Aboriginal Heart Health @AHPC_VU #HeartHealth: the first step in getting Australia’s health on track

 

” One Australian dies every 12 minutes from CVD including heart attack and stroke – 40 percent prematurely. People with type 2 diabetes are 3-4 times more likely to suffer a heart attack or stroke. People with CVD are also at risk of kidney disease.”

Australia spends more on cardiovascular diseases than on any other disease group (3). The costs of CVD amount to over 12% of all health care expenditure. In 2011, CVD was the second most burdensome disease group in Australia, causing 15% of the total $4.5 million disability-adjusted life years lost (4).

Diseases of the circulatory system are also closely associated with other major chronic health conditions such as diabetes, cancer, chronic obstructive pulmonary disease and arthritis.

This policy paper builds upon the work of the National Vascular Disease Prevention Alliance (NVDPA) and leading Australian health researchers to reinvigorate and reinforce the case for preventing CVD and its risk factors and in turn, to reduce disability, comorbidity and premature death.

These experts agree that the most important next step that the Australian Government should take to prevent and manage CVD is promoting an Absolute Cardiovascular Risk Assessment in primary practice.

The experts called for:

Targeted screening and treatment for absolute risk assessment of cardiovascular disease for adults aged 45–74 years and from 35 years for Aboriginal and Torres Strait Islanders in line with guidelines.”

Heart Health: the first step in getting Australia’s health on track

 ” The National Vascular Disease Prevention Alliance (NVDPA) has today supported calls for heart and stroke disease risk assessments to be embedded alongside type 2 diabetes and kidney disease risk assessment in routine GP visits for everyone over 45.

Australian Health Policy Collaboration (AHPC) released the policy paper Heart Health: the first step in getting Australia’s health on track in Canberra today.”

Download a copy : Heart Health: the first step in getting Australia’s health on track

 

AHPC-heart-health-policy-paper

Read over 30 Aboriginal Heart Health articles HERE

 ” Aboriginal and Torres Strait Islander people are up to three times more likely to suffer a stroke than non-Indigenous Australians and almost twice as likely to die, according to the Australian Bureau of Statistics “

Read over 70 Aboriginal Stroke Health articles HERE

Read over 130 Aboriginal Diabetes Health Articles HERE

The paper recommends a national investment in Absolute Cardiovascular Risk Assessment (ACVR) screening and outlines a national primary care strategy to reduce the impact of cardiovascular disease (CVD) on the community.

This paper builds on the NVDPA proposal for an integrated health check for cardiovascular disease, type 2 diabetes and chronic kidney disease.

NVDPA member and Stroke Foundation Chief Executive Officer Sharon McGowan said regular integrated health checks delivered by GPs will ensure people at high risk were identified and managed.

“Chronic diseases are Australia’s greatest health challenge and leading cause of illness, disability and death. However, much of this burden could be prevented through early detection and early treatment,’’ Ms McGowan said.

“Integrated health checks will help ensure Australians stay alive, stay well longer and stay out of hospital.”

AHPC Director Professor Rosemary Calder said embedding risk assessments into GP visits would be the single most effective strategy for chronic disease prevention.

The NVDPA and AHPC both recommend that integrated risk assessments be supported by the Medicare Benefits Schedule and promoted through the community and Primary Health Networks.

The AHPC Heart Health report was developed in collaboration with leading national clinical and policy experts and in consultation with the Royal Australian College of General Practice and the NVDPA.

The NVDPA includes the Stroke Foundation, the National Heart Foundation, Kidney Health Australia and Diabetes Australia.

The Heart Health report follows the AHPC’s policy roadmap, Getting Australia’s Health on Track, 2016 which aims to significantly reduce preventable illness and disability.

See NACCHO Aboriginal Health Alert #GetonTrack Report : The ten things we need to do to improve our health 

NACCHO Aboriginal Health and #RHD @RHDAustralia and @MenziesResearch release an educational short film on rheumatic heart disease in pregnancy

“I chose to help create this film because I wanted to help young women living with RHD and make sure they can access information about contraception, pregnancy and planning for a baby.

What is the take home message from the film?

“The film points out the main needs of a young woman living with RHD to help care for herself, her heart and her baby. The film re-assures young women with RHD that they can have a normal healthy pregnancy; they just need to take extra care of themselves.”

RHDAustralia sat down with one of the directors, Ms Kenya McAdam, a 21 year old Jaru and Kira woman from Halls Creek, Western Australia currently living in Katherine, Northern Territory.

See Kenya’s full story PART 2 Below

For Kenya this film was deeply personal and an intimate reflection on life as a young woman living with RHD. Kenya developed RHD at 15 years old and required open heart surgery within 3 months of diagnosis. Since that time, Kenya has worked with RHDAustralia to raise awareness about this 100% preventable disease.

The target audience for this film is girls and young women from ages 13 to 20s who have mild to moderate RHD

You can find these films and other important resources on the RHDAustralia resource page.

NACCHO and AMA support RHD Prevention

With Aboriginal and Torres Strait Islander Australians still 20 times more likely to die from RHD, the AMA’s call for firm targets and a comprehensive and consultative strategy is welcome. We encourage governments to adopt these recommendations immediately.

“As noted by the AMA, it is absolutely critical that governments work in close partnership with Aboriginal health bodies. Without strong community controlled health services, achieving these targets for reducing RHD will be impossible.

While this is a long term challenge, the human impacts on Aboriginal and Torres Strait Islander communities are being felt deeply right now. Action is required urgently.

NACCHO is standing ready to work with the AMA and governments to develop and implement these measures. We have to work together and we have to do it now.”

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson Matthew Cooke pictured above at Danila Dilba Health Service NT with AMA President Dr Michael Gannon

NACCHO Aboriginal Health #RHD : AMA Report Card on Indigenous Health highlights need for Aboriginal community controlled services

The RHD Story

A new film written and directed by a group of Northern Territory Indigenous women follows the story of Tess, a young women whose boyfriend, Jamie, reveals his desire to start a family.

While surprised and happy, she’s not told Jamie about her rheumatic heart disease (RHD).

She’s not sure how her heart disease will affect her pregnancy or if she can have a baby at all. Looking for answers, Tess turns to her best mate, her mum and the local health clinic for guidance on what to do next.

Will they have the answers?

The film will be launched in Bagot Community, Darwin on 6 October. Sharing a Heartbeat is freely available in English and Kriol with plans to make the film available in more Indigenous languages.

You can find these films and other important resources on the RHDAustralia resource page.  Additional print resources are linked with the English and Kriol through the resource page on our website.

By embracing two-ways learning and a spirit of cross cultural cooperation, RHDAustralia and Menzies School of Health Research are proud to announce the completion of the first ever   educational short film on rheumatic heart disease in pregnancy entitled Sharing a Heartbeat.

Hi Kenya, why did you decide to get involved in the creation of this film?

“I chose to help create this film because I wanted to help young women living with RHD and make sure they can access information about contraception, pregnancy and planning for a baby.

What is the take home message from the film?

“The film points out the main needs of a young woman living with RHD to help care for herself, her heart and her baby. The film re-assures young women with RHD that they can have a normal healthy pregnancy; they just need to take extra care of themselves.”

From a personal perspective, the film answered my unanswered questions. For other young women with RHD, I think it will help them understand more about approaching pregnancy.”

Having Kenya involved from the very start was central to ensuring the film was produced from a patient centric, woman centric and gender sensitive standpoint. But of equal importance was making certain it was developed to be culturally appropriate and safe. This was accomplished by including Indigenous women throughout the process, whether in the design, development, testing or making of the resource.

One of the key contributors alongside Kenya was Noeletta McKenzie whose daughter, Raychelle, was diagnosed with RHD four years ago at the age of nine. Noeletta’s been involved in numerous community development projects in Maningrida and Darwin and was quick to answer a call for assistance with the making of the film. “I saw the advertisement on the RHDAustralia Facebook page and enquired about how I could support with the development of the resource.” Noeletta helped to co-write the film and to guide and consult the actors on set.

When asked about why it was important to have Indigenous women involved in the making of the film she told us “I feel that as the resource is targeted at Indigenous young women, we needed to ensure that they were featured. It’s also about cultural safety and cultural context, educating our young women in our way.”
Leading by example, Noeletta is instilling these qualities into her daughter as well. When asked if the film has helped her daughter learn more about her RHD, Noeletta said “She’s well aware of the disease and how as a young woman it has affected her life. She would like to be a part of an advisory group to share her experience and pass on her knowledge.”

Acknowledgements

There were many people involving in the making of this film and we would like to thank the actors, directors, writers, and producers for producing such a well-crafted and meaningful film that is educational, culturally responsive, collaborative and meaningful. This film was produced by RHDAustralia and made possible with a grant from NTPHN.

Background

Literature reviews and content surveillance of health promotion material from Australia and New Zealand shows that there is very little information available for girls and women who have RHD. A recently completed study conducted by the Australian Maternity Outcomes Surveillance System (AMOSS) has shown that for Indigenous women in Australia, there are many misconceptions around rheumatic heart disease (RHD) and how it can impact their pregnancies.

Films directed by Indigenous women on any content are rare. Rheumatic heart disease is up to twice as common in women, and tends to affect women during their child bearing years. There is a 30-50% increased cardiac workload in normal pregnancy.

The target audience for this film is girls and young women from ages 13 to 20s who have mild to moderate RHD.

Part 2 Rheumatic heart disease a blight on Indigenous population

When Kenya McAdam wasn’t bedridden as a child, she would drag herself to school and sit in the classroom. “I wouldn’t move,” says the 21-year-old childcare worker, whose current good health is proof that she has survived rheumatic heart disease.

From The Australian

But Australia has a high level of the disease, which is caused by a bacterial infection of the throat and skin and is common in poverty-stricken nations.

Some of the nation’s leading medical researchers are meeting today in Darwin to create a plan to wipe out the life-threatening condition, which disproportionately affects indigenous Australians.

Pediatrician Jonathan Carapetis, who has led research efforts for 20 years, says young people such as Ms McAdam are up to 122 times more likely to contract the disease than non-indigenous youngsters. And it affects one in 43 indigenous people living in ­remote and rural Australia.

“It’s entirely preventable, yet the rates of this devastating condition among Aboriginal and Torres Strait Islander people are among the highest in the world,” says Professor Carapetis, director of Perth’s Telethon Kids Institute. “It should no longer exist in Australia.”

Rheumatic heart disease can result in permanent damage to the heart if it is not treated with antibiotics. It is caused by a bacterial infection of the throat and skin, which can result in heart failure and other complications, including stroke, without antibiotic treatment.

Ms McAdam’s life was saved by heart surgery to repair leaky valves after a cardiac arrest and years of breathlessness. “My mum thought that only older people suffer from heart attacks,” she said.

Her younger brother and sister must endure a painful penicillin injection every month for up to 10 years to prevent further infections.

But many affected indigenous youth fail to receive more than half their monthly penicillin requirement. More than 2600 ­people in the Northern Territory have rheumatic heart disease, while sufferers in Western Australia’s remote Kimberley Region are recorded as dying at an average age of 41.

Professor Carapetis said research institutes around Australia were collaborating on ways to prevent and treat streptococcus infections that lead to the disease, such as long-acting penicillin or an antibacterial vaccine.

Heather D’Antoine, from Menzies School of Health Research’s Aboriginal Programs, said today’s meeting to discuss lifesaving initiatives “can’t come soon enough”.

“The impact on our community is devastating; children must travel for heart surgery; young adults live with premature disability; and pregnant women face high-risk pregnancies,” she said.

NACCHO Aboriginal Health and #Obesity : Download #TippingtheScales Report Leading health orgs set out 8 urgent actions for Federal Government

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 30 + NACCHO Obesity articles published last 5 years

Read over 30+ NACCHO Nutrition and Healthy foods published last 5 years

Thirty-four leading community, public health, medical and academic groups have today united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking new action plan, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition (OPC) and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required. Areas include:

  1. Time-based restrictions on TV junk food advertising to kids
  2. Set clear food reformulation targets
  3. Make the Health Star Rating mandatory by July 2019
  4. Develop a national active transport strategy
  5. Fund weight-related public education campaigns
  6. Introduce a 20% health levy on sugary drinks
  7. Establish a national obesity taskforce
  8. Develop and monitor national diet, physical activity and weight guidelines.

OPC Executive Manager Jane Martin said the eight definitive policy actions in Tipping the Scales addressed the elements of Australia’s environment which set individuals and families up for unhealthy lifestyles, rather than just focusing on treating the poor health outcomes associated with obesity.

Watch video HERE : How does junk food marketing influence kids

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese. This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult,” Ms Martin said.

“The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 But Australia still has no strategy to tackle our obesity problem. It just doesn’t make sense.

“Without action, the costs of obesity and poor diet to society will only continue to spiral upwards. The policies we have set out to tackle obesity therefore aim to not only reduce morbidity and mortality, but also improve wellbeing, bring vital benefits to the economy and set Australians up for a healthier future.”

Professor of Epidemiology and Equity in Public Health at Deakin University, Anna Peeters, said the 34 groups behind the report were refusing to let governments simply sit back and watch as growing numbers of Australians developed life-threatening weight and diet-related health problems.

“For too long we have been sitting and waiting for obesity to somehow fix itself. In the obesogenic environment in which we live, this is not going to happen. In fact, if current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by diseases linked to overweight and obesity, such as type 2 diabetes, cancer heart disease, between 2011-20501,” Professor Peeters said.

“Obesity poses such an immense threat to Australia’s physical and economic health that it needs its own, standalone prevention strategy if progress is to be made. There are policies which have been proven to work in other parts of the world and have the potential to work here, but they need to be implemented as part of a comprehensive approach by governments. And they need to be implemented now.

“More than thirty leading organisations have agreed on eight priorities needed to tackle obesity in Australia. We would like to work with the Federal Government to tackle this urgent issue and integrate these actions as part of a long-term coordinated approach.”

In addition to the costs to society, the burden of obesity is felt acutely by individuals and their families.

As a Professor of Women’s Health at Monash University and a physician, Professor Helena Teede sees mothers struggle daily with trying to achieve and sustain healthy lifestyles for themselves and their families, while having to deal with the adverse impact of unhealthy weight, especially during pregnancy.

“As a mother’s weight before pregnancy increases, so does the substantive health risk to both the mother and baby. Excess weight gain during pregnancy further adds to these risks and is a key driver of infertility, long-term obesity, heart disease and type 2 diabetes, while for the child, their risk of becoming overweight or obese and developing chronic diseases in later life greatly increases,” Professor Teede said.

“The women I see are generally desperate for help to improve their lifestyle and that of their families. They want to set themselves and their families up for healthy, long lives.

“Currently, there is a lot of blame placed on individuals with unhealthy diets and lifestyles seen as being due to individual and family discipline. Women from all backgrounds and walks of life struggle with little or no support to achieve this. It is vital that we as a community progress beyond placing all responsibility on the individual and work towards creating a policy context and a society that supports healthy choices and tips the scales towards obesity prevention to give Australian families a healthy start to life.”

The calls to action outlined in Tipping the Scales are endorsed by the following organisations: Australian Chronic Disease Prevention Alliance (which includes the Heart Foundation, Cancer Council Australia, Kidney Health Australia, Diabetes Australia and the Stroke Foundation), Australian Health Policy Collaboration (AHPC), Australian Medical Students’ Association (AMSA), Australian & New Zealand Obesity Society (ANZOS), Australasian Society of Lifestyle Medicine, Baker Heart & Diabetes Institute, CHOICE, Consumers Health Forum of Australia, Deakin University’s Global Obesity Centre (GLOBE), Institute For Physical Activity and Nutrition (IPAN), Monash Centre for Health, Research and Implementation (MCHRI), LiveLighter, Menzies School of Health Research, The University of Melbourne’s Melbourne School of Population & Global Health, Melbourne Children’s (which includes The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute and the University of Melbourne), the National Rural Health Alliance Inc, Nutrition Australia, Obesity Australia, Obesity Policy Coalition, Obesity Surgery Society of Australia & New Zealand, Parents’ Voice, Public Health Association of Australia and Sugar By Half.

Download the Tipping the Scales action plan and snapshot at opc.org.au/tippingthescales


1. Obesity Australia. Obesity: Its impact on Australia and a case for action. No time to Weight 2. Sydney, 2015.

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 Research Alert : @NRHAlliance Aboriginal health risk factors #rural and #remote populations

 ” Health risk factors like smoking, excessive drinking, illicit drug use, lack of physical activity, inadequate fruit and vegetable intake and overweight have powerful influences on health, and there are frequently clear inter-regional differences between the prevalence of these.

While it can be argued that there is some degree of personal choice involved in whether individuals have a poor health risk profile, there is clear evidence that external factors such as environment, opportunity, and community culture each have very strong influences.

For example, access to affordable healthy food can often be poor in smaller communities and this, coupled with lower incomes in these areas, adversely affects the quality of peoples’ diets, the prevalence of overweight, and consequently the prevalence of chronic disease.”

From the National Rural Health Alliance Research View HERE

National data pertaining to personal health risk factors typically comes from the ABS National Health Survey and the AIHW National Drug Strategy Household Survey (NDSHS). Some State and Territory Health Departments run their own health surveys (which cannot be aggregated nationally with each other or with the ABS survey because of the different methodologies and definitions used (think different State rail gauges). Consequently data describing aspects of health in regional and especially remote areas can be thin (ie with imprecise estimates in some or all areas).

Example 1

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

Example 2

NACCHO provided graphic

Table 16 Below : Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59% )

At the time of writing, the most recent National Health Survey was conducted in 2014-15[1], while the most recent AIHW NDSHS[2] was conducted in 2016, with most recently available results from the 2013 NDSHS. The most recent ABS Australian Aboriginal and Torres Strait Islander Health Survey[3] was conducted in 2012-13.

Some organisations (eg the Public Health Information Development Unit (PHIDU)) have calculated modelled estimates for small areas (eg SLA’s and PHN’s), where the prevalence of some risk factors has been predicted based on the age, sex and socioeconomic profile of the population living there.

Some sites (eg ABS) present risk factor data as crude rates, other sites (eg PHIDU) present risk factor data as age-standardised rates.  The advantage of the age-standardised rates is that the effect of age is largely removed from inter-population comparisons.

For example, older populations (eg those in rural/regional areas) would be expected to have higher average blood pressure than younger (eg Major cities) populations even though the underlying age-specific rates happened to be identical in both populations (because older people tend to have higher blood pressure than younger people).

While crude rates for the older population will be higher, the age-standardised rates in such a comparison would be the same – indicating a higher rate that is entirely explainable by the older age of one of the populations.

Both crude and age standardised rates are useful in understanding the health of rural and remote populations.

 


[1] http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001

[3] http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocumentSmoking

Table 1: Smoking status, by remoteness, 2013 and 2014-15

MC

IR

OR/Remote

Percentage

Current daily smoker (18+) (crude) 2014-15 (a)

13.0

16.7

20.9

Current smoker (18+) (Age standardised) 2014-15 (b) (includes daily, weekly, social etc smoking)

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

Current smoker (daily, weekly, or fortnightly) 14+ (crude) 2013 (c)

14.2

17.6

22.6

24.6

Current smoker (daily, weekly, or fortnightly) 14+ (Age standardised) 2013 (d)

14.2

18.6

23.6

24.4

Mean number of cigarettes smoked per week, smokers aged 14 years or older 2013 (e)

85.9

113.1

109.4

126.2

Sources:

Compared with Major cities (13%), the prevalence of daily smoking by people 18 years and older in Inner regional (17%) and Outer regional/Remote areas (21%) is higher.

The NDSH survey reflects these trends albeit with a slightly different age group (14+) and a different definition of smoking (daily plus less frequently), but the NDSH survey adds detail for remote areas where smoking rates are higher again (around 25% versus around 23% in Outer regional).

In addition, the average number of cigarettes smoked by each smoker is higher in regional/rural areas (~110/week) than in Major cities (86/week), and higher again (126/week) in remote areas.

 

Smoking – exposure, uptake, establishment, quitting

Table 2: Smoking characteristics by Remoteness, 2013, 2014 and 2014-15

MC

IR

OR

remote

8.8

17.8

19.3

27.8

Proportion of pregnant women who gave birth and smoked at any time during the pregnancy (2013, crude, National Perinatal Data Collection, exposure tables, Table 5.1.2 )

8.5

17.0

18.9

27.5

Proportion of pregnant women who gave birth and smoked in the first 20 weeks of pregnancy (2013, crude, National Perinatal Data Collection) exposure tables, Table 5.2.2)

3.6

3.1

4.1

*9.4

Proportion of dependent children (aged 0–14) who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS exposure tables, Table 6.3)

2.5

2.0

2.7

*2.9

Proportion of adults aged 18 or older who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS, exposure tables, Table 7.3)

16.2

15.4

14.7

15.5

Average age at which people aged 14–24 first smoked a full cigarette (2013, crude, NDSHS, uptake tables, Table 9.3)

17.8

22.7

17.8

28.3

Proportion of 12–17 year old secondary school students smoking at least a few puffs of a cigarette (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, uptake tables, Table 10.3

54.7

61.1

64.9

67.2

Proportion of persons (aged 18 or older) who have smoked a full cigarette (2013, crude,  NDSHS, uptake tables, Table 10.8)

2.5

3.4

2.5

3.7

Proportion of secondary school students (aged 12–17) who have smoked more than 100 cigarettes in their lifetime (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, transition tables, Table 2.3)

20.2

25.9

44.1

45.2

Proportion of young people (aged 18–24) who have smoked more than 100 cigarettes in their lifetime (2013, crude, NDSHS, transition tables, Table 2.6)

21.3

16.8

19.0

15.5

Quitting: Proportion successfully gave up for more than a month (2013, crude, NDSHS, cessation tables, Table 4.3)

29.2

34.2

31.7

32.9

Quitting, Proportion unsuccessful (2013, crude, NDSHS, cessation tables, Table 4.3)

46.3

48.0

47.4

45.2

Quitting: Proportion any attempt (2013, crude, NDSHS, cessation tables, Table 4.3)

35.2

36.3

36.1

36.0

Mean age at which ex-smokers aged 18 or older reported no longer smoking (2013, crude, NDSHS, cessation tables, Table 11.2)

53.1

51.5

46.3

45.0

The proportion of ever smokers aged 18 or older who did not smoke in the last 12 months (2013, crude, NDSHS, cessation tables, Table 12.3)

4.9

6.0

4.8

7.0

Proportion of secondary school students (aged 12–17) who were weekly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 1.3)

6.9

9.3

6.8

10.4

Proportion of secondary school students (aged 12–17) who were monthly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 13.3)

13.0

16.7

21.2

18.8

Proportion of adults aged 18 or older who are daily smokers (2014-15, crude, ABS NHS, established tables, Table 3.3)

10.9

7.8

2.9

n.p.

Proportion of smokers aged 18 or older who are occasional smokers (smoke weekly or less than weekly) (2014-15, crude, ABS NHS, established tables, Table 14.3)

40.1

44.7

42.3

52.7

Proportion of Aboriginal and Torres Strait Islander people aged 18 or older who are daily smokers (2012-13, crude, ABS Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, established tables, Table 8i.3)

Source: http://www.aihw.gov.au/alcohol-and-other-drugs/data/ (sighted 11/7/17)
Note: Those estimates above with asterix have large standard errors and should be treated carefully.

Women in rural and remote areas were much more likely to smoke during pregnancy, with 28% of women in remote areas smoking during pregnancy, compared with 18-19% in regional/rural areas, and 9% in Major cities.

It is unclear whether exposure to environmental tobacco smoke varies by remoteness.

Young people outside major cities appeared to have their first cigarette at an earlier age (~15 years as opposed to ~16 years in Major cities.

Secondary school students in Inner regional (~23%) and remote (~28%) areas were more likely to have had at least a few puffs of a cigarette than those in major cities (~18%).

While 20% of young people in Major cities had smoked more than 100 cigarettes in their lifetime, 26%, 44% and 45% of young people in Inner regional, Outer regional and remote areas had done so.

People outside Major cities were as likely or slightly more likely to have attempted to quit smoking, but were less likely to be successful (and more likely to be unsuccessful).

A higher proportion of secondary students outside Major cities were weekly or monthly smokers (6%, 5% and 7% in IR, OR and remote areas versus 5% in Major cities weekly, 9%, 7%, and 10% in IR, OR and remote areas versus 7% in Major cities monthly).

Table 3: Current daily smoker, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness, 2012-13

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Prevalence of smoking amongst Aboriginal and Torres Strait Islander people 15 years and older is around 35%-40% in Major cities and regional/rural areas, and close to 50% in remote areas. Note that while the pattern is similar in Table 2 and Table 3 above, the figures for 18+ and 15+ year olds are slightly different.

Smoking Trends

Table 4: Comparison of declines in smoking rate estimates across remoteness areas, people 18+, based on ABS NHS surveys, 2001 to 2011-12

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

From Table 4 above, rates of smoking have clearly declined in Major cities areas, but have been slower to decline in Inner regional and Outer regional/Remote areas. Rates of smoking in rural areas, apparently static last decade, now appear to be declining. Rates in Major cities and Inner regional areas have declined to 0.59 and 0.76 times the 2001 rates in these areas. The 2014-15 rate in Outer regional areas is 0.79 times the 2001 rate.

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Source: ABS NHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ established tables, Table 3.3 (sighted 11/7/17)

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Source: AIHW NDSHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ tobacco smoking table S3.12 (sighted 11/7/17)

Note: Smokers include daily, weekly and less frequent smokers.

Figures 1 and 2 above both show clear declines in Major cities and Inner regional areas, but the trend in Outer regional and Remote areas is less clear, with ABS data showing a decline in daily smoking rates for people aged 18+ between 2007-8 and 2014-15, but NDSHS data showing little change in smoking rates for people 14+ between 2007 and 2013.

Alcohol

Table 5: Alcohol risk status, by remoteness, 2013 and 2014-15

Alcohol consumption

MC

IR

OR/Rem

Exceeded 2009 NHMRC lifetime risk guidelines, people 18+, crude %, 2014-15 (a)

16.3

18.4

23.4

Exceeded 2009 NHMRC lifetime risk guidelines, people 15+, age standardised %, 2014-15 (b)

15.7

17.4

22.0

Exceeded 2009 NHMRC single occasion risk guidelines, people 18+, crude %, 2014-15 (a)

42.7

48.5

46

MC

IR

OR

R/VR

Abstainer/ex-drinker, crude %, 14+, 2013 (c)

23.1

18.9

20.5

17.5

Low lifetime risk, crude %, 14+, 2013 (c)

60.2

62

56.9

47.6

High lifetime risk, crude %, 14+, 2013 (c)

16.7

19.1

22.6

34.9

low single occasion risk, crude %, 14+, 2013 (c)

40.4

41.8

38.1

30.8

Single occasion risk less than weekly, crude %, 14+, 2013 (c)

23.5

24.4

23.6

22.8

Single occasion risk at least weekly, crude %, 14+, 2013 (c)

13

14.9

17.8

28.9

Sources:

Table 6: Alcohol consumption against 2009 NHMRC guidelines, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness 2012-13

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

The figures in Table 6 are not strictly comparable with those for the total population in Table 5, because  Table 6 refers to people who are 15 years and older, while Table 5 refers to people who are 18 years and older.

The percentage of the 15+ ATSI population exceeding 2009 NHMRC Lifetime risk guidelines is around 15-20% with little apparent inter-regional variation, compared with, for the total population 18+,  16% in Major cities, increasing to 23% in Outer regional/remote areas.

The percentage of the 15+ ATSI population exceeding the 2009 single occasion risk guidelines is around 50-60%, and around 40% in Very remote areas, compared with, for the total population 18+,  40-50% in Major cities, rural and regional areas.

Alcohol trends

Table 7: Type of alcohol use and treatment for alcohol, by remoteness area (per 1,000 population)

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

Source: NDSHS,  http://www.aihw.gov.au/alcohol-and-other-drugs/data/  alcohol -supplementary data tables, Table S18

Notes:
Single occasion risk (monthly): Had more than 4 standard drinks at least once a month
Lifetime risk: On average, had more than 2 standard drinks per day
Very high risk (yearly): Had more than 10 standard drinks at least once a year
Very high risk (monthly): Had more than 10 standard drinks at least once a month
Very high risk (weekly): Had more than 10 standard drinks at least once a week

There is a clear increase in the prevalence of people who drink alcohol in such a way as to increase their single occasion risk (eg from car accident, assault, fall, etc) and their lifetime risk (eg from chronic disease – liver disease, dementia, cancer etc) as remoteness increases.

In 2013, single occasion risk ranged from 25% of people 14 years or older in major cities to 42% of people in remote areas, while lifetime risk increased from 17% in major cities to 35% in remote areas.

In 2013, The prevalence of people who drank more than 10 standard drinks in one sitting at least once per week, increased from just under 3% in Major cities to 7% in remote areas.

In 2013-14, there were just under 70 closed treatment episodes per 1,000 people living in Major cities, increasing to around 80 and 90 per 1,000 population in Inner and Outer regional areas, to 155 per 1,000 people living in remote Australia.

 

Illicit drug use 2013

Table 8: Illicit drug use, “recent users” 14+, 2013

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

Source: AIHW National Drug Strategy Household Survey, 2013. http://www.aihw.gov.au/alcohol-and-other-drugs/data/  Illicit drug use (supplementary) tables S5.6, S5.11, S5.17, S5.21, S5.26.

Note: * indicates large standard error (therefore some degree of uncertainty)

Illicit drug use appears to be higher in Outer regional and remote areas compared with Major cities and Inner regional areas, in large part due to higher rates of cannabis use in these areas, but with apparent lower use of ecstasy and cocaine in regional areas compared with Major cities.

 

Physical activity

Table 9: Physical inactivity, people 18+, 2014-15

MC

IR

OR/Remote

Percentage of people aged 18+ who undertook no or low exercise in the previous week (crude) (a)

64.3

70.1

72.4

Percentage of people aged 18+ who undertook no or low exercise in the previous week (age standardised) (b)

64.8

68.6

71

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that level of exercise is based on exercise undertaken for fitness, sport or recreation in the last week.

Physical inactivity appears to be more prevalent with remoteness, increasing from 65% of people in Major cities to 71% in Outer regional/remote areas.

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

Average daily steps, 18+ years, 2011-12 (a)

7,393

7,388

7,527

Average daily steps, 5-17years, 2011-12 (b)

9,097

9,266

9,160

Sources:

In 2011-12, adults living in Outer regional/Remote areas took slightly more steps than those living in Major cities or Inner regional areas, while the number of steps taken by children and adolescents in regional/Remote areas was slightly greater compared with those in Major cities.

Table 11: Average time spent on physical activity and sedentary behaviour by persons aged 18+, 2011-12

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

Notes:
(a) Includes walking for transport/fitness, moderate and vigorous physical activity.
(b) Sedentary is defined as sitting or lying down for activities.

Source: ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 5.1

Adults living in Inner regional and Outer regional/Remote areas were about as likely as (or very slightly less likely than) those in Major cities to be sedentary in their leisure time, but appeared to be slightly less likely to be sedentary overall (ie their work involved a greater level of physical activity).

Table 12: Whether children aged 2-17 years met physical and screen-based activity recommendations, 2011-12

MC

IR

OR/Rem

Crude percentage

Met physical activity recommendation on all 7 days(a)(b)

27.5

34.3

34.2

Met screen-based activity recommendation on all 7 days(b)(c)

28.0

29.7

31.0

Met physical activity and screen-based recommendations on all 7 days (a)(b)(c)

9.7

10.9

14.2

Notes:
(a) The physical activity recommendation for children 2–4 years is 180 minutes or more per day, for children 5-17 years it is 60 minutes or more per day. See Physical activity recommendation in Glossary.
(b) In 7 days prior to interview.
(c) The screen-based recommendation for children 2–4 years is no more than 60 minutes per day, for children 5-17 years it is no more than 2 hours per day for entertainment purposes.

Source:
ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 14.3

Children in rural and regional Australia appeared more likely (34% vs 28%) to meet physical activity recommendations and slightly more likely (30%vs 28%) to meet screen-based activity recommendations than their Major cities counterparts.

 

Fruit and vegetable consumption

Table 13: Fruit and vegetable consumption, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that adequacy of consumption is based on comparison with 2013 NHMRC guidelines.

Half of adult Australians eat insufficient fruit, with little clear difference between major cities and regional/rural areas.

Around 90% of adult Australians ate insufficient vegetables, with little clear difference between major cities and regional/rural areas.

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

 

 

Overweight and Obesity

Table 15: Overweight and Obesity, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Adults in rural/regional areas are more likely to be overweight or obese than people in Major cities (69% vs 61%).

However, there were inter-regional BMI and gender differences:

  • Compared with those in Major cities, males in Inner regional and especially Outer-regional areas were less likely to be overweight (41% and 34%, vs 44%) but much more likely to be obese (33% and 38% vs 26%).
  • Compared with those in Major cities, females in Inner regional and Outer-regional areas were about as likely to be overweight (~29%) but much more likely to be obese (~33% vs 25%).

 

Table 16: Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59%).

These figures compare with 61% – the prevalence of overweight/obesity for (predominantly non-Indigenous) people living in Major cities.

 

High blood pressure

Table 17: High blood pressure, people 18+, by Remoteness, 2014-15

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Age for age, people in rural/regional Australia appeared to be as likely, or very slightly more likely to have high blood pressure than their counterparts in Major cities (~23% vs ~24%). However, because people in rural/regional areas are older (on average), the prevalence of people with high blood pressure is higher (~26% vs 22%) than

Updated 31/07/2017
To view archived Risk Factors click here

NACCHO Aboriginal Remote Health : Governments urged to fund dialysis treatment in remote communities

 ” The premature death of Dr G Yunupingu could have been prevented if recommended funding models for dialysis services were already in place, his doctor has said.

With a new funding model to increase the service in remote communities currently under consideration, Dr Paul Lawton urged swift government action to assist in Yunupingu leaving a legacy.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change. ”

Reports Helen Davidson from Darwin writing in the Guardian  See Full report Part 1 Below

The case for change

Aboriginal and Torres Strait Islander people experience disproportionate levels of CKD regardless of urban, region or rural locality. Compared with the general population, Aboriginal and Torres Strait Islanders are four times more likely to have CKD and develop ESKD

In remote and very remote areas of Australia, the incidence of ESKD for Aboriginal and Torres Strait Islander people is especially high with rates almost 18 times and 20 times higher than those of comparable non-Indigenous peoples.

The greater prevalence of CKD in some Aboriginal and Torres Strait Islander communities is due to the high incidence of risk factors including diabetes, high blood pressure and smoking, in addition to increased levels of inadequate nutrition, alcohol abuse, streptococcal throat and skin infection and poor living conditions.

See Kidney Health Australia Recommendation

Download full Budget submission Kidney Health Australia

3. Investing in appropriate patient support services in remote and regional locations

In remote areas, 78% of patients have to relocate to access dialysis or transplant services, compared with 39% of those who live in rural areas and 15% of urban Indigenous ESKD patients.

Separation from country creates significant biological, psychological, social and economic consequences on the health and wellbeing of consumers, their families, communities the wider health and welfare system.

At present, there is inadequate support for Aboriginal and Torres Strait Islander patients to assist and support the renal pathway journey, including emotional and social support.

Incidence of new Indigenous patients starting kidney replacement therapy. 2010-2014

A Patients Opinion

” One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.”

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. see Health Authority responses below part 2 

See also :  Indigenous health organisations unite to improve remote dialysis treatment 

Part 1 :Dialysis funding could have prevented Dr G Yunupingu’s death, says doctor

The musician’s doctor says his premature death would have been prevented if he could have been cared for on his home island

The 46-year-old Gumatj musician and singer from remote Arnhem Land died in Royal Darwin hospital last Tuesday, after battling kidney and liver illnesses.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Media reports aired questions about how Yunupingu spent his last days before being hospitalised, but his doctor Paul Lawton said Yunupingu was in control of his health decisions even if they weren’t always on his doctor’s terms, and suffered being away from home.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change.

“Of course he would have been much happier not to have to have a legacy but to be home supported by family on Elcho Island. He may be alive today if that were possible,” he said.

“It could have been possible if there was a funding model that allowed that to happen. Such a funding model has been proposed, and it needs to be supported and agreed to by the minister forthwith.”

Indigenous Australians suffer kidney disease at rates up to 50 times that of non-Indigenous people. The rate of end-stage kidney disease is seven times higher for Indigenous people, and in very remote communities it is 30 times higher.

The number of people at end-stage is growing annually, forcing large numbers to travel into town centres for care, away from family, country, and culture.

“Every person from a remote community … when they end up in renal failure and have to start dialysis, the first thing people want to know is when and if they can get home and if they can receive treatment close to home,” Lawton said. “Dr Yunupingu was no different.”

In 2015 the federal government launched a review of more than 5,700 items on the Medicare Benefits Scheme to determine how they can be “aligned with contemporary clinical evidence and practice and improve health outcomes for patients”.

The review is led by expert panels exploring different areas of health, and has no mandate to find savings.

The expert panel on renal health has published its recommendations, including a new MBS item to provide dialysis in very remote areas by nurses, Aboriginal health practitioners and health workers.

The report noted the likelihood of direct costs of providing staffed dialysis services in very remote areas being much higher, but said no studies so far had considered the broader impact of relocating for treatment.

“It has undeniable social, economic and health consequences,” the report countered. “As a result of these social and economic costs, relocated patients often miss treatments, which has a negative impact on health outcomes.

“As requirements for dialysis can extend over many years, it makes sense to provide services where people live, have support and can continue to contribute to their communities.”

The report is open for public comment, and according to the department of health a final report will be delivered to the minister in December this year.

“It’s a big step forward potentially but one of the challenges in bureaucracies is that sometimes these things spend a lot of time going around in circles,” Lawton said.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

“But unfortunately we weren’t able to get him home to Elcho Island because supported dialysis is not available. And clearly a blind man can’t do dialysis themselves.”

PART 2

Access To Specialist Healthcare in the Kimberley For Desert People.

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. I live with my elderly wife and extended family. Mulan is our home.

For people living in very remote communities such as ours, English is a second or third language. Communication with mutual understanding is vital.

I’m sharing this story about our recent healthcare experiences so that frail persons don’t suffer as my wife did.

Recently my wife required a cardiac appointment in Broome.

This involved a morning flight from Mulan to Halls Creek; waiting for the Greyhound bus; then leaving at 10pm that evening to ride to Broome (8 hours to the west). All this was booked through the Patient Assisted travel Scheme office (PATS).

After her appointment my wife was left in Broome with no money, no return bus fare and no accommodation. She spent the night homeless. My wife was rescued by the local police who recognised she was hypoglycaemic and took her to Broome Hospital where she was stabilised.

With the help and intervention of a friend, PATS was contacted and a return bus fare was organised for that evening to Halls Creek where my wife was hospitalised for three days waiting for a flight back to Mulan. This could have been avoided with better planning, travel, accommodation and effective communication.

One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.

Kidney disease is a major health concern in our communities. My point is why can’t we have a dialysis machine in Balgo – our biggest community in the desert, 30 minutes from my community? This would reduce the number of patients and their carers travelling to a major town, so avoiding a lot of financial and other social situations. I know there are renal machines in other communities – it makes sense! In the long run, the money spent on transferring our mob across the Kimberley would surely pay for a machine and staff.

My wife will require ongoing medical care. Yet her experience is part of a much larger story where our younger people (who escort loved ones to towns for treatment) are subject to the vices a town offers. In going to town, many of them get lost from their cultural identity. Having services in country closer to home and keeping our families in community helps to avoid these social issues.

I hope that sharing our story will result in more effective planning and improved services in the future.

Response 1 to Mulan Man

Dear Mulan Man,

Firstly I want to apologise again for your wife’s experience in Broome. It was very good of your friend to notify us of your wife’s situation at the time, and I am pleased the PATS officer on the day was able to make contact with your wife and her escort to provide them with some refreshments and return tickets to Halls Creek. You are right, there was a communication issue in the arrangement of this trip, as the PATS staff had expected your wife to return to the PATS office directly after her appointment to retrieve her return ticket, but this was clearly not your wife’s expectation. We will work to improve this communication.

I would also like to thank you very much for engaging with us in this forum to share your story, which was clearly distressing, and yet also includes suggestions for improvement. Your story is a great example of what a forum like this can bring to the planning and delivery of health services.

The WA Country Health Service aims to provide care closer to home, where this is safe and feasible. We need to hear from the people living in communities like yours to be able to gain a real appreciation of the challenges you face, and work to ease your access to our services, either by better travel arrangements, or bringing the care closer to you.

Where possible, in new remote clinic builds or funded remote clinic refurbishments, we are ensuring there is the capacity for a dialysis room to accommodate home dialysis therapy on country. Examples of this are Wangkatjunka and Looma remote clinics. There are Renal Dialysis Hostels being built or already built in Kununurra, Fitzroy Crossing, Derby and Broome, to ease the burden of accommodation when people do need to attend the dialysis centres in those towns. WA Country Health Service is also developing a Renal Health Strategy, and will continue to work in close partnership with our renal service delivery providers.

I agree there are also opportunities for us to work more cohesively with other agencies in the Kimberley in undertaking the logistics of moving our consumers, equipment and those delivering care around the region. You have provided some very logical suggestions to resolve the issues you raised, and we would like to arrange to meet with you, and members of your community, to further identify the barriers you face accessing health care and your suggested solutions to those barriers.

You can contact me to discuss how to arrange this meeting. The other signatories to this reply will also attend to engage with you and your community.

Margi Faulkner, Broome Hospital Operations Manager

Dr David Gaskell, Kimberley Regional Medical Director

Carmen Morgan, Kimberley Regional Director of Nursing and Midwifery

Response 2

Dear Mr Mulan Man

We’ve had opportunity to talk together recently which I’ve valued.

Thanks to your help, I want to share here some of the changes we’ve made in improving our health services.

As you know, the Patient Assisted Travel Scheme (PATS) provides travel and accommodation subsidies to patients for whom specialist care is not locally available.

PATS is State-funded with one policy for all WA. All PATS staff are required to follow these State-wide rules. They seek to ensure a safe and planned journey when transporting clients from home to a health service and back.

PATS policy ensures that vulnerable patients can choose a family member as escort to accompany them. This escort is responsible for assisting the patient throughout the journey. Roles include assistance in communication, physical support, need for encouragement, and help with cultural needs. You have pointed out that some aboriginal people speak other languages more fluently than English (like Kukutja). PATS staff seek to identify need for a translator and so make necessary arrangements.

Yet there are many variables beyond our control which create uncertainty – like phone coverage, bus and plane operations, timings, the conduct of the escort and other people, or the weather. For the patient, navigating all this uncertainty only compounds the stress of suffering and separation from home. Of all this, I am mindful.

So, in response to the first part of your story, have we done anything to improve the provision and quality of our PATS services?

Yes, we have made several improvements. Here’s the current situation:

The PATS booking service has been increased from 5 days to every day of the week, from 0800hrs to 1600hrs, by phone or email. This ensures that, every day, a PATS officer is able to make a booking or assist a patient with their journey. We have extended the Aboriginal Liaison Officer (ALO) service from 5 days to every day of the week. ALO hours have been extended also. Broome now has 5 positions. Between them, they work every day, including weekends, from 0630 to 2200 hours. As this period covers the arrival and departure times of all scheduled Greyhound bus and plane services, an Aboriginal Liaison Officer is present to meet clients from their plane or bus and assist them with their onward journey. So transport home can be booked, our Aboriginal Liaison Officers inform all transiting clients to present to the PATS Front Office. With arrangements in place, patients return to and wait in the transit lounge. From there, an officer takes them to the bus or plane on time. Remoter health facilities do not have a PATS Office, of course, so the PATS team works closely with local staff to ensure that travel planning and documentation are explained clearly and in person to clients. A spare seat on the KAMS (Kalamunda Aeronautical Model Society) plane, when available, has been allocated to PATS clients and will be used for this purpose in the future. A major development just pre-dating your post was that WACHS Kimberley secured the Skippers Charter Plane service from Broome to Halls Creek via Fitzroy Crossing, 3 times weekly. This flight schedule had been at risk of closure.

Thanks for your engagement on and off line. I think that being in closer touch makes so much difference. I’m aware that your wife had an awful experience not long ago. I hope that she gains some peace of mind in knowing that you sharing her story has led to improvements which will help other patients on their travels to and from health care.

Regarding the need for dialysis care closer to home, we have spoken together. I need to post this now yet I wish to reassure you here that the ‘bigger picture’ is being looked at by all the key agencies – WA Department of Health, WA Country Health Service, Kimberley Aboriginal Medical Services overseeing the Kimberley Renal Service, and our visiting specialists from Royal Perth Hospital. Much thought and planning are going in to improving the delivery of quality-assured services closer to home. In the township of Fitzroy Crossing, for example, a new Renal Health Centre is soon to open with 4 dialysis chairs. Yet there are many communities (as in your desert community of Mulan in the Kutjungka) without access to a haemodialysis service nearby. We are acutely aware. All of us Kimberley Health providers want to deliver the State Government’s commitment to have a mobile dialysis unit operate here in the dry season, as soon as possible. This will allow dialysis patients to go home for a while so they can re-connect with family and friends on Country. Given the right resources, this will be delivered. I will keep in touch.

Would it be helpful if we meet together? If you would like this, if privileged to be invited, I will come to your Country soon.

With best wishes to you and your wife,

David

Dr David Gaskell

a/Regional Director, Regional Medical Director

WA Country Health Service, Kimberley

NACCHO Aboriginal Heart @RHDAustralia Health : #NAIDOC2017 In 11 languages health messages speak to patients

 

” After watching the acute rheumatic fever (ARF) ‘Important Health Message’ in his own language, Warlpiri, Jacob (aged 10), no longer fights when he is due for his regular benzathine penicillin G (BPG) injections.

The ARF ‘Important Health Message’ video is a short film with key messages for communities and families about the impact and prevention of ARF.

It is now available in eleven Indigenous languages.”

See Warlpiri Example HERE

Jacob was talking with Melissa Van Leeuwen, Clinical Nurse Consultant, during a telehealth session after his younger sister was also diagnosed with acute rheumatic fever. Jacob has heard this information before but this time was different. It was the first time Jacob had realised the consequence of not getting his injections. This is the power of in-language health messages.

Melissa said, “I love seeing how people come to understand about ARF and rheumatic heart disease (RHD) in their own languages. I’ve watched people start to nod and respond to different parts of the video. When asked prior to the video if they know anyone with ARF or RHD they often say no, but afterward many tell me they have family members and/or friends who have been affected by the disease.”

Melissa, a Clinical Nurse Consultant for the Northern Territory Rheumatic Heart Disease Control Program based in Alice Springs, uses the ‘Important Health Message’ video to help her clients understand the causes, symptoms and treatment of ARF and RHD.

Melissa gets lots of positive feedback from people hearing these messages in their own language.  Tanya, the mother of a six-year-old Melissa diagnosed with ARF, said, “Now I understand why my aunty is sick as well as my little girl”.  Often English is a second, third or even fourth language for Melissa’s patients. Terrin (aged 32) said, “I’m glad I could hear this in my language as English isn’t easy to understand”. And Terrance (aged 11) was very excited to hear the video in Warlpiri as the voice was his grandmother’s!

The Important Health Message video is available in English, Burarra, Anindilyakwa, Yolgnu Matha, Pitjantjatjara, Warlpiri, West Kimberley Kriol, Tiwi, Pintupi-Luritja, Murrinh Patha, Kunwinjku and Arrernte through the RHDAustralia resources database.

 

Benny’s Journey in English – Children’s cartoon Website Link
Benny’s Journey in Torres Strait Creole – Children’s cartoon Website Link
BPG Injection sites and methods video Website Link
Administering BPG: Injection sites and methods – Information flyer File Link
IHHP – Merredin “Gotta Keep it Strong”
Important Health Message: prevention of rheumatic fever: Arrernte Website Link
Important Health Message: prevention of rheumatic fever: Kunwinjku Website Link
Important Health Message: prevention of rheumatic fever: Murrinh Patha Website Link
Important Health Message: prevention of rheumatic fever: Pintupi-Luritja Website Link
Important Health Message: prevention of rheumatic fever: Tiwi Website Link
Important Health Message: prevention of rheumatic fever: West Kimberley Kriol Website Link
Important Health Message: prevention of rheumatic fever: Warlpiri Website Link
Important Health Message: prevention of rheumatic fever: Pitjantjatjara Website Link
Important Health Message: prevention of rheumatic fever: Yolgnu Matha Website Link
Important Health Message: prevention of rheumatic fever: Anindilyakwa Website Link

If you are unable to access the videos via YouTube and Vimeo please contact us at info@rhdaustralia.org.au for a downloadable file.

If you are interested in having the video translated into another language RHDAustralia can assist with the process of finding translators and adding the voice over to the video.

Aboriginal #MensHealthWeek @HeartAust @CancerCouncilOz : Make sure you have a regular #ACCHO health check fellas !

 ” Heart disease was the leading cause of death for Aboriginal and Torres Strait Islander people, who experience and die from cardiovascular disease at much higher rates than other Australians.

When compared with other Australians, Aboriginal and Torres Strait Islander people were 1.3 times as likely to have cardiovascular disease, three times more likely to have a major coronary event, such as a heart attack and more than twice as likely to die in hospital from coronary heart disease.”

Aboriginal Chronic Care Officer with Northern NSW Local Health District, Anthony Franks speaking at the #MensHealthWeek Heart Foundation sponsored workshop in Grafton : Workshop photos Colin Cowell NACCHO media

Part 1 Heart Foundation Aboriginal Resources

We have a a variety of information sheets about heart conditions and risk factors for Aboriginal and Torres Strait Islander peoples.

View and download the PDFs here, or call our Health Information Service on 1300 36 27 87 to order copies.

Part 2 For Cancer Council info see separate NACCHO Men’s Health promotion below

Let’s face it, your nuts don’t get a lot of love.

Give them a bit of a feel, it’s the polite thing to do. If something doesn’t feel right, go see an ACCHO  doctor. It’s an important step in detecting testicular cancer early

See info below or here

Pictured above Dave Ferguson from NACCHO Member Service  Bulgarr Ngaru AMS : Below some of the workshop participants with trainee doctors from Wollongong University experiencing Aboriginal health prevention

ABORIGINAL and Torres Strait Islander men are 19 times more likely to die from chronic rheumatic heart disease, so a series of workshops in Ballina and Grafton was held to raise awareness of the risk factors for heart disease among Aboriginal and Torres Strait Islander men.

It’s all part of a program across Northern NSW for Men’s Health Week which will run from June 12-19.

The workshops provided a comfortable environment for Aboriginal and Torres Strait Islander men to learn and ask questions about ways to reduce their chances of experiencing heart disease.

All workshop participants had to complete a health questionnaire and have a blood pressure test

“The idea of these workshops is to raise awareness around the different signs and symptoms of heart disease, and also around prevention and management of the disease,” Mr Franks said,

“This is a new, collaborative approach to addressing this issue, working together with existing avenues such as healthy lifestyle and exercise programs to assist participants to make the most of what they’ll be learning.”

At the workshops men will learn about the importance of heart health checks, stress reduction, quitting smoking and healthy eating from community health practitioners, hospital cardiac nurses, and other health practitioners in a culturally safe environment.

Examples of Men’s Health Week International

 

See Link or read below

What is testicular cancer?

Testicular cancer is the second most common cancer in young men (aged 18 to 39).1

The most common type is seminoma, which usually occurs in men aged between 25 and 50 years. The other main type is non-seminoma, which is more common in younger men, usually in their 20s.

In 2013, 721 new cases of testicular cancer were diagnosed in Australia. For Australian men, the risk of being diagnosed with testicular cancer by age 85 is 1 in 218. The rate of men diagnosed with testicular cancer has grown by more than 50% over the past 30 years, however the reason for this is not known.

The five-year survival rate for men diagnosed with testicular cancer is close to 98%.

In 2014, there were 23 deaths from testicular cancer.


Testicular cancer symptoms

Testicular cancer may cause no symptoms. The most common symptom is a painless swelling or a lump in a testicle.

Less common symptoms include:

  • feeling of heaviness in the scrotum
  • swelling or lump in the testicle
  • change in the size or shape of the testicle
  • feeling of unevenness
  • pain or ache in the lower abdomen, the testicle or scrotum
  • back pain
  • enlargement or tenderness of the breast tissue (due to hormones created by cancer cells).

Causes of testicular cancer

Some factors that may increase a man’s risk of testicular cancer include:

  • undescended testicle (when an infant)
  • family history (having a father or brother who has had testicular cancer).

There is no known link between testicular cancer and injury to the testicles, sporting strains, hot baths or wearing tight clothes.


Diagnosis for testicular cancer

Tests used to diagnose testicular cancer include:

  • ultrasound (to confirm the presence of a mass) and
  • blood tests for the tumour markers alpha-fetoprotein, beta human chorionic gonadotrophin and lactate dehydrogenase.

However, the only way to definitely diagnose testicular cancer is by surgical removal of the affected testicle. While many other types of cancers are diagnosed by biopsy (removing a small piece of tissue from the tumour), cutting into a testicle could spread the cancer to other parts of the body. Hence the whole testicle needs to be removed if cancer is strongly suspected.


Treatment for testicular cancer

Staging

In addition to the results of the diagnostic tests above, a chest X-ray and CT scans of the chest, abdomen and pelvis are done to determine whether and how far the cancer has spread.

Stage 1 means the cancer is found only in the testicle, stage 2 means it has spread to the lymph nodes in the abdomen or pelvis, and stage 3 means the cancer has spread beyond the lymph nodes to other areas of the body such as the lungs and liver.

If the cancer is found only in the testicle (stage 1), removal of the testicle (orchidectomy) may be the only treatment needed. If the cancer has spread beyond the testicle, chemotherapy and/or radiotherapy may be used as well.

Treatment team

Depending on your treatment, your treatment team may include a number of the following professionals:

  • GP who looks after your general health and coordinates specialist treatment
  • urologist who specialises in the treatment of diseases of the urinary system and male reproductive system
  • medical oncologist who prescribes chemotherapy treatment
  • radiation oncologist who prescribes radiation therapy
  • cancer nurses
  • endocrinologist who specialises in diagnoses and treatment of disorders of the endocrine system. For men who have had both testicles removed, this will include testosterone replacement
  • other health professionals such as dietitians, social workers and physiotherapists.

Palliative care

In some cases of testicular cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of testicular cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.


Screening for testicular cancer

There is no routine screening test for testicular cancer. While it is important to get to know the regular look and feel of your testicles and let your doctor know if you notice anything unusual, there is little evidence to suggest that testicular self-examination detects cancer earlier or improves outcomes.

 


Prognosis for testicular cancer

Prognosis means the expected outcome of a disease. An individual’s prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease.

All testicular cancers can be treated and most testicular cancers are successfully treated.


Preventing testicular cancer

There are no proven measures to prevent testicular cancer.


Source

Understanding Testicular Cancer, Cancer Council Australia © 2016. Last medical review of source booklet: September 2016.

Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.

1) Excluding non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries.

 

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.

 

 

 

Aboriginal Health : Second Atlas of Healthcare Variation highlights higher Aboriginal hospitalisation rates for all 18 clinical conditions

 

“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization

The most disturbing example of this  has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.

 Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.

 “Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Please note

  • Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status

DOWNLOAD Key-findings-and-recommendations

Mr Martin Bowles Secretary Dept of Health  launches the Second Australian Atlas of Healthcare Variation

A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.

“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.

“While there are a variety of factors contributing to these differences,  the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.

“These findings show that recommended care for chronic diseases is not always provided.  Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.

“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.

“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.

“The Atlas also examined  variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and  21-fold  difference in rates of endometrial ablation.  The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations.  These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758

 

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