcomes have worsened in some areas.

  • The proportion of adults reporting high levels of psychological distress increased from 27 per cent in 2004-05 to 33 per cent in 2014-15, and hospitalisations for self-harm increased by 56 per cent over this period.
  • The proportion of adults reporting substance misuse in the previous 12 months increased from 23 per cent in 2002 to 31 per cent in 2014-15.
  • The adult imprisonment rate increased 77 per cent between 2000 and 2015, and whilst the juvenile detention rate has decreased it is still 24 times the rate for non-Indigenous youth.

Change over time cannot be assessed for all the indicators — some indicators have no trend data; some indicators report on service use and change over time might be due to changing access rather than changes in the underlying outcome; and some indicators have related measures that moved in different directions.

Finally, data alone cannot tell the complete story about the wellbeing of Aboriginal and Torres Strait Islander Australians, nor can it fully tell us why outcomes improve (or not) in different areas. To support the indicator reporting, case studies of ‘things that work’ are included in this report. However, the relatively small number of case studies included reflects a lack of rigorously evaluated programs in the Indigenous policy area.

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 2 NACCHO Background : IAHP Indigenous Australians’ Health Programme

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

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

The following themes comprise the Programme:

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

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

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

Part 3 NACCHO background history February 2016

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

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

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

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

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

2.Indigenous Australians’ Health Programme – Service Maintenance Programme

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

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

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

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

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

 

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

 

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

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

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

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

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

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

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

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

Part 1

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

FROM The Mandarin

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

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

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

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

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

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

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

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

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

The draft framework says it aims to:

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

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

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

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

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

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

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

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

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

Do they demonstrate cultural respect towards Indigenous Australians?

Four elements of good evaluation

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

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

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

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

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

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

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

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

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

Recognition of an Aboriginal Health Problem

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

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

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

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

Efforts to Improve Indigenous Health

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

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

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

Strategies to ‘Close the Gap’

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

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

Obstructions to Closing the Gap

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

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

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

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

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

Indigenous Health: the current situation

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

Where to from here?

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

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

Social Dimensions which affect Health

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

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

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

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

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

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

NACCHO Aboriginal Health and Smoking : Download Tackling Indigenous Smoking Program prelim. evaluation report

 ” The overall goal of the national Tackling Indigenous Smoking (TIS) program is to improve the health of Aboriginal and Torres Strait Islander people through local population specific efforts to reduce harm from tobacco.

The purpose of this preliminary report is to provide a mid-term evaluation of progress to date in implementing the first year of the three year (2015-2018) TIS program.

The TIS programme with a budget of $116.8 million over 3 years ($35.3 million in 2015-16; $37.5 million in 2016-17 and $44 million in 2017-18) was announced by the Government, on 29 May 2015.”

Download 133 page PDF report Here :

NACCHO Download Dept Health Tackling Indigenous Smoking Evaluation June 2017

The report found the program is operating effectively, using proven approaches to change smoking behaviours, and delivering evidence-based local tobacco health promotion activities. I am pleased the report recommends it continues,

Smoking is the most preventable cause of disease and early death among Aboriginal people and accounts for almost one-quarter of the difference in average health outcomes between indigenous and non-indigenous Australians.

“The program provides grants in 37 urban, rural, regional and remote areas to assist local communities to develop localised anti-smoking campaigns

Minister Ken Wyatt

Read over 100 plus NACCHO articles published in past 5 years

This mid-term evaluation looks at progress to date of the TIS program, particularly in terms of regional grants delivering localised Indigenous tobacco interventions.

Source of intro

See list all 35 Recipients below

It does not look at long-term impact in relation to a reduction of smoking rates at a national level.

Findings focus on (see in full below 1-9)

  • the shift to TIS
  • community engagement and partnerships
  • localised health promotion
  • access to quit support
  • contribution to evidence base
  • National Best Practice Unit and TIS portal
  • governance and communications.

A number of key recommendations emerging from the evaluation are included in the report.(see Below Part 2)

Findings

1. Shift to TIS

Since the implementation of the TIS program, all grant recipients are primarily focused on planning for, and/or delivering, targeted and tailored activities that directly address reduction of smoking prevalence within communities.

For some grant recipients, broader health promotion activities without a clear link to tobacco reduction have dropped off significantly as a result of the shift to TIS, whilst for others the integration of healthy lifestyle and tobacco control strategies has been successful. There are varying degrees of clarity among grant recipients about the extent to which there is flexibility to tap into healthy lifestyle activities under the new guidelines.

2.Community engagement and partnerships

Community engagement and involvement in the design and planning of localised TIS programs is a key priority for grant recipients, and a key indicator of successful TIS activities.

While challenges were identified in terms of handling competing priorities in community, adhering to cultural protocols, and the change in focus of the TIS program and uncertainty about ongoing funding, in the main, grant recipients have demonstrated substantial progress in involving community in design and planning and garnering support for TIS activities.

This is evidenced by the popularity of community events hosted/attended by the TIS team and the proactivity of local community and Elders in advocating for tobacco control.

The success of the TIS program and the capacity for grant recipients to operate as a multi-level population health program in their region is highly dependent upon the quality and reach of partnerships between grant recipients and other agencies/organisations.

Whilst challenges to regional collaborations were reported, overall there has been a noticeable increase in the reporting of grant recipient collaboration and partnerships, representing an important shift to both a wider regional focus and wider community approach to tobacco reduction.

3.Localised health promotion

At the local level, a range of multi-component health promotion activities around tobacco control are being undertaken by grant recipients, in collaboration with external stakeholders. Local partnerships are crucial to the successful implementation of localised health promotion activities through facilitating access to priority populations, supporting capacity-building and enabling a broader population reach to achieve awareness and understanding of the health impacts of smoking and quitting pathways. viii

Increased levels of community support and ownership for local solutions to tackling Indigenous smoking are being seen across the TIS sites.

4.Community education

Community education, is being undertaken by all grant recipients. This manifests in a range of ways, including health promotion activities at community/sporting events, drama shows and comedy and social marketing.

The involvement of local champions and Elders in local education and awareness raising events and activities is recognised as central to tobacco control messages resonating with target audiences.

It has also been recognised that targeting priority groups, such as young people and pregnant women, requires the adaptation of messages so that they resonate with those groups.

Grant recipients are partnering with key local organisations (e.g. schools, other AMS etc.) to overcome some of the challenges around access to these priority groups.

Many grant recipients have established or showed progress in establishing social marketing campaigns to supplement other health promotion activities. Campaigns are developed largely through a strength-based approach, with ‘local faces and local places’ taking precedence. Grant recipients have acknowledged the challenges in measuring the impact of social marketing campaigns although some are demonstrating a commitment to collecting data on awareness, and influences on motivations and attempts to quit.

5.Smoke-free environments

An area that has been recognised by grant recipients as requiring attention is the promotion and establishment of smoke-free environments, particularly in rural and remote locations. Modelling smoke-free environments within the grant recipients’ own workplace is one way in which this issue is being addressed, with some evidence of success.

Challenges to the implementation of smoke-free workplaces include getting support from senior leaders or Board members who smoke, and organisations where tobacco control is not the main priority. Monitoring the compliance of smoke-free environments presented an additional challenge to grant recipients. Some external organisations have requested support to become smoke-free, and successful examples of smoke-free environments including smoke-free community events are evident.

Shifting attitudes around second-hand smoke (e.g. smoking indoors and in cars) and some evidence of behaviour change were reported by grant recipients and community members.

6.Access to quit support

TIS funded organisations are encouraged to take a systems approach to activity planning. The TIS program is part of a larger preventive health care system, all connected in different ways such as through referral pathways, and client appointments.

A key component of the TIS program is therefore enhancement of referral pathways and promoting access to quit support. Grant recipients have developed a range of opportunities for community members to achieve smoking cessation, with referral pathways having been established in two key areas: clinic-based referrals within their organisation and referrals made during localised TIS health promotion activities.

For some, successful referral pathways are dependent upon grant recipients partnering with external organisations.

Improving access to culturally appropriate support to quit has been a key focus of the grant recipients over the past 12 months.

Quitline enhancements are a component of the TIS program and data suggests that referrals to Quitline are higher in urban and some rural areas. Continuing to build strong partnerships between grant recipients and Quitline will be key to increasing referrals from local TIS programs into Quitline where appropriate.

Another key focus for grant recipients has been in increasing the skills of TIS workers and other professionals in contact with Aboriginal and Torres Strait Islander people to provide smoking cessation education and brief interventions. Quits kills training, and other smoking cessation education programs, have been accessed to support this goal.

7.Contributions to evidence base

The shift to delivering activities based in evidence and focusing more on outcomes than outputs has been welcomed by grant recipients, in the main, and has provided greater direction for activities and a goal to work towards.

A range of activities were undertaken by grant recipients to develop or strengthen their evidence base and work towards measurable outcomes. Collecting data remained challenging for some remote grant recipients operating in contexts with low literacy levels and where English is not the first language. Health service grant recipients wanting to collect population level data was also challenging when services are operating on different databases within a region and where there was an unwillingness to share data.

Overall, grant recipients expressed a willingness to focus on outcomes, and the confidence and capability to obtain data, although interpreting and reporting on data was presented as a challenge.

8.National Best Practice Unit and TIS portal

Advice and guidance around monitoring, measuring and further improving local TIS programs is provided to grant recipients through the NBPU TIS. Grant recipients have indicated that they value the support and advice provided through the NBPU TIS and this has aided in building their confidence and capacity to undertake monitoring and evaluation activities.

Some grant recipients reported that an additional level of support from NBPU TIS was needed. Resistance to change is common in any business when new processes are set in place. NBPU TIS therefore expected, and has witnessed, some resistance to this change. However, it continues to engage with grant recipients and support significant processes of change, not just reporting and compliance.

Another component of the work of the NBPU TIS is the development and ongoing maintenance and improvement of the Tackling Indigenous Smoking Resource and Information Centre (TISRIC) and its home, the TIS Portal (hosted by Australian Indigenous HealthInfoNet).

Information and resources to support grant recipients in planning, monitoring, and evaluating activities, as well as information on workforce development is provided through the TIS Portal.

In addition, the Portal hosts an online forum (TIS Yarning Place) that enables grant recipients from across the country to share information and ask questions. Evaluation findings suggest that, whilst grant recipients are utilising the TIS Portal, some grant recipients have identified opportunities to enhance the useability of the TIS Portal.

9.Governance and communications

Various components of support are provided to grant recipients by the department and the NBPU TIS regarding the new focus and priorities and expectations of the TIS program.

To ensure consistent program messaging, and to enhance performance reporting, a range of initiatives were undertaken in the latter half of 2016 to clarify the roles and responsibilities of the various ‘players’ in the national TIS program.

The loss of experienced staff due to funding uncertainty has represented a significant challenge for several grant recipients in their planning and implementing activities.

Particularly in remote areas, recruitment has been an issue for many grant recipients due to the mix of skills demanded of TIS staff. Grant recipients report continued issues attracting and retaining staff with only short term contracts under the new TIS program.

Despite these concerns, indications are that providing grant recipients are given sufficient time and support to execute their Action Plans, they are on track for achieving stated tobacco reduction outcomes. The key risk to this is workforce stability, which would be mitigated by timely advice about the outcome of ongoing funding arrangements.

A number of key recommendations have emerged out of the evaluation findings:

Overall recommendations

1. Department: The TIS program in its current form should be continued, with a move away from short-term funding cycles.

2. Department: Provide immediate advice about the funding of TIS from June 2017 to end of current funding cycle.

Shift to TIS

3. Department: Provide clarity around what is allowable in relation to healthy lifestyle activities within the current iteration of the TIS program  Community engagement and partnerships

4. Grant recipients: Continue to broker partnerships and leverage relationships.

5. NBPU TIS: Continue to build capability of grant recipients to broker partnerships and leverage relationships through the distribution and promotion of relevant resources.

Community education and awareness

6. Grant recipients: Continue to identify and prioritise key groups, especially pregnant women.

7. Grant recipients: Ensure evidence-based best practice community education models (including monitoring and evaluation approaches) are sought and adopted where appropriate.

8. NBPU TIS: Ensure the evidence-based best practice community education models (including monitoring and evaluation approaches) are available, particularly for priority target groups such as pregnant women and activities around social marketing.

Smoke-free environments

9. Grant recipients: Continue to explore implementing smoke-free workplaces and enhance support for smoke-free public spaces.

10. National Coordinator: Lead a dialogue between regional leaders, including CEOs, Board members of TIS and non-TIS funded organisations around establishing smoke-free environments.

Access to quitting support

11. Grant recipients: Continue to strengthen partnerships with Quitline and other quit support structures where appropriate.  Contribution to larger evidence base

12. Grant recipients: Build on routine and existing data sources to reduce data collection burden.

National support

13. Grant recipients: Continue to seek feedback from NBPU TIS regarding M&E activities where required.

14. NBPU TIS: Continue to respond to feedback from GRs around M&E needs and TIS portal content and use ability.

15. Department: Articulate the role of the National coordinator  in the context that the program has evolved and as such his role has evolved. Governance and communication

16. Department: Provide greater clarification of TIS funding parameters, especially in terms of incorporation of healthy lifestyle activities and one-on-one smoking cessation support.

The Tackling Indigenous Smoking (TIS) regional tobacco control grants aim to improve the wellbeing of Aboriginal and Torres Strait Islander people through population health activities to reduce tobacco use. It is an initiative of the Australian Government Department of Health (DoH).

At the end of 2015, a number of organisations were notified of their success in gaining a TIS grant for culturally appropriate tobacco cessation programs. The grants were awarded to a variety of service providers across the nation.

The 35 organisations that have commenced their programs are:

With the program funding provided until 2018, the successful organisations will work towards the intended outcomes of the TIS programme, including:

  • encouraging community involvement in and support for local tobacco control activities
  • increasing community understanding of the dangers of smoking and chewing tobacco
  • improving knowledge, skills and a better understanding of the health impacts of smoking.

Aboriginal Health Programs-Debate : Evaluating #Indigenous programs : a toolkit for change

 

 ” The Federal Government recently announced it will allocate $10 million a year over four years to strengthen the evaluation of Indigenous programs.

However, given that the average cost of an evaluation is $382,000, the extra $10 million a year for Indigenous program evaluations will not go far.

To make the most of this additional funding the government must change the way it evaluates and monitors programs.”

Sarah Hudson Researcher The Centre for Independent Studies

Download the report HERE

Evaluating Indigenous programs a tool kit for change

” Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being.

While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.”

 ” Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,”

Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne. See Article 2 Below

” Evaluation at the contract, program and outcome level will ensure we not only know where the money is being spent, but we will know what works and why.

“This is important for the government and taxpayers, but more important for communities in whose name the money is spent.

“It will also mean we will be better able to assess where our investm­ent needs to be focused in the future — and ensure the IAS continues to deliver outcomes for indigenous communities.”

From Indigenous Affairs Minister Nigel Scullion Article 3 below

 Feb 3 2017 NACCHO Aboriginal Health #IAS Funding : Turnbull government to spend $40m evaluating effectiveness of Indigenous programs 

Although formal evaluations for large government programs are important, evaluation need not involve outside contractors. Government must adopt a learning and developmental approach that embeds evaluation into a program’s design as part of a continuous quality improvement process.

It is not enough just to evaluate, government must actually use the findings from evaluations to improve service delivery. Unfortunately, many government agencies ignore evaluations when making funding decisions or implementing new programs.

Analysis of 49 Indigenous program evaluation reports, found only three used rigorous methodology.

Overall, the evaluations were characterised by a lack of data and the absence of a control group, as well as an overreliance on anecdotal evidence.

Adopting a co-accountability approach to evaluation will ensure that both the government agency funding the program and the program provider delivering the program are held accountable for results.

An overarching evaluation framework could assist with the different levels of outcomes expected over the life of the program and the various indicators needed to measure whether the program is meeting its objectives.

Feedback loops and a process to escalate any concerns will help to ensure government and program providers keep each other honest and lessons are learnt.

Analysis of Indigenous program evaluations

Mapping of total federal, state and territory and non-government/not-for-profit Indigenous programs identified 1082 Indigenous specific programs. Of these:

49 were federal government programs;

• 236 were state and territory programs; and

• 797 were programs delivered by non-government organisations.

The largest category of programs were health related programs (n=568) followed by cultural programs (n=145) then early childhood and education programs (n=130) — see Figure 1.

The program category with the highest number of evaluations was health (n=44), followed by early childhood and education (n=16). However, percentage wise, more programs were evaluated under the jobs and economy category (15%) than the other program categories.

Of the 490 programs delivered by Aboriginal organisations, only 20 were evaluated (4%). The small number of businesses delivering a program (n=6) meant that while there were only two evaluations of Indigenous programs provided by a business, this category had the highest percentage of programs evaluated (33%).

Similarly, while only six of the 33 programs delivered by schools and universities were evaluated, this category had the second highest percentage of programs evaluated (23%). Conversely, government and non-Indigenous NGO delivered programs had the highest number of evaluations, n=36 and n=24, but much lower percentages of evaluations as the number of overall programs was higher, n=278 and n=276.

A total of 49 evaluation reports were analysed and assessed against a scale rating the rigour of the methodology. Only three evaluation reports utilised strong methodology (see Figure 4).

In general, Indigenous evaluations are characterised by a lack of data and the absence of a control group, as well as an over-reliance on anecdotal evidence

Suggestions for policy makers and program funders include:

  • Embedding evaluation into program design and practice — evaluation should not be viewed as an ‘add on’ but should be built into a program’s design and presented as part of a continuous quality improvement process with funding for self-evaluation provided to organisations.
  • Developing an evidence base through an accountability framework with regular feedback loops via an online data management system — to ensure data being collected is used to inform practice and improve program outcomes and there is a process for escalating concerns.

Suggestions for program providers include:

  • Embedding evaluation into program practice — evaluation should not be viewed as a negative process, but as an opportunity to learn.
  • Developing an evidence base through the regular collection of data via an online data management system to not only provide a stronger evidence base for recurrent funding, but also to improve service delivery and ensure client satisfaction with the program

Article 2 Govt co-design ‘not an equal partnership’: Aboriginal health CEO

Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,” Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne.

A particularly vivid example of this is engagement on the establishment of family violence hubs around the state. Gallagher, who is on the family violence industry taskforce, said she was handed a draft plan already outlining the main priorities on Monday, and asked to provide a written response by Wednesday. “A report the size of a PhD,” she added.

“So when they say ‘we want to co-design with you guys’, always ask them what their version of co-designing is,” she told the audience. “Without systematic change in mainstream attitudes and practices, and incorporation of Aboriginal peoples in all stages of policy design, health policies will remain unproductive.”

While Gallagher says she understands the challenges of trying to co-design with a community, government needed to make a more concerted effort to do it properly.

“It doesn’t give us due respect of being part of the beginning right through to the evaluation.”

Culture is strength

Aboriginal culture is often seen in the wider Australian population as a barrier to health, implying that assimilation is the only way forward, Gallagher said.

She rejects this idea. “Cultural differences need to be celebrated and preserved. They are a source of strength and resilience for our peoples, which offer protective factors against traumatic life events.”

Cultural safety and trust can have a big impact on engagement with institutions. She points to the fact that around the country, Aboriginal people are discharged against medical advice or at their own risk at eight times the rate of the rest of the population. This has obvious flow on effects for overall wellbeing.

“When we have a culturally safe place for patients and our people, we improve access to services and improve health for individuals, therefore health for families, therefore health for communities.”

Also in The MandarinIndigenous policy evidence, where it exists, over-relies on anecdotal evidence

Creating that environment should not only be up to Aboriginal employees or a good CEO, but come out of an organisation’s systems. This means more than just creating a few identified positions — it’s everyone’s responsibility.

Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being. While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.

“Possessing a strong sense of cultural identity is also vital for one’s self-esteem. A positive cultural connection not only contributes to better mental health and physical health, but may lessen the consequences of social prejudice against Aboriginal peoples.”

Yet despite plenty of experience to show the importance of culture as a source of resilience, it “remains largely unexplored” as a public health resource, she says.

Funding models that don’t fit

Governments ignoring the role of culture creates other problems, Gallagher explains.

The Commonwealth made a capital investment a few years ago to create a childcare centre and kindergarten in Melbourne’s northern suburbs called Bubup Wilam. Recurrent funding was only given for two years, with the idea that it would become self-sustaining by the end of that short period.

“Bubup Wilam grew and evolved and it’s a beautiful childcare centre and kindergarten for Aboriginal children, where they can learn and express aboriginal culture but also have access to what every other kid has access to.

Despite the success, it’s “struggling to continue that at the moment” and is trying to raise funds in the community, she says, “because it doesn’t just provide a kindergarten like for a mainstream nuclear family.”

“Because a lot of the kids and families that access Bubup Wilam are families that live well under the poverty line, a lot of them are touched by the child protection system. What Bubup Wilam tries to do is work with the children, but also work with the families — the mum or the dad or the caregiver — and that takes a lot of resources.

“So our model there does not fit within the mainstream model of how they fund a nuclear, non-Aboriginal childcare centre. … So that’s an example of how the differences and different needs and funding formulas don’t fit what we need to achieve.”

This comes back to the co-design problem: governments aren’t paying enough attention to what the community says, and end up designing the system to fit what they think the community needs, which is different to what it really needs.

“It’s about involving us from the word go,” says Gallagher.

“What Fitzroy might need is different to what Fitzroy Crossing might need.”

Part 3 : Indigenous Affairs Minister Nigel Scullion

The Turnbull government will spend $40 million evaluating its indigenous affairs programs in an attempt to counter a national audit office report expected to be harshly critical of the way billions of dollars have been allocated.

Sidelined prime ministerial indigen­ous adviser Warren Mundine said yesterday the report, to be tabled today, was expected to be “damning”, as was the official Clos­ing the Gap report due within days.

The audit office report follows a Senate inquiry last year that blasted the 2014 implementation of the Abbott government’s flagship multi-billion-dollar Indigenous Advancement Strategy.

A 2015 Productivity Commission report found there was insufficient evidence being collected about the outcomes of indigenous programs and that “formal rigorous evaluations of indigenous programs that set the benefits of particular policies for reducing disadvantage against the costs are relatively scarce”.

Spending on mainstream and indigenous-specific programs and services has been estimated by the government to be worth $30 billion. A Centre for Independent Studies report last year found only 8 per cent of 1082 indigenous-spec­ific programs, worth $5.9bn, had been effectively evaluated.

However, Indigenous Affairs Minister Nigel Scullion, who will announce the four-year evalua­tion program today, said reporting, monitoring and evaluation of the IAS had already been improved­, and accounting for how much was being spent in the portfolio was now possible.

“However, we need to continually build on this and further strengthen the evaluation of our investment to ensure that money allocated through the IAS is invest­ed in ways that make the greatest difference for our first Australians,” Senator Scullion said. “By establishing a multi-year funding allocation, we are ensuring there will be a long-term plan for evaluation and a formal strategy to monitor and review how individ­ual contracts and program streams are contributing to our effort­s to deliver better outcomes for indigenous Australians.

Senator Scullion said the evaluation would be rolled out in close consultation with Aborigines and Torres Strait Islanders, including­ indigenous-run firms. “Indig­enous-run companies are currently delivering rigorous evaluation for the government and this new framework will continue this partnership,” he said.