NACCHO Aboriginal Health and Alcohol Research : New ADAC APP a will be ‘game changer’ to gauge realistic drinking habits says @ScottADAC

“Obviously there’s people who want the research done to help their community.

Once we get this app going, it’ll become very clear very quickly where the money should be spent.

That doesn’t mean you’ve just got to chuck money at them, but having Aboriginal-controlled issues and understanding which way they want to go.”

Jimmy Perry, a Ngarrindjerri/Arrernte man and an Aboriginal health worker involved in the project, said communities had a positive response.

 Read over over 200 Aboriginal Health Alcohol and Other Drugs articles published by NACCHO over the past 7 years 

Download the APP Research

18-lee-developing-tablet-computer-app-bmc-med1_final-data

Originally published HERE 

Researchers say a new app has the potential to more accurately reflect the nation’s drinking habits.

The ADAC and app researchers hoped the app would be available to download by the end of the year.

Key points : 

  • App developers say it will get a more accurate drinking history than a face-to-face interview with a trained health professional
  • The Aboriginal Drug and Alcohol Council says the app could replace the National Drug Strategy Household Survey
  • Researchers say alcohol consumption among Aboriginal women is under-represented by up to 700 per cent in national surveys

The Grog App was designed for use by Indigenous Australians but could be used by anyone.

Dr Kylie Lee, a senior research fellow at the Centre of Research Excellence in Indigenous Health and Alcohol who was also involved in the app’s development, said the new technology would create a more accurate database.

“Aboriginal women, their drinking is under-represented in the national surveys by up to 700 per cent and 200 per cent in men.

“Undeniably we need to do better … this app offers a great opportunity to do that.”

Researchers believe the app would elicit greater detail than the National Drug Strategy Household Survey which has been used for more than 30 years.

Dr Lee said the prospect of collating improved data collection on the difficult topic of drug and alcohol consumption was “exciting”.

“I think it really could be a game changer because it’s giving an opportunity for a safe place where they can just tell their story in terms of what they use or what they drink,” she said.

How it works

Take a Virtual Tour HERE

Participants answer a range of broad and specific questions on the app about alcohol and based on that information, they are allocated into a category on a sliding scale from ‘non-drinker’ to ‘high risk’.

Dr Lee said immediate feedback was very helpful.

She said the app could alleviate issues in the way alcohol data was typically collected, for example participants were more likely to be asked about standard drinks but not non-standard containers.

“Like a soft drink bottle, a juice bottle, a sports bottle et cetera so the app has facilities to show how much you put in the bottle,” Dr Lee said.

“It’s very exciting the level of detail you’re going to get.”

Professor Kate Conigrave, the app’s chief investigator and an addiction specialist at Royal Prince Alfred Hospital, agreed the new technology could provide greater clarity.

“I’m aware of the traps,” she said.

“One patient I saw had been recorded by a doctor as drinking three standard drinks a day but when I took a drinking history I said, ‘what do you drink them out of?’, and he showed me a sports bottle,” Professor Conigrave said.

“He was drinking three full sports bottles of wine a day, so that’s about 30 standard drinks a day.”

PHOTO: Professor Conigrave says the images used in the app can trigger the participant’s memory, making their drinking history more accurate. (Supplied: Kate Conigrave)

Professor Conigrave said the national health survey often contained “tiny” numbers from Indigenous communities.

“The sample sizes are so small, it’s hard to get a meaningful picture,” she said.

She said the app would provide a level of comfortability and anonymity which may lead to more accurate data, than an interview with a trained health professional.

“People can be a bit embarrassed about what they’re drinking and it can be a bit hard to admit to someone you know, ‘when I drink I have 12 cans of beer,'” she said.

Taking it to the communities

The app is in its second phase of testing.

In the first phase, Aboriginal and Torres Strait Islanders in remote, regional and urban parts of South Australia and Queensland were asked to describe their drinking habits.

Research on the app has now progressed to the second round, during which the focus was on the technology’s validity as an on-the-ground survey tool.

Scott Wilson, who was leading the development of the app at the Aboriginal Drug and Alcohol Council (ADAC), said the second phase was a “major prevalence study” which would include participants from the local hospital and prison.

The location for the trial has not been made public.

“In the big major surveys people in those areas are always excluded,” Mr Wilson said.

“When you consider that I might be in hospital for an alcohol-related illness or I might be in jail because of an alcohol or drug-related crime, my voice or results are never included.”

The ADAC and app researchers hoped the app would be available to download by the end of the year.

In the meantime, they planned to have discussions with the government over the future use of the app and pursue grant opportunities.

Dr Lee said she was excited for the potential of the new technology.

“Eventually I think it would be a great tool to roll out nationally … using it in the same way as the National Drug Strategy Household Survey,” she said

NACCHO Aboriginal #MentalHealth #SuicidePrevention @NMHC Communique : @GregHuntMP roundtable meeting to review investment to date in mental health and suicide prevention : #TimeToFixMentalHealth #TomCalma @AUMentalHealth @FrankGQuinlan @PatMcGorry @amapresident @headspace_aus

” Minister for Health, Greg Hunt, hosted a Government-led roundtable this week to review investment to date in mental health and suicide prevention, to hear from the sector on current gaps and priorities, to understand what is and is not working, and to advise on the upcoming national forum on youth mental health and suicide prevention.

Minister Hunt and Prime Minister Scott Morrison are committed to working towards zero-suicide for all Australians, including our youth.

From the National Mental Health Commission 6 June 

( The Indigenous ) Suicide rates are an appalling national tragedy that is not only depriving too many of our young people of a full life, but is wreaking havoc among our families and communities.

As anyone who has experienced a friend or family member committing suicide will know, the effects are widespread and devastating and healing can be elusive for those left behind.

It is time that we draw a line under this tragic situation that is impacting so significantly on Aboriginal and Torres Strait Islander communities  “

Noting Professor Tom Calma AO was a participant in the meeting via telephone link and opened the meeting with a discussion on Indigenous suicide. 

See this quote and 140 Plus Aboriginal Health and Suicide Prevention articles published by NACCHO in last 7 Years 

Those in attendance welcomed the Government’s commitment, with a number noting that suicide prevention needs to be a priority across all age groups, especially those groups with the highest suicide rates.

The conversation covered a range of key issues, challenges and opportunities for reform and action. Particular discussion points included:

  • Social determinants of mental health: there is a fundamental need to focus on the social determinants of mental health for all Australians, noting and emphasising the range of factors that contribute to distress in young Australians. This is an important factor for all young people and communities, with particular reference to the factors impacting on Aboriginal and Torres Strait Islander children and youth.
  • The impact of trauma and disadvantage: conversation centred on the impacts of trauma and disadvantage and the importance of supporting, for example, young people in out-of-home care, those living in poverty and individuals who are in the justice system.
  • Support for children and families: in order to improve the lives of young Australians, there is a need to better support children and families in the early years. This includes support for neurodevelopmental disorders. In the same way headspace has been developed for young people, there was a suggestion that mental health services focused on children and families could show real benefits.  There is strong support for a focus on prevention
  • Support for Schools: a continued need was highlighted around the role of, and support for, schools, including primary schools and early learning centres. Schools are a critical component of a ‘whole of community’ approach in building supportive environments for children and young people.   It was suggested that for families who may not seek services but who were in need a way of ‘connecting’ may be through digital tools, to identify and support children and parents in those families.
  • Impact on youth: young people can be seriously impacted and influenced by the suicide death of other young people who are their friends, peers, family members or celebrities. More timely and sophisticated data and comprehensive local responses are needed to assist in the reduction of risk for further lives being lost following a suicide.
  • Data: The importance of being able to collect, analyse and provide accurate data was highlighted.  This data is significant across mental health services and particularly for suicide prevention, treatment and support services.
  • Service reform: there is a need for service reform to better respond to people with mental health concerns that are too complex to be managed by a GP at a primary health care level but not so acute as to require specialist tertiary mental health services. While there are some good programs and services to build upon, there is a lack of equity across all regions and access remains a key issue for those requiring psychological and other services. We also need to integrate mental health services with drug and alcohol services.
  • Workforce development: there is an urgent need to focus on training and supporting the diverse professionals working with those at risk of or with mental health issues – health and allied health staff, drug and alcohol workers, school counsellors, psychologists, peer workers and many others. The role of peer workers was recognised as being a critical one and this must be included in all workforce development strategies and initiatives.
  • Peer and carer support: many families and peers supporting those who are in suicidal distress and/or living with challenging mental health and drug and alcohol concerns needed immediate and quality support themselves as they are also at risk for mental ill-health. Families and friends are the largest non-clinical workforce providing care and support for Australians and there is an immediate need to provide better supports for them.
  • Regional and national leadership: while attendees were supportive of regional planning and action, it was suggested that stronger guidance at a national level was needed in order to ensure equity and quality of service responses across the country, with a recognition of the importance of the role of Primary Health Networks.  Further work is needed to ensure that the roles and responsibilities of all governments were clarified, together with accountability. The Fifth National Mental Health and Suicide Prevention Plan, and particularly the Suicide Prevention Implementation Plan, are key drivers for clearer accountability and integrated and coordinated responses.
  • Funding models: there was discussion on how best to fund services across the range of needs, including the current review of Medicare and the role of private health insurance.

A collective agreement and strong commitment was reached that a collaborative approach is vital to achieving improved mental health outcomes for all Australians, including children and youth.

There is significant support for a 2030 Vision for mental health and suicide prevention, to be led by the Commission and to ensure that the systematic changes required to best service the community can be identified, prioritised and achieved. This Vision would be look beyond the current plans and strategies.

Attendees acknowledged the commitment to mental health and quality program responses in recent years, together with the increased funding in the 2019/20 federal budget for expanded youth and adult mental health services in the community, together with initiatives to strengthen the collection of critical data around suicide and mentally healthy workplaces.  They also noted the current enquiries being undertaken by the Productivity Commission and the Victorian Royal Commission.  However, there needs to be an increased focus on longer term systems reform.  The Commission has been tasked with taking a leading role in this and will work closely with the sector to develop a reform pathway.

Participants embraced the importance of hope, recognising not only the significant investment to date but that youth mental health services in Australia have been copied by other nations.  There is strong support for improvements in mental health and suicide prevention across all levels of government and community.

As outlined by the Minister for Health, this was an opportunity to review the current status and continue this important discussion.  It is one of many conversations that will continue with the sector at organisational, group and individual levels.

The Commission will provide updates in sector engagement and discussions as they occur.

Lucy Brogden

Chair, National Mental Health Commission

Christine Morgan

CEO, National Mental Health Commission

 

NACCHO Aboriginal #RefreshtheCTGRfresh and #FASD2018 @GregHuntMP and @KenWyattMP unveil a new National Fetal Alcohol Spectrum Disorder (FASD) Strategic Action Plan 2018- 2028 and more than $7 million in new funding.

“Success is underpinned by a team effort, with collaboration between families, communities, service providers and governments.

FASD requires a national approach, linking in closely with local solutions. We are acknowledging the scale of the issue in Australia and intensifying efforts to address it.”

The Minister for Indigenous Health and Minister for Aged Care, Ken Wyatt AM, said the Government’s approach to FASD was to invest in activities which have been shown to be effective.

“This plan will show us the way forward to tackle the tragic problem of FASD – guiding future actions for governments, service providers and communities in the priority areas of prevention, screening and diagnosis, support and management, and tailoring needs to communities.

Alongside the plan’s release, I am pleased to announce a new investment of $7.2 million to support activities that align with these priority areas.

This funding will enable work to start immediately and help protect future generations and give children the best start possible.

Minister for Health Greg Hunt said the Government is committed to reducing the impact of FASD on individuals, families and communities.

Download a PDF copy of Plan 

National Fetal Alcohol Spectrum Disorder Strategic Action Plan 2018-2028

The forum delegates agreed that there was an urgent need for action to prevent FASD in our Top End communities, and across the Northern Territory.

It is essential that our responses do not stigmatise women or Aboriginal people.

It is important that we don’t lay blame, but instead work together, to support our women and young girls.

Everyone is at risk of FASD, so everyone must be informed the harmful effects of drinking while pregnant.

Our men also need to step up and support our mothers, sisters, nieces and partners, to ensure that we give every child the best chance in life.”

A landmark Top End Foetal Alcohol Spectrum Disorder (FASD) forum* was held in Darwin on 30-31 May 2018

Read over 25 NACCHO Aboriginal Health and FASD articles published over 6 years

The Federal Government is stepping up its fight against Fetal Alcohol Spectrum Disorder (FASD) today by unveiling a new national action plan and more than $7 million in new funding.

Fetal Alcohol Spectrum Disorder is the term used to describe the lifelong physical and neurodevelopmental impairments that can result from fetal alcohol exposure.

FASD is a condition that is an outcome of parents either not being aware of the dangers of alcohol use when pregnant or planning a pregnancy, or not being supported to stay healthy and strong during pregnancy.

This funding will enable new work to get underway and build on proven programs – to help protect future generations and give children the best possible start in life.

Key Points of action plan

FASD will be tackled across a range of fronts – including prevention, screening and diagnosis, support and management, and priority populations at increased risk of harm.

PREVENTION: $1.47 million including new consumer resources and general awareness activities – including national FASD Awareness Day, translation of awareness materials into a variety of First Nations languages, and promotion of alcohol consumption guidelines, and bottle shop point of sale warnings.

SCREENING: $1.2 million to support new screening and diagnosis activities, which will include reviewing existing tools and developing new systems and referral pathways, to assist professionals in community settings.

MANAGEMENT: $1.2 million goes to management and support activities, including tailored resources for people working in the education, justice and police sectors.

LOCAL TARGETING: $1.27 million to develop targeted resources, to meet local cultural and community needs.

BUILDING ON SUCCESS: $1.55 million to continue proven activities – with support for Australia’s FASD Hub, a one-stop shop containing the FASD Register and public awareness campaigns.

The Strategic Action Plan also establishes an expert FASD Advisory Group – which will report to the National Drug Strategy Committee on the progress being made, while promoting successful models and highlighting emerging issues and evidence.

From the FASD Workshop in Perth this week 

The plan is committed to breaking FASD’s impact on

  • Encounters with the law
  • Family breakdowns
  • Deaths in custody
  • Suicides and chronic health conditions

FASD requires a national approach, linking in closely with local solutions.

We are acknowledging the scale of the issue in Australia and intensifying efforts to address it.

The activities and actions outlined in the priority areas of the Plan are intended to guide future action – they are not compulsory and can be adopted as needed, along with other interventions and programs, based on local needs.

Activities should be evidence informed and based on best available research and data – actions should be tailored to individual communities and regions.

Since 2014, the Liberal National Government has provided almost $20 million in direct funding to tackle

NACCHO Aboriginal Health NEWS : @AIHW report : The consumption of #alcohol, #tobacco and other #drugs is a major cause of preventable disease and illness in our communities

The consumption of alcohol, tobacco and other drugs is a major cause of preventable disease and illness in our comminities

There are a wide range of data sources available that contribute to our understanding of alcohol, tobacco and other drug use.

This web report from AIHW is intended to be a general reference for contemporary data on alcohol, tobacco and other drugs in Australia.

SEE Full Report 

This report consolidates the most recently available information regarding the use of tobacco, alcohol, cannabis, meth/amphetamines and other stimulants, the non-medical use of pharmaceutical drugs, illicit opioids (heroin) and new (and emerging) psychoactive substances (NPS).

Key trends in the availability, consumption, harms and treatment are identified and detailed data are presented for vulnerable populations.

These population groups include Aboriginal and Torres Strait Islander people, homeless people, older people, people from culturally and linguistically diverse backgrounds, people identifying as lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ), people in contact with the criminal justice system, people with mental health conditions, young people and people who inject drugs

Key findings Aboriginal and Torres Strait Islander people 

  • There has been significant declines in the proportion of Aboriginal and Torres Strait Islander people smoking and consume alcohol that exceeds lifetime risk guidelines (consuming more than two standard drinks per day on average).
  • The prevalence of smoking by Indigenous people has declined from 55% in 1994 to 45% in 2014–15.
  • The proportion of Indigenous people that consume alcohol as levels that exceed lifetime risk guidelines has reduced from 19% in 2008 to 15% in 2014–15.
  • In 2011, tobacco use accounted for 12% of the burden of disease for Indigenous Australians. This accounts for 23.3% of the health gap between Indigenous and non-Indigenous Australians.
  • In 2016, more than 1 in 4 (27%) Indigenous Australians used an illicit drug in the last 12 months. This was 1.8 times higher than for non-Indigenous Australians (15.3%).
  • The most commonly used illicit drug by Indigenous Australians is cannabis (16.7%), followed by the non-medical use of pharmaceutical drugs (11.0%).
  • Of clients of alcohol and other drug, treatment services, 15% were Indigenous Australians aged 10 and over, which is an overrepresentation relative to their population size.

Currently there are almost 800,000 Aboriginal or Torres Strait Islander people (see Box ATSI1) living in Australia, accounting for 2.8% of the Australian population [1]. There are substantial differences in measures of health and welfare between Aboriginal or Torres Strait Islander people and non-Indigenous Australians.

Box ATSI1: Aboriginal and Torres Strait Islander people

The terms ‘Aboriginal and Torres Strait Islander people’ is preferred in Australian Institute of Health and Welfare (AIHW) publications when referring to the separate Indigenous peoples of Australia. However, the term ‘Indigenous’ Australians is used interchangeably with ‘Aboriginal and Torres Strait Islander’ in order to assist readability.

The Australian Burden of Disease Study identified that Aboriginal or Torres Strait Islander people experience a burden of disease that is 2.3 times the rate of non-Indigenous Australians [2]. The gap in the disease burden is due to a range of factors including disconnection to culture, traditions and country, social exclusion, discrimination and isolation, trauma, poverty, and lack of adequate access to services [3]. Tobacco, alcohol, and other drugs are key risk factors contributing to the health gap between Indigenous and non-Indigenous Australians [2].

Box ATSI2. Data sources examining tobacco, alcohol and other drug use by Aboriginal and Torres Strait Islander people

There are a number of data sources that provide information about tobacco, alcohol and other drug use by Aboriginal and Torres Strait Islander people.

The National Aboriginal and Torres Strait Islander Social Survey (NATSISS) [4] and the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) [5] collected by the ABS are designed to obtain a representative sample of Indigenous Australians. In relation specifically to tobacco smoking, the ABS has consolidated data from six large, national, multistage random household surveys to identify trends between 1994 and 2014–15 [6].

The AIHW’s National Drug Strategy Household Survey (NDSHS) uses a self-completion questionnaire to capture information about drug and alcohol use among the general Australian population; however it is not specifically designed to obtain reliable national estimates for Indigenous people. In 2016, 2.4% of the NDSHS (unweighted) sample aged 12 and over (or 568 respondents) identified as being of Aboriginal or Torres Strait Islander origin. The estimates produced by the NDSHS should be interpreted with caution due to the low sample size [7].

There are also other data sources that provide information relevant to Aboriginal and Torres Strait Islander people.

  • Australia’s Burden of Disease study analyses the impact of nearly 200 diseases and injuries in terms of living with illness (non-fatal burden) and premature death (fatal burden). In 2015, a report was released that provides estimates of burden of disease between Indigenous and non-Indigenous Australians [8].
  • The National Perinatal Data Collection covers each birth in Australia and includes information on Indigenous mothers and their babies [6].
  • The Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS) contains information on treatment provided to clients by publicly funded alcohol and other drug services including Indigenous clients [9].
  • The Online Services Report (OSR) contains information on the majority of Australian Government-funded Aboriginal and Torres Strait Islander substance use services [6].

Tobacco smoking

While tobacco smoking is declining in Australia, it remains disproportionately high among Indigenous Australians. Data from the Australian Bureau of Statistics (ABS) has shown:

  • In 1994, the Indigenous Australian survey data showed that 55% of Indigenous Australians aged 18 and over were smokers; 20 years later, in 2014–15, this had declined to 45% (Table S3.4).
  • Over a similar 20-year period, the National Health Survey (NHS) the proportion of non-Indigenous smokers aged 18 and over declined, from 24% in 1995 to 16% in 2014–15 (Table S3.5).
  • There appears to have been no change to the gap in smoking prevalence between the Indigenous Australian adult population and the non-Indigenous Australian adult population from 1994 to 2014–15. Even though the Indigenous Australian smoking rates are declining, the non-Indigenous rate is declining at a similar rate, therefore the gap remained constant [6] (Figure ATSI1).

Most of the decline in smoking occurred in non-remote areas. Over the 20-year period, the proportion of Indigenous Australians aged 18 and over in non-remote areas who were smokers declined from 55% to 42%, while the proportion in remote areas remained relatively stable at between 54% and 56% (Table S3.4).

In 2014–15, Indigenous males were more likely than Indigenous females to be smokers (47% compared with 42%) [1].

Geographic trends

The 2014–15 NATSISS provides estimates of tobacco smoking for Indigenous Australians by jurisdiction. According to the 2014–15 NATSISS, 39% of Indigenous Australians aged 15 and over smoked daily. Those from the Northern Territory (45%) and Western Australia (42%) surpassed this national average, while Indigenous Australians from South Australia (35%) were the least likely to be a current daily smoker [4] (Table S3.3).

Tobacco smoking in pregnancy

Indigenous Australians are at an elevated risk of smoking during pregnancy compared with non-Indigenous Australians. The National Perinatal Data Collection showed that:

  • Indigenous mothers accounted for 19% of mothers who smoked tobacco at any time during pregnancy in 2015, despite accounting for only around 4% of mothers.
  • The age-standardised rate of Indigenous mothers smoking during pregnancy has decreased from 50% in 2009 to 45% in 2015.
  • Almost 1 in 2 (45%) Indigenous mothers reported smoking during pregnancy—compared with 12% of non-Indigenous mothers (age-standardised).
  • The age-standardised rate of Indigenous mothers quitting smoking during pregnancy (14%) is about half that of non-Indigenous mothers (25%) (based on mothers who reported smoking in the first 20 weeks of pregnancy and not smoking after 20 weeks of pregnancy) [10].

Alcohol consumption

Abstinence (non-drinkers)

  • The 2016 NDSHS found that Indigenous Australians aged 14 and over were more likely to abstain from drinking alcohol than non-Indigenous Australians (31% compared with 23%, respectively) and abstinence among Indigenous Australians has been increasing since 2010 when it was 25% [7] (Table S3.1).
  • This pattern is consistent with data from the 2012–13 AATSIHS, where 28% of Indigenous Australians reported abstaining from drinking compared with 18% of non-Indigenous Australians [5].

Lifetime risk

  • The 2014–15 NATSISS found that the proportion of Indigenous Australians aged 15 years and over who exceeded the NHMRC lifetime risk guidelines for alcohol consumption (consuming more than 2 standard drinks per day on average) decreased between 2008 and 2014–15 (19% compared with 15%; non age-standardised proportions). The overall change is largely due to a decline in non-remote areas (19% in 2008 to 14% in 2014–15) [4] (Table S3.6).
  • Comparisons between Indigenous and non-Indigenous Australians are only available using age-standardised data from the 2012–13 AATSIHS and is not comparable to the 2014–15 NATSISS. The findings showed that lifetime risky drinking of Indigenous Australians aged 15 and over was similar to that of non-Indigenous Australians (9.8% compared with 9.7%; age-standardised) [5] (Table S3.7).

Single occasion risk

  • According to the 2014–15 NATSISS, 30% of Indigenous Australians aged 15 and over exceeded the single occasion risk guidelines for alcohol consumption (non age-standardised proportions), which is a decline since 2002 (35%).
  • Comparisons between Indigenous and non-Indigenous Australians are only available using age-standardised data from the 2012–13 AATSIHS and is not comparable to the 2014–15 NATSISS. The 2012–13 AATSIHS reported that 1 in 2 (50%) Indigenous Australians exceed the single occasion risky drinking guidelines (more than 4 standard drinks on a single occasion in past year). This was 1.1 times the rate that non-Indigenous Australians (44%) that exceeded these guidelines [5] (Table S3.7).

Risky alcohol consumption

  • According to the 2016 NDSHS, almost 1 in 5 Indigenous Australians (18.8%) consumed 11 or more standard drinks at least once a month. This was 2.8 times the rate that non-Indigenous Australians (6.8%) consumed this amount of alcohol [7] (Table S3.1).

Geographic trends

Between 2002 and 2014–15 there was a decline in the proportion of Indigenous Australians that resided in New South Wales Victoria, Queensland, South Australia, Western Australia and the Australian Capital Territory that exceeded the lifetime and single occasion risk guidelines (Figure ATSI2). Indigenous Australians residing in Tasmania (36%), the Australian Capital Territory (ACT) (35%), Queensland (33%) and Western Australia (33%) had higher rates of exceeding the single occasion drinking guidelines than the national average [4] (Table S3.8).

Indigenous Australians residing in Western Australia (16%), New South Wales (16%) and Queensland (15%) surpassed the national average for exceeding lifetime risk guidelines [4] (Table S3.9).

Illicit drug use

In the 2014–15 NATSISS, Aboriginal and Torres Strait Islander people aged 15 and over were asked whether they had used illicit substances in the last 12 months, and the types of illicit substances they had used during that period [4]. The data showed that:

  • Almost one-third (30%) of Indigenous Australians aged 15 and over reported having used illicit substances in the last 12 months, up from 22% in 2008.
  • Males were significantly more likely than females to have used illicit substances (34% compared with 27%), as were people in non-remote areas compared with those in remote areas (33% compared with 21%).
  • Cannabis was the most commonly reported illicit drug used by Aboriginal and Torres Strait Islander people in the last 12 months at 19% (25% of males compared with 14% of females).
  • The non-medical use of analgesics and sedatives (such as painkillers, sleeping pills and tranquilisers) was also relatively common (13%), with females (15%) being more likely than males (11%) to have used analgesics and sedatives.
  • One in twenty (5%) Indigenous Australians aged 15 and over reported having used amphetamines or speed in the last 12 months (6% of males compared with 3% of females) [4] (Figure ATSI3).

The 2016 NDSHS data showed that (other than ecstasy and cocaine), Indigenous Australians aged 14 and over recent used of illicit drugs was at a higher rate than non-Indigenous Australians (Table S3.1). Rates of illicit drug use in 2016 for Indigenous Australians aged 14 and older were:

  • Over one in four (27%) used any illicit drug in the last 12 months—1.8 times higher than non-Indigenous Australians (15.3%)
  • One in five (19.4%) used cannabis in the last 12 months—1.9 times higher than non-Indigenous Australians (10.2%)
  • Around one in 10 (10.6%) used a pharmaceutical for non-medical use—2.3 times higher than non-Indigenous Australians (4.6%) [7] (Table S3.1)
  • 3.1% used meth/amphetamines in the last 12 months—2.2 times higher than non-Indigenous Australians (1.4%).

The differences between Indigenous and non-Indigenous Australians were still apparent even after adjusting for differences in age structure (Figure ATSI4). There were no significant changes in illicit use of drugs among Indigenous Australians between 2013 and 2016, however due to the small sample sizes for Indigenous Australians, the estimates of the NDSHS should be interpreted with caution.

Geographic trends

Indigenous Australians aged 15 and over residing in the Northern Territory (22%) were the least likely to report substance use, while those from the Australian Capital Territory (41%) and Victoria (40%) were the most likely to report using substances.

Indigenous Australians from the Northern Territory (22%) and Queensland (29%) were the only jurisdictions below the national average (30%) [4] (Table S3.3).

Health and harms

The health status of Aboriginal and Torres Strait Islander people are considerably lower than for non-Indigenous Australians. For instance:

  • 35.1% of Aboriginal or Torres Strait Islander people compared with 58.3% of non-Indigenous Australia self-assessed their health as ‘excellent’ or ‘very good’ (age-standardised per cent).
  • 32.5% of Indigenous Australians compared with 12.3% of non-Indigenous Australians reported high/very high psychological distress (age-standardised per cent).
  • 71.0% of Aboriginal or Torres Strait Islander people reported having a long-term health condition compared with 55.3% of non-Indigenous Australians (age-standardised per cent) [4] (Table S3.6).

Almost 1 in 2 Indigenous Australians with a mental health condition were a daily smoker (46%) and about 2 in 5 (39%) to have used substances in the last 12 months. This was higher than for Indigenous  Australians with other long-term health conditions (33% and 24%, respectively) or those with no long term health condition (39% and 29% respectively) [4] (Table S3.11).

The Australian Burden of Disease Study provides an indication of the risk factors that contribute to the health gap between Indigenous and non-Indigenous Australians. In 2011, tobacco use accounted for 23.3% of the gap, and alcohol and drug use contributed to 8.1% and 4.1% of the gap, respectively [8] (Table S3.12).

Treatment

Indigenous Australians are also overrepresented in drug and alcohol treatment services. In 2016–17, the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS) showed that 15% of clients were Indigenous Australians aged 10 and over (Table S3.13). Indigenous Australians (3,313 per 100,000 population) were 7 times more likely to receive AOD treatment services than non-Indigenous Australians (430 per 100,000 population) were. Specifically where:

  • Amphetamines was the principal drug of concern, Indigenous Australians (1,204 per 100,000 population) were 8 times more likely than non-Indigenous Australians (155 per 100,000 population).
  • Heroin was the principal drug of concern Indigenous Australians (911 per 100,000 population) were 7 times more likely than non-Indigenous Australians (123 per 100,000 population) were.
  • Cannabis was the principal drug of concern Indigenous Australians (867 per 100,000 population) were 7 times more likely than non-Indigenous Australians (126 per 100,000 population) were.
  • Alcohol was the principal drug of concern Indigenous Australians (136 per 100,000 population) were 7 times more likely than non-Indigenous Australians (26 per 100,000 population) [9] (Table S3.14).

Dependence on opioid drugs (including codeine, heroin and oxycodone) can be treated with pharmacotherapy therapy using substitute drugs such as methadone or buprenorphine. The National Opioid Pharmacotherapy Statistics Annual Data collection (NOPSAD) provides information on clients receiving opioid pharmacotherapy treatment on a snapshot day each year. For jurisdictions where data was provided, in 2017:

  • Around 1 in 10 clients (9%) were Indigenous, an overrepresentation relative to their population size.
  • Indigenous Australians were almost 3 times as likely (70 clients per 10,000 population) to receive pharmacotherapy treatment as non-Indigenous Australians (26 clients per 10,000 population) [11] (Table S3.15).

Data from the OSR shows that 2015–16, there were 80 organisations around Australia that provided alcohol and other drug treatment services to around 32,700 Aboriginal and Torres Strait Islander clients [6]. The OSR data also shows that:

  • All 80 organisations reported that alcohol was one of the top five common substance-use issue, followed by cannabis (94%) and amphetamines (70%)
  • Treatment episodes were more likely to be to occur in non-residential settings (87%)
  • One third of all treatment episodes were in Very remote areas (32%) and the highest proportion of clients were located in Major cities (35%).

Policy context

The Aboriginal and Torres Strait Islander Health Performance Framework 2017

The Aboriginal and Torres Strait Islander Health Performance Framework 2017 includes a suite of products that give the latest information on how Aboriginal and Torres Strait Islander people in Australia are faring according to a range of 68 performance measures across 3 tiers: Tier 1—health status and outcomes, Tier 2—determinants of health, and Tier 3—health system performance. The measures are based on the Aboriginal and Torres Strait Islander Health Performance Framework and cover data that has been collected on the entire health system, including Indigenous-specific services and programs, and mainstream services [12].

National Aboriginal Torres Strait Islander Peoples Drug Strategy 2014–2019

The National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy 2014–2019 was a sub-strategy of the National Drug Strategy 2010–2015 and remains a sub-strategy under the National Drug Strategy 2017–2025. The overarching goal of this sub-strategy is to improve the health and wellbeing of Aboriginal and Torres Strait Islander people by preventing and reducing the harmful effects of alcohol and other drugs (AOD) on individuals, families and their communities [13].

NACCHO Aboriginal Health and #TopEndFASD18 : “Let’s Make #FASD History” says Top End Foetal Alcohol Spectrum Disorder (FASD) forum with 6 key messages to be taken into account addressing FASD:

 ” The forum delegates agreed that there was an urgent need for action to prevent FASD in our Top End communities, and across the Northern Territory.

It is essential that our responses do not stigmatise women or Aboriginal people.

It is important that we don’t lay blame, but instead work together, to support our women and young girls.

Everyone is at risk of FASD, so everyone must be informed the harmful effects of drinking while pregnant.

Our men also need to step up and support our mothers, sisters, nieces and partners, to ensure that we give every child the best chance in life.”

A landmark Top End Foetal Alcohol Spectrum Disorder (FASD) forum* was held in Darwin on 30-31 May 2018

Read over 25 NACCHO Aboriginal Health and FASD articles published over 6 years

“ Territorians want and deserve access to high quality health services,” Ms Fyles said.

Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD “

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin see Ministers Press Release Part 2 below

#TopEndFASD18  Bringing together Aboriginal leaders, FASD experts, Aboriginal community-controlled organisations, government representatives, medical professionals, and Non-Government organisations. Approximately 180 delegates representing 37 organisations across the Northern Territory.

FASD is often considered to be a ‘hidden’ disability, because more often than not, the physical characteristics of the individual are not easily recognised. Instead, an individual may present with learning and behavioural difficulties, which may present for a range of disorders.

As a result, FASD is not easily identified and individuals can go undiagnosed and receive inadequate treatment and support.

The forum heard from the NT Minister for Health and the Attorney General Natasha Fyles, NT Children’s Commissioner, Colleen Gwynne, Professor Elizabeth Elliott, Dr James Fitzpatrick, NOFASD and FASD Hub.

The forum also heard from Aboriginal community controlled organisations Danila Dilba, Wurli Wurlinjang, Anyinginyi Health Services, Aboriginal Medical Services Alliance Northern Territory and the North Australian Aboriginal Justice Agency.

Over two days, the forum delegates discussed the impacts of FASD on individuals, families and communities and acknowledged that alcohol misuse and its consequences are an issue for all Territorians, particularly our most vulnerable. Delegates also heard the evidence on how the prevalence of FASD impacts many of our services, including health, education and justice. Delegates learnt that trauma runs deep, and healing and making the right connections is crucial.

The delegates raised the following key messages to be taken into account in addressing FASD:

 1.Prevention and raising awareness

FASD is entirely preventable, much of its impacts are also irreversible. The harms caused by alcohol in our communities are not acceptable and we will all work together to develop prevention and intervention strategies that are culturally appropriate and relevant for our 2

people and communities. It is acknowledged that current and proposed alcohol control measures in the NT are a critical component of prevention.

2. Collaborative Approaches

The forum identified an urgent need for Aboriginal organisations, government agencies, NGOs and local communities to work together to develop policies and programs for women, men, children and communities in the Top End communities and to contribute to the development of an NT FASD Strategy. This needs to be Aboriginal community-led by the health, education, justice and child protection sectors.

 3.Access to FASD resources

It was evident that there is a need for more investment in developing culturally appropriate tools and resources for local Aboriginal communities and key stakeholders working on the frontline and also at the strategic level.

4.Assessment and Treatment services

An identified priority need is for the establishment of multi-disciplinary neuro-developmental assessment and treatment services that are strategically linked with existing service settings, including primary health care, education, child protection and the justice system.

5.Support for children and families

Research is needed to better understand how best to support children and families with FASD and other related issues that also often affect families, such as trauma. We refer to the Fitzroy Valley as a best practice model, as many strong women and leaders in the community worked in partnership with FASD experts and research institutes.

6.Workforce

The skilling and expansion of the workforce needed for prevention, assessment and treatment of FASD, particularly the community based remote Aboriginal workforce, was identified as an important need.

From this forum, we have heard the experiences about the high levels of despair and sense of disempowerment and hurt of our people and these are sad stories. We were also enlightened by the enthusiasm, dedication, passion and hope from local communities, all professions and services, that want to do more and can do more to make FASD History!

*APO NT will be producing a full report on the outcomes of the FASD Forum over the coming weeks.

Generational Change: Putting the spotlight on Foetal Alcohol Spectrum Disorder

30 May 2018

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin.

“Territorians want and deserve access to high quality health services,” Ms Fyles said.

“Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

“That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

“Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD.

“This strategy was supported by recommendations in the recent Riley Review into Alcohol Policy and Legislation Alcohol Report and is now an important part of the Territory Labor Government’s Alcohol Harm Minimisation Action Plan to deliver sweeping alcohol reforms for generational change.”

The NT Department of Health funded the Aboriginal Peak Organisations NT (APONT) to deliver the 2 day forum.

The themes of the Forum are:

  • Increase knowledge and raise awareness about FASD in Top End communities and the impact of alcohol during pregnancy on the developing baby;
  • Understand the impact of FASD on children, youth and their families
  • Identify the challenges, issues and solutions for governments, service providers and other key stakeholders;
  • Identify culturally appropriate resources, tools and protocols
  • Establish a Top End FASD Network.

Minister Fyles said that Forum provides an important consultation opportunity with the health sector and community to feed into the development of the NT’s FASD Strategy, for release later this year.

“Stories will be shared and ideas and actions generated to inform the Strategy, which in turn will help guide communities and Government to work together in partnerships to prevent FASD,” Ms Fyles said.

“The NT FASD Strategy will promote the screening of alcohol use before and during pregnancy; appropriate multi-disciplinary assessment; early intervention, support and case management; and will develop targeted education campaigns for those who are most at risk from alcohol-related harms.

“This work is supported in our Government’s 10-Year Early Childhood Development Plan to lead cultural change in reducing alcohol consumption and harms in the community.

“Our whole of government approach to respond to FASD will be crucial to preventing this completely preventable lifelong and permanent condition.”

 

NACCHO Aboriginal Health and #Alcohol : @healthgovau National Alcohol strategy 2018-2026 for public consultation Closes 11 February 2018

” The National Alcohol Strategy 2018- 2026 outlines Australia’s agreed approach to preventing and minimising alcohol-related harms.

The National Alcohol Strategy provides a national framework and highlights a number of opportunities for action under each of the priority areas of focus.

These opportunities are examples of activities or initiatives that could be considered at either local, jurisdictional (state and territory) or national levels, including a mix of broad population approaches and targeted approaches.”

Download a draft copy

Consultation Draft National Alcohol Strategy 2018-2026

Consultation closes 11 February 2018

The Department of Health has opened a public consultation process, and is inviting stakeholders and the general public to provide feedback on the National alcohol strategy 2018-2026.

See Website

As a sub-strategy of the National drug strategy 2017-2026, the National alcohol strategy is overseen by the Ministerial Drug and Alcohol Forum. The Forum consists of Ministers from across Australia with responsibility for alcohol and other drug policy  from the health and justice/law enforcement portfolios from each jurisdiction.

On 27 November 2017, members agreed that the draft National alcohol strategy will undergo a public consultation process to further inform the strategic direction and priorities of the strategy.

The online submission process is now open and will close on 11 February 2018. Feedback from the consultation will be considered by the Ministers at their next meeting in 2018, and the strategy revised.

To lodge a submission, please email nationaldrugstrategy@health.gov.au.

Disproportionate Impacts of Alcohol-Related Harm

This Strategy recognises that alcohol-related harms are not experienced uniformly across the population, with disproportionate levels of harm being experienced within some contexts and communities.

Read over 190 NACCHO Articles Alcohol and other Drugs posted over the past 5 years

Aboriginal and Torres Strait Islander people

Overall, Aboriginal and Torres Strait Islander people are more likely to abstain from drinking alcohol than non-Aboriginal and Torres Strait Islander people (31% compared with 23% respectively). However, among those who did drink, higher proportions drank at risky levels (20% exceeding the lifetime risk guidelines) and were more likely to experience alcohol-related injury than non-Aboriginal and Torres Strait Islander people (35% compared to 25% monthly, respectively).26

For this reason, Aboriginal and Torres Strait Islander people suffer from disproportionate levels of harm from alcohol, including alcohol-related mortality rates that are 4.9 times higher than among non-Aboriginal and Torres Strait Islander people.27

The poorer overall health, social and emotional wellbeing of Aboriginal and Torres Islander people than non-Aboriginal and Torres Strait Islander people are also significant factors which can influence drinking behaviours.28

People in remote areas

People residing in remote areas have reported drinking alcohol in quantities that place them at risk of harm at higher levels that those living in less remote regions.

People in remote and very remote areas were 1.5 times as likely as people in major cities to consume 5 or more drinks at least monthly and 2.4 times as likely to consume 11 or more drinks

Pregnant women (or those planning a pregnancy)

Alcohol consumption during pregnancy can result in birth defects and behavioural and neurodevelopmental abnormalities including Fetal Alcohol Spectrum Disorder (FASD). Data from states and territories have estimated FASD rates at 0.01 to 1.7 per 1000 births in the total population and 0.15 to 4.70 per 1000 births for the Aboriginal and Torres Strait Islander population.31 There is evidence that indicates some communities are experiencing much higher incidences of FASD and therefore the lifelong impacts of FASD.32

The relationship between the consumption of alcohol during pregnancy and the expression of FASD is complex, but avoiding drinking before or during pregnancy eliminates the risk of FASD.

Around 1 in 2 women report consuming alcohol during their pregnancy, with 1 in 4 women continuing to drink after they are aware they are pregnant. Of these women, 81% drank monthly or less with 16.2% drinking 2–4 times a month.33

Background

The Ministerial Drug and Alcohol Forum is co-Chaired by the Commonwealth Ministers with portfolio responsibility for alcohol and other drugs (AOD), and justice/law enforcement.

Membership consists of two Ministers from each jurisdiction, one each from the health/community services portfolios (with AOD policy responsibilities) and one from the justice/law enforcement portfolios.

The Commonwealth, State and Territory governments have a shared responsibility to build safe and healthy communities through the collaborative delivery and implementation of national strategic frameworks to reduce AOD related harms for all Australians.

The Forum will be supported by the National Drug Strategy Committee (NDSC) in the implementation and monitoring of these national strategic frameworks.

 

NACCHO Aboriginal Health and #Alcohol : New review explores the harmful effects of alcohol use in the Aboriginal and Torres Strait Islander context

 ” The review highlights that alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.

While Aboriginal and Torres Strait Islander people are around 1.3 times more likely to abstain from alcohol than non-Indigenous people, those who do drink alcohol are more likely to experience health-related harms than their non-Indigenous counterparts.

 Furthermore, the evidence presented in this review suggests that effective strategies to address the problem of harmful alcohol use include: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering up shelters “

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre (Knowledge Centre) has published a new Review of the harmful use of alcohol among Aboriginal and Torres Strait Islander people.

Read over 188 NACCHO Aboriginal Health and Alcohol Articles published over the past 5 years

https://nacchocommunique.com/category/alcohol-and-other-drugs/

The review explores the harmful effects of alcohol use in the Aboriginal and Torres Strait Islander context examining: patterns of use; health impacts; underlying causal factors; policies and interventions to address these impacts; and ways to further reduce harm.

View in Full Here

This review will help to inform, support and educate those working in Aboriginal and Torres Strait Islander health in Australia.

Ah 99

Key facts

The Australian context

  • Harmful use of alcohol is a problem for the Australian community as a whole. It is estimated that in 2011, alcohol caused 5.1% of the total burden of disease in Australia.
  • The social cost of all drug use in Australia in 2004–05 was estimated at $55.2 billion ($79.9 billion in 2016 dollars), with alcohol alone contributing 27.3%, and alcohol combined with illicit drugs adding a further 1.9%.

Extent of alcohol use among Aboriginal and Torres Strait Islander people

  • Alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.
  • Aboriginal and Torres Strait Islander people are about 1.3 times more likely to abstain from alcohol than non-Indigenous people.
  • Aboriginal and Torres Strait Islander people are at least 1.2 and 1.3 times more likely to consume alcohol at levels that pose risks to their health over their lifetimes and on single drinking occasions than non-Indigenous people.
  • Aboriginal and Torres Strait Islander men are more than twice as likely as Aboriginal and Torres Strait Islander women to consume alcohol at risky levels.

Health impacts of alcohol use among Aboriginal and Torres Strait Islander people

  • Excessive alcohol consumption poses a range of health risks – both on single drinking occasions and over a person’s lifetime, including alcoholic liver disease, behavioural disorders, assault, suicide and transport accidents.
  • In NSW, Qld, WA, SA and the NT from 2010–2014 Aboriginal and Torres Strait Islander males and females died from conditions solely caused by alcohol more frequently than non-Indigenous males and females (4.7 and 6.1 times respectively).
  • The overall rate of suicide among Aboriginal and Torres Strait Islander people in 2015 was 2.1 times higher than among non-Indigenous people. For the period 2011–2015, 40% of male suicides and 30% of female suicides were attributable to alcohol use.
  • There is strong qualitative evidence linking alcohol and other drug (AOD) use and poor mental health among Aboriginal and Torres Strait Islander people.
  • Age standardised rates of hospitalisation for Aboriginal and Torres Strait Islander people in the years 2012–13, 2013–14 and 2014-15 were 2.7, 2.3 and 2.4 times those of non-Indigenous people.
  • In 2011, alcohol accounted for an estimated 8.3% of the overall burden of disease among Aboriginal and Torres Strait Islander Australians; a rate 2.3 times higher than among non-Indigenous people.
  • In addition to harms to health, high levels of alcohol use can contribute to a range of social harms, including child neglect and abuse, interpersonal violence, homicide, and other crimes.

Policies and strategies

  • Initial responses to the concerns about harmful alcohol use among Aboriginal and Torres Strait Islander people in the 1970s were driven not by governments but by Aboriginal and Torres Strait Islander people themselves who recognised that non-Indigenous mainstream responses were non-existent or largely culturally inappropriate.
  • The level of harm caused by alcohol in any community is a function of complex inter-relationships between the availability of alcohol, and levels of individual wellbeing and social conditions that either protect against or predispose people or groups to harmful levels of consumption.
  • As well as addressing the consequences of harmful levels of alcohol consumption, policies and intervention strategies must also address the underlying causal relationships. In the case of Aboriginal and Torres Strait Islander people this means addressing social inequality.
  • As part of the current Australian Government’s Indigenous advancement strategy (IAS), a number of programs are in place that aim to address social inequality and the broad social determinants of harmful alcohol use.
  • Government policy documents most directly relevant to the minimisation of alcohol-related harm among Aboriginal and Torres Strait Islander people are the National drug strategy 2017–2026 (NDS) and the National Aboriginal and Torres Strait Islander peoples’ drug strategy 2014–2019 (NATSIPDS).
  • The National drug strategy 2017–2026 provides a tripartite approach to reducing the demand for and supply of alcohol, and the immediate harms its causes.
  • There is a strong evidence base for the effectiveness of a range of interventions including: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering-up shelters.
  • Government programs to address Aboriginal and Torres Islander inequality have been in place since the 1970s – what is now the National Drug Strategy was introduced in 1985. While there have been some improvements, as evidenced by various Government reports, progress has been slow and while there have been increases in funding these have not been sufficient to meet need.
  • There is evidence that – provided with adequate resourcing – the culturally safe services provided by community-controlled organisations result in better outcomes. Aboriginal and Torres Strait Islander people should be key players in the design and implementation of interventions to address harmful alcohol use in their own communities, with capacity building within Aboriginal community-controlled organisations a central focus.
  • The way forward is for Australian Governments to honour the commitments made in the NATSIPDS to work with Aboriginal and Torres Strait Islander people and to resource interventions on the basis of need.

HealthInfoNet Director, Professor Neil Drew says ‘The latest review, written by Professor Dennis Gray and colleagues from the National Drug Research Institute (NDRI) in Western Australia, is a vital new addition to our suite of knowledge exchange resources.

It makes the large body of evidence available in a succinct, evidence-based summary prepared by world renowned experts.

This delivers considerable time savings to a time poor workforce striving to keep up to date in a world where the sheer weight of new information can often seem overwhelming.

I am delighted to release this important new resource to support the Aboriginal and Torres Strait Islander alcohol and other drug (AOD) sector.’

The review highlights that alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.

While Aboriginal and Torres Strait Islander people are around 1.3 times more likely to abstain from alcohol than non-Indigenous people, those who do drink alcohol are more likely to experience health-related harms than their non-Indigenous counterparts.

Furthermore, the evidence presented in this review suggests that effective strategies to address the problem of harmful alcohol use include: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering up shelters.

http://aodknowledgecentre.net.au/aodkc/alcohol/reviews/alcohol-review

This review will help to inform, support and educate those working in Aboriginal and Torres Strait Islander health in Australia.

 

NACCHO Aboriginal Maternal Health Services News : Part 1.@AIHW releases Report : Part 2 .@HealthInfoNet Free #FASD Webinar 29 Nov

AMAT 

” The gap between the health of Aboriginal and Torres Strait Islander children and non-Indigenous children begins before birth, with babies born to Aboriginal and Torres Strait Islander mothers significantly more likely to have been exposed to tobacco smoke in utero, to be born pre-term, and to have a low birthweight (weighing less than 2,500 grams at birth) (AIHW 2015b).

These inequalities continue throughout early childhood for Aboriginal and Torres Strait Islander children, with higher mortality rates and higher rates of illness and poor health.

 This report presents the findings of a project which assessed Aboriginal and Torres Strait Islander women’s access to hospitals with public birthing services and 3 other types of maternal health services across Australia, then investigated possible high-level associations between access, maternal risk factors and birth outcomes.”

Download the report here

AIHW Indigenous Maternal Health .pdf

The findings of a project which assessed Aboriginal and Torres Strait Islander women’s access to hospitals with public birthing services and 3 other types of maternal health services across Australia,

Access to services

The study examined the geographic access of Indigenous women of child-bearing age (15–44) to 4 types of on-the-ground maternal health services: hospitals with a public birthing unit; Indigenous-specific primary health-care services (ISPHCSs); Royal Flying Doctor Service clinics; and general practitioners (GPs).

Using 1 hour drive time boundaries around these locations and population counts from the 2011 Census at a range of geographic levels (SA2, remoteness, jurisdiction), the study found:

  • approximately one-fifth (25,600 or 21%) of Indigenous women of child-bearing age lived outside a 1 hour drive time from the nearest hospital with a public birthing unit
  • nearly all (97%) Indigenous women of child-bearing age had access to at least 1 type of maternal health service within a 1 hour drive time. The lowest levels of access were for women in Very remote and Remote areas, where 84% and 93%, respectively, had access to at least 1 type of service.
  • Indigenous women of child-bearing age in Major cities, Inner regional and Outer regional areas had more types of services available to them within a 1 hour drive time than did women in more remote areas. Thus, they had more choice in which service they use

Association with area-level maternal risk factor and birth outcomes

Examining possible associations between geographic accessibility to services, maternal risk factors and birth outcomes at the Indigenous Region level, the study found that poorer access to:

  • GPs was associated with higher rates of pre-term birth and low birthweight
  • ISPHCSs with maternal/antenatal services was associated with higher rates of smoking and low birthweight
  • hospitals with public birthing units was associated with higher rates of smoking, pre-term birth and low birthweight
  • at least 1 service was associated with higher smoking rates and higher rates of pre-term delivery and low birthweight

An analysis at Primary Health Network (PHN) level found fewer significant associations, which is likely to be due to the PHNs’ size—particularly in jurisdictions with large Indigenous populations (such as the Northern Territory and Western Australia)—which may mask important intra-area variation.

This report was not able to take into account ISPHCSs which did not report to the Online Services Report collection, including state or territory maternal health services, outreach services, and antenatal/postnatal clinics conducted from hospitals which do not have birthing units.

It also focused on spatial accessibility and did not take into account other aspects of maternal health services such as cultural competency. Future analyses could incorporate other indicators or measures of access, maternal risk factors and birth outcomes.

1.Introduction

The gap between the health of Aboriginal and Torres Strait Islander children and non-Indigenous children begins before birth, with babies born to Aboriginal and Torres Strait Islander mothers significantly more likely to have been exposed to tobacco smoke in utero, to be born pre-term, and to have a low birthweight (weighing less than 2,500 grams at birth) (AIHW 2015b).

These inequalities continue throughout early childhood for Aboriginal and Torres Strait Islander children, with higher mortality rates and higher rates of illness and poor health.

The factors that contribute to poor infant and child health are complex and include maternal health (maternal weight, pre-existing health conditions); maternal risk factors (smoking and alcohol consumption during pregnancy, maternal nutrition); maternal age; social determinants (socioeconomic position and education); cultural determinants; and access to health services (such as antenatal care and child health services).

While access to health services will not eliminate the health gap between Indigenous and non-Indigenous babies and young children on their own, services have an important role to play in ameliorating the effects of the other factors listed above.

This report focuses on Aboriginal and Torres Strait Islander women’s geographic access to public birthing units and maternal health services, in order to identify areas with potential gaps in these services.

The report then examines whether there is an association between accessibility to services, maternal risk factors during pregnancy, and birth outcomes. It builds on a series of analyses the AIHW has been undertaking which are aimed at identifying geographic areas with potential gaps in services for Aboriginal and Torres Strait Islander Australians (AIHW 2014a, 2015c).

Background

Fetal health and development represents an intersection between physiological processes and the greater social context and environment. Inequalities in infant health outcomes are not randomly distributed throughout society, but are a reflection of broader social, environmental, historical, economic and cultural conditions (known as the ‘social determinants’ of health).

Figure 1.1 provides a conceptual overview of these processes, illustrating how these higher-level factors (‘distal’ determinants) affect contextual factors and individual mothers’ resources (intermediate factors)—which, in turn, affect ‘proximal’ determinants of both maternal health and maternal risk factors. These proximal determinants are those which then have a direct effect on fetal development.

Distal determinants (such as the long-term effects of colonisation and its effect on factors such as self-determination, the disruption of ties to land), and the adverse impact of racism, have all had an effect on Aboriginal and Torres Strait Islander people’s socioeconomic and psychosocial well-being (Osborne et al. 2013; Reading & Wein 2009).

Compared with non-Indigenous mothers, Aboriginal and Torres Strait Islander women have higher rates of the factors associated with poor infant health outcomes: on average, they have poorer socioeconomic status, lower levels of education, higher levels of psychosocial distress, are more likely to live in poor housing and are more likely to live in areas with fewer health services (intermediate determinants).

These intermediate determinants affect the proximal determinants of maternal health and maternal risk factors during pregnancy, which then have physiological effects on fetal health and development and increase the likelihood of pre-term birth. Available data show that Indigenous mothers have higher rates of a variety of health risks: they are 1.6 times as likely to be obese as non-Indigenous mothers and to have higher rates of pre-existing hypertension and pre-existing diabetes (which are linked with poorer birth outcomes) (AIHW 2016).

One of the strongest behavioural risk factors for poor birth outcomes and subsequent infant mortality and child mortality is smoking. Maternal smoking during pregnancy has been linked with intrauterine growth restriction (IUGR), poor lung development, stillbirth, pre-term birth, and placenta abruption. IUGR and low birthweight can increase the risk of poor perinatal outcomes such as necrotising enterocolitis and respiratory distress syndrome, and have long-term effects such as increased risks for short stature, cognitive delay, cerebral palsy, and poor cardiovascular health (Reeves & Bernstein 2008). Babies born to mothers who smoke during and after pregnancy are also more likely to die from Sudden Infant Death Syndrome.

AIHW multivariate analyses of perinatal data for the period 2012–2014 indicates that, excluding pre-term and multiple births, 51% of low birthweight births to Indigenous mothers were attributable to smoking, compared with 16% for non-Indigenous mothers (AIHW 2017). Evidence suggests that maternal exposure to second-hand smoke reduces birthweight as well.

While rates of smoking during pregnancy have decreased, data from 2013 show that 47.3% of Indigenous mothers smoked during pregnancy, compared with 10% of non-Indigenous mothers (AIHW 2016). The likelihood of smoking is not randomly distributed throughout society, but is related to the intermediate and proximal determinants shown in Figure 1.1.

Role of services

Figure 1.1 positions antenatal care/birthing services as mediating factors that can ameliorate the effects of distal, intermediate and proximate determinants, by working in partnership with Aboriginal and Torres Strait Islander mothers to ensure they have the knowledge, medical care, practical support and social support they require to improve their chances of having a healthy baby.

For example, early access to care can improve infant health through promoting positive change (such as reducing or stopping smoking), and identifying physiological risk factors which may require more specialised management (AIHW 2014b). High-quality, evidence-based and culturally competent (refer to Box 1.1) maternal and child health services, working in partnership with pregnant Aboriginal and Torres women, can help improve maternal and birth outcomes.

Women’s use of antenatal care services is affected by a number of factors, however, such as the availability and the financial and cultural accessibility of services as described above, as well as maternal factors such as early recognition of pregnancy and the perceived value attached to antenatal care (Kruske 2011; Pagnini & Reichman 2000).

Previous work has shown that, while nearly all Aboriginal and Torres Strait Islander mothers access antenatal care prior to giving birth, they are less likely than non-Indigenous mothers to access care early in the pregnancy (51% of Indigenous mothers attend an antenatal visit in the first trimester, compared with 62% of non-Indigenous mothers).

Spatial variation in Aboriginal and Torres Strait Islander women’s access to maternal health services 3

Box 1.1: Culturally competent maternal and child health services

Culturally competent antenatal care services are those in which woman-centred care is provided in ways that are respectful, understanding of local culture, and meet the emotional, cultural, practical and clinical needs of the women.

There are a number of aspects which characterise culturally competent maternal care services, some of which include having Indigenous-specific programs, having Aboriginal and Torres Strait Islander staff members, providing continuity of care, viewing women as partners in their care, having a welcoming physical environment, and ensuring that cultural awareness and safety is the responsibility of all staff members in the service (Kruske 2011).

Part 2 Prevalence of FASD Among Youth Under the Care of Juvenile Justice in Western Australia: How Shall We Work Together to Close this Gap? [webinar]

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre (the Knowledge Centre) is hosting a Fetal alcohol spectrum disorder (FASD) webinar on Wednesday 29 November with guest presenter Dr Raewyn Mutch from the Telethon Kids Institute.

The theme for the webinar is Prevalence of FASD among youth under the care of Juvenile Justice in Western Australia: how shall we work together to close this gap? The webinar will run for approximately one hour, and will discuss a recent program that investigates FASD and the criminal justice system.

Dr Mutch is a Consultant Paediatrician, and works with Refugee Health at the Department of General Paediatrics, Princess Margaret Hospital for Children, as well as the Alcohol, Pregnancy and FASD department at Telethon Kids Institute. In addition, Dr Mutch also works as a Clinical Associate Professor at the School of Medicine, Dentistry and Health Sciences at the University of Western Australia.

The webinar will be free to attend, but you will need a browser with the latest version of Flash, and a stable internet connection. We’d recommend that participants use a pair of headphones, rather than their computer’s sound, as the sound quality will be better.

The webinar will be held at:

  • 1pm AEDT (NSW, Vic, Tas, ACT)
  • 12.30pm ACDT (SA)
  • 12pm AEST (Qld)
  • 11:30am ACST (NT)
  • 10am AWST (WA).

To attend the webinar, please click on this link about five minutes before it’s due to commence. If you have any queries about the webinar please refer to the contact details below.

Contacts

Millie Harford-Mills
Research Officer
Australian Indigenous HealthInfoNet
Ph: (08) 9370 6358
Email:

 

NACCHO Aboriginal Women’s Health #FASD Workshop dates : Development of the National #FASD Strategy 2018 – 2028

The Australian Government Department of Health is undertaking consultations to inform the development of the National FASD Strategy 2018– 2028.

The Strategy will provide a national approach for all levels of government, organisations and individuals on strategies that target the reduction of alcohol related harms relating to FASD, reducing the prevalence of FASD in Australia and provide advice and linkages on the support which is available for those affected by the disorder.

The objectives of the National FASD Strategy 2018 – 2028 are:

  • strengthen efforts and address the whole-of-life impacts of FASD;
  • address the whole-of-population issues;
  • support collaborative cross sectoral approaches required to prevent FASD in Australia; and
  • provide information and support those living with and affected by the disorder.

The Department has engaged Siggins Miller Consultants Pty Ltd (Siggins Miller) to undertake the development of the National FASD Strategywhich includes consultation with stakeholders and the development of a national strategy which provides a national holistic approach to reducing the prevalence of FASD; support Australians living with the disorder; guide the activities of individuals and communities as well as all levels of government, the public and research sectors, Not-For-Profit organisations which can adapted and implemented across Australia.

Siggins Miller is an experienced Australian consultancy company providing services for over 20 years in policy and program research, evaluation and management consultancy. The Siggins Miller project team is led by Professor Mel Miller (Director) and Mr James Miller (Senior Consultant).

As part of the consultation process, Siggins Miller will be conducting face-to-face strategy development workshops. There will also be other opportunities to provide feedback including through supplementary telephone interviews and written submissions.

The consultation period will run from 1st July, 2017 and conclude on the 1st September, 2017.

The workshops will be attended by with individuals and organisations working on FASD, individuals and organisations working with people affected by FASD, public health organisations and representatives of State and Territory Departments including: Health, Corrections and Juvenile Justice and Education and National Aboriginal Community Controlled Health Organisation (NACCHO) Affiliates.

The workshops will be catered and run from 9:30am – 3:30pm. Face-to-face strategy development workshops will be held in and on:

Sydney: Tuesday, August 1, 2017.

Canberra: Thursday August 3, 2017.

Melbourne: Tuesday,August 8, 2017.

Hobart: Thursday, August 10, 2017.

Brisbane: Tuesday,August 15, 2017.

Cairns: Thursday, August 17, 2017.

Perth: Tuesday,August 22, 2017.

Broome: Thursday, August 24, 2017.

Darwin: Tuesday,August 29, 2017.

Alice Springs: Thursday, August 31, 2017.

Adelaide: Monday, September 4, 2017.

Exact addresses of venues are in the process of being finalised and will be communicated to all stakeholder by Siggins Miller in the coming weeks.

It should be noted that due to capacity of venues, spaces to attend the face-to-face strategy development workshops are limited in each location. Invited participants will also be responsible for any costs associated with attending the face-to-face workshop in each location.

Siggins Miller will be in contact with you by email in the coming weeks with an invitation for you to attend one of the face-to face strategy development workshops.

In the meantime, should you have any questionsabout the consultation and written submission process, please contact Siggins Millerby email on fasdstrategy@sigginsmiller.com.au or by phone on: 1800 055 070.

Please note that the 1800 number provided is a message bank service in which you can leave your inquiry, a senior Siggins Miller staff member will endeavour to return your call within 72 hours.