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

 

Aboriginal Health and #Disability #NDIS : $3 million plan to address the cultural barriers and disadvantage

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Aboriginal and Torres Strait Islander people are 1.8 times more likely to have a disability than other Australians

“We are announcing today up to $3 million in funding over three years for two targeted projects that will support the Plan; a research project to support Aboriginal and Torres Strait Islander prisoners and ex-prisoners with disability as well as a trial on integrated health and education approaches to support students with disability in remote communities.”

Federal Government Press Release 17 October 2017

Read 23 NACCHO Aboriginal Health and Disability Articles

Read 18 NACCHO Aboriginal Health and NDIS Articles

A $3 million plan has been unveiled to address the cultural barriers and disadvantage faced by Aboriginal and Torres Strait Islander people with disability.

Minister for Social Services, Christian Porter, Assistant Minister for Disability Services, Jane Prentice and Minister for Indigenous Affairs, Nigel Scullion, said the Australian Government Plan to Improve Outcomes for Aboriginal and Torres Strait Islander People with Disability (the Plan) will drive better outcomes for Aboriginal and Torres Strait Islander people with disability, their families and carers.

Download PDF Copy

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Or for persons requiring Listen or Easy to Read

“We are announcing today up to $3 million in funding over three years for two targeted projects that will support the Plan; a research project to support Aboriginal and Torres Strait Islander prisoners and ex-prisoners with disability as well as a trial on integrated health and education approaches to support students with disability in remote communities.”

Assistant Minister Prentice said consultations over the last three years show that Aboriginal and Torres Strait Islander people with disability face unique challenges.

“The Plan recognises the importance of supporting Aboriginal and Torres Strait Islander people with disability, particularly in remote locations.

“We need to ensure services are delivered within a cultural framework that is appropriate for the community’s customs and practices.”

The plan identifies five key priority areas for action:

  • Housing – access to appropriately designed shelter and accessible, well-designed communities that are fully inclusive of all residents.
  • Justice System – the right to be free from racism and discrimination and a disability-inclusive justice system
  • Education – an inclusive high quality education system that is responsive to the needs of Aboriginal and Torres Strait Islander people with disability
  • Economic security – including employment and business ownership opportunities
  • Health Services – that meet the needs of Aboriginal and Torres Strait Islander people with disability to ensure the highest possible health and wellbeing outcomes.

See Detail Below or in the Plan

“By addressing these issues head on, this Plan aims to achieve improved outcomes and overall social, emotional, cultural, and economic wellbeing for Aboriginal and Torres Strait Islander people with disability and their families and carers,” Minister Porter said.

Extract- Executive Summary

The Australian Government is committed to building an environment that enables Aboriginal and Torres Strait Islander people with disability to achieve improved life outcomes and overall social, emotional, cultural and economic wellbeing.

The development of a dedicated Australian Government plan to improve outcomes of Aboriginal and Torres Strait Islander people with disability seeks to build the capacity of service systems, including disability services and Indigenous programs, to better meet the needs of Aboriginal and Torres Strait Islander people with disability in a culturally safe and appropriate way. The Plan also aims to support workers and carers in their continuing efforts in Aboriginal and Torres Strait Islander communities.

The Plan acknowledges that disability is everyone’s responsibility:

• Australian Government

• state/territory government

• local government

• business and industry sectors

• not–for–profit and community organisations

• Aboriginal and Torres Strait Islander people, communities and organisations.

The Plan is the first of its kind and will be built on over time. The Plan will build on significant work currently being undertaken by the Australian Government to improve outcomes for Aboriginal and Torres Strait Islander people with disability. Consultations on the Plan have been undertaken over the last three years across government agencies together with community stakeholders, including Aboriginal and Torres Strait Islander people with disability, their representative organisations, researchers and community organisations.

The Plan highlights five key areas that stakeholders view as priorities for future consideration by the Australian Government, highlighting work that is already underway in these areas, along with potential strategies to address each of the areas:

1. Aboriginal and Torres Strait Islander people with disability have access to appropriately designed shelter and live in accessible, well designed communities that are fully inclusive of all their residents.

2. Aboriginal and Torres Strait Islander people with disability have the right to:

• be free from racism and discrimination

• have their rights promoted

• a disability inclusive justice system.

3. Aboriginal and Torres Strait Islander people with disability achieve their full potential through participation in an inclusive, high quality education system that is responsive to their needs. People with disability have opportunities for lifelong learning.

4. Aboriginal and Torres Strait Islander people with disability, their families and carers have opportunities to gain economic security through employment and business ownership, enabling them to plan for the future and exercise choice and control over their lives.

5. Aboriginal and Torres Strait Islander people with disability attain the highest possible health and wellbeing outcomes throughout their lives, enabled by all health services capabilities to meet the needs of people with disability.

6 .To ensure that the Plan leads to substantive and meaningful change for Aboriginal and Torres Strait Islander people with disability, any actions or strategies under the Plan must be:

Measurable The priorities and actions outlined in the Plan must be measurable to track progress and outcomes.

Replicable While Aboriginal and Torres Strait Islander people and communities are diverse, there needs to be some consistency in approach and general principles for success that can be applied across different communities.

Sustainable The Plan represents a starting point in the development of a new approach for improving the lives of Aboriginal and Torres Strait Islander people with a disability. The Plan seeks to outline reform and action that will be sustainable over the long-term.

Flexible The Plan recognises that different people and different communities have different needs. While adhering to principles of sustainability and best practice in the delivery of services, implementation needs to be responsive to the unique requirements of individuals and communities.

Cultural The Plan recognises that Aboriginal and Torres Strait Islander people with disability will have similar physical and structural requirements as non–Indigenous people, but that service delivery needs to be undertaken in a cultural context to achieve success.

Area 5: Aboriginal and Torres Strait Islander people with disability attain the highest possible health and wellbeing outcomes throughout their lives, enabled by all health and disability services having the capability to meet their needs.

Why is it important?

Holistic health care and coordination between health and disability services are paramount for those with disabilities. Many Aboriginal and Torres Strait Islander people, those with a disability and those without, access Aboriginal and Torres Strait Islander community controlled health services as they deliver holistic, comprehensive and culturally appropriate health care, and have an understanding of the cultural needs of Aboriginal and Torres Strait Islander people.

While these services meet general health needs through comprehensive primary health care, there is still a need for health workers to receive appropriate training on disability issues. Workers aware of disability needs are able to facilitate appropriate referral pathways for clients to receive any required additional disability services and supports.

Access to disability services is limited by cultural considerations as well as by geographical location, environmental factors, capacity and level of need. Cultural safety can be at risk where the only service within geographic reach is designed for the general population without achieving cultural competency for Aboriginal and Torres Strait Islander care.

Summary of press release

The Australian Government is committed to working in a spirit of collaboration with states and territories, local government, Aboriginal and Torres Strait Islander people, and communities and organisations to deliver real outcomes and foster greater opportunities for Aboriginal and Torres Strait Islander people with disability, their families and carers.

 

Aboriginal Health Research @NHMRC Road Map 3: A Strategic Framework for Improving Aboriginal Health through Research for public consultation.

The National Health and Medical Research Council (NHMRC) has released the draft Road Map 3: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research (Road Map 3) for public consultation.

The aims of the public consultation are to:

  1. Seek feedback on the draft Road Map 3, including comments on the objective and priority areas
  2. Identify any gaps in Road Map 3, and
  3. Seek feedback on the inclusion of an Action Plan.

NHMRC has committed to develop Road Map 3 to guide and communicate its objectives and investment in Aboriginal and Torres Strait Islander health research for the next decade. Road Map 3 builds on the previous documents, Road Map I (2002) and Road Map II (2010).

From March to July 2017, the NHMRC and its Principal Committee Indigenous Caucus (PCIC) worked with Nous Group (Nous) to conduct a national consultation process for the development of Road Map 3.

The consultation process for Road Map 3 began with a series of interviews with nine leaders from Aboriginal and Torres Strait Islander health and research peak bodies.  This was followed by seven workshops across Australia attended by researchers, health workers, government officials and community leaders. An online survey was also made available for those who could not attend the workshops.

Scope of this public consultation

NHMRC is seeking responses to a series of questions related to the development of Road Map 3.

Consultation Questions:

  1. Is the proposed objective of Road Map 3 relevant?  Why/why not?
  2. Are the three priority areas of Road Map 3 accurate?  Why/why not?
  3. Are there any further priority areas to add?
  4. Is there anything missing from Road Map 3?  Please provide further details.
  5. Are there any other comments you would like to make regarding Road Map 3?

Consultation dates:

Opening date – Friday, 13 October 2017 – 12:00pm, AEST

Closing date – Sunday, 10 December 2017 – 11:59pm, AEST

Extensions will not be provided.

Consultation document:

Supporting documents:

Please note: These documents are for information only and are not open for public consultation.

Please note: If you are having problems downloading a document, please right-click on the link and select “Save Target/Link as…” and choose a location to save the file to.

Personal information

Please provide your contact details: Name, Organisation (if relevant), Email, and Phone number.  This information will not be used or disclosed for any other purpose.

How NHMRC will consider submissions

Due consideration will be given to submissions that address the public consultation questions and provide additional evidence that meets the inclusion criteria.  NHMRC’s Principal Committee Indigenous Caucus (PCIC) will provide advice to NHMRC on responses received.

Privacy and confidentiality

After the final document Road Map 3 is released, submissions may be made publicly available via the NHMRC online public consultation portal, unless they have been requested NOT to be published.

How to make your submission

Provide a submission by response to the above questions using the submission form provided below, and email through to NHMRCroadmap3@nousgroup.com.au. (link sends e-mail)

Contact for further information:

Samantha Faulkner, Aboriginal and Torres Strait Islander Adviser

Email: Samantha.faulkner@nhmrc.gov.au (link sends e-mail

WEBSITE

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 #MentalHealthDay : Australia’s new digital #mentalhealth gateway now live

 ” Today we are launching our new digital mental health gateway – Head to Health.

Head to Health is an essential tool for the one in five working age Australians who will experience a mental illness each year.

The website helps people take control of their mental health in a way they are most comfortable with and can complement face-to-face therapies.

Evidence shows that for many people, digital interventions can be as effective as face-to-face services.

Head to Health provides a one-stop shop for services and resources delivered by some of Australia’s most trusted mental health service providers.

They include free or low-cost apps, online support communities, online courses and phone services.

Head to Health provides a place where people can access support and information before they reach crisis.

The Hon. Greg Hunt MP Minister for Health launching www.headtohealth.gov.au

See full press release from Minister Part 3 below

 ” For Aboriginal and Torres Strait Islander peoples, the strength of personal identity is often connected to culture, country and family.

Like all of us, however, you can have problems with everyday things like money, jobs and housing that can impact your social and emotional wellbeing. On top of that, you might have to deal with racism, discrimination, bullying, gender-phobia, and social inequality ”

READ MORE ON THIS TOPIC HERE

 ” Aboriginal and Torres Strait Islander health and wellbeing combines mental, physical, cultural, and spiritual health of not only the individual, but the whole community. For this reason, the term “social and emotional wellbeing” is generally preferred and better understood than terms like “mental health” and “mental illness”.

Addressing social and emotional wellbeing for Aboriginal and Torres Strait Islander peoples requires the recognition of human rights, the strength of family, and the recognition of cultural diversity – including language, kinship, traditional lifestyles, and geographical locations (urban, rural, and remote).”

READ MORE ON THIS TOPIC HERE  

Part 1 NACCHO BACKGROUND

Read over 160 NACCHO Aboriginal Mental Health Articles published over 5 yrs

Read over 115 NACCHO Suicide Prevention Articles published over 5 yrs Including

NACCHO Aboriginal Health : #ATSISPEP report and the hope of a new era in Indigenous suicide prevention

Our NACCHO CEO Pat Turner as a contributor to the report attended the launch pictured here with Senator Patrick Dodson and co-author Prof. Pat Dudgeon

After almost two years of work, ATSISPEP released a final report in Canberra on the 10th of November 2016.

Download the final #ATSISPEP report here

atispep-report-final-web-pdf-nov-10

Part 2 Mental Health Australia campaign

We need to see tackling stigma around mental health as a way to improve the health of the nation, improve our productivity, improve our community engagement, and improve our quality of life.”

“Yes we’ve come a long way to challenge and change perceptions, and paved the way for many to tell their story, but there is still great stigma associated with mental illness.”

“This year, my #mentalhealthpromise is to challenge Australia to look at mental health through a different light. Let’s look at the positives we can achieve as a community by reducing stigma and changing our approach to improving someone’s health.”

Mental Health Australia CEO Mr Frank Quinlan

Today World Mental Health Day – Tuesday 10 October – and Mental Health Australia is calling on the nation to further reduce stigma and promise to see mental health in a positive light.

‘Do you see what I see?’ challenges perceptions on mental illness aiming to reduce stigma.

‘Do you see what I see?’ promotes a positive approach to tackling an issue that affects one in five Australians.

‘Do you see what I see?’ aims to put a new light on the conversation… from dark to bright. Incorporating the successful #MentalHealthPromise initiative, which last year saw both the

Prime Minister and Opposition Leader make a mental health promise to the nation, ‘Do you see what I see?’ will also feature a series of photos from across Australia, shedding light and colour on an issue which is still cloaked in darkness.

“We’ve all seen it before… The stock black and white photo of someone sitting with their head in their hands signifying mental illness. That’s stigma… and stigma is still the number one barrier to people seeking help. Help that can prevent and treat,” said Mental Health Australia CEO Mr Frank Quinlan.

“We have to see things differently, and see the positive outcomes of tackling this issue if we are to see real benefits and reductions in the rate of mental illness affecting the nation.”

“We need to see mental health, and mental wealth through our own eyes, through the eyes of a family member or close friend and through the eyes of those in our community who don’t have that support around them.”

‘What will your #MentalHealthPromise be?

Making and sharing a mental health promise is easy and takes just a few minutes at www.1010.org.au

Part 3 The Hon. Greg Hunt MP Minister for Health press release Continued

Australia’s new digital mental health gateway now live

As part of our over $4 billion annual investment in mental health, the Turnbull Government is today launching our new digital mental health gateway – Head to Health.

Head to Health provides a place where people can access support and information before they reach crisis.

And it will continue to grow with additional services, a telephone support service to support website users, and further support for health professionals to meet the needs of their patients.

I encourage not only people seeking help and support, but anyone wanting to learn more on how to maintain good mental health wellbeing, to visit the website at: www.headtohealth.gov.au.

The Turnbull Government supports the need for a long term shift in mental health care towards early intervention, and the Head to Health gateway will help with this.

We have recently announced $43 million in funding for national suicide prevention leadership and support activity to organisations across Australia such as R U OK?, Suicide Prevention Australia and Mindframe.

This year we are investing $92.6 million in the headspace program to improve access for young people aged 12–25 years who have, or are at risk of, mental illness.

In addition, we have provided $52.6 million to beyondblue, which will partner with headspace and Early Childhood Australia to provide tools for teachers to support kids with mental health concerns and provide resources to help students deal with challenges.

Digital mental health services are an important part of national mental health reform and have been identified in the recently endorsed Fifth National Mental Health and Suicide Prevention Plan.

Building a digital mental health gateway was a key part of the Government’s response to the National Mental Health Commission’s Review of Mental Health Programs and Services.

 

Aboriginal Health Lifestyle Campaigns : Minister @KenWyattMP investing in #DeadlyRoos partnership, a Community Controlled initiative. #DeadlyChoices

“Deadly Choices is what I like to call a ‘jewel in the crown’ of Indigenous health, achieving some stunning results since it kicked off in South East Queensland four years ago.

The Deadly Kangaroos is an expansion of this program, using the star power of the ambassadors and the excitement of this year’s World Cup to reach more even communities.

Our national rugby league stars need to be in peak physical condition to play at the top of their game and we appreciate the players’ support to start discussions with Aboriginal and Torres Strait Islander people about ways to improve their health “

Minister for Indigenous Health, Ken Wyatt AM, said legendary Kangaroos coach Mal Meninga and other Indigenous and non-Indigenous players would become ambassadors for the Institute for Urban Indigenous Health’s Deadly Choices program, to extend its reach across Australia.

The launch in Canberra was attended by the NACCHO Chair Matthew Cooke (pictured on right )

Members of the elite Australian Kangaroos Rugby League 2017 World Cup squad will headline the expansion of a successful grassroots campaign to improve Aboriginal and Torres Strait Islander health.

Deadly Choices is a community-based health lifestyle campaign launched in 2013.

There is particular focus on young people and the importance of exercise, education, school attendance, quitting smoking and regular preventive health checks.

Through media campaigns, sports carnivals and community events it has prompted:

    • Almost 19,000 annual health checkups in South East Queensland
    • Active patient numbers to triple to over 330,000
    • 1,155 smoke-free household pledges
    • More than 3,300 smoker interventions

“Experience shows that sport and sporting legends can help communities kick major goals in health awareness and foster real change,” the Minister said.

“I encourage everyone to support Australia in the World Cup in October, just as the Kangaroos are supporting better health outcomes for Aboriginal and Torres Strait Islander people, and all Australians.”

The ambassadors will make appearances at game day events as the Australian team travels through the ACT, New South Wales, the Northern Territory and regional Queensland for the World Cup.

“Key ambassadors for the Deadly Kangaroos are Johnathan Thurston and Greg Inglis,” the Minister said. “Also, the best three players from the national men’s and women’s teams at the Arthur Beetson Deadly Choices Murri Rugby League carnival will also be chosen as community ambassadors to promote positive health messages.

“Merchandise, including a special Deadly Kangaroos World Cup jersey, has been produced as an incentive for people to have a health check.

“The messages will also be promoted through television, radio, social media and at coaching clinics and Aboriginal community controlled health services.”

The Australian Government is contributing $235,000 to help support the Deadly Kangaroos campaign

The Rugby League World Cup runs from 26 October – 2 December 2017.

Aboriginal #Nutrition Health and #Sugar : @healthgovau Health Star Rating System review closes 17 August

 ” The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.”

See Sugar, sugar everywhere MJA insight article in full Part 3 below

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

ABS Report abs-indigenous-consumption-of-added-sugars 

See Part 1 below for Aboriginal sugar facts

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system is undertaking a five year review of the HSR system.

The five year review of the system is well underway, with a public submission process opening on 8 June 2017 on the Australian Department of Health’s online Consultation Hub.

Since the consultation period has been opened there has been strong interest in the system from stakeholders representing a diverse range of views.

To ensure that as much evidence as possible is captured, along with stakeholders’ views on the system, a further two week extension to the consultation period has been agreed and it will now close on 17 August 2017

See full survey details Part 2 Below

Part 1 Aboriginal sugar facts

ABS Report

abs-indigenous-consumption-of-added-sugars

Aboriginal and Torres Strait Islander people consume around 14 per cent of their total energy intake as free sugars, according to data from the Australian Bureau of Statistics (ABS).

The World Health Organization (WHO) recommends that free sugars contribute less than 10 per cent of total energy intake.

Director of Health, Louise Gates, said the new ABS report showed Aboriginal and Torres Strait Islander people are consuming an average of 18 teaspoons (or 75 grams) of free sugars per day (almost two cans of soft drink), four teaspoons more than non-Indigenous people (14 teaspoons or 60 grams).

OTHER KEY FINDINGS

    • Aboriginal and Torres Strait Islander people derived an average of 14% of their daily energy from free sugars, exceeding the WHO recommendation that children and adults should limit their intake of free sugars to less than 10% of dietary energy.
    • Free sugars made the greatest contribution to energy intakes among older children and young adults. For example, teenage boys aged 14-18 years derived 18 per cent of their dietary energy from free sugars as they consumed the equivalent of 25 teaspoons (106 grams) of free sugars per day. This amount is equivalent to more than two and a half cans of soft drink. Women aged 19-30 years consumed 21 teaspoons (87 grams) of free sugars, which contributed 17 per cent to their total energy intake.
    • The majority (87%) of free sugars were consumed from energy dense, nutrient-poor ‘discretionary’ foods and beverages. Two thirds (67%) of all free sugars consumed by Aboriginal and Torres Strait Islander people came from beverages, led by soft drinks, sports and energy drinks (28%), followed by fruit and vegetable juices and drinks (12%), cordials (9.5%), and sugars added to beverages such as tea and coffee (9.4%), alcoholic beverages (4.9%) and milk beverages (3.4%).
    • Intakes were higher for Aboriginal and Torres Strait Islander people living in non-remote areas where the average consumption was 78 grams (18.5 teaspoons), around 3 teaspoons (12 grams) higher than people living in remote areas (65 grams or 15.5 teaspoons).
    • Aboriginal and Torres Strait Islander people consumed 15 grams (almost 4 teaspoons) more free sugars on average than non-Indigenous people. Beverages were the most common source of free sugars for both populations, however Aboriginal and Torres Strait Islander people derived a higher proportion of free sugars from beverages than non-Indigenous people (67% compared with 51%).

Part 2 @healthgovau Health Star Rating System review closes 17 August

Introduction

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system, is undertaking a five year review of the HSR system. The HSR system is a front-of-pack labelling (FoPL) scheme intended to assist consumers in making healthier diet choices. The findings of the review will be provided to the Australia and New Zealand Ministerial Forum on Food Regulation (Forum) in mid‑2019.

In parallel with this consultation on the HSR system five year review, the HSRAC is conducting a dedicated investigation of issues and concerns raised about the form of the food (‘as prepared’) rules in the Guide for Industry to the HSR Calculator. These enable additional nutrients to be taken into account when calculating star ratings based on foods prepared according to on-label directions. A specific consultation process seeking input into this investigation opened on 19 May 2017 and will close at 11.59 pm 30 June 2017. The form of the food (‘as prepared’) consultation can be viewed on the Australian Department of Health’s Consultation Hub.

The HSR system

The HSR system is a public health and consumer choice intervention designed to encourage people to make healthier dietary choices. The HSR system is a voluntary FoPL scheme that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It is not a system that defines what a ‘healthy’ or ‘unhealthy’ food is, but rather provides a quick, standardised way to compare similar packaged foods at retail level. The more stars, the healthier the choice. The HSR system is not a complete solution to assist consumers with choosing foods in line with dietary guidelines, but should be viewed as a way to assist consumers to make healthier packaged food choices.  Other sources of information, such as the Australian Dietary Guidelines and the New Zealand Eating and Activity Guidelines, also assist consumers in their overall food purchasing decisions.

The HSR system aims to:

1. Enable direct comparison between individual foods that, within the overall diet, may contribute to the risk factors of various diet related chronic diseases;

2. Be readily understandable and meaningful across socio-economic groups, culturally and linguistically diverse groups and low literacy/low numeracy groups; and

3. Increase awareness of foods that, within the overall diet, may contribute positively or negatively to the risk factors of diet related chronic diseases.

The HSR system consists of the graphics, including the words ‘Health Star Rating’, the rules identified in the HSR system Style Guide, the algorithm and methodology for calculating the HSR identified in the Guide for Industry to the HSR Calculator, and the education and marketing associated with the HSR implementation.

The HSR system is a joint Australian, state and territory and New Zealand government initiative developed in collaboration with industry, public health and consumer groups. The system is funded by the Australian government, the New Zealand government and all Australian jurisdictions during the initial five year implementation period.

From June 2014, food manufacturers started to apply HSRs to the front of food product packaging. Further information on the HSR system is available on the HSR website. The New Zealand Ministry for Primary Industries (MPI) website also provides information on the HSR system in New Zealand.

Purpose and scope of the review
The five year review of the HSR system will consider if, and how well, the objectives of the HSR system have been met, and identify options for improvements to and ongoing implementation of the system (Terms of reference for the five year review).

With a focus on processed packaged foods, the objective of the HSR system is:

To provide convenient, relevant and readily understood nutrition information and /or guidance on food packs to assist consumers to make informed food purchases and healthier eating choices.

The HSRAC has agreed that the areas of communication, system enhancements, and monitoring and governance will be considered when identifying whether the objectives of the HSR system have been achieved.

Although HSRAC will need to be a part of the review process, a degree of independence is required and independent management and oversight of the review is an important factor to ensure credible and unbiased reporting. An independent consultant will be engaged to undertake the review. Specific detail about the scope of the review will be outlined in the statement of requirement for the independent consultant. A timeline for the five year review of the HSR system has been drafted and will be updated throughout the review.

Next steps in the review process

As part of the five year review, HSRAC is seeking evidence based submissions on the consultation questions provided in this discussion paper.

This consultation is open to the public, state and territory governments, relevant government agencies, industry and public health and consumer groups.

Making a submission

The HSRAC is seeking submissions on the merits of the HSR system, particularly in response to the consultation questions below. The aim of the questions is to assist respondents in providing relevant commentary. However, submissions are not limited to answering the questions provided.  Please provide evidence or examples to support comments. Some areas of this review are technical in nature therefore comments on technical issues should be based on scientific evidence and/or supported by research where appropriate. Where possible, please provide citations to published studies or other sources.

While the HSRAC will consider all submissions and proposals put forward, those that are not well supported by evidence are unlikely to be addressed as part of the five year review.

Enquiries specifically relating to this submission process can be made via email to: frontofpack@health.gov.au. Please DO NOT provide submissions by email.

After the consultation period closes the HSRAC will consider the submissions received and will prepare a summary table of the issues raised which will be published on the HSR website. All information within the summary table will be de-identifiable and will not contain any confidential material.

HSRAC will treat information of a confidential nature as such. Please ensure that material supplied in confidence is clearly marked ‘IN CONFIDENCE’ and is provided in a separate attachment to non-confidential material. Information provided in the submissions will only be used for the purpose of the five year review of the HSR system and will not be used for any other purpose without explicit permission.

Please see the Terms of Use and Privacy pages at the bottom of this page for further information on maintaining the security of your data.

For further information about the HSR system, including its resources and governance structure, please refer to the Australian HSR website and the New Zealand MPI website.

Part 3 Sugar Sugar MJA Insights

Originally published Here

IT’S hard to escape sugar, not only in what we eat and drink, but also in the daily news and views that seep into so many corners of our lives.

There’s nothing new about concern over sugar. I can trace my own fights with the sugar industry back to the 1960s, and since their inception in 1981, the Australian Dietary Guidelines have advised limiting sugary foods and drinks. The current emphasis in many articles in newspapers, magazines, popular books and online blogs, however, go further and recommend eliminating every grain of the stuff from the daily diet.

Taking an academic approach to the topic, the George Institute for Global Health has published data based on the analysis of 34 135 packaged foods currently listed in their Australian FoodSwitch database. They found added sugar in 87% of discretionary food products (known as junk foods in common parlance) and also in 52% of packaged foods that can be described as basic or core foods.

The George Institute’s analysis is particularly pertinent to the Department of Health’s Health Star Rating System, and found that some of the anomalies in the scheme could be eliminated by penalising foods for their content of added sugars rather than using total sugars in the product, as is currently the case.

The definition of “added sugars” used in Australia also needs attention, a topic that has been stressed in the World Health Organization’s guidelines. I will return to this later.

In Australia, the nutrition information panel on the label of packaged foods must include the total sugars present. This includes sugars that have been added (known as extrinsic sugars) as well as any sugars present naturally in ingredients such as milk, fruit or vegetables (intrinsic sugars).

There is no medical evidence to suggest that intrinsic sugars are a problem – at least not if they occur in “intact” ingredients. If you consume fruit, for example, the natural dietary fibre and the bulk of the fruit will limit the amount of the fruit’s intrinsic sugars you consume. However, if the sugar is extracted from the structure of the fruit, it becomes easy to consume much larger quantities. Few people could munch their way through five apples, but if you extract their juice, the drink would let you take in all the sugar and kilojoules of five apples in less than a minute.

The Australian Dietary Guidelines do not include advice to restrict fruit itself because there is high level evidence of its health value. The guidelines do, however, recommend that dried fruit and fruit juice be restricted – the equivalent of four dried apricot halves or 125 mL juice consumed only occasionally.

Contrary to the belief of some bloggers, Australia’s dietary guidelines have never suggested replacing fat with sugar. That was a tactic of some food companies who marketed many “low” or “reduced” fat foods where the fat was replaced with sugars or some kind of refined starch.

The wording of Australia’s guideline on sugar has changed. The initial advice to “avoid too much sugar” led to the sugar industry’s multimillion dollar campaign “Sugar, a natural part of life”. This included distributing “educational” material to the general public, politicians, doctors, dentists, pharmacists and other health professionals discussing the importance of a “balanced diet”.

In spite of fierce lobbying by the sugar industry, the next revision of the guidelines retained a sugar guideline, although it was watered down to “eat only moderate amounts of sugars”. Some school canteen operators reported that they had been confronted by sweet-talking sellers of junk foods omitting the word “only” from this guideline.

The evidence for sugar’s adverse effects on dental health have long been known, but the evidence against sugar and its potential role in obesity and, consequently, in type 2 diabetes and other health problems has grown stronger. The most recent revision of the National Health and Medical Research Council’s Dietary Guidelines, therefore, emphasises the need to “limit” added sugars and lists the foods that need particular attention.

Sugary drinks have been specifically targeted because the evidence against them is strong and extends beyond epidemiological studies. Double-blind trials now clearly link sugary drinks with weight gain, the only exceptions being a few trials funded by the food industry.

Added sugar is not the only topic for public health concern, and hence the government’s Health Star Rating System was set up to introduce a simple front-of-pack labelling scheme to assist Australians reduce their intake of saturated fat, salt and sugars from packaged foods.

A specially commissioned independent report (Evaluation of scientific evidence relating to Front of Pack Labelling by Dr Jimmy Chun Yu Louie and Professor Linda Tapsell of the School of Health Sciences, University of Wollongong) found that added sugars were the real problem, but the food industry argued that the scheme should include total sugars because this was already a mandatory inclusion on food labels and routine chemical analysis couldn’t determine the source of sugars.

This was a strange argument since food manufacturers know exactly how much sugar they add to any product, just as they know how many “offset” points the Health Star Rating System allows for the inclusion of fruit, vegetable, nuts or legumes. The content of these ingredients is only disclosed on the food label if used in the product’s name.

The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.

How can caramel topping or various types of confectionery, such as strawberry flavoured liquorice, each get 2.5 stars? Why do some chocolates sport 3.5 stars, while worthy products such as Greek yoghurt without any added sugars get 1.5 and a breakfast cereal with 27% sugar gets four stars?

The fact that over a third of Australian’s energy intake comes from discretionary products (40% for children) is the elephant in the room for excess weight. We need to reduce consumption of these products and allotting them health stars is not helping.

It’s clearly time to follow our dietary guidelines and limit both discretionary products and added sugar. Of the nutrients used in the current algorithm for health stars, the George Institute’s analysis shows that counting added rather than total sugars has the greatest individual capacity to discriminate between core and discretionary foods.

However, in moving to mandate added sugars on food labels and using added sugars in health stars, it’s vital to define these sugars. The World Health Organization has done so: “Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.

Regular sugar in Australia could be described as cane juice concentrate. It has no nutrients other than its carbohydrate. Fruit juice concentrates are also just sugars with no nutrients other than carbohydrates. At present the Health Star Rating System allows products using apple or pear juice concentrate to be counted as “fruit” and used to offset the total sugars. This is nonsense, and gives rise to confectionery, toppings and some breakfast cereals scoring stars they do not deserve.

Other ways to boost health stars also need attention. Food technologists boast they can manipulate foods to gain extra stars (Health Star Rating Stakeholders workshop, Sydney, 4 August 2016). For example, adding wheat, milk, soy or other protein powder, concentrated fruit purees or a laboratory-based source of fibre such as inulin will all give extra “offset” points to reduce adverse points from saturated fat, sugar or salt. Indeed, some food technologists have even suggested they could revert to using the especially nasty trans (but technically unsaturated) fatty acid from partially hydrogenated vegetable oils to replace naturally occurring saturated fat.

My alternative is to go for fresh foods and minimise packaged foods. If the stars look too good to be true, check the ingredient list. But remember that Choice found sugar may go by more than 40 different names. Buyer beware!

NACCHO NEWS ALERT: COAG Health Ministers Council Communique acknowledge the importance #ACCHO’s advancing Aboriginal health

 

  Included in this NACCHO Aboriginal Health News Alert

  1. All issues 11 included in  Communique highlighting ACCHO health
  2. Health Ministers approve Australia’s National Digital Health Strategy
  3. Transcript Health Minister Hunt Press Conference

” The Federal Minister for Indigenous Health, Ken Wyatt, attended the COAG Health Council discussed the Commonwealth’s current work on Indigenous health priorities.

In particular this included the development of the 2018 iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 that will incorporate strategies and actions to address the social determinants and cultural determinants of health.

Ministers also considered progress on other key Indigenous health issues including building workforce capability, cultural safety and environmental health, where jurisdictions can work together more closely with the Commonwealth to improve outcomes for Aboriginal and Torres Strait Islander peoples.

Ministers acknowledged the importance of collaboration and the need to coordinate activities across governments to support a culturally safe and comprehensive health system.

Ministers also acknowledge the importance of community controlled organisations in advancing Aboriginal and Torres Strait Islander health. ”

1.Development of the next iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 COAG Health Council 

Read over 50 NACCHO NATSIHP Articles published over past 50 years

INTRODUCTION

The federal, state and territory Health Ministers met in Brisbane on August 4 at the COAG Health Council to discuss a range of national health issues.

The meeting was chaired by the Victorian Minister for Health, the Hon Jill Hennessy MP.

Health Ministers welcomed the New South Wales Minister for Mental Health, the Hon Tanya Davies MP, the Victorian Minister for Mental Health, the Hon Martin Foley MP, the ACT Minister for Mental Health Mr Shane Rattenbury and the Minister for Aged Care and Minister for Indigenous Health, the Hon Ken Wyatt AM, MP who participated in a joint discussion with Health Ministers about mental health issues.

Major items discussed by Health Ministers today included:

2.Andrew Forrest and the Eliminate Cancer Initiative

Mr Andrew Forrest joined the meeting to address Health Ministers in his capacity as Chairman of the Minderoo Foundation to discuss the Eliminate Cancer Initiative. The Minderoo Foundation is one of Autralia’s largest and most active philanthropic groups. It has established the Eliminate Cancer Initiatve (the Initiative), a global initiative dedicated to making cancer non-lethal with some of the world’s leading global medicine and anti-cancer leaders.

The Initiative is a united effort to convert cancer into a non-lethal disease through global collaboration of scientific, medical and academic institutes, commercially sustained through the support of the philanthropic, business and government sectors worldwide.

Australia has a critical role to play in this highly ambitious and thoroughly worthwhile goal.

3.Family violence and primary care

Today, Health Ministers discussed the significant health impacts on those people experiencing family violence.

Health Ministers acknowledged that health-care providers, particularly those in a primary care setting, are in a unique position to create a safe and confidential environment to enable the disclosure of violence, while offering appropriate support and referrals to other practitioners and services.

Recognising the importance of national leadership in this area, Ministers agreed to develop a plan to address barriers to primary care practitioners identifying and responding to patients experiencing family violence.

Ministers also agreed to work with the Royal Australian College of General Practitioners to develop and implement a national training package.

Further advice will be sought from Primary Health Networks on existing family violence services, including Commonwealth, State and NGO service providers in their regions, with a view to developing an improved whole-of-system responses to the complex needs of clients who disclose family violence

4.Fifth National Mental Health and Suicide Prevention Plan

Health Ministers endorsed the Fifth National Mental Health and Suicide Prevention Plan 2017-2022 and its Implementation Plan.

The Fifth Plan is focused on improvements across eight targeted priority areas:

1. Achieving integrated regional planning and service delivery

2. Effective suicide prevention

3. Coordinated treatment and supports for people with severe and complex mental illness

4. Improving Aboriginal and Torres Strait Islander mental health and suicide prevention

5. Improving the physical health of people living with mental illness and reducing early mortality

6. Reducing stigma and discrimination

7. Making safety and quality central to mental health service delivery

8. Ensuring that the enablers of effective system performance and system improvement are in place

The Fifth Plan also responds to calls for a national approach to address suicide prevention and will be used to guide other sectors and to support health agencies to interact with other portfolios to drive action in this priority area.

Ongoing collaboration and engagement across the sector and with consumers and carers is required to successfully implement the Fifth Plan and achieve meaningful reform to improve the lives of people living with mental illness including the needs of children and young people.

Health Ministers also agreed that mental health workforce issues would be considered by the Australian Health Ministers’ Advisory Council.

5.The National Psychosocial Supports Program

Health Ministers agreed to establish a time-limited working group to progress the Commonwealth’s National Psychosocial Supports program. This will have the objective of developing bilateral agreements to support access to essential psychosocial supports for persons with severe mental illness resulting in psychosocial disability who are not eligible for the NDIS.

Those bilateral agreements will take into account existing funding being allocated for this purpose by states and territories.

6.Strengthened penalties and prohibition orders under the Health Practitioner Regulation National Law

Health Ministers agreed to proceed with amendments to the Health Practitioner Regulation National Law (the National Law) to strengthen penalties for offences committed by people who hold themselves out to be a registered health practitioner, including those who use reserved professional titles or carry out restricted practices when not registered.

Ministers also agreed to proceed with an amendment to introduce a custodial sentence with a maximum term of up to three years for these offences.

These important reforms will be fast tracked to strengthen public protection under the National Law. Preparation will now commence on a draft amendment bill to be brought forward to Ministers for approval, with a view to this being introduced to the Queensland Parliament in 2018. The Western Australian Parliament is also expected to consider legislative changes to the Western Australian National Law.

7.Amendment to mandatory reporting provisions for treating health practitioner

Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible.

Health Ministers agreed that doctors should be able to seek treatment for health issues with confidentiality whilst also preserving the requirement for patient safety.

A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioners that they can feel able to seek treatment for their own health conditions anywhere in Australia.

Agree for AHMAC to recommend a nationally consistent approach to mandatory reporting, following discussion paper and consultation with consumer and practitioner groups, with a proposal to be considered by COAG Health Council at their November 2017 meeting, to allow the amendment to be progressed as part of Tranche 1A package of amendments and related guidelines.

8.National Digital Health Strategy and Australian Digital Health Agency Forward Work Plan 2018–2022

Health Ministers approved the National Digital Health Strategy and the Australian Digital Health Agency Work Plan for 2018-2022.

Download Strategy and work plan here  

The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health.

This Strategy will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control and transparency.

Expanding the public reporting of patient safety and quality measures

Health Ministers supported Queensland and other interested jurisdictions to collaboratively identify options in relation to aligning patient safety and quality reporting standards across public and private hospitals nationally.

Ministers agreed that the Australian Commission on Safety and Quality in Health Care (ACSQHC) would undertake work with other interested jurisdictions to identify options in relation to aligning public reporting standards of quality healthcare and patient safety across public and private hospitals nationally.

The work be incorporated into the national work being progressed on Australia’s health system performance information and reporting frameworks.

 

9.National human biomonitoring program

Health Ministers noted that human biomonitoring data can play a key role in identifying chemicals which potentially cause adverse health effects and action that may need to be taken to protect public health.

Health Ministers agreed that a National Human Biomonitoring Program could be beneficial in assisting with the understanding of chemical exposures in the Australian population.

Accordingly, Ministers agreed that the Australian Health Ministers’ Advisory Council will explore this matter in more detail by undertaking a feasibility assessment of a National Human Biomonitoring Program.

Clarification of roles, responsibilities and relationships for national bodies established under the National Health Reform Agreement

States and territories expressed significant concern that the proposed Direction to IHPA will result in the Commonwealth retrospectively not funding activity that has been already delivered by states and territories but not yet funded by the Commonwealth.

States and territories were concerned that this could reduce services to patients going forward as anticipated funding from the Commonwealth will be less than currently expected.

The Commonwealth does not agree with the concerns of the states and territories and will seek independent advice from the Independent Hospital Pricing Authority (IHPA) to ensure hospital service activity for 2015-2016 has been calculated correctly. The Commonwealth committed to work constructively and cooperatively with all jurisdictions to better understand the drivers of increased hospital services in funding agreements.

10.Legitimate and unavoidable costs of providing public hospital services in Western Australia

Health Ministers discussed a paper by Western Australia on legitimate and unavoidable costs of providing public hospital services in Western Australia, particularly in regional and remote areas, and recognised that those matters create a cumulative disadvantage to that state. Health Ministers acknowledged that Western Australia will continue to work with the Commonwealth Government and the Independent Hospital Pricing Authority to resolve those matters.

11.Vaccination

Health Ministers unanimously confirmed the importance of vaccination and rejected campaigns against vaccination.

All Health Ministers expressed their acknowledgement of the outgoing Chair, the Hon Ms Jill Hennessy and welcomed the incoming Chair Ms Meegan Fitzharris MLA from the Australian Capital Territory.

Health Ministers approve Australia’s National Digital Health Strategy

Digital information is the bedrock of high quality healthcare.

The benefits for patients are signicant and compelling: hospital admissions avoided, fewer adverse drug events, reduced duplication of tests, better coordination of care for people with chronic and complex conditions, and better informed treatment decisions. Digital health can help save and improve lives.

To support the uptake of digital health services, the Council of Australian Governments (COAG) Health Council today approved Australia’s National Digital Health Strategy (2018-2022).

Download Strategy and work plan here  

In a communique issued after their council meeting in Brisbane August 4 , the Health Ministers noted:

“The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health. It will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control, and transparency.”

Australian Digital Health Agency (ADHA) CEO Tim Kelsey welcomed COAG approval for the new Strategy.

“Australians are right to be proud of their health services – they are among the best, most accessible, and efficient in the world.

Today we face new health challenges and rapidly rising demand for services. It is imperative that we work together to harness the power of technology and foster innovation to support high quality, sustainable health and care for all, today and into the future,” he said.

The Strategy – Safe, seamless, and secure: evolving health and care to meet the needs of modern Australia – identifies seven key priorities for digital health in Australia including delivery of a My Health Record for every Australian by 2018 – unless they choose not to have one.

More than 5 million Australians already have a My Health Record, which provides potentially lifesaving access to clinical reports of medications, allergies, laboratory tests, and chronic conditions. Patients and consumers can access their My Health Record at any time online or on their mobile phone.

The Strategy will also enable paper-free secure messaging for all clinicians and will set new standards to allow real-time sharing of patient information between hospitals and other care professionals.

Australian Medical Association (AMA) President Dr Michael Gannon has welcomed the Strategy’s focus on safe and secure exchange of clinical information, as it will empower doctors to deliver improved patient care.

“Doctors need access to secure digital records. Having to wade through paperwork and chase individuals and organisations for information is

archaic. The AMA has worked closely with the ADHA on the development of the new strategy and looks forward to close collaboration on its implementation,” Dr Gannon said.

Royal Australian College of General Practitioners (RACGP) President Dr Bastian Seidel said that the RACGP is working closely and collaboratively with the ADHA and other stakeholders to ensure that patients, GPs, and other health professionals have access to the best possible data.

“The Strategy will help facilitate the sharing of high-quality commonly understood information which can be used with confidence by GPs and other health professionals. It will also help ensure this patient information remains confidential and secure and is available whenever and wherever it is needed,” Dr Seidel said.

Pharmacy Guild of Australia National President George Tambassis said that technology would increasingly play an important role in supporting sustainable healthcare delivery.

“The Guild is committed to helping build the digital health capabilities of community pharmacies and advance the efficiency, quality, and delivery of healthcare to improve health outcomes for all Australians.

“We are working with the ADHA to ensure that community pharmacy dispensing and medicine-related services are fully integrated into the My Health Record – and are committed to supporting implementation of the National Digital Health Strategy as a whole,” George Tambassis said.

Pharmaceutical Society of Australia (PSA) President Dr Shane Jackson said that the Strategy would support more effective medicationmanagement, which would improve outcomes for patients and improve the efficiency of health services.

“There is significant potential for pharmacists to use digital health records as a tool to communicate with other health professionals, particularly during transitions of care,” Dr Jackson said.

The Strategy will prioritise development of new digital services to support newborn children, the elderly, and people living with chronic disease. It will also support wider use of telehealth to improve access to services, especially in remote and rural Australia and set standards for better information sharing in medical emergencies – between the ambulance, the hospital, and the GP.

Consumers Health Forum (CHF) Leanne Wells CEO said that the Strategy recognises the importance of empowering Australians to be makers and shapers of the health system rather than just the users and choosers.

“We know that when consumers are activated and supported to better self-manage and coordinate their health and care, we get better patient experience, quality care, and better health outcomes.

“Digital health developments, including My Health Record, are ways in which we can support that to happen. It’s why patients should also be encouraged to take greater control of their health information,” Leanne Wells said.

Medical Software Industry Association (MSIA) President Emma Hossack said that the Strategy distils seven key themes that set expectations at a national level.“The strategy recognises the vital role industry plays in providing the smarts and innovation on top of government infrastructure.

This means improved outcomes, research, and productivity. Industry is excited to work with the ADHA to develop the detailed actions to achieve the vision which could lead to Australia benefitting from one of the strongest health software industries in the world,” Emma Hossack said.

Health Informatics Society of Australia (HISA) CEO Dr Louise Schaper welcomed the Strategy’s focus on workforce development.

“If our complex health system is to realise the benefits from information and technology, and become more sustainable, we need clinical leaders with a sound understanding of digital health,” Dr Schaper said.

The Strategy was developed by all the governments of Australia in close partnership with patients, carers and the clinical professionals who serve them – together with leaders in industry and science.

The Strategy draws on evidence of clinical and economic benefit from many sources within Australia and overseas, and emphasises the priority of patient confidentiality as new digital services are implemented.

The ADHA has established a Cyber Security Centre to ensure Australian healthcare is at the cutting edge of international data security.

The ADHA, which has responsibility for co-ordinating implementation of the Strategy, will now be consulting with partners across the community to develop a Framework for Action. The framework will be published later this year and will detail implementation plans for the Strategy.

The National Digital Health Strategy Safe, seamless and secure: evolving health and care to meet the needs of modern Australia is available on

https://www.digitalhealth.gov.au/australias-national-digital-health-strategy (https://www.digitalhealth.gov.au/australias-national-digital-health-strategy)

Greg Hunt Press Conference

Topics: COAG Health Council outcomes; The Fifth National Mental Health and Suicide Prevention Plan; support for doctors and nurses mental health; hospital funding; same-sex marriage

GREG HUNT:
Today was a huge breakthrough in terms of mental health. The Fifth National Mental Health Plan was approved by the states.

What this is about is enormous progress on suicide prevention. It has actually become the Fifth National Mental Health and Suicide Prevention Plan, so a real focus on suicide prevention.

In particular, the focus on what happens when people are discharged from hospital, the group in Australia that are most likely to take their own lives.

We actually know not just the group, but the very individuals who are most at risk. That’s an enormous step.

The second thing here is, as part of that plan, a focus on eating disorders, and it is a still-hidden issue. In 2017, the hidden issue of eating disorders, of anorexia and bulimia, and the prevalence and the danger of it is still dramatically understated in Australia.

The reality is that this is a silent killer and particularly women can be caught up for years and years, and so there’s a mutual determination, a universal determination to progress on eating disorders, and that will now be a central part of the Fifth National Mental Health and Suicide Prevention Plan.

And also, as part of that, we’ve included, at the Commonwealth’s request today, a real focus on early intervention services for young people under 16. Pat McGorry has referred to it as CATs for Kids, meaning Crisis Assessment Teams, and the opportunity.

And this is a really important step because, for many families, when they have a crisis, there’s nowhere to turn. This is a way through. So those are all enormous steps forward.

The other mental health area where we’ve made big, big progress is on allowing doctors to seek routine mental health treatment.

There’s an agreement by all of the states and territories to work with the Commonwealth on giving doctors a pathway so as they can seek routine mental health treatment without being reported to the professional bodies.

JOURNALIST:
What has led to the increased focus on eating disorders? Has there been an uptick in the number of suicides resulting from that, or has there been an uptick in the number of cases?

GREG HUNT:
No, this has been silently moving along. It’s a personal focus. There are those that I have known, and then when we looked the numbers shortly after coming in, and dealt with organisations such as the Butterfly Foundation, they explained that it’s been a high level issue with the worst rate of loss of life amongst any mental health condition.

And so that’s a combination both of suicide, but also of loss of life due to physical collapse. And so it’s what I would regard as a personal priority from my own experience with others, but then the advocacy of groups like Butterfly Foundation has finally landed. It should’ve happened earlier, but it’s happening on our watch now.

JOURNALIST:
That would be my next question, is that I’m sure advocacy groups will say this is great that it’s happened, but it’s taken the Government so long. Why is it that you’re focussing on it now as opposed to…?

GREG HUNT:
I guess, I’ve only just become Minister. So from day one, this is one of the things I’ve wanted to do, and I’m really, personally, deeply pleased that we’ve made this enormous progress.

So I would say this, I can’t speak for the past, it is overdue, but on our watch collectively we’ve taken a huge step forward today.

Then the last thing is I’ve seen some reports that Queensland and Victoria may have been upset that some of their statistical anomalies were referred to what’s called IHPA (Independent Hospital Pricing Authority).

The reason why is that some of their figures simply didn’t pass the pub test.

The independent authority will assess them, but when you have 4000 per cent growth in one year in some services, 3300 per cent growth in some years in other services, then it would be negligent and irresponsible not to review them.

It may be the case that there was a more than 40-fold increase in some services, but the only sensible thing for the Commonwealth to do is to review it.

But our funding goes up each year every year at a faster rate than the states’ funding, and it’s gone up by $7.7 billion dollars since the current health agreement with the states was struck.

JOURNALIST:
Is that, sorry, relating to private health insurance, or is that something separate?

GREG HUNT:
No, that’s just in relation to, a couple of the states lodged claims for massive growth in individual items.

JOURNALIST:
Thank you. So was there a directive given today regarding private health policies to the states? Was that something that was discussed or something that …?

GREG HUNT:
Our paper was noted, and the states will respond. So we’ve invited the states to respond, they’ll respond individually.

JOURNALIST:
And regarding that mental health plan, besides their new focus on eating disorders, how is it different from previous mental health plans?

GREG HUNT:
So, a much greater focus on suicide prevention, a much greater focus on eating disorders, and a much greater focus on care for young children under 16.

JOURNALIST:
Is that something that you can give more specific details about? You’re saying there’s a much greater focus, but is there any specific information about what that would mean?

GREG HUNT:
As part of the good faith, the Commonwealth, I’ve written to the head of what’s called the Medical Benefits Schedule Review, so the Medicare item review, Professor Bruce Robinson and asked him and their team to consider, for the first time, specific additional treatment, an additional treatment item and what would be appropriate for eating disorders.

Aboriginal Health #Garma2017 : #Makarrata ,canoes and the #UluruStatement @TurnbullMalcolm @billshortenmp Full Speech transcripts

 ” Djapiri said Bill and I are in the same canoe and on this issue we certainly are – but we are not alone, we are not alone in the canoe. We are in the same canoe with all of you as well and we need to steer it wisely to achieve our goal, to achieve that goal of Makarrata.

Beyond Constitutional Recognition, that work continues every day. I reflect on the Makarrata discussion of the late 70’s and 80’s. A list of demands was sent to the Minister for Aboriginal Affairs in 1981. It called for rights to land and resources, compensation, the creation of Aboriginal schools, medical centres and an Aboriginal bank.

Despite a final agreement not being reached at the time, we have achieved some of the policies called for. The Commonwealth provided $433 million to 137 Aboriginal Medical Services across the country last financial year.

As Prime Minister I will continue to do all I can to ensure that being an Aboriginal and Torres Strait Islander Australian means to be successful, to achieve, to have big dreams and high hopes, and to draw strength from your identity as an Indigenous person in this great country.

That’s why, as we renegotiate the Closing the Gap targets with the various state and territory jurisdictions later this year, my Government has insisted on a strengths based approach.

Indigenous people are not a problem to be solved.

You are our fellow Australians. Your cultures are a gift to our nation.”

Selected extracts from the full Prime Minister Speech 5 August Garma see Part 2 Full Speech

Download full copy Garma 2017 PM full Speech

” Djapirri said, she told me of a dream of a canoe, paddled by the Prime Minister and myself.

That in itself is an arresting image. Two captains. But in all seriousness, we appreciated I think the power of that illusion, the power of that dream.

Here at Garma, on the lands of the Gumatj, we gather to talk about a Yolngu word. Makarrata.

It is not just now a Yolngu word – I put it to you it’s a national test.

Coming together, after a struggle.

And for the first Australians, it has been a very long struggle indeed.

– A struggle against dispossession and discrimination, exclusion and inequality.

– A struggle against violence and poverty, disease and diminished opportunity.

– A struggle for better health, for better housing, for safer communities, more jobs, for longer lives.

– A struggle against injustice and racism: from the sporting field to the courts of our land.

Above all, a struggle for a better future for their children: a struggle to be counted, to be heard, to be recognised.

At Uluru, you gave us the statement from the heart.

A call for:

– A voice enshrined in the Constitution

– A declaration to be passed by all parliaments, acknowledging the unique place of the first nations in Australian history, their culture, their connection.

And a Makarrata Commission to oversee a process of agreement-making and truth-telling.

All three of these objectives speak to the long-held and legitimate aspirations of our First Australians:

– A proper acknowledgment of Aboriginal histories and the dispossession that followed upon the arrival of the Europeans

– A bigger say in the issues which affect you – no more ‘solutions’ imposed without consultation or consent

And a more lasting settlement, a new way forward, a new pathway including through treaties.

These ideas are not new – but the Uluru statement did articulate these with new clarity, a new passion, a new sense of truth and purpose “

Selected extracts The Hon Bill Shorten speech  Garma 5 August 2017 see in full Part 3 Below

Download full speech Garma 2017 PM full Speech

Part 1 Media Coverage

View NITV Media coverage

When it comes to Aboriginal constitutional reform, picture Malcolm Turnbull and Bill Shorten sitting in a canoe – and the opposition leader thinks he’s the only one paddling.

The Labor leader has backed a referendum question on an indigenous voice to parliament, while the prime minister has failed to commit bipartisan support.

The two politicians are moving together downstream, struggling to balance the boat to achieve reconciliation, Gumatj leader Djapirri Mununggirritj has told Garma Festival in northeast Arnhem Land.

Mr Shorten called it an “arresting image” but said he was disappointed Mr Turnbull dismissed his end of year referendum question deadline as “very ambitious”.

“We support a declaration by all parliaments, we support a truth telling commission, we are not confronted by the notion of treaties with our first Australians,” he said.

Mr Turnbull acknowledged many Aboriginal leaders were disappointed the government didn’t give “instant fulfilment” to the Referendum Council’s recommendations.

He described the Yolgnu elder’s canoe analogy as apt, saying his cabinet will give the matter careful consideration to keep the aspiration of Makarrata, or coming together after a struggle, from capsizing.

An “all or nothing approach” to constitutional change risks rocking the boat, resulting in a failed referendum, and Mr Turnbull called for time to develop a winnable question to put to Australian voters.

“We are not alone in the canoe, we are in the canoe with all of you and we need to steer it wisely to achieve that goal of Makarrata,” he said.

Mr Turnbull said there’s still many practical questions about what shape the advisory body would take, whether it would be elected or appointed and how it would affect Aboriginal people around the country.

Specifically, he questioned what impact the voice to parliament would have on issues like child protection and justice, which are largely the legislative domain of state and territory governments.

But Mr Shorten said debate over Aboriginal recognition in the nation’s founding document has dragged on for the past decade.

“I can lead Mr Turnbull and the Liberal party to water but I can’t make them drink,” he said.

Having led the failed 1999 republic referendum campaign, Mr Turnbull warned that Australians are “constitutionally conservative”, with just eight out of 44 successful since federation.

But Mr Shorten said “Aboriginal Australians do not need a balanda [white person] lecture about the difficulty of changing the constitution”.

Mr Shorten’s proposal of a joint parliamentary committee to finalise a referendum question has been met with cynicism by indigenous leaders.

The Above AAP

 

 Part 2 PRIME MINISTER Garma SPEECH :

Ngarra buku-wurrpan bukmak nah! Nhuma’lanah.

Ngarra Prime Minister numalagu djal Ngarra yurru wanganharra’wu nhumalangu bukmak’gu marrigithirri.

Ngarra ga nhungu dharok ga manikay’ ngali djaka wanga’wu yirralka.

I acknowledge and pay respect to your country, and your elders.

As Prime Minister, I’m here to talk to you and learn from you.

I acknowledge and respect your language, your song lines, your dances, your culture, your caring for country, and your estates.

I pay my respects to the Gumatj people and traditional owners past, present and future, on whose land we are gathered.

I also acknowledge other Yolngu people, First Peoples from across the country and balanda here today including Bill Shorten, Nigel Scullion and all other Parliamentary colleagues but above all I acknowledge our Parliamentary colleagues, Indigenous Parliamentary colleagues. Truly, voices of First Australians in the Parliament. Thank you for being here today and for the wisdom you give us, you together with my dear friend Ken, so much wisdom in the Parliament.

I offer my deep respect and gratitude to the Chairman of the Yothu Yindi Foundation, Dr Galarrwuy Yunupingu for hosting Lucy and me with your family. It was lovely to camp here last night and the last music was beautiful, serene and like a lullaby sending us all off to our dreams. Thank you. Emily was the last singer – beautiful.  And of course we woke here to the beautiful sounds of Gulkala.

I again as I did yesterday extend our deep condolences to the family of Dr G Yunupingu at this very sad time. He brought the Yolngu language to the people of Australia and his music will be with us forever.

I’ve come here to North East Arnhem Land to learn, participate respectfully and can I thank everyone so far I’ve had the chance to talk with. I am filled with optimism about our future together as a reconciled Australia.

Last month scientists and researchers revealed new evidence that our First Australians have been here in this land for 65,000 years.

These findings show that Indigenous people were living at the Madjedbebe rock shelter in Mirarr Country, at Kakadu east of Darwin, 18,000 years earlier than previously thought.

Among the middens, rock paintings, remains, plants and ochre, was the world’s oldest-known ground-edge axe head.

These findings place Australia on centre stage in the story of human origin, including mankind’s first long-distance maritime voyage – from Southeast Asia to the Australian continent.

Our First Peoples are shown as artistically, as technologically advanced, and at the cutting edge of technology in every respect.

Importantly, they confirm what Aboriginal people have always known and we have known – that your connection, your intimate connection to the land and sea are deep, abiding, ancient, and yet modern.

This news is a point of great pride for our nation. We rejoice in it, as we celebrate your Indigenous cultures and heritage as our culture and heritage – uniquely Australian.

As Galarrwuy said yesterday as he spoke in Yolngu, he said: “I am speaking in Australian.” Sharing, what a generosity, what a love, what a bigness he showed there as he does throughout his life and his leadership.

I want to pay tribute to the work of so many of you here today, who are leading the healing in communities, building bridges between the old and new, and looking for ways to ensure families and communities are not just surviving, but thriving.

Particularly the Indigenous leaders who every day wear many hats, walk in both worlds, and yet give tirelessly for their families and their communities. You often carry a very heavy load, and we thank you.

Where western astronomers look up at the sky and look for the light, Yolngu astronomers look also deep into the dark, using the black space to uncover further information, to unravel further mysteries.

So while we are both looking at the night sky, we are often looking at different parts. And yet through mutual respect, sharing of knowledge and an openness to learning, together we can see and appreciate the whole sky.

Those same principles are guiding us toward Constitutional Recognition.

The final Referendum Council report was delivered, as you know, on the 30th of June. Bill Shorten and I were briefed by the Referendum Council two weeks ago. The report was a long time coming and I know some would like an instant fulfillment of its recommendations.

Let me say, I respect deeply the work of the Referendum Council and all of those who contributed to it, and I respect it by considering it very carefully and the Government is doing so, in the first instance with my colleagues, including Ken Wyatt the first Indigenous Australian to be a Federal Minister, and together we consider it with our Cabinet. That is our way, that is our process, that is how we give respect to serious recommendations on serious matters.

And I do look forward to working closely and in a bipartisan way with the Opposition as we have done to date.

Djapiri said Bill and I are in the same canoe and on this issue we certainly are – but we are not alone, we are not alone in the canoe. We are in the same canoe with all of you as well and we need to steer it wisely to achieve our goal, to achieve that goal of Makarrata. Thank you again Galarrwuy for that word.

We share a sense of the significance of words. I love words and language. There is a great definition. What is the difference between poetry and prose? The best definition of poetry that I have ever found is that which cannot be translated, it can only be felt.

The Referendum Council’s report as Marcia reminded us is the fourth major report since that time and it adds immensely to the depth of knowledge. It gave us the Uluru Statement from the Heart, and I congratulate all those who attended on reaching an agreement. That was no small task.

It tells us that the priority for Aboriginal and Torres Strait Islander peoples is to resolve the powerlessness and lack of self-determination experienced – not by all, but certainly by too many.

I have been discussing it with leaders, the leaders of our First Australians and will continue to do so as we develop the next steps.

But there are still many questions:

What would the practical expression of the voice look like? What would the voice look like here for the Yolngu people? What would it look like for the people of Western Sydney, who are the largest population of Aboriginal peoples in Australia?

Is our highest aspiration to have Indigenous people outside the Parliament, providing advice to the Parliament? Or is it to have as many Indigenous voices, elected, within our Parliament?

What impact would the voice have on issues like child protection and justice, where the legislation and responsibility largely rest with state and territory governments?

These are important questions that require careful consideration. But the answers are not beyond us.

And I acknowledge that Indigenous Australians want deeper engagement with government and their fellow Australians, and to be much better consulted, and represented in the political, social and economic life of this nation.

We can’t be weighed down by the past, but we can learn from it.

Australians are constitutionally conservative. The bar is surmountable, you can get over it but it is a high bar. That’s why the Constitution has often been described as a frozen document.

Now many people talk about referendums, very few have experienced leading a campaign. The 1999 campaign for a Republic – believe me, now, one of the few subjects on which I have special knowledge – the 1999 campaign for a Republic has given me a very keen insight into what it will take to win, how hard it is to win, how much harder is the road for the advocate for change than that of those who resist change. I offer this experience today in the hope that together, we can achieve a different outcome to 1999. A successful referendum.

Compulsory voting has many benefits, but one negative aspect is that those who for one reason or another are not interested in an issue or familiar with it, are much more likely to vote no – it reinforces an already conservative constitutional context.

Another critical difference today is the rise of social media, which has changed the nature of media dramatically, in a decade or two we have a media environment which is no longer curated by editors and producers – but freewheeling, viral and unconstrained.

The question posed in a referendum must have minimal opposition and be clearly understood.

A vital ingredient of success is popular ownership. After all, the Constitution does not belong to the Government, or the Parliament, or the Judges. It belongs to the people.

It is Parliament’s duty to propose changes to the Constitution but the Constitution cannot be changed by Parliament. Only the Australian people can do that.

No political deal, no cross party compromise, no leaders’ handshake can deliver constitutional change.

Bipartisanship is a necessary but far from a sufficient condition of successful constitutional reform.

To date, again as Marcia described much of the discussion has been about removing the racially discriminatory provisions in the Constitution and recognising our First Australians in our nation’s founding document.

However, the Referendum Council has told us that a voice to Parliament is the only option they advise us to put to the Australian people. We have heard this, and we will work with you to find a way forward.

Though not a new concept, the voice is relatively new to the national conversation about constitutional change.

To win, we must all work together to build a high level of interest and familiarity with the concept of a voice, and how this would be different, or the same, as iterations of the past like the National Aboriginal Conference or the Aboriginal and Torres Strait Islander Commission.

We also need to look to the experience of other countries, as we seek to develop the best model for Australia.

The historic 1967 Referendum was the most successful in our history because of its simplicity and clarity. The injustices were clearly laid out – Indigenous people were not enjoying the rights and freedoms of other citizens. The question was clearly understood – that the Commonwealth needed to have powers to make laws for Indigenous Australians. And the answer seemed obvious – vote yes to ensure the Commonwealth gave Indigenous people equal rights.

To succeed this time around, we need to develop enough detail so that the problem, the solution and therefore the question at the ballot box are simple, easily understood and overwhelmingly embraced.

One of the toughest lessons I learnt from the Referendum campaign of ‘99 was that an ‘all or nothing’ approach sometimes results in nothing. During the campaign, those who disagreed with the model that was proposed urged a “no” vote, arguing that we could all vote for a different Republic model in a few years. I warned that a “no” vote meant no republic for a very long time.

Now, regrettably, my prediction 18 years ago was correct. We must avoid a rejection at a referendum if we want to avoid setting Makarrata reconciliation back.

We recognise that the Uluru statement is powerful because it comes from an Indigenous-designed and led process. And because it comes from the heart, we must accept that it is grounded in wisdom and truth.

It is both a lament and a yearning. It is poetry.

The challenge now is to turn this poetry that speaks so eloquently of your aspiration into prose that will enable its realisation and be embraced by all Australians.

This is hard and complex work. And we need to take care of each other as we continue on this journey. We need to take care of each other in the canoe, lest we tip out of it.

Yesterday afternoon was a powerful show of humanity. As we stood together holding hands – Indigenous and non-Indigenous people – we stood together as Australians. As equals.

And we will have the best chance of success by working together. This cannot be a take it or leave it proposal. We have to come to the table and negotiate in good faith, and I am committed to working with you to find a way forward.

Galarrwuy – you gave us your fire words yesterday, thank you again. We will draw on them as we look to light the path forward for our nation.

And when considering how to do that, we are inspired by the success of the Uluru process. The statement that emerged from Uluru was designed and led by Indigenous Australians and the next steps should be too.

To go to a referendum there must be an understanding between all parties that the proposal will meet the expectations of the very people it claims it will represent.

Now we have five Aboriginal members of our Parliament. They will be vital in shaping and shepherding any legislation through the Parliament. They too are bridge builders, walking in both worlds, and their contribution to the Parliament enriches us all.

The Australian Parliament and the nation’s people – Indigenous and non-Indigenous – must be engaged as we work together to find the maximum possible overlap between what Indigenous people are seeking, what the Australian community overall will embrace and what the Parliament will authorise.

I have been learning that the word Makarrata means the ‘coming together after a struggle’— Galarrwuy told us a beautiful story this morning about a Makarrata here in this country. And a Makarrata is seen as necessary, naturally, if we are to continue our path to reconciliation.

But just like the night sky, reconciliation means different things to different people. This complexity convinces me that our nation cannot be reconciled in one step, in one great leap. We will only be reconciled when we take a number of actions, both practical and symbolic.

Beyond Constitutional Recognition, that work continues every day. I reflect on the Makarrata discussion of the late 70’s and 80’s. A list of demands was sent to the Minister for Aboriginal Affairs in 1981. It called for rights to land and resources, compensation, the creation of Aboriginal schools, medical centres and an Aboriginal bank.

Despite a final agreement not being reached at the time, we have achieved some of the policies called for. The Commonwealth provided $433 million to 137 Aboriginal Medical Services across the country last financial year. Indigenous Business Australia provides low interest loans to help Indigenous Australians secure economic opportunities including home ownership with 544 new housing loans made last year. The Aboriginal Benefits Account supports Northern Territory Land Councils and provides grants for the benefit of Aboriginal people living in the Territory.

We now spend $4.9 billion on the Indigenous Advancement Strategy.

And we are empowering communities through our Indigenous Procurement policy.

I am pleased to announce today the Commonwealth has officially surpassed half a billion dollars in spending with Indigenous businesses all over Australia. I am looking forward to sharing the full two-year results in October. This is a spectacular increase from just $6.2 million being won by Indigenous businesses only a few years ago under former policies.

Since 2008 the Commonwealth has been helping improve remote housing and bring down rates of overcrowding, with $5.4 billion to build thousands of better homes over ten years.

And the land is returning to its traditional owners.

More than 2.5 million square kilometres of land, or about 34 per cent of Australia’s land mass is today recognised under Native Title. Another 24 per cent is covered by registered claims and by 2025, our ambition is to finalise all current Native Title claims.

So we are standing here on Aboriginal land – land that has been rightfully acknowledged as yours and returned to you. And we are standing here near the birthplace of the land rights movement. A movement of which the Yolngu people were at the forefront.

As a nation we’ve come a long way.

In the Northern Territory, more than 50 per cent of the land is now Aboriginal land, recognised as Aboriginal land.

Just like the land at Kenbi which, on behalf of our nation, I returned to the traditional owners, the Larrakia people last year.

Earlier this year I appointed June Oscar AO, who has been acknowledged earlier, as the first female Aboriginal and Torres Strait Islander Social Justice Commissioner, who has agreed to report on the issues affecting Indigenous women and girls’ success and safety.

And all of that work contributes to a better future for our First Australians.

But there is much more to be done in not just what we do, but how we do it – as we work with our First Australians. We are doing things with our First Australians, not to them.

Now Galarrwuy – I have read and read again your essay Rom Watungu. It too is a story from the heart, of your father, of his life and when his time came, how he handed his authority to you, the embodiment of continuity, the bearer of a name that means “the rock that stands against time”

But rocks that stand against time, ancient cultures and lore, these are the strong foundations on which new achievements are built, from which new horizons can be seen – the tallest towers are built on the oldest rocks.

You, Galarrwuy, ask Australians to let Aboriginal and Torres Strait Islanders breathe and be free, be who you are and ask that we see your songs and languages, the land and the ceremonies as a gift.

As Prime Minister I will continue to do all I can to ensure that being an Aboriginal and Torres Strait Islander Australian means to be successful, to achieve, to have big dreams and high hopes, and to draw strength from your identity as an Indigenous person in this great country.

That’s why, as we renegotiate the Closing the Gap targets with the various state and territory jurisdictions later this year, my Government has insisted on a strengths based approach. Indigenous people are not a problem to be solved. You are our fellow Australians. Your cultures are a gift to our nation.

There’s so much more work to be done.

But in doing so, Aboriginal and Torres Strait Islander people, and all Australians, continue to connect with pride and optimism – with mabu liyan, in Pat’s language from the Yawuru people – the wellbeing that comes with a reconciled harmony with you, our First Australians, our shared history truthfully told and a deeper understanding of the most ancient human cultures on earth, and the First Australians to whom we have so much to thank for sharing them with us.

Thank you so much.

Part 3 Opposition Leader’s Garma Speech

Good morning everybody.

I’d like to acknowledge the traditional owners of the land upon which we meet, I pay my respects to elders both past and present.

I recognise that I stand on what is, was and always will be Aboriginal land.

I acknowledge the Prime Minister and his wife Lucy.

I wish to thank Gallarwuy and the Gumatj for hosting us – and on behalf of my Labor team who are here, Senator Pat Dodson, Senator Malarndirri McCarthy, the Hon Linda Burney, the Hon Kyam Maher, supported also by local Members of Parliament the Hon Warren Snowden and Luke Gosling, and Territory Minister Eva Lawler.

We are very grateful to be part of this gathering.

Also Clementine my daughter asked me to thank you for letting her join in the bunggul yesterday afternoon, she loved it.

At the opening yesterday, we were privileged, all of us, to be at a powerful ceremony, where we remembered Dr G Yunupingu, a man who was born blind – but helped Australians see.

From his island, his words and his music touched the world.

But I also understand that the words of our host were about setting us a test, reminding all of us privileged to be here that there is serious business to be done.

Here at Garma, on the lands of the Gumatj, we gather to talk about a Yolngu word. Makarrata.

It is not just now a Yolngu word – I put it to you it’s a national test.

Coming together, after a struggle.

And for the first Australians, it has been a very long struggle indeed.

– A struggle against dispossession and discrimination, exclusion and inequality.

– A struggle against violence and poverty, disease and diminished opportunity.

– A struggle for better health, for better housing, for safer communities, more jobs, for longer lives.

– A struggle against injustice and racism: from the sporting field to the courts of our land.

Above all, a struggle for a better future for their children: a struggle to be counted, to be heard, to be recognised.

In 2015, the Referendum Council was created with a very clear mission.

To consult on what form Constitutional Recognition should take – how it should work.

To listen to Aboriginal people and to be guided by their aspirations.

And to finally give them a say in a document from which too long they been excluded.

Since then, thousands of the first Australians have explained to the rest us what

Recognition means – for all of us, for our children and indeed for all of our futures.

We asked for your views, we sought your counsel – and, in large numbers, it was answered.

At Uluru, you gave us the statement from the heart.

A call for:

– A voice enshrined in the Constitution

– A declaration to be passed by all parliaments, acknowledging the unique place of the first nations in Australian history, their culture, their connection.

– And a Makarrata Commission to oversee a process of agreement-making and truth-telling.

All three of these objectives speak to the long-held and legitimate aspirations of our

First Australians:

– A proper acknowledgment of Aboriginal histories and the dispossession that

followed upon the arrival of the Europeans

– A bigger say in the issues which affect you – no more ‘solutions’ imposed without consultation or consent

– And a more lasting settlement, a new way forward, a new pathway including through treaties.

These ideas are not new – but the Uluru statement did articulate these with new clarity, a new passion, a new sense of truth and purpose.

And let me speak truthfully on behalf of Labor, the Opposition.

I cannot be any more clear than this: Labor supports a voice for Aboriginal people in our Constitution, we support a declaration by all parliaments, we support a truth-telling commission.

We are not confronted by the notion of treaties with our first Australians.

For us the question is not whether we do these things, the question is not if we should do these things but when and how.

The Parliament needs to be engaged.

The Parliament needs to be engaged now.

The Parliament needs to start the process of engaging with the people of Australia now.

It does not come as a surprise to me, that following upon a report of the

Referendum Council, the Parliament’s next step must be to consider this report.

And in doing so, we must carry its message from the heart of Australia into our hearts as parliamentarians. With optimism, with understanding, not with a desire to find what is wrong, but to find the desire to make these concepts work in the interests of all.

If we were all gathered here now, back in 1891 and 1894 and 1897 to write the Constitution, we would never dream of excluding Aboriginal people from the Census.

But in 1901, they did.

If we were starting the Constitution from scratch, we would not diminish the independence of Aboriginal people – with racist powers.

But in 1901, they did.

And if we were starting on an empty piece of paper, we would, without question, recognise the First Australians’ right to a genuine, empowered voice in the decisions that govern their lives.

Now as you know, we cannot unmake history. We do not get the change to start all over again – but it doesn’t mean that we are forever chained to the prejudices of the past.

The Prime Minister’s observations though are correct about the difficulties of constitutional change. But I ask also that we cannot let the failure of 1999 govern our future on this question.

Voting for a constitutional voice is our chance to bring our Constitution home, to make it better, more equal and more Australian.

A document that doesn’t just pay respect to the weight of a foreign crown, but also recognises the power and value of the world’s oldest living culture, recognises that

Aboriginal people were here first.

And of course, let us reject those who say that symbolic change is irrelevant because dealing with these questions does not mean walking away from the real problems of inequality and disadvantage.

– Talking about enshrining a voice does not reduce our determination to eradicate family violence

– It doesn’t stop us creating good local jobs, training apprentices, treating trachoma or supporting rangers on country.

– It doesn’t distract us from the crisis in out-of-home care, youth suicide or the shocking, growing number of Aboriginal people incarcerated for not much better reason than the colour of their skin.

Aboriginal and Torres Strait Islander peoples don’t have to choose between historical justice and real justice, you don’t have to choose between equality in society and equality in the Constitution – you have an equal right to both.

The Uluru Statement has given us a map of the way forward – and today I finally want to talk about how we follow it, how we take the next step.

Not the obstacles ahead, not the problems, real as they are.

Aboriginal Australians don’t need a balanda lecture about the difficulty of changing the Constitution, our inspiration friends, should not be the 1999 referendum, it should be the 1967 referendum.

You have lived that struggle, every day.

Let me be very clear. In my study of our history, in my experience, nothing has ever been given to Aboriginal people – everything that is obtained has been fought for, has been argued for, has been won and built by Aboriginal people.

Think of the Freedom Riders

Think of the Bark Petition, which Gallarwuy was witness to

Think of the Gurindji at Wave Hill

Eddie Mabo and his fight for justice

Nothing was ever sorted by simply waiting until someone came along said let me do it for you. It is not the way the world is organised.

Every bit of progress has been driven by pride, by persistence by that stubborn refusal to not take no for an answer when it comes to the pursuit of equality.

Now making the case for change and encouraging Australians to vote yes for a recognition, reconciliation, and truth – this is not easy.

But before we can do that we surely must agree on the referendum question that has to be the long overdue next step.

I have written to our Prime Minister, we’ve proposed a joint parliamentary committee – which they’re taking on board, having a look at – to be made up of Government, the Opposition and crossbench MPs – to work with Aboriginal leaders right across Australia.

This committee will have two key responsibilities.

One – advising the Parliament on how to set-up a Makarrata Commission and create a framework for truth-telling and agreement making, including treaties.

Two – what would a voice look like. Whilst there are many questions, none of these are insurmountable.

And three, as a matter of overdue recognition – to endeavour to finalise a referendum question in a timely fashion. There’s no reason why that couldn’t be done by the end of this year.

The issues have been traversed for a decade.

Now friends this is not a committee for the sake of a committee, it’s not another mechanism for delay. It is the necessary process of engagement of the Parliament.

But we have had ten years plus of good intentions, but it is time now perhaps, for more action.

The Parliament does have a key role to play here, in setting the question.

The Parliament could agree on the question this year if we all work together so that the people could vote not long after that.

Voting to enshrine a voice in a standalone Referendum – free from the shadow of an election, or the politics of other questions.

It may seem very hard to imagine, it may seem very hard to contemplate.

But it is possible to imagine a great day, a unifying day, a famous victory, a Makaratta for all.

As I said yesterday, we’ve heard plenty of speeches, there are many fine words… but perhaps people have a right to be impatient after ten years – indeed after 117 years.

So the test I set isn’t what we say here, in this beautiful place.

It’s what we do when we leave.

It’s the honesty of admitting that after the event, what is it that we do.

The test I set for myself is can I come here at future Garmas and look you in the eye and say I have done everything I can, because if I cannot say to you that I have done everything I that I can, then I can’t be truthful with my heart.

Yesterday Gallarwuy spoke with a tongue of fire, he told a powerful truth.

He said that for more than two centuries we had been two peoples – living side-by-side, but not united.

I think that is the challenge for politics too.

Djapirri who just spoke up before me, she’s talked about hope. There is the hope that you refer to, you have the Prime Minister and the Leader of the Opposition. We are here side-by-side, and now we need to be united, not to kick the can down the road, but united on a process that says this parliament will respect what we have heard from Aboriginal people.

Not just at Uluru, but for decades.

In 1967, Aboriginal and Torres Strait Islanders were counted. In 2017, you are being heard.

There is no reason why we can’t enshrine a voice for Aboriginal people in our Constitution.

Djapirri said, she told me of a dream of a canoe, paddled by the Prime Minister and myself. That in itself is an arresting image. Two captains. But in all seriousness, we appreciated I think the power of that illusion, the power of that dream.

My party is ready.

I think Australia is ready.

The fine words that we heard at the opening yesterday, they remind me of the fire dreaming symbol, which is in the front of the Parliament of Australia.

Fire.

That fire dreaming symbol is from central Australia but it is connected isn’t it, by the word of Djapirri yesterday.

Again, that spirit of fire it is a gift from Indigenous people to all Australians and I sincerely will endeavor to make sure that spirit of fire infuses our Parliament.

Aboriginal Health Media Alert @AlanTudgeMP Speech : “No child will live in poverty” – 30 years later, a new direction

 Entrenched disadvantage

” Entrenched disadvantage or impoverishment is perhaps the toughest overall challenge in Australia, but arguably the most important to address. We cannot solve it by doubling the number of services once again. We cannot solve it by having another step-increase in welfare payments.

Rather, we need collectively to put our minds to the underlying factors, which have changed since Hawke’s day, and be clear eyed about how to tackle them.”

Social fabric of communities declined ?

 ” Noel Pearson frequently notes that over the last 30 or 40 years, despite formal racism ending and a huge increase in money invested in remote communities, the social fabric of them has declined.

The dysfunction that characterises many of the remote communities today was not there in the 60s and 70s. Children went to school then; the men had jobs; and the respect for elders was strong.”

Are Aboriginal communities over serviced ?

 ” In Aboriginal communities, the extent of service growth has reached close to saturation level. The Auditor-General found that Aboriginal communities now have one service for every five residents. At the time of writing its report in 2013, it found that Wilcannia, for example, had 102 funded services from 18 state and federal agencies, with 17 further proposed. Its Indigenous population was 474.

In other areas, there are a similar array of services. They are not always coordinated and some are more useful than others. But along with welfare increases, the services sector has meant that we have a situation today where no one need go hungry.”

Welfare and cash less Debit cards

 ” I have been overseeing the development and implementation of the Cashless Debit Card for the last two years, which works to limit the amount of welfare cash than can be spent on drugs and alcohol. To date it is working effectively and we plan on expanding it further. Thirty one percent of participants say they are better able to care for their children as a result.

In addition, we are introducing trials of drug testing of welfare recipients to identify issues and assist them to get off their addictions.”

The Hon Alan Tudge MP Minister for Human Services July 20

Watch video here

Thirty years ago, almost to the day, the then Prime Minister Bob Hawke made the statement that by 1990, “no Australian child will live in poverty.” It was a powerful message, signalling that government policy would be geared towards those least fortunate and least capable of looking after themselves.

But thirty years on, poverty still exists among children and more generally. On just one measure, around 29,000 children are homeless at some point in any given year. We are one of the richest countries in the world, and have experienced 25 years of uninterrupted economic growth, yet impoverishment still exists in our nation. How can this be?

Today, I would like to discuss the nature of poverty in Australia, particularly amongst children, and how we are faring 30 years after Hawke’s pledge. My main argument is that the primary approach to tackling child poverty over the last 30 years – higher income support payments and more community services – will not provide the solution to significantly reducing entrenched impoverishment over the next 30 years.

Rather, we will have to collectively address what I call the ‘pathways to poverty’ more systemically. These include welfare and other dependencies, poor education standards and family breakdown. This is the focus of much of the government’s efforts.

POVERTY IN AUSTRALIA

There is no good single definition of poverty. The most commonly cited definition, and that used by the OECD, is that a person is in poverty when their disposable income is less than 50 percent of that of the median household income.

On this measure, there are three million Australians living in poverty, including 731,000 children (17.4 percent of all children), according to the last Poverty Report by ACOSS. Compared to a decade ago, the poverty rate – again using this measure – has slightly dropped overall, but the proportion of children living in poverty has increased by two percent.

This measure of poverty is useful in identifying the pockets of low income and for highlighting wealth inequality. For example, it shows that children in lone parent families are more than three times more likely to be in the low income category than children in coupled families. But this is about the end of its usefulness. The measure says nothing about the absolute level of income. As long as there was any wealth inequality, the measure would say that there was poverty, even if everyone was very well off in absolute terms. Moreover, it would suggest that if we made middle income Australians worse off, the poverty rate would decline because the median income would dip.

Absolute poverty or absolute deprivation is a more useful measure for assessing the well-being of very poor Australians. That is, can people afford the basics for themselves and their children such as food, clothing, shelter and education? I believe this is also how most Australians would conceptualise poverty and what they would be concerned about from a policy perspective.

On this measure, we are doing better in large part because of the approach to impoverishment over the last 30 years: higher social security payments and an increase in the number of social services. The Parliamentary Library notes “over the last thirty years, a combination of income transfer and program responses, such as funding for homelessness services, have more or less ameliorated the worst effects of poverty for most Australians… Few Australians live in absolute poverty.”

This is not surprising when one examines the welfare payment increases over this time. For example:

  •  A couple on an unemployment benefit with one to two children today receives between 27 percent and 38 percent more in real terms than they would have done thirty years ago.
  •  A single parent on an unemployment benefit with one to two children today receives between 34 percent and 67 percent more in real terms than they would have done thirty years ago.
  •  A person on an unemployment benefit without children today receives around 10 percent more in real terms than thirty years ago.

Today, an unemployed couple with three children would receive about $48,000 in welfare payments each year. This is the equivalent to a $60,000 salary. A single mother on a parenting payment with two children would receive over $31,000 in payments each year. On top of that, they may be eligible for a public house and many other free services. The welfare system allows for advances on payments and emergency payments in times of crisis. Tens of millions is provided in the form of emergency relief on top of this.

These figures I quote are not a lot of money, but nor is it complete deprivation. It is a good safety net to ensure that no one need go hungry or without clothing, shelter and the basics.

The greatest challenge is perhaps being an unemployed person with no children. This payment is modest, but as the Minister for Social Services, Christian Porter, has pointed out, the number of unemployed people who live just on this payment is very small – less than one percent – and then they typically come off the payment quickly.

The increases in welfare payments described above has been complemented by a significant increase in social services over the last 30 years. Today, there are programs and services for a vast array of social problems; homelessness, activities after school, breakfast programs, domestic violence initiatives, mental health, youth programs and more.

In Aboriginal communities, the extent of service growth has reached close to saturation level. The Auditor-General found that Aboriginal communities now have one service for every five residents. At the time of writing its report in 2013, it found that Wilcannia, for example, had 102 funded services from 18 state and federal agencies, with 17 further proposed. Its Indigenous population was 474.

In other areas, there are a similar array of services. They are not always coordinated and some are more useful than others. But along with welfare increases, the services sector has meant that we have a situation today where no one need go hungry.

This does not mean that people don’t struggle. We know they do. The Social Policy Research Centre survey in 2010 found, for example, that almost one in five have insufficient funds to have a week’s holiday away from home each year; almost one in ten struggled to get comprehensive home or car insurance and many struggled to afford regular dental checks.

There are still very significant problems, which I will come to, but we should be collectively proud that absolute poverty is now rare in Australia.

However, while absolute poverty is rare, impoverishment still exists in many pockets. We see it acutely in remote Indigenous communities, but it is apparent in many other pockets of Australia including in the suburbs of our largest cities.

It is not complete lack of income that is always the problem, but a general dysfunction that means that children’s potential is not able to be maximised.

The most acute and tragic example of this is Fetal Alcohol Spectrum Disorder, which affects an estimated 25 percent of babies in some places. In essence, their brain is affected from the alcohol abuse of their mother.

Over 225,000 children suffer from abuse or neglect or were at risk of suffering from this last year – a “national shame” according to Father Frank Brennan.

As I mentioned at the outset, around 29,000 children are homeless at some stage in any given year.

Around 1 in 14 Year 9 students (7 percent) do not meet the national minimum standard for reading. Thousands of young Australians go through the education system and remain functionally illiterate. I have met teenagers who sign their name with an ‘X’.

One in eight children live in a jobless household.

This is the real impoverishment today and comes about despite the increases in welfare payments, increases in social services and an economy which has grown for 25 years straight.

Noel Pearson frequently notes that over the last 30 or 40 years, despite formal racism ending and a huge increase in money invested in remote communities, the social fabric of them has declined. The dysfunction that characterises many of the remote communities today was not there in the 60s and 70s. Children went to school then; the men had jobs; and the respect for elders was strong.

But it is not an indigenous issue; it is a human issue. It is just that we see the issues most acutely in the remote communities and, therefore, they provide lessons for the rest of Australia.

And this comes to my main point. Few suggest that increasing the level of welfare payments and significantly increasing the number of services in remote locations will improve the circumstances of children in those areas. There are sometimes big payments delivered in the form of royalties (which is the equivalent of a large increase in income support payments) but they don’t make the difference.

This is the same across Australia. We have done well in alleviating absolute poverty through higher welfare payments and more social services, but this formula will not provide the step-change improvement to addressing modern impoverishment over the next thirty years.

My concern is that many in the social services sector and even many in the business community believe that an increase in welfare payments remains the primary solution to modern impoverishment. Further, the focus on higher payments means that less thought is given to the fundamental reasons why impoverishment exists despite the increases in payments over the years.

If more money was the answer, we would have solved many of the problems years ago. Unfortunately the challenges of modern impoverishment are more complex. We need the best minds put towards the issues in a more sophisticated manner. I would like to see the business groups and ACOSS, and other groups with a commitment to addressing disadvantage, examine the underlying issues of modern impoverishment as much as they argue for higher payments.

The goal must be broader than ending relative inequality (which underpins the standard definition of poverty) or even absolute poverty (which is largely, although not completely, addressed in Australia). Fundamentally, it is more about providing the best opportunity for children and adults to have the choice and opportunity to achieve their potential. In this regard, it is Nobel Laureate Amartya Sen’s definition of poverty that is most useful in my  view.

That is, alleviation of poverty is actually about people having the capability and freedom to participate in society and choose their own destiny.

An Australian may be relatively wealthy in global terms and be without hunger or lack of clothing but if their education is poor, or they have drug or alcohol addictions, then their capabilities and choices will be limited. Their potential is not able to be realised.

PATHWAYS TO POVERTY

A good way to think about modern impoverishment and how we can better address it is to consider what I call the ‘pathways to poverty.’

This name – the pathways to poverty – and the framework that I want to briefly outline has come from the United Kingdom’s Centre for Social Justice. But my experience from working on indigenous issues for over 15 years and my work in the welfare portfolio informs my belief that it is also a useful framework for Australia. It is a useful framework for thinking about how to maximise choice and opportunity.

The Centre for Social Justice outlines five pathways to poverty that require attention.

The first is family breakdown. As the Centre for Social Justice notes, the “family is where the vast majority of us learn the fundamental skills for life; physically, emotionally and socially it is the context from which the rest of life flows.” Wherever there are strong families – regardless of their makeup – there are typically strong capable children. Children don’t tend to go hungry when part of a strong family.

Unfortunately, over the last few decades family breakdown and family dysfunction have become more common, particularly in the least advantaged sections of society.

One of the more remarkable changes of our society in the last 30 or 40 years is the growth in sole parent families. In the mid-1970s, 9.2 percent of families with children under 15 were sole parent; today it is 15.8 percent. I make no judgment on any of these families – I grew up in one of them – but a breakdown of family structure contributes to impoverishment for many. As I noted above, single parent families are more than three times more likely to be living in relative income poverty compared to couples with children.

Care for the elderly can also be compromised when families break apart.

The second pathway to poverty is ‘worklessness’. Work is the most effective route out of poverty, both in absolute and relative terms. If we examine ACOSS’s poverty report (which looks at relative poverty), we find that 62 percent of unemployed people are in their definition of poverty, whereas only four percent of full time workers fit their definition. By working, people’s capabilities are strengthened. The reverse is also true; long term welfare dependence diminishes capability and confidence.

It is commonly said, and it is true, that the best form of welfare is a job.

Our goal must be not only the creation of jobs – which is central to the government’s agenda – but the elimination of impediments to people taking up work when it is available.

Reducing welfare dependency is a critical part of the welfare reform agenda, which Minister Porter, the Minister for Employment, Michaelia Cash and I have been leading. We have strengthened the compliance system to encourage able people to maximise their opportunities of finding work. Minister Porter has initiated the Priority Investment approach (modelled from the successful New Zealand initiative) to fund and harness the ideas of the private and community sector to reduce dependency and encourage people into work. Minister Cash has initiated the PaTH program to reduce the risk to businesses of offering opportunities to unemployed people and to encourage those people to take them up. We now have mobility incentives in place so that people are more able to move if work is not available in the immediate region.

This is a huge task to address what, in many cases, has become intergenerational welfare dependence. But it is essential work to addressing impoverishment.

The third pathway is drug and alcohol addictions. This is a further factor that is seen acutely in remote communities, but is increasingly common throughout disadvantaged communities across Australia. The Centre for Social Justice summarises it well; “Addiction to drugs and alcohol remains a shocking feature of life in many disadvantaged neighbourhoods. It shreds the fabric our society. It wrecks families, ruins childhood, causes mental illness, encourages welfare dependency, and fuels a revolving door of crime and incarceration.”

This has got worse in recent decades and there is no easy solution to this.

A great deal has been done to crack down on the supply of drugs (and in some places to limit alcohol availability). But with drugs like ‘ice’, which is synthetic and easily manufactured, we will never be able to beat it on the supply side alone.

This is why we have been looking at the demand side, as well as providing structured support to assist people get off their addiction.

I have been overseeing the development and implementation of the Cashless Debit Card for the last two years, which works to limit the amount of welfare cash than can be spent on drugs and alcohol. To date it is working effectively and we plan on expanding it further. Thirty one percent of participants say they are better able to care for their children as a result.

In addition, we are introducing trials of drug testing of welfare recipients to identify issues and assist them to get off their addictions.

We are also reforming the reasonable excuse rules for job-seekers so that their addiction is only accepted as a reasonable excuse for non-compliance with their mutual obligations if they are receiving treatment for their addition.

This has been complemented by the provision of over $685 million for treatment and support services.

Ultimately, though, we need to change cultural attitudes towards drug taking. Most young people still take drugs for the first time because of social reasons. We have changed cultural attitudes towards other addictions, including smoking, and can do so with drugs.

The fourth pathway is education failure. Australia has a very good education system but there is complete education failure in some pockets. In the Northern Territory, only a quarter of children attend school often enough to learn effectively (which is about 80 percent of the time). Thousands of children leave the school system after ten years functionally illiterate.

Again, this is neither an indigenous issue, nor one that has always been apparent. Rather, it is apparent in the suburbs of our cities, and at least in the indigenous context, has got worse in the last few decades. In the 1970’s, schooling was the norm with Noel Pearson reflecting that no one from his grandfather’s generation was illiterate.

Their income might be higher today, but a child who is functionally illiterate has few options in life.

While the states and territories have primary responsibility for school education, the Turnbull Government is contributing, including through its indigenous education initiatives as well as the extra funding to the Smith Family’s Learning for Life program.

The final pathway is indebtedness and lack of financial capability. If one is not in control of their finances, it is very difficult to be in control of one’s life. There is little data on the extent of this problem at the most disadvantaged end of the spectrum. In 2013-14, 30 percent of low income households had household debt three or more times the household disposable income. This is up from 22 percent a decade earlier. The Social Policy Research Centre survey, that I mentioned earlier, found that 18 percent of people did not have $500 in savings for an emergency situation.

There are several programs in place to try and alleviate this problem, but I am not convinced that we have the formula just right yet. For example, we provide $100 million each year to improve people’s financial wellbeing or capability, yet only 4 percent of people who seek emergency relief are connected to financial management assistance. One in five people with more than 50 percent of their income from welfare say they have difficulty understanding financial matters.

We need to do better in this space, acknowledging that some have very basic capability and, therefore, need quite intense income management while others would benefit from financial management assistance to be on a much better footing.

CONCLUSION

These ‘pathways to poverty’ can be debated by well-meaning people. Some of them interact with each other and, perhaps, there are other factors that should be included, such as housing security and mental health.

My intent in outlining this framework was not to provide the solution to each of the problems – an impossible task in 30 minutes – but to provide an alternative way to think about impoverishment in Australia today and a flavour of government initiatives which contribute towards alleviating it.

Entrenched disadvantage or impoverishment is perhaps the toughest overall challenge in Australia, but arguably the most important to address. We cannot solve it by doubling the number of services once again. We cannot solve it by having another step-increase in welfare payments.

Rather, we need collectively to put our minds to the underlying factors, which have changed since Hawke’s day, and be clear eyed about how to tackle them.