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.

 

NACCHO Aboriginal Health News : Indigenous Health Minister @KenWyattMP visits , promotes and engages with our ACCHO’s during #NAIDOC2017 week

 

 “ This week, celebrating and acknowledging the power of our languages, the importance of language, but even where we’ve think we’ve lost languages I’m often surprised with the older people within our communities who can still speak the language.

And in my own country there are people teaching Noongar language and reviving the veracity of the language. Now language often is an identifier of who we are and what country we’re associated with.

NAIDOC Week is about celebrating, enjoying ourselves within our community, having fun, but also reflecting. 

Alice Springs : Ken Wyatt being interviewed by Kyle Dowling from CAAMA radio about Congress ACCHO Alice Springs and  the 11 organisations partnering in the new Central Australia Academic Health Science Centre SEE PART 3 Below

Aboriginal Health #NAIDOC2017 : New Aboriginal-led collaboration has world-class focus on boosting remote Aboriginal health

Victoria / VACCHO / VAHS

APY LANDS

Kowanyama /Cairns QLD  :

“I am closely involved with the Darwin and Kimberley suicide prevention trials, part of the Federal Government’s $192 million commitment to addressing regional mental health issues,

“What we learn from those sites, which have acute suicide rates, will be made available as appropriate for North Queensland, in close collaboration with local communities.”

Mr Wyatt, in was Cairns  speaking at the myPHN Conference (see Part 3 for PHN Press Release ) said close engagement with the community and respecting locally endorsed solutions to guard against suicide was the way forward

Part 1  : Minister rolls out mental health action plan for Kowanyama

FINDINGS from suicide prevention trials being carried out in Western Australia will be implemented in the Far North to help lower the rising suicide rate in indigenous communities.

From The Cairns Post

Indigenous Health Minister Ken Wyatt says he is “very concerned” about reports of the suicide rates in the region’s remote indigenous population growing to become one of the highest in the world.

The Weekend Post has reported concerns by community leaders at Kowanyama that the mental health crisis was sparked by the tragedy in the community in October, when a vehicle rammed into a house full of mourners, resulting in one death and 25 people being serious injured.

There had been more than 20 suicides or attempts at Kowanyama, which has a population of about 1200, since the ­October tragedy.

Mr Wyatt, was Cairns  speaking at the myPHN Conference, said close engagement with the community and respecting locally endorsed solutions to guard against suicide was the way forward.

“I am closely involved with the Darwin and Kimberley suicide prevention trials, part of the Federal Government’s $192 million commitment to addressing regional mental health issues,” he said.

“What we learn from those sites, which have acute suicide rates, will be made available as appropriate for North Queensland, in close collaboration with local communities.”

An experienced social work has been flown into Kowanyama to join a mental health clinical nurse consultant who travels to the remote Cape York community for four-day visits.

Mr Wyatt said further emergency action was underway with the federally-funded Northern Queensland Primary Health Network working with the Royal Flying Doctor Service to expand mental health services at Kowanyama.

“This additional commitment has already ensured an extra clinician for the community, to provide support and targeted suicide prevention activities with this full-time position starting on Tuesday, July 11,” he said.

If you or someone you know needs assistance please call Lifeline Australia on 13 11 14.

Cairns Apunipima

 Part 2  : Working with communities to deliver better health is our primary aim
The nation’s Primary Health Networks (PHNs) are being encouraged to work closely with communities to tackle health challenges and improve the wellbeing of all Australians.
Aged Care Minister and Indigenous Health Minister Ken Wyatt said he hoped opening the 2nd annual myPHN Conference in Cairns today would help guide a new era in effective and efficient care.
 
This year’s conference theme of ‘Transforming Healthcare Together’ challenges current beliefs on the best ways to improve patient outcomes,” said Minister Wyatt.
“PHNs are leading the charge in this space. After undertaking detailed analysis of their regions’ specific health needs, they are now commissioning services to fill these gaps.
 
“These range from building the capacity of General Practitioners (GPs) and tackling mental health, chronic conditions and obesity, to engaging with consumers in disease prevention.
The Minister said the first stage of the national trial of Health Care Homes was another example of the fresh approach to the care of people with complex conditions.
“Participating GPs and Aboriginal Community Controlled Health Services will work closely with patients and specialists, pharmacists and allied health care to empower patients to take an active role in health improvements,” he said.
 
Minister Wyatt said primary health providers had a vital role in helping improve Indigenous health and that of older Australians.
“Despite the progress we’ve made to date, Indigenous people still have a shorter life expectancy and are more likely to develop chronic conditions such as diabetes  kidney and cardiovascular diseases than non-Indigenous Australians,” Minister Wyatt said.
 
We have to do better, and primary health professionals are well placed to develop innovative new programs that can make a real difference.”
A good example is the Northern Queensland PHN workforce investment, including funding more than 100 Aboriginal and Torres Strait Islander people to become qualified indigenous health workers. 
 
The conference also focuses on how social and cultural influences can effect  health outcomes, promising new hope for closing the life expectancy gap for Indigenous Peoples.
 
Innovation and new thinking will help deliver a stronger health and aged care system,” said Minister Wyatt.
 
“Learning from the experiences of other communities and nations will also keep older Australians healthier for longer, and give them more flexibility on when and how they access care as they age.
“Better health is a partnership between governments, the health sector, and the consumer. Greater collaboration and new models of care promise positive outcomes.”

Part 3 Transcript of Interview on CAAMA Radio with Kyle Dowling on 5 July 2017

Ken Wyatt:What I like about the centre is that it is an alliance of organisations that have been heavily involved in research around many of the health issues impacting on our people. But what’s more important significant is that Congress is the lead agency or the lead player in all of this and having that Aboriginal leadership working so closely with the expertise and knowledge and skills and capability of research is fantastic.

Kyle Dowling: Ken Wyatt, the Federal Minister for Indigenous Health and Aged Care, recently congratulated the 11 organisations partnering in the new Central Australia Academic Health Science Centre.

Ken Wyatt: Any of us have the capability and capacity to take leading voices. It’s whether we have the confidence and courage to do it at times. And I think Congress has really set a framework for showing that they are leaders. That they are prepared to go and fight for the things they believe in, but equally they work very closely with people who’ve got a like-minded thinking who want to make a difference.

I think the other part that is important in this is their voices are also about translating research into real change on the ground in the community with families. And that’s an important translation of research into practice. And they’ve been around a long time so their knowledge of the health of people within the area, but not only the area, but nationally has been well-based on being involved with the community, listening to community, but treating community for the range of illnesses that they’ve seen over the years. So I want to complement them on their vision, but also being a leader to demonstrate that our voices do count. That they are important.

Kyle Dowling: : So Ken, can you just talk to us about the actual role of the Central Australia Academic Health Centre and the importance of the collaboration between Aboriginal community-controlled health services and leading medical researchers.

Ken Wyatt:What’s important about the centre is that it’s now recognised as a centre of excellence for research. That means it gives them access to Commonwealth funding out of the Futures Research Fund, but also NHMRC funding as well. They’re also recognised as being of a national standing in the quality of what they are capable of doing, but the team they have within that alliance. So you’re really saying that you- you’ve brought together this incredible group of skills, resources and thinking that will be used to tackle some of those complex issues on the ground.

Yesterday, Alan Cass talked about renal disease and the work that affected him into making the decision to look at the whole issue of progression to dialysis and what we still need to do. And he talked about some of the alarming figures here that- when you think about the number of Aboriginal people within the Territory- those figures are extremely high. So we’ve got to do something about it and that’s what he’s talking about when he is involved in this collaborative centre.

Kyle Dowling: Why Central Australia? Why was this area the right place for the centre?

Ken Wyatt: Look, I think it’s just natural to expect it to be here because you’ve got an incredible organisation like Congress. You have Aboriginal leadership here whose thinking and whose passion for making a difference for people here and across Australia. But you’ve also got these incredible alliances with Flinders Uni, Baker IDI, and there’s other collaborative members of that group who are also deliverers of services. And if we think of the history of the Territory, there have been some outstanding individuals that have been involved. So you only have to look at the Menzies Research Centre, the work that they have done. It’s a natural fix and it’s a good mix of bringing some incredible people together to work on these issues.

Kyle Dowling: Now the partners in the CAAHSC have identified research priorities. Can you touch on a little bit of those?

Ken Wyatt: The five areas that they have identified are good, but the one that excites me is the whole issue of workforce and development of capacity. But developing of capacity for Aboriginal research- there was a young woman I met yesterday who has become a researcher and her passion for that work now is growing. It’s- and she becomes an example for others that research is an important area and that I can do it, so can you. And that workforce capacity also means that they will be looking at, not only what’s needed today, but the type of skills we’ll need for tomorrow and the future. And aged care is in that mix.

I had a good meeting with Congress this morning about older people who live in this area that I need to have a look at the issues around their needs, but equally be made aware of the number of older people now living in community and what we have to do for them.

Kyle Dowling: Now, Central Research has been dubbed a hub of hope for Indigenous health. How would you describe Central Research as in fact being a hub of help for Indigenous hope.

Ken Wyatt: That whole hub of hope I see in an optimistic sense. I see it as a group of people believing what they do, but then wanting to turn that into having access to further work they have to do to find and identify reasons. And I use the term causes of the cause.

So what are the causes that cause an illness or what are the causes that cause renal failure. And then to look at how do we go upstream and prevent that from happening. So if it’s skin diseases, if it’s other factors that result in kidney failure, then how do we address and tackle those. But equally what they’ll be looking at is what treatment can we provide and what treatment can we also think about providing at the local community level because the problem with dialysis is that you really need to live with the chairs are that provide you with that life-saving support. But ultimately if we can find a cure for kidney failure then that makes it far more expecting of pushing out life, but also preventing kidney failure and giving people in any individual hope for a future, hope for a longer life because the point I want to make is that every person we lose out of our community is a history book.

We never write our histories, we never write our stories on paper. We only learn in transmission in conversation, art, the stories we tell dance. Now when we take one of those people out, that’s the end of that story. We can never go back and re-read it, and that’s why that the work that this centre does is critical in keeping people alive longer because young people like you will need the knowledge of the stories, but also the history and every aspect that gives us what is important spiritually, culturally, but as an identity as an individual within our community.

Kyle Dowling: Before I do let you go, I did just want to get a quick message from you. It is NAIDOC Week. Your message to everyone across the country on NAIDOC weekend, what NAIDOC means to you as an Aboriginal person?

Ken Wyatt: This week, celebrating and acknowledging the power of our languages, the importance of language, but even where we’ve think we’ve lost languages I’m often surprised with the older people within our communities who can still speak the language. And in my own country there are people teaching Noongar language and reviving the veracity of the language. Now language often is an identifier of who we are and what country we’re associated with.

NAIDOC Week is about celebrating, enjoying ourselves within our community, having fun, but also reflecting.

Kyle Dowling: Yes, well on that note, Ken thank you for taking out your time to have a chat with us here on CAAMA Radio and thank you for tuning in.

That’s going to be it for Strong Voices today. Thank you for tuning in. I hope you enjoyed the program. Make sure you check out our CAAMA webpage. It’s caama.com.au. Make sure you check out our social media as well -our Facebook and Twitter. And we’ll be back the same time tomorrow.

Aboriginal Health #NAIDOC2017 : New Aboriginal-led collaboration has world-class focus on boosting remote Aboriginal health

“One of the clear innovations that our Centre already offers is acknowledging that the principle of Aboriginal community control is fundamental to research, university and health care partnerships with regional and remote Aboriginal communities,”

Ms Donna Ah Chee Congress CEO said it was satisfying to achieve recognition for the strong health leadership and collaboration that already exists in Central Australia ( see editorial Part 3 below)

  ” The centre’s accreditation this week with the National Health and Medical Research Council proved the “landmark research” by consortium members had “huge potential” to address serious indigenous health issues.

The objective is to evaluate problems and find practical solutions fast, to prevent health problems and give speedy but lasting benefits to patients within community,”

Announcing $222,000 in seed funding, Federal Indigenous Health Minister Ken Wyatt see full story PART 2 from the Australian below

Photo above : Traditional Arrernte owners welcome Ken Wyatt MP to Alice Springs to launch the Central Australia Academic Health Science Centre

An academic health science centre in Central Australia is the first Aboriginal-led collaboration to achieve Federal Government recognition for leadership in health research and delivery of evidence-based health care.

The Federal Minister for Indigenous Health and Aged Care, the Hon Ken Wyatt MP, today announced that the Central Australia Academic Health Science Centre (CAAHSC) was one of only two consortia nationally to be recognised as a Centre for Innovation in Regional Health (CIRH) by Australia’s peak funding body for medical research, the National Health and Medical Research Council (NHMRC).

To be successful in their bid, the 11-member consortium was required to demonstrate competitiveness at the highest international levels across all relevant areas of health research and translation of research findings into health care practice.

With NHMRC recognition, the CAAHSC joins an elite group of Australian academic health science centres that have so far all been based in metropolitan areas including Melbourne,

Sydney and Adelaide. The CAAHSC is also in good company internationally, with long established collaborations including Imperial College Healthcare in the UK and Johns Hopkins Medicine in the USA.

The CAAHSC, whose membership includes Aboriginal community controlled and government-run health services, universities and medical research institutes, was formally established in 2014 to improve collaboration across the sectors in support of health.

Such synergy is vital in order to make an impact in remote central Australia, considering the vast geographical area (over 1 million square kilometres) and the health challenges experienced particularly by Aboriginal residents.

The CAAHSC consortium reflects the importance of Aboriginal leadership in successful research and health improvement in Central Australia.

The Chairperson of CAAHSC is Mr John Paterson, CEO of the Aboriginal Medical Services Alliance Northern Territory, the peak body for the Aboriginal community controlled health services sector in the NT.

With the leadership of CEO Ms Donna Ah Chee, Central Australian Aboriginal Congress was the lead partner on the group’s bid to become a CIRH.

The CAAHSC is a community driven partnership, where Aboriginal people themselves have taken the lead in identifying and defining viable solutions for the health inequities experienced in the Central Australia region.

The CAAHSC partners have a long and successful track record of working together on innovative, evidence-based projects to improve health care policy and practice in the region.

Such projects include a study that examined high rates of self-discharge by Aboriginal patients at the Alice Springs Hospital, which in many cases can lead to poor health outcomes.

This research was used to develop a tool to assess self-discharge risk which is now routinely used in care, and to expand the role of Aboriginal Liaison Officers within the hospital.

Another collaborative project designed to address the rising rates of diabetes in pregnant women involves the establishment of a patient register and birth cohort in the

Northern Territory to improve antenatal care in the Aboriginal population.

CAAHSC Chair, Mr John Paterson agrees, saying the CIRH would serve as a model for other regional and remote areas both nationally and internationally, particularly in its governance, capacity building, and culturally appropriate approaches to translational research.

Mr Paterson said he hoped NHMRC recognition would attract greater numbers of highly skilled researchers and health professionals to work in Central Australia, and that local Aboriginal people would become more engaged in medical education, research and health care delivery.

He also hopes that achieving status as a CIRH will be instrumental in attracting further resources to the region, including government, corporate and philanthropic support.

Mr Paterson said the consortium is now focussed on building a plan across its five priority areas: workforce and capacity building; policy research and evaluation; health services research; health determinants and risk factors; and chronic and communicable disease.

This will include development of research support ‘apprenticeships’ for Aboriginal people and pursuit of long-term financial sustainability.

The partners of the Central Australia Academic Health Science Centre include: Aboriginal Medical Services Alliance Northern Territory (AMSANT); Baker Heart and Diabetes Institute; Charles Darwin University; Centre for Remote Health (A joint centre of Flinders University and Charles Darwin University); Central Australian Aboriginal Congress; Menzies School of Health Research; Central Australia Health Service (Northern Territory Health); CRANAplus; Flinders University; Ngaanyatjarra Health Service and the Poche Centre for Indigenous Health and Wellbeing.

1.Chronic Conditions

Chronic diseases are the most important contributor to the life expectancy gap between Indigenous and non-Indigenous Australians. Given their impact on premature mortality, disability and health care utilisation in Central Australia it is unsurprising that chronic disease has become the primary focus for addressing Indigenous Australian health disadvantage.

The Central Australia AHSC has considerable research and translation expertise with those chronic conditions that most impact the Aboriginal Australian population, including diabetes, heart disease, renal disease and depression.

Some of our focus areas are: understanding the developmental origins of adult chronic disease through targeted multi-disciplinary research focused on in-utero, maternal and early life determinants; understanding and preventing the early onset and rapid progression of heart, lung and kidney disease and diabetes within Aboriginal people, and developing and supporting capacity development of the chronic disease workforce within Aboriginal communities and health services.

2.Health Determinants and Risk Factors

In order to support the health of Central Australians, we recognise the importance of transcending boundaries between the biological, social and clinical sciences. The Central Australia AHSC takes an interdisciplinary approach to understanding social gradients, their determinants, and pathways by which these determinants contribute to illness, and consequently to forwarding policy responses to reduce health inequalities.

The Central Australia AHSC is interested in exploring the role of stress, intergenerational trauma and other psychosocial factors, as well as uncovering the biological pathways by which social factors impact on cardiometabolic risk, mental illness and other conditions of relevance to Indigenous communities.

3.Health Services Research

As a regional hub servicing a high proportion of Aboriginal people spread across an extensive area, Central Australia serves as an exemplar environment through which to address critical issues of national importance – for instance, targeted and practical research focused on the National Health and Hospital Reform agenda, the ‘Close the Gap’ reforms and the Indigenous Advancement Strategy.

Through health services research, the Central Australia AHSC is chiefly interested in developing and equipping primary care and hospital services with the skills, methods and tools by which to improve health care quality, appropriateness and accessibility.

Towards this goal, we are involved in developing, trialling, evaluating and establishing the cost-effectiveness of novel health system approaches to the identification, management and prevention of acute care, chronic disease and mental illness

4.Policy Research and Evaluation

The Central Australia AHSC brings together the expertise of leading clinician researchers, public health specialists and health service decision makers.

The Central Australia AHSC provides the capacity to evaluate the systems that underpin change management in health care through policy, protocol and evaluation research, and to support quality improvement processes through health provider training.

While being locally relevant, our works also informs jurisdictional and national health policy and practice in Aboriginal and remote health and implementation of national health reforms.

5.Workforce and Capacity Building

Central Australia’s health care workforce encompasses health care providers in hospitals, remote Aboriginal communities, and outreach services, including Aboriginal health practitioners, nurses, allied health providers, general practitioners and specialists.

Remoteness and the challenging work environment often translate to high levels of health provider staff turnover.

The Central Australia AHSC’s ongoing focus on professional development and capacity building facilitates health work force sustainability by providing relevant training and support and by attracting new health care providers who are also involved in research.

Workforce and capacity building undertaken by the AHSC partners includes the delivery of education programs (including tailored remote and Indigenous health postgraduate awards for doctors, nurses and allied health practitioners), growing research capacity (supervised formal academic qualifications and informal mentoring), and conducting research to inform workforce recruitment and retention.

Part 2 World-class focus on boosting remote health

Alice Springs mother Nellie Impu is part of a grim health statistic profoundly out of place in a first-world nation: one in five pregnant Aboriginal women in the Northern Territory has diabetes.

Photo : Nellie Impu, left, with Wayne, Wayne Jr and nurse Paula Van Dokkum in Alice Springs. Picture: Chloe Erlich

From the Australian July 5

For pre-existing type 2 diabetes, that’s at a rate 10 times higher than for non-indigenous women; more common gestational diabetes is 1.5 times the rate.

Mrs Impu became part of that statistic almost five years ago when she was pregnant with son Wayne. So the announcement of a new central Australian academic health science centre, led by the Aboriginal community-controlled health service sector and bringing together a consortium of 11 clinical and research groups, is a big deal for her and many women like her.

The diabetes treatment she underwent while carrying Wayne will continue for more than a decade as part of a longitudinal study.

“We know there is a link ­between mums with diabetes in pregnancy and outcomes for their babies as they grow, including ­future possibilities of type 2 diabetes, which work like this can help us track,” said research nurse Paula Van Dokkum, who works with consortium member Baker IDI Heart and Diabetes Institute.

Wayne is meeting all his childhood development targets, and his mother said the ongoing association with the centre would help her in “trying to make sure he grows up healthy and strong”.

Announcing $222,000 in seed funding, federal Indigenous Health Minister Ken Wyatt said the centre’s accreditation this week with the National Health and Medical Research Council proved the “landmark research” by consortium members had “huge potential” to address serious indigenous health issues.

“The objective is to evaluate problems and find practical solutions fast, to prevent health problems and give speedy but lasting benefits to patients within community,” Mr Wyatt said.

The academic health science centre model, well ­established internationally, brings together health services, universities and medical research institutes to better produce evidence-based care.

The Alice Springs-based enterprise will aim to tackle a ­cancer-causing virus endemic in indigenous central Australia, its only significant instance outside South America and central Africa.

The human T-lymphotropic virus type 1 causes a slow death over 20 years with leukaemia, chronic cough, respiratory problems and respiratory failure. It can be acquired through breast milk in early childhood as well as through blood or sexual contact.

A recent study found HTLV-1 infection rates in a central Australian indigenous community of more than 40 per cent. One result, the inflammatory disease bronch­iectasis, is a leading cause of death for young adults at the Alice Springs hospital.

The program will also address the soaring demand for dialysis in remote communities, with indigenous Australians five times as likely to have end-stage kidney disease than other Australians.

Alice Springs hospital is home to the largest single-standing ­dialysis service in the southern hemisphere, with 360 patients.

Part 3 Alice Springs: the Red Centre of medical innovation

London, Boston, Toronto, Melbourne … and Alice Springs.

Although there may be little in common between these major cities and the heart of Australia’s outback, an announcement this week brings the Red Centre into the company of international players in translational health research, including prestigious institutions such as Imperial College Healthcare in Britain and Johns Hopkins Medicine in the US.

This week, the Central Australia Academic Health Science Centre was given the official seal of approval by the National Health and Medical Research Council.

The Central Australia consortium was one of only two centres recognised as a centre of innovation in regional health for its leadership in health research and delivery of evidence-based healthcare.

And now there’s opportunity in the Red Centre to do even more.

It may well be the most remote academic health science centre in the world, and perhaps the only academic health science centre in the world led by Aboriginal people. With such esteemed recognition for this remote, Aboriginal-led, evidence-based healthcare collaboration, it is hoped that public and private support will also follow.

As a model well established abroad and gaining momentum in Australia, academic health science centres are partnerships between health services, universities and medical research institutes whose collaborative work ensures that translational health research leads to evidence-based care and better health outcomes for patients.

For the 11 partners behind the Central Australia partnership, recognition as a centre for innovation in regional health acknowledges the outstanding collaboration that has existed in this region for several years, and particularly the leadership offered by the Aboriginal sector.

Working with the other partners in the consortium, Aboriginal community-controlled health services are taking the lead in identifying and defining viable solutions for the health inequities experienced in the region.

The work of the Central Australia partners is practical and responsive.

Interested in resolving what had become a troubling issue at Alice Springs Hospital, a resident physician researcher initiated a study that found nearly half of all admitted Aboriginal patients had self-discharged from the hospital in the past, with physician, hospital and patient factors contributing to this practice.

The research findings were used to develop a self-discharge risk assessment tool that is now routinely used in hospital care, and to expand the role of Aboriginal liaison officers within the hospital.

Considering the vast and remote geographical area — more than one million square kilometres — and the health challenges experienced particularly by Aboriginal residents who make up about 45 per cent of the region’s population of about 55,000 people, the Central Australia consortium faces unique and significant challenges. In this respect, Alice Springs may be more like Iqaluit in the Canadian Arctic than London or Baltimore.

But in other ways this relatively small academic health science centre may be at an advantage.

With its closely knit network of healthcare providers, medical researchers, medical education providers and public health experts working together, community-driven approaches to identifying issues and developing evidence-based solutions have become a standard approach in Central Australia.

In this setting of high need and limited resources, working collectively is sensible, practical and necessary.

Importantly, there is the possibility to do a lot more.

The consortium hopes such recognition will help to attract top healthcare providers and researchers, to increase educational offerings and to develop local talent, especially Aboriginal people.

The evidence is resounding. A research oasis in the desert, this centre for innovation is fertile ground for investment by government, corporations and philanthropists alike.

Donna Ah Chee is chief executive of the Central Australian Aboriginal Congress. John Paterson is chief executive of the Aboriginal Medical Services Alliance Northern Territory.

NACCHO Aboriginal Kidney Health #NAIDOC2017 @KenWyattMP announces $6.3 million investment in family friendly housing for kidney patients

The recent Central Australia Renal Study identified accommodation as the greatest challenge to indigenous kidney patients moving to towns for dialysis,

After relocating, these patients and family members often ended up homeless, socially and culturally isolated, and in many instances having to live in town camps.

We acted promptly, prioritising housing to help solve these challenges for families already under immense financial and emotional pressure from this debilitating disease.

Now patients will be comfortably housed, within easy reach of clinical treatment.”

Indigenous Health Minister Ken Wyatt

A joint housing refurbishment project has delivered accessible, family friendly homes for Northern Territory renal patients.

Welcoming the completion of eight houses in Alice Springs and two in Tennant Creek, Indigenous Health Minister Ken Wyatt said collaboration between the Australian and Territory governments had yielded a win-win for some of the most vulnerable people in the NT.

Download Central Australia Renal Study  Report

Executive summary – Central Australia Renal Study

The Central Australia Renal Study was undertaken against the following background:

  • Increasing numbers of Aboriginal people in the Central Australia (CA) region requiring renal replacement therapy (RRT), predominantly in Alice Springs.
  • Recognition of the lack of culturally appropriate service options and, in particular, service options allowing treatment as close to home as possible.
  • Recognition that treatment may require relocation and, where it does, support needs to be provided for patients and families.
  • Concerns about the negative impact of a lack of culturally appropriate service options on treatment uptake.

The project

The Australian Government contributed $6.3 million to refit and modify the homes, after the NT Government provided the original houses.

Minister Wyatt said Central Australia accounted for more than 640 patients known to have chronic kidney disease stages 3, 4 or 5.

“The problem is particularly high in the NT, where kidney health complications among indigenous people are compounded by remoteness and challenging living conditions,” he said.

Federal Government Investment Indigenous Health

The Government was now investing $3.6 billion over four years from 2017-18 for the Indigenous Australians’ Health Program, an increase of $724 million compared with expenditure over the previous four years.

“Continued growth in the program will improve access to culturally appropriate, comprehensive primary health care for Indigenous Australians and address areas of critical need through targeted investments to close the gap,” Minister Wyatt said.

Background

The Central Australia Renal Study was a joint study by the Australian, Northern Territory, South Australian and Western Australian Governments to develop a range of feasible clinical service delivery models and care pathways to best meet (current and projected) needs for Aboriginal and Torres Strait Islander patients from remote communities requiring dialysis in Central Australia.

The study, funded by the Australian Government, assesses the current issues surrounding the delivery of renal services in Central Australia and takes account of stakeholder consultation and activity-based data.

The study was conducted by the George Institute for Global Health for the Commonwealth Department of Health and Ageing.

The study was commissioned to assess the current issues surrounding the delivery of renal services in Central Australia taking into account, stakeholder consultation and activity-based data. The findings were to inform policy recommendations on the most effective and feasible service delivery options and care pathways for Aboriginal and Torres Strait Islander peoples in need of renal services, including dialysis, and identify issues around the distribution of these services.

The Report of the Central Australia Renal Study consists of four sections:

Executive Summary – PDF 204 KB
Executive Summary (online)

Part 1: Key findings and Recommendations, and Part 2: Final Report – PDF 1316 KB
Part 1: Key findings and Recommendations, and Part 2: Final Report (online)

Part 3: Technical Report – PDF 1706 KB
Part 3: Technical Report (online)

Part 4: Technical Appendices – PDF 939 KB
Part 4: Technical Appendices (online)

 

NACCHO Aboriginal Health News : $20 million Streamlined Support for Aboriginal Community Health Services

This is fundamental to the Turnbull Government’s policy of partnership, our commitment to doing things with, not to, the Indigenous community

Under the agreement, NACCHO will receive the funding and will form a collaborative network with its State and Territory counterpart organisations to finance and support local health services.

The agreement provides the network with funding certainty, allowing organisations to plan for the future and improve their effectiveness.”

Federal Indigenous Health Minister Ken Wyatt

Download

NACCHO Ken Wyatt Press Release June 20 2017

Minister Wyatt says a new Network Funding Agreement will streamline the provision of $20 million a year in health service support through the National Aboriginal Controlled Community Health Organisation (NACCHO).

The unified funding arrangements, signed on Friday, will allow the Commonwealth to work better with Australia’s peak indigenous community health organisation.

Minister Wyatt said the agreement was focussed on outcomes, allowing service funding to be administered through an Aboriginal-controlled agency.

“I have been hearing from Aboriginal and Torres Strait Islander people about the kind of care they want, and this agreement will help deliver it,” he said.

“We know that strong, Aboriginal-administered care plays a pivotal role in improving health outcomes, but it can face challenges supplying services on the ground.

“‘This new approach will allow service providers to access the assistance they need to enable them to deliver crucial, quality care to their clients.”

Minister Wyatt said the new network would also ensure that Aboriginal and Torres Strait Islander voices were heard clearly at all levels of health administration.

“The aim is to streamline funding and communication, to continue our shared commitment to Closing The Gap,” he said.

NACCHO Aboriginal Health : The #NTIntervention 10 years on – history and evaluations

 ” And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.”

Pat Turner AM CEO NACCHO speaking to Nick Grimm ABC (see full Interview Below

 

 Picture above : Powerhouse panel at UTS Sydney last night talking about the 10th anniversary of the #NTIntervention: @KylieSambo @Bunbajee Pat Turner & @LarissaBehrendt #IndigenousX

  ” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives.

See 10 Years history of the NT Intervention Below Part 2 after the Interview

 Major General David Chalmers, of the Inter-Agency Northern Territory Emergency Response Task Force, and Mal Brough, indigenous affairs minister, are greeted by David Wongway, a member of the Imanpa Local Community Council

 ” In 2008, following the change of government after the 2007 Federal Election, the Rudd Labor Government re-framed the intervention through a new national policy focus on “Closing the Gap”. Rudds’ intention to re-work the Intervention to focus more closely on reforming the welfare system linked closely with the already existing targets of the Close the Gap Campaign.

The aims of the campaign are set out in the 2012 National Indigenous Reform Agreement ”

 The Intervention and the Closing the Gap Campaign see part 3

 ” Evaluating the Intervention is not an easy task. Impartial data is difficult to find and there is a mass of complex and conflicting information. However, by looking at the Closing the Gap targets that were set by the Government and considering human rights concerns, we have provided our assessment. Below we give major features of the Intervention a score out of 10.  We also score it for compliance with human rights.”

Issues with Evaluating the Interventionhow did we work out our grades? Part 4

NT Intervention – nothing has changed for the better: Pat Turner

Hear Interview HERE

NICK GRIMM: Ten years ago this week, one of the defining moments in Australian national life began unfolding in remote communities in the outback.

The Northern Territory intervention was launched by the then Howard government in response to reports of social dysfunction and allegations of endemic abuse of women and children in remote communities.

Since then, the policy has continued under governments of both persuasions.

But 10 years on critics of the Intervention say it’s fixed nothing.

Pat Turner is currently CEO of the National Aboriginal Community Controlled Health Organisation.

She was previously a CEO of the Aboriginal and Torres Strait Islander Commission, ATSIC, and had a long career as a senior Commonwealth public servant.

I spoke to Pat Turner a little earlier.

Pat Turner, can I start by asking you this: Ten years on, what’s the best thing you have to say about the Northern Territory Intervention?

PAT TURNER: (Laughs) Nothing, really, I’m afraid.

It was a complete violation of the human rights of Aboriginal people in the Northern Territory.

It came out of the blue, following the Commonwealth Government’s reading and response to The Little Children Are Sacred report.

NICK GRIMM: So how would you describe the legacy of the process that began 10 years ago?

PAT TURNER: Well, I think it’s still a shambles.

You know, both sides of politics were responsible.

While it was introduced by the Liberal government, the Coalition under John Howard and Mal Brough, it was carried on also by Jenny Macklin and Kevin Rudd and Gillard and so on.

So the legacy is that Aboriginal people were completely disempowered.

They had the Army going into communities in their uniforms. They had no idea why the Army was there.

You know, to send the Army in at a time like that was just totally confusing. People were terrified that they’d come to take the kids away. There would be no explanation as to why they were going in.

And it wasn’t their fault; it was the way the Government handled it.

The government also, at the time, insisted that every child under 16 have a full medical check. Now, actually what they were looking for, I think, was whether a child had been sexually abused.

And we said, at the time, those of us who were opposed to the way the Government was handling this, “You cannot do that without parental permission. You must have parental permission. You would not do a medical check on any other child in Australia and you should not do that with our children without their parents’ say-so”.

And what’s more, fine, go ahead, do a full medical check, but what are you going to do when you find the otitis media, when you find the trachoma, when you find the upper respiratory diseases, when you find rheumatic heart disease? Where…

NICK GRIMM: All those common medical conditions in those areas.

PAT TURNER: Absolutely, absolutely. And what are you going to do to treat these people?

Because you don’t have the health services that Aboriginal people should have. You don’t have those in place.

And they were paying doctors a phenomenal salary.

They also, of course, introduced the infamous cashless welfare card, called it ‘income management’, where 60 per cent of the income was quarantined for food and clothes and so on.

People weren’t allowed to get access to video, so that was a… and that was fine for X-rated videos and adult videos, but certainly not for entertainment, which a lot of families relied on in outlying communities.

And it had ramifications. I mean, there was a young Aboriginal businesswoman in Tennant Creek whose business went bust because she couldn’t hire out videos.

NICK GRIMM: Well, in your view, can we say that anything has changed for the better in those remote communities?

PAT TURNER: No.

Look, the other thing that happened at the time, Nick, was there was a reform in local government.

So, from the hundreds of Aboriginal community councils that were in place, they all became part of these super shires, nine super shires, so all the decision making at the local community level had evaporated.

And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.

And what’s more, I called it at the time the Trojan Horse to get the land that our people have under freehold inalienable title in the Northern Territory.

And I thought it was a land grab, and I still believe that, you know, the Commonwealth certainly wanted to have a greater say over Aboriginal land in the Northern Territory – as did the Northern Territory Government, by the way.

NICK GRIMM: Yeah, well we’ve talked about the situation on the ground there in the Northern Territory.

What then would you say have been the national implications of the Intervention?

PAT TURNER: Well, I think without the evidence they’ve adopted – you know, Alan Tudge is very keen on the cashless welfare card, as is Twiggy Forrest, who promoted it.

While I see that, you know, there may be, you know, some opportunity for women to buy more food, it’s fine if you have access to fresh produce at a reasonable price that you could expect to pay in a major regional centre like Alice Springs.

You go out to the communities, the prices are at least double if not tripled, and they’re stale, rotten, old vegetables and meats and so on.

So, you know, that’s where government services need to step up through their outback stores and make sure that people are getting really fresh produce all the time, and healthy produce.

NICK GRIMM: Alright, Pat Turner, thanks very much for talking to us.

PAT TURNER: You’re most welcome. Thank you.

NICK GRIMM: Pat Turner is CEO of the National Aboriginal Community Controlled Health Organisation.

Part 2

” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives. “

See 10 Years history of the NT Intervention

Intervention was directed at addressing the disproportionate levels of violence in Indigenous communities in the Northern Territory, as well as the endemic disadvantage suffered in terms of health, housing, employment and justice.

It was also a direct response to the Ampe Akelyernemane Meke Mekarle Report (‘Little Children are Sacred Report’) into sexual abuse of Indigenous children. This report was commissioned by the then Northern Territory Chief Minister Clare Martin following an interview on the ABC’s Lateline program, in which Alice Springs Senior Crown Prosecutor Dr Nanette Rogers SC commented that the violence and sexual abuse of children that was entrenched in Indigenous society was ‘beyond most people’s comprehension and range of human experience’. The then Commonwealth Minister for Families, Community Services and Indigenous Affairs, Mal Brough, indicated in his second reading speech introducing the NTNERA that “[t]his bill… and the other bills introduced in the same package are all about the safety and wellbeing of children.”

The Little Children are Sacred Report was the result of in-depth research, investigation and community consultation over a period of over eight months by members of the Northern Territory Board of Inquiry. The focus of their inquiry was instances of sexual abuse, especially of children, in Northern Territory Indigenous communities. The findings were presented to Chief Minister Martin in April 2007 and released to the public in June. The striking facts, graphic imagery and ardent plea for action contained in this report saw this issue gain widespread attention both in the media and in the political agenda, inciting divisive debate and discussion.

The NTNERA was enacted by the Howard Government just two months after the report was released to the public, allowing little time for consultation with Indigenous communities. It was framed as a ‘national emergency’ with army troops being deployed to Indigenous communities in the Northern Territory. This took place in the lead up to the 2007 Federal Election, in which the Labor Party under Kevin Rudd defeated the Howard Government after four terms of Liberal government.

The Intervention in 2007

The Intervention was a $587 million package of legislation that made a number of changes affecting specified Indigenous communities in the Northern Territory. It included restrictions on alcohol, changes to welfare payments, acquisition of parcels of land, education, employment and health initiatives, restrictions on pornography and other measures.

The package of legislation introduced included:

  • NorthernTerritory National Emergency Response Act 2007.
  • Social Security and Other Legislation Amendment (Welfare Payment Reform) Bill 2007.
  • Families, Community Services and Indigenous Affairs and Other Legislation Amendment. (Northern Territory National Emergency Response and Other Measures) Act 2007.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 1) 2007-2008.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 2) 2007-2008.

In order to enact this package of legislation, several existing laws were affected or partially suspended, including:

  •  Racial Discrimination Act 1975.
  •  Aboriginal Land Rights (Northern Territory) Act 1976.
  • Native Title Act 1993(Cth).
  • Northern Territory Self-Government Act and related legislation.
  • Social Security Act 1991.
  • IncomeTax Assessment Act 1993.

A raft of reforms and regulations were introduced by this package of legislation, including:

  • Restricting the sale, consumption and purchase of alcohol in prescribed areas. This included the prohibition of alcohol in certain areas prescribed by the legislation, making collection of information compulsory for purchases over a certain amount and the introduction of new penalty provisions.
  • ‘Quarantining’ 50% of welfare payments from individuals living in designated communities and from beneficiaries who were judged to have neglected their children.
  • Compulsorily acquiring townships held under title provisions of the Native Title Act 1993 with the introduction of five year leases in order to give the government unconditional access. Sixty-five Aboriginal communities were compulsorily acquired.
  • Linking income support payments to school attendance for all people living on Aboriginal land, and providing mandatory meals for children at school at parents’ cost.
  • Introducing compulsory health checks for all Aboriginal children.
  • Introducing pornography filters on publicly funded computers, and bans on pornography in designated areas.
  • Abolishing the permit system under the Aboriginal Land Rights Act 1976 for common areas, road corridors and airstrips for prescribed communities,.
  • Increasing policing levels in prescribed communities. Secondments were requested from other jurisdictions to supplement NT resources.
  • Marshalling local workforces through the work-for-the-dole program to clean-up and repair communities.
  • Reforming living arrangements in prescribed communities through introducing market based rents and normal tenancy arrangements.
  • Commonwealth funding for the provision of community services.
  • Removing customary law and cultural practice considerations from bail applications and sentencing in criminal trials.
  • Abolishing the Community Development Employment Projects (CDEP).

Changes under successive governments

After an initial focus on preventing child sexual abuse, successive federal governments re-designed and re-framed the Intervention. This involved linking the Intervention with the broader ‘Closing the Gap’ campaign, introducing new measures such as the BasicsCard and tougher penalties for the possession of alcohol and pornography. Changes were also made to the operation of the Racial Discrimination Act (see section on Human Rights). The current package of legislation retains the support of the Liberal Government and is due to expire in 2022.

2008 Changes

The Intervention was introduced in 2007 by the Howard Government, but a change of government in September of that year saw the Labor Government under Kevin Rudd gain power. After some consultation and minor changes, the NTNERA and associated legislation were initially maintained.

In 2008 Rudd apologised to the members of the Stolen Generations on behalf of the nation. In 2009, Rudd also declared support for the most substantive framework for the rights of Indigenous peoples, the UN Declaration on the Rights of Indigenous Peoples. The previous Howard government had voted against the ratification of this treaty. Article 3 of the Declaration states that:

‘Indigenous peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development’.

The failure to recognise this right to self-determination would become one of the major points of criticism for the Intervention.

In 2009 Rudd implemented the BasicsCard.  The card is used to manage income in certain areas of the Northern Territory. It cannot be used to purchase alcohol, tobacco, tobacco-products, pornography, gambling products or services, home-brew kits or home-brew concentrate.

During the period 2009-2010 the Rudd Government committed itself to a re-design of the Intervention, with a focus on reinstating the suspended provisions of the Racial Discrimination Act (RDA). The Social Security and Other Legislation Amendment (Welfare Reform and Reinstatement of Racial Discrimination Act) Act 2010 (Cth) repealed the ‘special measures’ that had been created under the original Intervention to suspend the operation of the RDA. However, this new legislation still did not comply with the RDA as it continued to discriminate against Indigenous Australians through land acquisition and compulsory income management.These measures overwhelmingly  affect Indigenous people.

The focus of the government then shifted slightly, concentrating more closely on the need to ‘tackle the destructive, intergenerational cycle of passive welfare’ (see then Minister for Families, Community Services and Indigenous Affairs Jenny Macklin’s second reading speech). The Rudd government explicitly linked the Intervention to the ‘Closing the Gap’ targets, changing the focus of the Intervention from the protection of children from sexual abuse to the reform of the welfare system.

2012 changes

The legislative basis for the Intervention was due to expire in 2012.  Decisions regarding its future had to be made. Under the Gillard Government, the StrongerFuturesin the Northern Territory Act 2012 (Stronger Futures) replaced the NTNERA and extended the Intervention for a further ten years to 2022.  The StrongerFutureslegislation comprises three principal Acts (the Stronger Futures package), plus associated delegated legislation. The three Acts are:

  • Stronger Futures in the Northern Territory Act 2012;
  • Stronger Futures in the Northern Territory (Consequential and Transitional Provisions) Act 2012; and
  • Social Security Legislation Amendment Act 2012.

In 2013, the  Parliamentary Joint Committee on Human Rights examined Stronger Futures and the related legislation in their 11th Report. They noted that although the StrongerFutureslegislative package repealed the Northern Territory Emergency Response (‘NTER’) legislation, it retained three key policy elements:

  • The tackling alcohol abuse measure: the purpose of this measure was ‘to enable special measures to be taken to reduce alcohol-related harm to Aboriginal people in the Northern Territory.
  • The land reform measure: the land reform measure enabled the Commonwealth to amend Northern Territory legislation relating to community living areas and town
  • camps to enable opportunities for private home ownership in town camps and more flexible long-term leases.
  • The food security measure: the purpose of this measure was ‘to enable special measures to be taken for the purpose of promoting food security for Aboriginal communities in the Northern Territory’; modifying the legislation involves a 10 year timeframe with most provisions other than the alcohol measures being reviewed after 7 years.

The key changes imposed under the 2012 Stronger Futures legislation package consist of:

  • Expansion of income management through the BasicsCard and the increase of ‘quarantined’ payments to 70%.
  • Increased penalties related to alcohol and pornography, with as much as 6-months jail time for a single can of beer.
  • Expansion of policy that links school attendance with continued welfare payments.
  • Introduction of licences for ‘community stores’ to ensure the provisions of healthy, quality food.
  • Commonwealth given power to make regulations regarding the use of town camps.

{Sources: SBS Factbox, Stronger Futures in the NT, Listening but not Hearing Report}

Although consultation with Indigenous communities did take place, there was much criticism of the nature of the consultative process and the extent to which it was acted upon. The ‘Listening butnot Hearing’ report by the Jumbunna Indigenous House of Learning concluded that “the Government’s consultation process has fallen short of Australia’s obligation to consult with Indigenous peoples in relation to initiatives that affect them”.

The Australian Council of Human Rights Agencies has also stated that it was ‘invasive and limiting of individual freedoms and human rights, and require[s] rigorous monitoring’. Amnesty International commented that the new package of legislation was the same as the original ‘Intervention, but with the pretence of being non-discriminatory.’

2014 changes

The current Intervention legislation is not due to expire until 2022. During his time as Opposition Leader, Tony Abbott supported extending the intervention into the future.

In a speech in February of 2014, then Prime Minister Abbott identified the importance of closing the gap through investment in indigenous programs, with a specific focus on school attendance. However, this speech was followed by massive budget cuts to Aboriginal legal and health services, early childhood education and childcare, and the consolidation of 150 Indigenous programs into 5 core programs. While the 2015 Budget reinstated funding to Family Violence legal services, these ongoing cuts are expected to detrimentally affect attempts to Close the Gap of Indigenous disadvantage.

The 2015 Budget modified the  Stronger Futures NPA, redirecting $988.2 million in funds to the new National Partnership Agreement on Northern Territory Remote Aboriginal Investment  (NPA) over eight years. This new NPA prioritises schooling, community safety and employment. This funding also aims to help the Northern Territory Government take full responsibility for the delivery of services in remote Indigenous communities. Additional funding will also be made available to extend the income management scheme until 2017. However, the new NPA has halved the spending allocated to health measures, and means that the Federal Government will have less control over target outcomes.

Government administered funding of $1.4 billion, previously available under Stronger Futures, will not be transferred to the new NPA, but will be delivered by the departments of Prime Minister and Cabinet and Social Services, outside the NPA framework. The new NPA will be complemented by a Remote Indigenous Housing Strategy that will receive $1.1 billion nationally.

Part 3 The Intervention and the Closing the Gap Campaign

The Council of Australian Governments (COAG) had identified six areas of Indigenous disadvantage to target as the basis for the Closing the Gap Campaign. These were:

  1. Early childhood;
  2. Schooling;
  3. Health;
  4. Economic Participation;
  5. Safe Communities; and
  6. Governance and Leadership (see Right to Self Determination below).

The Closing the Gap in the Northern Territory National Partnership Agreement (2009) ceased on the 30 June 2012. The Stronger Futures in the Northern Territory package which started on 1 July 2012 continued to support the Closing the Gap reforms.

The 6th Annual Progress Report on Closing the Gap was tabled in Parliament by then Prime Minister Tony Abbott on 12 February 2014. It outlined the commitments made by the Coalition government, including:

  • Consolidating the administration of Indigenous programs from eight government departments into the Department of the Prime Minister and Cabinet.
  • Establishing the Prime Minister’s Indigenous Advisory Council.
  • Increasing indigenous school  attendance  through  providing  $28.4 million funding for a remote school attendance program.
  • Improving indigenous  access to employment by commissioning a review and funding employment initiatives.
  • Supporting a referendum for the recognition of the First Australians in the Australian Constitution.

However, in the seventh annual progress report of 11 February 2015, then PM Tony Abbott labelled progress as ‘profoundly disappointing‘. The report concluded that 4 out of 7 targets were not on track to be met by their deadlines, with little progress in literacy and numeracy standards and a decline in employment outcomes since 2008.

Link to 2012 National Indigenous Reform agreement here.

Part 4 Issues with Evaluating the Intervention – how did we work out our grades? Part 4

Quantity of Evaluation:

The controversial nature of the Intervention and the need for expenditure to be accounted for has meant that there have been a large number of evaluations undertaken regarding various aspects of the Intervention. Within five years of the establishment of the Intervention, by December 2012, 98 reports, seven parliamentary inquiries and hundreds of submissions had been completed. However, the sheer quantity of these reports actually hinders the evaluation process, as it obstructs proper evaluation of effectiveness.

Impartiality of Evaluation:

The majority of evaluations of the Intervention have been undertaken by government departments and paid consultants. Australian National University researchers Jon Altman and Susie Russell suggest that the evaluation of the Intervention, instead of being an independent objective process, has been merged into the policy process and, in many cases, is performed by the policy-makers themselves. This means there is a real risk of evidence being ignored or hidden to suit an agenda.

Independent reports and government commissioned reports have often contradicted each other, with the government seeking to discredit independent reports rather than gathering additional data. This includes independent reports by researchers at Jumbunna Indigenous House of Learning at the University of Technology Sydney, Concerned Australians and the Equality Rights Alliance, all of which have often come to different conclusions than government reports.

Quality and Consistency of Evaluation:

The ‘final evaluation’ of the Intervention under the NTNER occurred in November 2011 with the publication of the Northern Territory Emergency Response Evaluation ReportHowever, the Stronger Futures legislation did not come into effect until August 2012. This left eight months unaccounted for.

Closingthe Gap in the Northern Territory Monitoring Reports are conducted every six months. A significant criticism is that they focus on bureaucratic ‘outputs’ rather than outcomes. Income management studies, for example, have reported on ‘outputs’ such as the number of recipients of the Basics Card or the total amount of income quarantined, rather than focusing on the card’s effectiveness for health and child protection outcomes.

Much of the data collected has also relied on self-assessment in the form of surveys, such as asking individuals to rate their own health rather than collecting and analysing data on disease. Another issue is the ad hoc nature of some reports. For example, the review of the Alcohol Management Plan in Tennant Creek was only conducted once. This makes it difficult to make comparisons over the life of the policy and evaluate the effectiveness of particular measures.

Independent statistical data can be hard to find, since information compiled by the Australian Bureau of Statistics is national in scope and cannot be translated directly into the context of the individual Indigenous communities in the Northern Territory. Indigenous Australians also have a lower median age than other Australians, meaning data on employment rates or incarceration rates can be statistically skewed.

Benchmarks for Evaluation:

ANU researchers Jon Altman and Susie Russell have noted that the “absence of an overarching evaluation strategy has resulted in a fragmented and confused approach”. They found that the 2007 Intervention did not have any documentation articulating the basis of the policy, nor how it should be evaluated. The first document to address this was the unpublished Program Logic Options Report which was developed in 2010; three years after the Intervention began. This means that there are no original benchmarks for evaluation, and that the decision to extend the program in 2012 was made without clear evidence as to its effectiveness. Furthermore, there is a limited connection between the benchmarks proposed in the 2010 Report and those used in later evaluations.

Aboriginal Health and #prevention : New report : @Prevention1stAU health : How much does Australia spend and is it enough?

 ” The verdict is in: Prevention is better than cure when it comes to tackling Australia’s chronic disease burden, but is Australia pulling its weight when it comes to tackling the nation’s greatest public health challenge?

A new economic report looking at what Australia invests in preventive health has found Australia ranks poorly on the world stage and has determined that governments must spend more wisely to contain the burgeoning healthcare budget.

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person.

One in two Australians suffer from chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, and accounts for 66 per cent of the burden of disease.”

The report, Preventive health: How much does Australia spend and is it enough? was co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education.

Download the report HERE

Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL

Produced by La Trobe University’s Department of Public Health, the report examines trends in preventive health spending, comparing Australia’s spending on preventive health, as well as the funding models used, against selected Organisation for Economic Co-operation and Development (OECD) countries.

The report also explores the question: ‘how much should Australia be spending on preventive health?’

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person. At just 1.34 per cent of Australian healthcare expenditure, the amount is considerably less than OECD countries Canada, New Zealand and the United Kingdom, with Australia ranked 16th out of 31 OECD countries by per capita expenditure.

Michael Thorn, Chief Executive of the Foundation for Alcohol Research and Education (FARE), a founding member organisation of the Prevention 1st campaign, says that when looking at Australia’s spend on prevention, it should be remembered that one third of all chronic diseases are preventable and can be traced to four lifestyle risk factors: alcohol and tobacco use, physical inactivity and poor nutrition.

“We know that by positively addressing and influencing lifestyle factors such as physical activity, diet, tobacco and   alcohol consumption, we will significantly reduce the level of heart disease, stroke, heart failure, chronic kidney disease, lung disease and type 2 diabetes; conditions that are preventable, all too common, and placing great pressure on Australian families and on Australia’s healthcare systems,” Mr Thorn said.

Report co-author, Professor Alan Shiell says we should not simply conclude that Australia should spend more on preventive health simply because we spend less than equivalent nations, and instead argues that Australia could and should spend more on preventive health measures based on the evidence of the cost effectiveness of preventive health intervention.

“The key to determining the appropriate prevention spend is to compare the added value of an increase in spending on preventive health against the opportunity cost of doing so.

“If the value of the increased spending on preventive health is greater than the opportunity cost, then there is a strong case to do so,” Professor Shiell said.

Professor Shiell says there is clear evidence that many existing preventive health initiatives are cost-effective.

“Studies suggest Australia’s health could be improved and spending potentially even reduced if government was to act on existing policy recommendations and increase spending on activities already considered cost-effective.

“We also suspect that the choice of funding mechanism, or how money is allocated to whom for prevention – is an important factor for the overall efficiency of health prevention expenditure,” Professor Shiell said.

The report highlights England’s efforts in evaluating and monitoring the cost effectiveness and success of its public health interventions and Mr Thorn believes Australia would do well to follow their lead.

“In the United Kingdom we have a conservative government no less, showing tremendous leadership to tackle chronic disease, with bold policy measures like the recently introduced sugar tax and broad-based physical activity programs, all of which are underpinned by robust institutional structures,” Mr Thorn said.

The report will be launched at a Forum at Parliament House in Canberra today, where public health experts, including the World Health Organization’s Dr Alessandro Demaio will explain how they would invest in preventive health if given $100 million to spend.