NACCHO Aboriginal Health and #ChronicDisease #Prevention News : @ACDPAlliance Health groups welcome action on added sugars labelling and further consider 10 recommendations to improve the Health Star Rating system

 

“Industry spends vast amounts of money advertising unhealthy foods, so it is essential that nutrition information is readily available to help people understand what they are eating and drinking.

Two in three Australian adults are overweight or obese and unhealthy foods, including those high in added sugars, contribute greatly to excess energy intake and unhealthy weight gain”

Chair of the Australian Chronic Disease Prevention Alliance Sharon McGowan said food labelling is an important part of understanding more about the products we consume every day

Read previous 70 NACCHO Aboriginal Health and Nutrition Healthy foods articles

The five year review of the HSR system (the Review) has now been completed. See Part 2 Below

Five Year Review of the Health Star Rating System – PDF 3211 KB

The Australian Chronic Disease Prevention Alliance welcomes the recent decisions to improve food labelling and provide clear and simple health information on food and drinks.

The Australia and New Zealand Ministerial Forum on Food Regulation announced yesterday it would progress added sugars labelling and further consider 10 recommendations to improve the Health Star Rating system.

Decisions were also made to provide a nationally consistent approach to energy labelling on fast food menu boards and consider the contribution of alcohol to daily energy intake.

Current Health Star Rating system.

Ms McGowan said overweight and obesity is a key risk factor for many chronic diseases.

“We welcome improvements to existing labelling systems to increase consumer understanding and provide an incentive for industry to create healthier products.”

The Ministerial Forum also released the independent review of the Health Star Rating system with 10 recommendations for strengthening the system, including changes to how the ratings are calculated, and setting targets and timeframes for industry uptake.

The Australian Chronic Disease Prevention Alliance has been advocating to improve the Health Star Rating system for years. While the Alliance supports stronger changes to the ratings calculator, Ms McGowan said it was promising to see recommendations enhancing consistency of labels and proposing a mandatory response if voluntary targets are not met.

“Under the current voluntary system, only around 30 percent of eligible products display the health star rating on the label and some manufacturers are applying ratings to the highest scoring products only,” Ms McGowan said.

SMH Editorial The epidemic of childhood obesity and chronic health conditions linked to bad diet has turned supermarket aisles into the front line of one of the hardest debates in politics.

“To truly achieve its purpose and help people compare products, the rating needs to be visible and consistently applied to all foods and drinks.”

The recommendations to improve the Health Star Rating system will be considered by Ministers later this year.

Ms McGowan added “We know that unhealthy food and drinks are a major contributor to overweight and obesity, and that food labelling should be part of an overall approach to creating healthier food environments.”

Read the Health Star Rating report here and the Ministerial Forum communique here.

The five year review of the HSR system (the Review) has now been completed.

Five Year Review of the Health Star Rating System – PDF 3211 KB
Five Year Review of the Health Star Rating System – Word 16257 KB

The five year review of the HSR system considered if and how well the objectives of the system have been met and has identified several options for improvements to the system, including communication, monitoring, governance and system/calculator enhancements.

The Review found that the HSR system has been performing well. Whilst there is a broad range of stakeholders with diverse opinions, there is also strong support for the system to continue.

The recommendations contained in the Review Report are designed to address some of the key criticisms of the current system. The key recommendations from the report are that:

  • the HSR system continue as a voluntary system with the addition of some specific industry uptake targets and that the Australian, state and territory and New Zealand governments support the system with funding for a further four years;
  • that changes are made to the way the HSR is calculated to better align with Dietary Guidelines, and including fruit and vegetables into the system; and
  • that some minor changes are made to the governance of the system, including transfer of the HSR calculator to Food Standards Australia New Zealand.

The next steps will be for members of the Australia and New Zealand Ministerial Forum on Food Regulation to respond to the Review Report, and the recommendations contained within. It is anticipated that Forum will respond before the end of 2019.
Five Year Review – Draft Report

A draft of the review report was made available for public comment on the Australian Department of Health’s Consultation Hub from Monday 25 February 2019 until midnight Monday 25 March 2019. Following consideration of comments received, the report will be finalised and provided to the Australia and New Zealand Ministerial Forum on Food Regulation (through the HSRAC and the Food Regulation Standing Committee) in mid-2019. mpconsulting sought targeted feedback on the draft recommendations – in particular, any comments on inaccuracies, factual errors and additional considerations or evidence that hadn’t previously been identified.

Draft Five Year Review Report – PDF 2928 KB
Draft Five Year Review Report – Word 21107 KB

A list of submissions for which confidentiality was not requested is below; submissions are available on request from the Front-of-Pack Labelling Secretariat via frontofpack@health.gov.au.

List of submissions: draft five year review report – PDF 110 KB
List of submissions: draft five year review report – Excel 13 KB
Five Year Review – Consultation

Detail on previous opportunities to provide feedback during and on the review are available on the Stakeholder Consultation page.

public submission process for the five year review was conducted between June and August 2017. mpconsulting prepared a report on these submissions and proposed a future consultation strategy. A list of submissions made is also available.

Submissions to the five year review of the HSR system – PDF 446 KB
Submissions to the five year review of the HSR system – Excel 23 KB

Report on Submissions to the Five Year Review of the Health Star Rating System – PDF 736 KB
Report on Submissions to the Five Year Review of the Health Star Rating System – Word 217 KB

5 Year Review of the Health Star Rating system – Future Consultation Opportunities – PDF 477 KB
5 Year Review of the Health Star Rating system – Future Consultation Opportunities – Word 28 KB

mpconsulting also prepared a Navigation Paper to guide Stage 2 (Wider Consultations Feb-Apr 2018) of their consultation strategy.

Navigation Paper – PDF 355 KB
Navigation Paper – Word 252 KB

Drawing on the early submissions and public workshops conducted across Australia and New Zealand in February- April 2018, mpconsulting identified 10 key issues relating to the products on which the HSR appears and the way that stars are calculated. A range of options for addressing identified issues were identified and, where possible, mpconsulting specified its preferred option. These issues are described in the Five Year Review of the Health Star Rating System – Consultation Paper: Options for System Enhancement.

Five Year Review of the Health Star Rating System – Consultation Paper: Options for System Enhancement – PDF 944 KB
Five Year Review of the Health Star Rating System – Consultation Paper: Options for System Enhancement – Word 430 KB

This Consultation Paper is informed by the TAG’s in-depth review of the technical components of the system. The TAG developed a range of technical papers on various issues identified by stakeholders, available on the mpconsulting website.

From October to December 2018, mpconsulting sought stakeholder views on the issues and the options, input on the impacts of the various options, and any suggestions for alternative options to address the identified issues. Written submissions could be made via the Australian Department of Health’s Consultation Hub.

mpconsulting held three further stakeholder workshops in Melbourne, Auckland and Sydney in November 2018 to enable stakeholders to continue to provide input on key issues for the review, including on options for system enhancements.
Five Year Review – Process

In April 2016, the Health Star Rating (HSR) Advisory Committee (HSRAC) commenced planning for the five year review of the HSR system.

Terms of Reference for the five year review follow:
Terms of Reference for the five year review of the Health Star Rating system – PDF 23 KB
Terms of Reference for the five year review of the Health Star Rating system – Word 29 KB

In September 2016, the HSRAC established a Technical Advisory Group (TAG) to analyse the performance of the HSR Calculator and respond to technical issues and related matters referred to it by the HSRAC.

HSRAC Members agreed that, in order to achieve a degree of independence, consultant(s) should be engaged to complete the review. In July 2017, following an Approach to Market process, Matthews Pegg Consulting (mpconsulting) was engaged as the independent reviewer.

The timeline for the five year review.
Five year review timeline – PDF 371 KB
Five year review timeline – Excel 14 KB

NACCHO Aboriginal Health #amafdw19 #Prevention #Smoking : At #NPC @AMApresident says the Federal Government must commit adequate resources to its proposed long-term national preventive health strategy :

“ Preventive health measures reduce the rate of chronic ill health and improve the health and wellbeing of all Australians, leading to better and healthier lives.

As a nation, we spend woefully too little on preventive health – around two per cent of the overall health budget.

A properly resourced preventive health strategy, including national public education campaigns on issues such as smoking and obesity, is vital to helping Australians improve their lifestyles and quality of life.

The Australian Government must commit adequate resources to its proposed long-term national preventive health strategy, and work with GPs to help improve the health of all Australians.

AMA President, Dr Tony Bartone, who addressed the National Press Club as part of Family Doctor Week, said the AMA is looking forward to working on the strategy, which Health Minister, Greg Hunt, first announced in a video message to the AMA National Conference in May.

Download full speech HERE

AMA President Press Club Address

” The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.”

SEE Part 2 below NATIONAL TOBACCO CONTROL SCOREBOARD 2019

Read over 130 Aboriginal Health and Smoking articles published by NACCHO in the last 7 years 

Part 1 AMA President, Dr Tony Bartone Prevention Press Release

“Family doctors – GPs – are best placed to manage preventive health, and can assist their patients in managing issues such as weight, alcohol consumption, physical activity, stress, substance use, and quitting smoking.

“Managing weight is a vital part of preventive health. Carrying excess weight contributes to cancers, high blood pressure, and musculoskeletal disorders like bad backs and neck pain. It also affects general health and wellbeing.

“Too many Australians drink at harmful levels, and this is dangerous to their health. Drinking in moderation, and within the guidelines, is a message all Australians should be aware of, and if you are worried about alcohol consumption, talk to your GP.

“Tobacco kills. There is no way to sugar coat the dangers of smoking. If you smoke, you increase your risk of coronary heart disease and cancer.

“Smoking can cause cancer of the lung, oesophagus, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum.

“If you want to quit smoking, start by seeing your family doctor.”

Dr Bartone will also announced the recipient of the 2019 Dirty Ashtray Award, which is presented to the government – Federal, State, or Territory – that has done the least over the past year to combat smoking.

AMA Family Doctor Week runs from 21 to 27 July 2019.

Background

  • In 2017-18, two-thirds of Australian adults and almost one-quarter of Australian children were overweight or obese.
  • Coronary heart disease is the nation’s leading single cause of death.
  • It is estimated that more than 1.2 million Australians have diabetes. The majority (85 per cent) have type 2 diabetes, which is largely preventable.
  • In 2013, diabetes contributed to 10 per cent of all deaths in Australia.
  • Tobacco is the leading cause of cancer in Australia.
  • In 2014-15, more than 1.6 million Australian males aged 15 years and over smoked, 90 per cent of whom smoked daily.
  • More than 1.2 million Australian females aged 15 years and over smoked, 91 per cent of whom smoked daily.
  • About one in 10 mothers smoked in the first 20 weeks of pregnancy.
  • In 2016, 57 per cent of daily smokers were aged over 40, and 20 per cent of daily smokers lived in remote and very remote areas of Australia.
  • Daily tobacco smoking has been trending downward since 1991, from 24 per cent to 12 per cent in 2016.
  • The proportion of people choosing never to take up smoking has increased to 62 per cent in 2016, from 51 per cent in 2001.
  • In 2016, almost one in three (31 per cent) current smokers aged 14 and over have used e-cigarettes.
  • Of current smokers in secondary school aged 16-17, more than one-quarter (26 per cent) smoked daily.

Sources: Australian Bureau of Statistics’ National Health Survey, Australian Institute of Health and Welfare, Heart Foundation.

 

Part 2 NATIONAL TOBACCO CONTROL SCOREBOARD 2019

To read all the states an Territories scores CLICK HERE

The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.

In contrast, the Queensland Government has achieved a remarkable hat trick by topping the scoring to win the coveted National Tobacco Control Scoreboard Achievement Award for leading the nation in tobacco control measures.

AMA President, Dr Tony Bartone, today released the results of the AMA/Australian Council on Smoking and Health (ACOSH) National Tobacco Control Scoreboard 2019 at the National Press Club in Canberra.

Dr Bartone congratulated Queensland on its strong consistent record in stopping people from smoking, and urged the Northern Territory to build momentum with its efforts on tobacco control, while noting the NT Government had amended and strengthened its tobacco control legislation earlier this year.

“The Queensland Government has continued to protect its community from second-hand smoke in a range of outdoor public areas including public transport, outdoor shopping malls, and sports and recreation facilities,” Dr Bartone said.

“Queensland Health is well ahead of other health services in recording smoking status, delivering brief intervention, and referring patients to evidence-based smoking cessation support such as Quitline.

“The Making Tracks – toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 – Policy and Accountability Framework indicates a commitment to reducing smoking among Indigenous communities.

“Funding continues for the B.Strong Brief Intervention training program to strengthen primary healthcare services for Indigenous smokers by increasing the brief intervention skills of health professionals, access to culturally effective resources, and referral to Quitline.

“A dedicated smoking cessation website – QuitHQ – has been developed for the Queensland community, which includes quit support, information for health professionals, and smoking laws. Promotion of QuitHQ includes on-line messages and billboards.”

Dr Bartone said that the Northern Territory is showing signs of moving ahead with stronger tobacco control programs, but we are yet to see solid action and proper funding.

“The NT Government has  published a new Tobacco Action Plan 2019-2023 stressing the need for  media campaigns, smoke-free spaces, sustaining quit attempts and preventing relapse, and identifying priority populations,” Dr Bartone said.

“But these good intentions are yet to be backed with the necessary funding.”

Dr Bartone said the AMA would like to see the Federal Government take on a greater leadership role to drive stronger nationally coordinated tobacco control to stop people smoking and stop people taking up the killer habit.

“The Federal Government has not run a major, national media campaign against smoking since 2012-13, when plain packaging was introduced,” Dr Bartone said.

“Nor has it implemented any further product regulation or constraints on tobacco marketing in that time.

“We would like to see the National Tobacco Campaign reinstated with additional and sustained funding.

“The $20 million announced during the Federal election health debate is a welcome start, but falls well short of the $40 million a year that is needed for a sustained public education program.

“That is a mere 0.24 per cent of the $17 billion the Government expects to reap from tobacco taxes in 2019-20.

“The Government should also implement a systemic approach to providing support for all smokers to quit when they come into contact with health services.

“These key ingredients should be part of the Minister’s commitment, first announced at the AMA National Conference in May, to develop a National Preventive Health Strategy in consultation with the AMA and other health and medical bodies.

“Smoking remains the leading cause of preventable death and disease in Australia, causing 19,000 premature deaths each year.

“Two-thirds of all current Australian smokers are likely to be killed by their smoking. That is a staggering 1.8 million people.

“While Australia is a world leader in tobacco control, more needs to be done to help people quit smoking, or not take it up in the first place.

“Big Tobacco is attempting to distract attention from evidence-based measures that will reduce smoking, while promoting itself as being concerned about health.

“This is particularly outrageous from an industry whose products kill more than seven million people each year.

“It is crucial that Australia maintains its strong evidence-based policies and avoids being diverted by Big Tobacco’s new distraction strategies, particularly following disturbing evidence from the US and Canada about the epidemic of youth e-cigarette use.

“We must remain vigilant against any attempts to normalise smoking, or make it appealing to young people.

“This includes following the advice of the National Health and Medical Research Council and the Therapeutic Goods Administration in regulating e-cigarettes, and not allowing them to be marketed as quit smoking aids until such time as there is scientific evidence that they are safe and effective.”

The AMA/ACOSH National Tobacco Control Scoreboard is compiled annually to measure performance in combating smoking.

Judges from the Australian Council on Smoking and Health (ACOSH), the Cancer Councils, and the National Heart Foundation allocate points to the State, Territory, and Australian Governments in various categories, including legislation, to track how effective each has been at combating smoking in the previous 12 months.

No jurisdiction received an A or B rating this year or last year.

AMA/ACOSH Award – Judges’ Comments

This year is the Silver Anniversary of the AMA/ACOSH National Tobacco Control Scoreboard. 

Since the introduction of the Award in 1994, daily smoking in Australia has halved from 26.1% in 1993 to 12.8% in 2016.

Importantly, the proportion of 12 to 17-year-old school students who have never smoked in their life has increased significantly from 33% in 1984 to 82% in 2017.

Australia has led the world in its implementation of a comprehensive approach to reduce smoking.

Since the early 1990s, Australia has implemented the following strategies to reduce smoking, many of which have been duplicated in other countries around the globe:

We call on the Australian, State and Territory Governments to implement the following recommendations:

  • allocate adequate funding from tobacco revenue (predicted to be $17 billion in 2019/2020) to ensure strong media campaigns at evidence-based levels;
  • ban all remaining forms of tobacco marketing and promotion and legislate to keep up with innovative tobacco industry strategies;
  • implement tobacco product regulation to decrease the palatability and appeal of tobacco products;
  • implement comprehensive action, including legislation, in line with Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect public health policy from direct and indirect tobacco industry interference, and ban tobacco industry political donations;
  • implement positive retail licensing schemes for all jurisdictions;
  • implement best practice support for smoking cessation across all health care settings;
  • ensure consistent funding for programs that will decrease smoking among Aboriginal and Torres Strait Islanders and other groups with a high prevalence of smoking; and
  • ensure further protection for the community from the harms of second-hand smoke.

Results

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

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

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

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

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

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

Download the APP Research

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

Originally published HERE 

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

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

Key points : 

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

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

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

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

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

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

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

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

How it works

Take a Virtual Tour HERE

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

Dr Lee said immediate feedback was very helpful.

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

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

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

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

“I’m aware of the traps,” she said.

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

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

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

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

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

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

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

Taking it to the communities

The app is in its second phase of testing.

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

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

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

The location for the trial has not been made public.

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

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

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

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

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

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

NACCHO Aboriginal Health and #715HealthChecks 2 of 3 : Report 1 : Indigenous health checks and follow-ups : Report 2 Download @AIHW We contrast the geographical variation in Indigenous PPH and PAD with the variation in uptake of Indigenous-specific health checks at the local-area level

Report 1 : Indigenous health checks and follow-ups

Through Medicare (MBS item 715), Aboriginal and Torres Strait Islander people can receive Indigenous-specific health checks from their doctor, as well as referrals for Indigenous-specific follow-up services.

  • In 2017–18, 230,000 Indigenous Australians had one of these health checks (29%).
  • The proportion of Indigenous health check patients who had an Indigenous-specific follow-up service within 12 months of their check increased from 12% to 40% between 2010–11 and 2016–17.

See online date HERE or extracts Part 1 below 

Report 2 : Regional variation in uptake of Indigenous health checks and in preventable hospitalisations and deaths

Potentially preventable hospitalisations (PPH) and potentially avoidable deaths (PAD) are hospitalisations and deaths that are considered potentially preventable through timely access to appropriate health care.

While the risk of these health outcomes depends on population characteristics to some degree, relatively high rates indicate a lack of access to effective health care.

In Australia, Aboriginal and Torres Strait Islander people have PPH and PAD rates that are more than 3 times as high as those for non-Indigenous people.

All Indigenous Australians are eligible for Indigenous-specific health checks, which are a part of the Australian Government’s efforts to improve Indigenous health outcomes. The health checks are conducted by GPs and are listed as item 715 on the Medicare Benefits Schedule.

In this report, we contrast the geographical variation in Indigenous PPH and PAD with the variation in uptake of Indigenous-specific health checks at the local-area level (Statistical Area Level 3), by Primary Health Network and by state or territory.

Download the report aihw-ihw-216

Overall, areas with large Indigenous populations tend to have high rates of PPH and PAD and high uptake rates of Indigenous health checks. That areas with high rates of health checks also tend to have high rates of PPH and PAD may seem counterintuitive. However, any effects of the health checks on the rates of PPH and PAD are likely to become more apparent over time as there has recently been a dramatic increase in the rates of Indigenous health checks in many parts of Australia. It is reasonable to expect that there will be some lag time between an increase in the uptake of health checks and when positive effects on health outcomes can be seen.

We use a regression model to identify areas with unexpectedly high or low rates of PPH given the demographic composition of their populations and other characteristics of the areas (such as remoteness). Cape York, Tasmania and the northern parts of the Northern Territory stand out as regions with unexpectedly low rates of PPH. Regions with unexpectedly high rates include Central Australia, the Kimberley and some inner parts of Darwin, Perth and Brisbane.

Unexpectedly high or low rates of PPH can be due to a number of factors including:

  • performance of the local health-care services, including past performance affecting the health of local people
  • accessibility of hospitals and relative use of hospitals or other health-care services
  • people with poor health moving from areas without services to areas with services (for high rates)
  • unaccounted factors that influence the risk of PPH
  • data issues.

These factors are all potentially important. How they influence reported health outcomes needs to be better understood to ensure that policy and management decisions are based on the best available information.

Part 2

Aboriginal and Torres Strait Islander people can receive an annual health check, designed specifically for Indigenous Australians and funded through Medicare (Department of Health 2016).

This Indigenous-specific health check was introduced in recognition that Indigenous Australians, as a group, experience some particular health risks.

The aim of the Indigenous-specific health check is to encourage early detection and treatment of common conditions that cause ill health and early death—for example, diabetes and heart disease.

NACCHO note : Many of ACCHO’s throughout Australia offer incentives like Deadly Choices shirts to have a 715 Health Check 

During the health check, a doctor—or a multidisciplinary team led by a doctor—will assess a person’s physical, psychological and social wellbeing (Department of Health 2016). The doctor can then provide the person with information, advice, and care to maintain and improve their health.

The doctor may also refer the person to other health care professionals for follow-up care as needed—for example, physiotherapists, podiatrists or dieticians.

This report presents information on the use of:

  • health checks provided under the Indigenous-specific Medicare Benefits Schedule (MBS) item 715; and
  • follow-up services provided under Indigenous-specific MBS items 10987 and 81300 to 81360.

The data include all Indigenous-specific health checks and follow-ups billed to Medicare by Aboriginal Community Controlled Health services or other Indigenous health services, as well as by mainstream GPs and other health professionals.

Note that the data are limited to Indigenous-specific MBS items, so do not provide a complete picture of health checks and follow-ups provided to Indigenous Australians.

For example, Indigenous Australians may receive similar care through other MBS items (that is, items that are not specific to Indigenous Australians), or through a health care provider who is not eligible to bill Medicare (see also Data sources and notes).

Throughout the report, ‘Indigenous-specific health checks’ is used interchangeably with ‘health checks’ to assist readability. Similarly, ‘Indigenous-specific follow-ups’ is used interchangeably with ‘follow-ups’.

Indigenous-specific health checks and follow-ups: data summary

Number of health checks

In 2017–18, there were about 236,000 Indigenous-specific health checks provided to about 230,000 Aboriginal and Torres Strait Islander people. The minimum time allowed between checks is 9 months, and so people can receive more than 1 health check in a year.

Between 2010–11 and 2017–18, the number of Indigenous Australians receiving a health check more than tripled—from about 71,000 to 230,000 patients.

See More Info

Geographic variation

 

Figure 3 shows the rate of Indigenous-specific health checks by four different geographic classifications—state/territory, remoteness area, Primary Health Network (PHN), and Statistical Areas Level 3 (SA3s).

This analysis is based on the postcode of the patient’s given mailing address. As a result, the data may not reflect where the person actually lived—particularly for people who use PO Boxes. This is likely to impact some areas more than others, and will also have a greater impact on the SA3 data than the larger geographic classifications. See Data sources and notes for information on areas most likely to be affected.

In 2017–18:

  • across states and territories, the Northern Territory had the highest rate of Indigenous-specific health checks (with 38% of the Aboriginal and Torres Strait Islander population receiving an Indigenous health check), followed by Queensland (37%). Tasmania had the lowest rate (13%).
  • across PHNs, the rate of Indigenous-specific health checks ranged from 4% (in Northern Sydney) to 42% (in Western Queensland).

See More Info

Number of follow-ups

Health checks are useful for finding health issues; however, improving health outcomes also requires appropriate follow-up of any issues identified during a health check (Bailie et al. 2014, Dutton et al. 2016).

Based on needs identified during a health check, Aboriginal and Torres Strait Islander people can access Indigenous-specific follow-up services—from allied health workers, practice nurses, or Aboriginal and Torres Strait Islander Health practitioners—through MBS items 10987, and 81300–81360 (see also Box 2).

Indigenous Australians may receive follow-up care through other MBS items that are also available to non-Indigenous patients. For example, if a person is diagnosed with a chronic health condition, the GP might prepare a GP Management Plan, or refer the person to a specialist. Data in this report relate to Indigenous-specific items only.

In 2017–18, there were about 324,000 Indigenous-specific follow-up services provided to 133,000 Indigenous Australians. This was an increase from around 18,500 follow-ups provided to 9,900 patients in 2010–11 (Figure 7).

See more info 

NACCHO Aboriginal Health and #CancerAwareness : @JacintaElston @KelvinKongENT Hey you mob It’s ok to talk about #cancer – For assistance download #YarnforLife resources

“Yarn for Life aims to reduce feelings of shame and fear associated with cancer and highlights the importance of normalising conversation around cancer and encouraging early detection of the disease.

It also emphasises the value of support along the patient journey.”

Professor Jacinta Elston, Pro Vice-Chancellor (Indigenous), Monash University, said that finding cancer early gave people the best chance of surviving and living well.

“Yarn for Life seeks to empower Aboriginal and Torres Strait Islander people to participate in screening programs, discuss cancer with their doctor or health care worker openly, and if cancer is diagnosed, complete their cancer treatment.”

Australia’s first Australian Aboriginal surgeon Associate Professor Kelvin Kong, University of Newcastle : continued below 

Download Yarn for Life Resources HERE

Read over 80 Aboriginal and Torres Strait Islander Cancer Awareness articles published by NACCHO over past 7 years 

In a national first, Cancer Australia has launched Yarn for Life, a new initiative to reduce the impact of cancer within Aboriginal and Torres Strait Islander communities by encouraging and normalising discussion about the disease.

Cancer is a growing health problem and the second leading cause of death among Indigenous Australians who are, on average, 40 percent more likely to die from cancer than non-indigenous Australians.

The multi-faceted health promotion Yarn for Life has been developed by and with Indigenous Australians, and weaves the central message that it is okay to talk about cancer by sharing personal stories of courage and survivorship from Aboriginal and Torres Strait Islander people.

Yarn for Life features 3 individual experiences of cancer which are also stories of hope.

“While significant gains have been made with regard to cancer overall, Aboriginal and Torres Strait Islander people continue to experience disparities in cancer incidence and outcomes. Cancer affects not only those diagnosed with the disease but also their families, carers, Elders and community,” said Dr Helen Zorbas, CEO, Cancer Australia.

Associate Professor Kong said it was also important for health services to support better outcomes for Indigenous patients by being culturally aware.

“For Aboriginal and Torres Strait Islander people, health and connection to land, culture community and identity are intrinsically linked. Optimal care that is respectful of, and responsive to, the cultural preferences, sensitivities, needs and values of patients, is critical to good health care outcomes.”

The Yarn for Life initiative is supported by two consumer resources which outline what patients should expect at all points on the cancer pathway.

Yarn for Life will feature television, radio and social media resources designed to be shared with friends, family and the community, to carry on the Yarn for Life conversation online.

SEEING YOUR DOCTOR OR HEALTH WORKER

Finding cancer early gives you the best chance of getting better and living well. The good news is there are things you can do to find cancer early. If there are any changes in your body that could be due to cancer, it’s really important to have them checked out. Speak to your health worker about:

  • any new or unusual changes in your body
  • how you are feeling
  • whether you are in any pain
  • whether anyone in your family has or had cancer
  • any other problems that are worrying you.

Free screening programs

It’s also important that you and your family participate in screening programs for breast, bowel and cervical cancers.

You can find out more about these free programs including how old you need to be to participate at cancerscreening.gov.au. Remember most of us will need to go to a check-up or screening at some point in our lives—so there’s no shame in talking to family or friends about it as well as your health care worker.

 

NACCHO Aboriginal Health and #Racism : Aboriginal Health promotion footage use by Sunrise Breakfast Show @sunriseon7 could be seen by some in the Yirrkala community as “damaged goods” says judge

 

“ The group alleges that by using the footage in conjunction with the discussion on child abuse, Sunrise implied they abused or neglected children.

They also claim Seven breached their confidence and privacy in using the footage, originally filmed for the promotion of Aboriginal health, for its unintended purpose; and that the network breached Australian consumer laws by acting unconscionably.

Yolngu woman Kathy Mununggurr and 14 others filed the lawsuit in February, claiming they had been defamed after blurred footage of them was broadcast in the background of the panel discussion.

Watch CEO Pat Turner , Olga Havnen CEO Danila Dilba and James Ward appear on #Sunrise to respond to Indigenous child protection issues #wehavethesolutions March 2018

Plus Read Extra Coverage HERE

Aboriginal children shown in footage that accompanied a breakfast television segment on child abuse in Indigenous communities could be seen by some in the community as “damaged goods”, a judge has said.

A group of Aboriginal people from a remote community in the Northern Territory is suing Channel Seven over the Sunrise “Hot Topics” panel discussion hosted by Samantha Armytage on March 13 last year.

Originally published HERE

The segment followed public commentary by then-Assistant Minister for Children David Gillespie on non-Indigenous families adopting at-risk Aboriginal children and featured commentator Prue MacSween, who said a “fabricated PC outlook” was preventing white Australians from adopting Aboriginal and Torres Strait Islander children.

“Don’t worry about the people that would cry and hand-wring and say this would be another Stolen Generation. Just like the first Stolen Generation where a lot of people were taken because it was for their wellbeing … we need to do it again, perhaps,” MacSween said during the discussion, which also featured Brisbane radio host Ben Davis.

The segment sparked an intense backlash, including protests outside the Sunrise studios at Sydney’s Martin Place and condemnation from the Australian Communications and Media Authority.

During a strike-out application brought by Seven on Wednesday, Seven’s barrister, Kieran Smark, SC, said there were issues with claiming those in the footage could be identified.

But Justice Steven Rares said Aboriginal communities in remote parts of Australia, particularly the Northern Territory, were “much more integrated than the suburbs of this country”.

“You’ve got a whole community up there, most of whom will be able to recognise each other, some of whom watch Sunrise,” Justice Rares said.

The group from the Yirrkala community allege the children in the footage were also defamed, but Mr Smark said a reasonable person would not shun and avoid a person they perceived to be a child victim of assault.

Mr Smark said ordinary people would react to victims of abuse with sympathy and it would be “counter-intuitive” to avoid them.

But Justice Rares said members of the community “might not be as sympathetic as you say”.

“The fact is imputations of abuse reflect on, as I understand it as a member of the community, whether you want to associate with people who are victims of abuse, because they are going to be disturbed by that abuse,” Justice Rares said.

“People are not going to associate with people they feel are damaged goods.”

Justice Rares said Aboriginal people had “by far” the highest rates of incarceration in Australia and many of those imprisoned came from traumatised backgrounds.

He dismissed Seven’s application to strike out the group’s pleadings.

Barrister Louise Goodchild, representing the group, said interpreters would need to be brought down for the trial and foreshadowed expert evidence in relation to cultural shame being heard.

 

 

NACCHO Aboriginal Health and #ClosingTheGap : Aboriginal owned health promotion company @SparkHealthAus denied right to use Aboriginal flag and use of word ‘gap’for #ClothingTheGap : @theprojecttv

 

“ The flag represents much more than just a business opportunity. 

It’s been an important symbol to Aboriginal people for a really long time, a symbol of resistance, of struggle of pride, and that’s why we’ve got such a strong attachment.

One ( of the two companies ) is an international worldwide company [pursuing us] for using the word ‘Gap’ and the other is for trying to share our culture.

The purpose of Spark Health is to improve Aboriginal peoples lives.”

Spark Health founder and Gunditjmara woman Laura Thompson spoke to the The Australian and the ABC describing the two-pronged attack after the Koori Mail broke the story 

Koori Mail reporter Darren Coyne worked really hard over the past few weeks to break an important story about copyright of the Aboriginal flag : See Page 3 June 5 Edition

Read Download HERE 

Six weeks, six deadly health dares, six workouts, one grouse piece of merch! Spark Health Australia are proud to work with the ACCHOHealth Services team at the Wathaurong Aboriginal Co-Op in Geelong to deliver ‘I Dare Ya’, a six week health and well-being program

An Aboriginal business is fighting for the right to feature the Indigenous flag in its “Clothing the Gap” fashion designs, while also fending off a copyright attack from a global retail giant.

Spark Health, which is an Aboriginal-owned health promotion business, has been told by US-based retailer GAP INC that it cannot use the word “Gap’’ in its fashion line, which plays on the phrase “Closing the Gap’’ that is used to describe the efforts to improve the lives of Aboriginal and Torres Strait Islander Australians.

SAN FRANCISCO, CA – FEBRUARY 20: Gap clothing is displayed at a Gap store on February 20, 2014 in San Francisco, California. Gap Inc.

To add to its woes, the Preston-based profit-for-purpose outfit has been sent a “cease and desist” letter by Queensland-based WAM Clothing over its use of the Aboriginal flag in its clothing designs.

The copyright of the Aboriginal flag is owned by its designer, Harold Thomas, a Luritja man, who has licensed its use in clothing exclusively to WAM.

Ms Thompson said she wrote to Mr Thomas requesting permission to use the Aboriginal flag in August last year.

She said she was happy to pay a fee in order to replicate the design.

An online petition started by Spark Health, criticising the exclusive licensing of the flag to a non-indigenous company, has gathered more than 20,000 + signatures so far.

Sign the petition or see Part 3 Below

“This is a question of control,” the petition reads.

“Should WAM Clothing, a non-indigenous business, hold the monopoly in a market to profit off Aboriginal peoples’ identity and love for ‘their’ flag?”

Spark Health director of operations, Sarah Sheridan, who is not indigenous, said WAM was exploiting Aboriginal Australia.

“Non-indigenous Australians must listen to, and support the voices of Aboriginal people and back their self-determination,” she said.

“Rather than exploiting them in the way that WAM clothing currently are.”

A WAM spokesperson said it was obligated to enforce the copyright.

“In addition to creating our own product lines bearing the Aboriginal flag, WAM Clothing works with manufacturers and sellers of clothing bearing the Aboriginal flag — including Aboriginal-owned organisations — providing them with options to continue manufacturing and selling their own clothing ranges bearing the flag, which ensures that Harold Thomas is paid a royalty,” the spokesperson said.

WAM provided a statement from Mr Thomas, in which he said, as the designer, it was up to him to decide who could use the Aboriginal flag.

“As it is my common law right and aboriginal heritage right … I can choose who I like to have a licence agreement to manufacture and sell goods which have the Aboriginal flag on it,” he said.

WAM Clothing was co-founded by Ben Wootzer, whose previous company Birubi Art was found to be in breach of Australian consumer law after selling over 18,000 Aboriginal such as boomerangs and didgeridoos were in fact made in Indonesia.

GAP Inc did not respond to The Australian’s request for comment.

Part 2

New licence owners of Aboriginal flag threaten football codes and clothing companies

Indigenous reporter Isabella Higgins

From the ABC News

The Aboriginal flag is unique among Australia’s national flags, because the copyright of the image is owned by an individual.

A Federal Court ruling in 1997 recognised the ownership claim by designer Harold Thomas.

The Luritja artist has licensing agreements with just three companies; one to reproduce flags, and the others to reproduce the image on objects and clothing.

WAM Clothing, a new Queensland-based business, secured the exclusive clothing licence late last year.

Since acquiring it, the company has threatened legal action against several organisations.

The ABC understands WAM Clothing issued notices to the NRL and AFL over their use of the flag on Indigenous-round jerseys.

A spokesman for the NRL said the organisation was aware of the notices, but would not comment further.

The ABC has contacted the AFL, but no official response has been received.

WAM Clothing said simply it was “in discussions with the NRL, AFL and other organisations regarding the use of the Aboriginal flag on clothing”.

The Aboriginal flag has been widely used on the country’s sporting fields, carried by Cathy Freeman in iconic moments at the 1994 Commonwealth Games and 2000 Sydney Olympics.

It only became a recognised national flag in 1995 under the Keating government, but had been widely used by the Aboriginal community since the 1970s.

The Torres Strait Islander flag was also recognised as a national flag at this time, but the copyright is collectively owned by the Torres Strait Regional Council.

The move to adopt both flags as symbols of state was somewhat controversial at the time, with the then opposition leader John Howard opposing the move.

PHOTO: Indigenous artist Harold Thomas is the designer of the Aboriginal flag. (ABC News: Nick Hose)

Former head of the Australian Copyright Council Fiona Phillips said there could be an argument for the Government or another agency buying back the copyright licence from Mr Thomas.

“The fact that the flag has been recognised since 1995 as an official Australian flag takes it out of the normal copyright context and gives it an extra public policy element,” she said.

She said it was an image of significance to a large part of the nation and it was important there was some control to avoid potential exploitation.

“It’s quite unusual for copyright to be held by an individual and controlled by an individual rather than a government or statutory authority who, maybe for policy reasons, has other interests in mind,” Ms Phillips said.

“There has to be a way that Mr Thomas can be remunerated fairly but where other people can also have access to the flag.”

Fight to stop flag ‘monopoly’

A Victorian-based health organisation, Spark Health, which produces merchandise with the flag on it, was issued with a cease and desist notice last week and given three business days to stop selling their stock.

The flag represents much more than just a business opportunity, the organisation’s owner, Laura Thompson said.

“It’s been an important symbol to Aboriginal people for a really long time, a symbol of resistance, of struggle of pride, and that’s why we’ve got such a strong attachment,” Ms Thompson said.

PHOTO: Laura Thompson was given three days to cease and desist selling her merchandise. (ABC News: Loretta Florance)

The organisation started an online petition, that has attracted about 13,000 signatures, calling on Mr Thomas to stop the exclusive licensing arrangements.

“We want flag rights for our people, we’ve fought enough, we’ve struggled, we don’t want to struggle to use our flag now,” Ms Thompson said.

“We don’t want anyone to have a monopoly over how we use the Aboriginal flag. The fact they’re a non-Indigenous company doesn’t sit well with me.

WAM Clothing said it would work with all organisations, and provide them with options to continue manufacturing their own clothing ranges bearing the flag.

“WAM Clothing has obligations under its Licence Agreement to enforce Harold Thomas’ Copyright, which includes issuing cease and desist notices,” a spokeswoman for the company said.

Mr Thomas said it was his “common law right” to choose who he enters licensing agreements with.

PHOTO: Spark Health produced a range of clothing featuring the Indigenous flag to help fund its community programs. (ABC News: Loretta Florance)

Wiradjuri artist Lani Balzan designed the NRL’s St George Illawarra Indigenous jersey for four years.

She said it was a disappointing development and will make her reconsider her designs for the football club and other institutions in the future.

“Schools, when they buy their uniforms through me, we put the Torres Strait and the Aboriginal flag on both shoulders, so I don’t know if we will be allowed to do that anymore,” she said.

“It’s not just the flag, it’s what represents them and our culture and who we are, to have some non-Indigenous company get copyright, it’s really upsetting.

“It’s disappointing because it’s coming down to money and the flag doesn’t represent money, it represents us as Aboriginal people, and our culture and who we are.”

Conduct of WAM director’s former business ‘unacceptable’

One of the directors of WAM Clothing, Benjamin Wooster, is the former owner of the now defunct Birubi Arts, a company taken to court over its production of fake Aboriginal art.

In October last year, the Federal Court found Birubi Arts was misleading customers to believe its products were genuine, when in fact they were produced and painted in Indonesia.

At the time, the Australian Competition and Consumer Commission said Birubi’s conduct was “unacceptable”.

Weeks later Birubi Arts ceased operating, and the next month the director and a new partner opened a new business, WAM Clothing.

Birubi Arts company sold more than 18,000 fake boomerangs, bullroarers, didgeridoos and message stones to retail outlets around Australia between July 2017 to November 2017.

The case is due before court again this week, for a penalty hearing, which some lawyers expect could see a hefty fine handed down that could run into the millions.

The company is now in the hands of liquidators, and the ABC understands it “doesn’t have any capacity” to pay further debts.

The director of WAM Clothing is also in charge of another company, Giftsmate, which has the exclusive licence with Mr Thomas to reproduce objects with the Aboriginal flag on it.

Mr Thomas reiterated his support for all the companies he worked with.

“It’s taken many years to find the appropriate Australian company that respects and honours the Aboriginal flag meaning and copyright and that is WAM Clothing,” Mr Thomas said.

“I have done this with Carroll & Richardson [flag licensee], Gifts Mate and the many approvals I’ve given to [other] Aboriginal and Non-Aboriginal organisations.”

Part 3 Join us in the fight for #FlagRights, for #PrideNotProfit.

We’ve always said that our products are conversation starters. We never thought as tiny little Aboriginal-led business that we’d come under scrutiny for celebrating the Aboriginal Flag or using the word ‘gap’ in our name as we try to self-determine our futures while we work towards adding years to peoples lives.

Show your support, sign the petition

Part 4

 

NACCHO Aboriginal Health Promotion #ClosingTheGap and the #AHW Workforce : Download Research : How can we make space for Aboriginal and Torres Strait Islander community health workers in health promotion ?

“Too many white Australians think the door opens to opportunity from the outside, when you’ve got to be let into the door from the inside’.

Noel Pearson, Aboriginal activist, The Australian, 7 May 2015. (Bita, 2015)

 “ The ‘AHW’ role was first established in the Northern Territory and recognized by the Western health system in the 1950s (Topp et al., 2018).

It was formally incorporated into Australia’s national health system in 2008 (National Aboriginal and Torres Strait Islander Health Worker Association, 2016).

Individuals can become an AHW if they are pursuing or hold a Certificate III, IV or higher degree diploma in, for example, primary health care, public health or a specific area of practice such as mental health.

In the mainstream health care sector, AHWs serve in ‘health worker’ or ‘outreach’ roles, providing clinical services, community outreach and education to improve access, health outcomes and the cultural appropriateness of services (McDermott et al., 2015).

Some also have specified AHW positions in prevention and health promotion. But the delivery of Indigenous health promotion in Australia is best exemplified by the work of Aboriginal Community Controlled Health Organisations (ACCHOs).

ACCHOs are primary health care services operated by the local Aboriginal community that they serve (NACCHO, 2018).

Their approach to providing comprehensive and culturally competent services draws on the cultural knowledge, beliefs and practices of their communities, and aligns with the Ottawa Charter principles aimed at enabling communities to take control of their own health care needs (WHO, 1986).

 AHW positions within ACCHOs may, therefore, reflect the full range of role types outlined in Table 1.

It is primarily within ACCHO-developed community programmes that other types of CHW roles and models for their delivery have been implemented, for example, lay-leader or peer-to-peer education models (McPhail-Bell et al., 2017).

 Yet many of these initiatives are only documented in programme reports within the ‘grey literature’ with much of the work undertaken in Aboriginal health promotion remaining under-researched and underreported ” 

Read over 290 Aboriginal Health Promotion articles published by NACCHO over the past 7 years 

Read this full research paper online HERE

Article Contents

Download the PDF Copy

Aboriginal Health Workers and Promotion

Photo top banner

 ” Mallee District Aboriginal Services health promotion co-ordinator Emma Geyer and MDAS regional tackling Indigenous smoking worker Nathan Yates are on the lookout for a local “deadly hero”. Picture: Louise Barker

MALLEE District Aboriginal Services (MDAS) is on the hunt for a “deadly hero” who will be the face of a campaign to encourage more Indigenous residents to visit the service for regular health check-ups.

MDAS regional tackling indigenous smoking worker Nathan Yates said the overarching aim of the campaign was to boost the health of the local indigenous population.

“Deadly Choices in our terminology is about making a good choice so for this it’s about making really healthy lifestyle choices because it’s all about trying to bridge the gap between life expectancy of indigenous and non-indigenous people,” Mr Yates said

Picture and story originally published Here

Abstract

Despite a clear need, ‘closing the gap’ in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems.

Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services.

The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out.

This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes.

Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)—a role situated primarily within the clinical health system.

In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion.

We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion; one that is distinct from, but complementary to, that of AHWs in clinical settings.

We provide examples of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities.

We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.

Kirstin Kulka prepares fruit and salad wraps for children at Coen.

Selected extracts

Aboriginal and Torres Strait Islander cultures in Australia are acknowledged to be the oldest living cultures in the world (Australian Government, 2017a), maintaining thriving and diverse communities for over more than 60 000 years, and implementing land management practices that are exemplary in their sustainability and productivity (Pascoe, 2018).

Hereafter, we use the term Aboriginal to describe the many different clans that make up this diverse peoples, including those from the Torres Strait. Following the British invasion and subsequent colonization of Australia, Aboriginal people across the nation suffered a sudden and complete rupture to all aspects of life including kinship, language, spirituality and culture.

The resulting health disparities experienced by Aboriginal people since colonization, and the inequalities that contribute to them, are well documented (AIHW, 2015). Despite the preponderance of evidence as to these inequities there has been only marginal progress in implementing effective strategies to improve health (McCalman et al., 2016).

Not enough research has focused on how Aboriginal knowledge is reflected in health programmes and services, and there are continued calls for Aboriginal people to be leaders of health-promoting endeavours (National Congress of Australia’s First People, 2016; NHMRC, 2018).

However, combatting systemic racism and reorienting the institutions of the dominant non-Aboriginal culture—i.e. government, health care, education—to include Aboriginal people in decision making and to enable their leadership is proving to be an ongoing challenge in both global and local health settings (George et al., 2015). The opening quote of this paper draws attention to this often-contested issue.

Community ownership of decision making for health has long been recognized as key to addressing the social determinants of health that underlie health disparities (WHO, 1978). Internationally, community health workers (CHWs) enable community involvement in health systems—particularly among minority communities—and contribute to positive health outcomes in a variety of settings (Goris et al., 2013; Kim et al., 2016).

In the USA, for example, the Indian Health Service has funded American Indian ‘Community Health Representatives’ since 1968 (Satterfield et al., 2002).

These health workers provide links between communities and health services, and build trust, relationships and culturally appropriate education and care. Maori CHWs play a similar bridging role in New Zealand by linking community members with health interventions and clinical services, providing health education and also working alongside traditional healers and supporting tribal development (Boulton et al., 2009).

In Australia, CHWs are largely operationalized as Aboriginal Health Workers (AHWs), although there is considerable variation in the kinds of roles they perform. The result is that some AHWs experience inflated role expectations that can contribute to unmanageable workloads and stress, reduced job satisfaction, and barriers to integration with other members of the health workforce (Bailie et al., 2013; Schmidt et al., 2016).

Yet variations in role definition for CHWs, and the associated problems, are not unique to Australia (Topp et al., 2018) and are well documented in the broader global CHW literature (Olaniran et al., 2017; Taylor et al., 2017). This variation is problematic as it impedes research into how CHWs influence health outcomes.

In this paper, we explore the lack of differentiation in the global literature between the types of CHW roles both internationally and within the Australian context. Differentiating the various types of CHW roles has enabled us to articulate the need for a specific community health promotion role, one that is distinct from, but complementary to, that of AHWs in clinical settings.

The impetus for writing this paper came from the experiences of two of the authors (NT and JG), an Aboriginal and a non-Aboriginal woman, who have worked in partnership for more than 15 years delivering and evaluating health promotion programmes in Australia.

The challenges we experienced in creating Aboriginal CHW-type positions within two mainstream health promotion programmes caused us to question whether the focus on AHW roles had created unintended barriers to involving Aboriginal people in other opportunities to address health.

By detailing our experience in creating community-based, Aboriginal CHW positions in health promotion, we aim to draw attention to the systemic and institutional barriers that impede expanding employment opportunities for Aboriginal people wanting to work in health.

The National Tackling Indigenous Smoking Workers Workshop was held from Tuesday 2 April to Thursday 4 April 2019 in Alice Springs. This workshop was one of the largest gatherings of TIS workers, partners, experts and supporters of the TIS program.

CHWs AND AHWs

Broadly, CHWs are individuals who may or may not be paid, who work towards improving health in their assigned communities and who often share some of the qualities of the people they serve. These may include similar cultural, linguistic or demographic characteristics; health conditions or needs; shared experiences or simply living in the same area.

However, the degree to which CHWs demographic or experiential profiles ‘match’ the target population also varies. And while most bring cultural and community knowledge to the role, many CHWs have little or no training in Western medicine or in navigating its health systems prior to becoming CHWs (Olaniran et al., 2017).

There is less agreement on the specifics of the CHW role including what they do, how they are trained, how these parameters link to outcomes, and even the titles they are given. One review evidenced 120 terms used to describe CHW roles including variants of ‘lay health educators’, ‘community health representatives’, ‘peer advisors’ and ‘multicultural health workers’ (Taylor et al., 2017).

Syntheses of literature on CHWs illustrate that the tasks they undertake are highly varied but often inadequately or inconsistently defined (Jaskiewicz and Tulenko, 2012; Kim et al., 2016). These issues, coupled with a general lack of contextual information about the role of CHWs, make it difficult to determine patterns or predictors of success.

This lack of clarity is documented as an ongoing barrier to the sustainability of CHW programmes, sometimes causing negative impacts on the workers themselves including burnout due a lack of appropriate training and mentoring support (Jaskiewicz and Tulenko, 2012; Schmidt et al., 2016). One review concluded that ‘the [CHW] role can be doomed by overly high expectations, lack of clear focus, and lack of documentation’ [(Swider, 2002), p. 19].

Previous research has classified CHW roles into typologies of main tasks and activities performed (Olaniran et al., 2017; Taylor et al., 2017). These include providing: (i) social support, (ii) clinical care, (iii) service development and linkages, (iv) health education and promotion, (v) community development, (vi) data collection and research and (vii) activism.

In practice, CHW activities overlap substantially, and tasks regularly extend across categories—both formally and informally (Jaskiewicz and Tulenko, 2012). In Table 1, we present different CHW role types alongside the theoretical models that underpin each.

Linking roles to theory can help differentiate and specify the mechanisms by which CHWs are meant to influence health through the core tasks they perform, and the specific skills related to each task.

NACCHO Aboriginal #MentalHealth and #JunkFood : Increasing how much exercise we get and switching to a healthy diet can also play an important role in treating – and even preventing – depression

” The review found that across 41 studies, people who stuck to a healthy diet had a 24-35% lower risk of depressive symptoms than those who ate more unhealthy foods.

These findings suggest improving your diet could be a cost-effective complementary treatment for depression and could reduce your risk of developing a mental illness.

From the Conversation / Megan Lee

 ” NACCHO Campaign 2013 : Our ‘Aboriginal communities should take health advice from the fast food industry’ a campaign that eventually went global, reaching more than  20 million Twitter followers.”

See over 60 NACCHO Healthy Foods Articles HERE

See over 200 NACCHO Mental Health articles HERE 

Worldwide, more than 300 million people live with depression. Without effective treatment, the condition can make it difficult to work and maintain relationships with family and friends.

Depression can cause sleep problems, difficulty concentrating, and a lack of interest in activities that are usually pleasurable. At its most extreme, it can lead to suicide.

Depression has long been treated with medication and talking therapies – and they’re not going anywhere just yet. But we’re beginning to understand that increasing how much exercise we get and switching to a healthy diet can also play an important role in treating – and even preventing – depression.

So what should you eat more of, and avoid, for the sake of your mood?

Ditch junk food

Research suggests that while healthy diets can reduce the risk or severity of depression, unhealthy diets may increase the risk.

Of course, we all indulge from time to time but unhealthy diets are those that contain lots of foods that are high in energy (kilojoules) and low on nutrition. This means too much of the foods we should limit:

  • processed and takeaway foods
  • processed meats
  • fried food
  • butter
  • salt
  • potatoes
  • refined grains, such as those in white bread, pasta, cakes and pastries
  • sugary drinks and snacks.

The average Australian consumes 19 serves of junk food a week, and far fewer serves of fibre-rich fresh food and wholegrains than recommended. This leaves us overfed, undernourished and mentally worse off.

Here’s what to eat instead

Mix it up. Anna Pelzer

Having a healthy diet means consuming a wide variety of nutritious foods every day, including:

  • fruit (two serves per day)
  • vegetables (five serves)
  • wholegrains
  • nuts
  • legumes
  • oily fish
  • dairy products
  • small quantities of meat
  • small quantities of olive oil
  • water.

This way of eating is common in Mediterranean countries, where people have been identified as having lower rates of cognitive decline, depression and dementia.

In Japan, a diet low in processed foods and high in fresh fruit, vegetables, green tea and soy products is recognised for its protective role in mental health.

How does healthy food help?

A healthy diet is naturally high in five food types that boost our mental health in different ways:

Complex carbohydrates found in fruits, vegetables and wholegrains help fuel our brain cells. Complex carbohydrates release glucose slowly into our system, unlike simple carbohydrates (found in sugary snacks and drinks), which create energy highs and lows throughout the day. These peaks and troughs decrease feelings of happiness and negatively affect our psychological well-being.

Antioxidants in brightly coloured fruit and vegetables scavenge free radicals, eliminate oxidative stress and decrease inflammation in the brain. This in turn increases the feelgood chemicals in the brain that elevate our mood.

Omega 3 found in oily fish and B vitamins found in some vegetables increase the production of the brain’s happiness chemicals and have been known to protect against both dementia and depression.

Salmon is an excellent source of omega 3. Caroline Attwood

Pro and prebiotics found in yoghurt, cheese and fermented products boost the millions of bacteria living in our gut. These bacteria produce chemical messengers from the gut to the brain that influence our emotions and reactions to stressful situations.

Research suggests pro- and prebiotics could work on the same neurological pathways that antidepressants do, thereby decreasing depressed and anxious states and elevating happy emotions.

What happens when you switch to a healthy diet?

An Australian research team recently undertook the first randomised control trial studying 56 individuals with depression.

Over a 12-week period, 31 participants were given nutritional consulting sessions and asked to change from their unhealthy diets to a healthy diet. The other 25 attended social support sessions and continued their usual eating patterns.

The participants continued their existing antidepressant and talking therapies during the trial.

At the end of the trial, the depressive symptoms of the group that maintained a healthier diet significantly improved. Some 32% of participants had scores so low they no longer met the criteria for depression, compared with 8% of the control group.

The trial was replicated by another research team, which found similar results, and supported by a recent review of all studies on dietary patterns and depression. The review found that across 41 studies, people who stuck to a healthy diet had a 24-35% lower risk of depressive symptoms than those who ate more unhealthy foods.

These findings suggest improving your diet could be a cost-effective complementary treatment for depression and could reduce your risk of developing a mental illness.

 

NACCHO Aboriginal Health Promotion  “Live Healthy. Live Long. Live Strong.” @KenWyattMP Officially launches the world’s first, Indigenous exclusively health-focussed television network – Aboriginal Health Television (AHTV) @TonicHealth_AU

” Engaging with our people in a culturally sensitive way is vital and SWAMS is always looking for new and innovative ways to do this on a large TV screen in our waiting rooms.

 After all we service more than 10,000 clients and average 50 new patients every month. Delivering important national and local health campaign messages and promotions via a digital TV channel saves lives. 

We can then follow up the patients with advice, clinical options and promotional material. We know that giving patients advice in their own language assists with their understanding of their health conditions and what services they can request from our clinical team.

Aboriginal Community Control even in health messaging is important and we will certainly make use of the offer to create our own unique promotional content.

I welcome the assistance provided from NACCHO to the Aboriginal Health Television Network about our needs, expectations and hopes that this service will help thousands of patients obtain the care they deserve in our health settings and WA hospitals.

South West Aboriginal Medical Service (SWAMS) CEO Lesley Nelson ( and NACCHO board member ) is proud that SWAMS is one of the first locations in Australia to have AHTV. See Full Speech Part 2 below 

  • Community Member Greg Vinmar
  • Federal Member for Forrest and Chief Government Whip, the Hon. Nola Marino MP
  • NACCHO Board Member for WA and South West Aboriginal Medical Service CEO, Lesley Nelson
  • Tonic Health Media Executive Director, Dr Norman Swan
  • Federal Minister for Indigenous Health, the Hon. Ken Wyatt AM, MP   (Front)

Media Coverage view HERE

Read previous NACCHO articles about Aboriginal Health Television (AHTV)

View Aboriginal Health Television (AHTV) website

www.aboriginalhealthtv.com.au

“The new network is an exciting step forward, built on local engagement, including local production of health and wellbeing stories, to reach the hearts and minds of our people and our families,

AHTV is a truly unique, ground-up opportunity to connect at the point of care and build stronger, healthier communities,”

Indigenous Health Minister Ken Wyatt AM spoke about the importance of AHTV from the South West Aboriginal Medical Service (SWAMS) in Bunbury, Western Australia, which is one of first 50 initial locations to install AHTV. It is expected the network will be broadcasting in 100 locations by May 2019. See full press release Part 3

WATCH AHTV HERE

Today the world’s first, Indigenous exclusively health-focussed television network – Aboriginal Health Television (AHTV) was officially launched by the Federal Minister for Indigenous Health, the Hon. Ken Wyatt AM, MP.

The Federal Government in July 2018 committed $3.4 million over three years to develop the targeted, culturally relevant AHTV network, which is expected to reach a First Nations’ audience of over 1.2 million people a month.

“The fundamental idea behind AHTV is to provide engaging, appropriate and evidence informed health content to Aboriginal people while they are waiting to see their health professional,” says Dr Norman Swan, Co-Founder of Tonic Health Media who is developing this not for profit network.

“We have evidence that this period in the waiting area is a time when people are most open to information which can improve their health and offer relevant questions to ask their health professional when they see them in the next few minutes.

“Our aim is to offer AHTV as a free, fully maintained service to all Aboriginal Community Controlled Health Organisations (ACCHOs) across Australia – around 300 locations. And it is already being rolled out, with SWAMS as one of our first. We know that our targeted messaging can make a big difference.

There’s nothing like knowledge to give people control over their decisions.

“AHTV, guided by its Advisory Group of highly respected Aboriginal health leaders and researchers, will continue to work closely with Aboriginal Peak Health Bodies and ACCHOs, to develop and deliver culturally relevant health messaging and lifestyle content.

“We are also partnering with third party content producers who specialise in Indigenous content to acquire and produce culturally relevant content,” Dr Norman Swan said.

Tonic Managing Director Dr. Matthew Cullen says the partnership is an important step towards Tonic’s goal of improving health outcomes for all Australians.

“AHTV provides a unique opportunity to communicate with Aboriginal audiences at the point of care when patients, their families, carers and health service providers are strongly focussed on health and wellbeing,” said Dr Cullen.

Aboriginal Health TV Advisory Group member, Associate Professor Chris Lawrence, says the delivery of a culturally relevant TV network that connects with Aboriginal and Torres Strait Islander communities will improve health outcomes.

“Australia has always been a world leader in health promotion. AHTV signals a new era in how health promotion messages are told and delivered to one of the world’s most vulnerable and at-risk populations.

“AHTV builds on this using digital technology to help close the gap, and improve the health and wellbeing of Indigenous Australians,” said Associate Professor Lawrence.

These sentiments were echoed by South West Aboriginal Medical Service (SWAMS) CEO Lesley Nelson who is proud that SWAMS is one of the first locations in Australia to have AHTV.

“Health promotion is a huge part of what we do at SWAMS, and we welcome any opportunity to communicate these important health messages to our clients,” Ms Nelson said.

“The fact that the content has been tailored to suit our local Aboriginal community means that our clients will benefit from health information that is relevant, culturally sensitive and meaningful to them. I strongly encourage Aboriginal Medical Services nation-wide to jump on board this fantastic initiative,” Ms Nelson added.

Jake Thomson, a proud Aboriginal man is playing a lead role in bringing AHTV to Indigenous communities. Belonging to the Wiradjuri Nation and growing up in Western Sydney, Jake is the Community Relationships Manager for AHTV.

“AHTV not only offers culturally relevant content, but it gives a voice to every community. By having the information they need, it will enable our people to consciously make the right choices, which in turn will lead to better health outcomes for Aboriginal and Torres Strait Islander people,” Jake said.

And that’s exactly the aim of AHTV. Its tagline “Live Healthy. Live Long. Live Strong.” is the message they are here to deliver.

Part 2 : South West Aboriginal Medical Service (SWAMS) CEO Lesley Nelson ( and NACCHO board member ) is proud that SWAMS is one of the first locations in Australia to have AHTV.

It is always a pleasure to welcome the Indigenous Health Minister to our South West Aboriginal Medical Service and staff from the Aboriginal Health Television Network. (Acknowledge any other VIPs in the audience).

Minister, this world first Aboriginal Health Television Network will assist our 70 staff who are based in six clinics to discuss with our patients’ topics like diabetes, dental health, sexual health, tobacco cessation, men’s and women’s health and heart health.

Engaging with our people in a culturally sensitive way is vital and SWAMS is always looking for new and innovative ways to do this on a large TV screen in our waiting rooms. After all we service more than 10,000 clients and average 50 new patients every month.

Delivering important national and local health campaign messages and promotions via a digital TV channel saves lives. We can then follow up the patients with advice, clinical options and promotional material.

We know that giving patients advice in their own language assists with their understanding of their health conditions and what services they can request from our clinical team.

Aboriginal Community Control even in health messaging is important and we will certainly make use of the offer to create our own unique promotional content. I welcome the assistance provided from NACCHO to the Aboriginal Health Television Network about our needs, expectations and hopes that this service will help thousands of patients obtain the care they deserve in our health settings and WA hospitals.

On behalf of the South West Aboriginal Medical Service and NACCHO I welcome the launch of this new world first service in our community by the Minister.

Part 3 NEW TV NETWORK CHANNELS GOOD HEALTH TO FIRST AUSTRALIANS

A new digital television network now rolling out across the nation aims to help Close the Gap in health equality by revolutionising the way hundreds of thousands of First Australians receive health information.

Today’s official launch of the Aboriginal Health TV (AHTV) network at the South West Aboriginal Medical Service in Bunbury, Western Australia, is backed by a three-year, $3.4 million commitment by the Liberal National Government, to ensure First Australian patients can access relevant health stories and advice at local treatment centres.

“The new network is an exciting step forward, built on local engagement, including local production of health and wellbeing stories, to reach the hearts and minds of our people and our families,” said Indigenous Health Minister Ken Wyatt AM.

“AHTV is a truly unique, ground-up opportunity to connect at the point of care and build stronger, healthier communities.”

The TV programs will be broadcast at Aboriginal Community Controlled Health Services around Australia.

Tonic Health Media (THM), the nation’s largest health and wellbeing network, is producing and commissioning targeted video content for AHTV, which is expected to be viewed by up to 1.2 million patients each month.

The programs on the new digital network feature issues including smoking, eye and ear checks, skin conditions, nutrition, immunisation, sexual health, diabetes, drug and alcohol treatment services and encourage the uptake of 715 health checks.

To ensure these important health messages reach as many people as possible content will also be repackaged for social media sites such as Facebook, Instagram and YouTube.

“South West Aboriginal Medical Service has been chosen as one of AHTV’s initial trial sites,” said Member for Forrest Nola Marino.

“This will add to the fantastic range of services that SWAMS already provides for the local community here in the South West.”

AHTV will be installed and maintained at no cost to local Aboriginal Community Controlled Health Services and plans to be self-sufficient within three years.

“It is expected the network will be broadcasting in 100 locations by May 2019, with the overall rollout planned for approximately 300 centres nationwide,” Minister Wyatt said.

“AHTV programming will also be available on Tonic Health Media’s existing platform which broadcasts in mainstream health services, meaning these important messages have the potential to reach the 50 per cent of our people who use non-Aboriginal medical services.”

Content licensing partnership agreements have been signed with ABC Indigenous and NITV and negotiations are underway with third-party production groups specialising in local Indigenous content.

The Liberal National Government’s AHTV commitment is part of the $3.9 billion dedicated to improving the health of Aboriginal and Torres Strait Islander people announced in the 2018-19 Budget.

For more details on the new network, see www.aboriginalhealthtv.com.au