NACCHO Aboriginal Health and #refreshtheCTGRefresh : Download the @AIHW National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017 showing improvements in 16 out of a possible 23 measures

Between June and December 2017, improvements were seen in 16 out of a possible 23 measures for which comparable data for both periods were available (see Table S1 for details). Results for a further indicator remained stable between reporting periods.

The improvements were seen in 12 of the 15 process-of-care measures with comparable data. Improvements were also seen in 4 of the 8 outcome measures, while 1 outcome measure remained stable. The largest improvements (4 or 5 percentage points) were seen in the recording practices for the measuring of:

  • influenza immunisations for clients with type 2 diabetes, which rose from 31% to 36%
  • influenza immunisations for clients with chronic obstructive pulmonary disease (COPD), which rose from 32% to 37%
  • influenza immunisations for clients aged 50 and over, which rose from 32% to 36%. ” 

 Extract from good news from AIHW Report

 Download full 158 page report HERE

aihw-ihw-200 (1)

Summary

This is the fifth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection. It presents data on all 24 nKPI indicators for the first time.

Data for this collection are provided to the Australian Institute of Health and Welfare (AIHW) by primary health care organisations that receive funding from the Australian Government Department of Health to provide services to Aboriginal and Torres Strait Islander people. Some primary health care organisations included in the collection receive additional funding from other sources, including state and territory health departments.

As of the June 2017 data collection, changes have been made to the data extraction method, with the Department of Health introducing a new direct load reporting process. This allowed Communicare, Medical Director, and Primary Care Information System (PCIS) clinical information systems (CISs) to generate nKPI data within their clinical system, and transmit directly to the OCHREStreams portal. Best Practice services were provided with an interim tool while MMEx has always had direct load capability.

61.9 % our ACCHO’s

The new process was introduced to provide a greater level of consistency between CISs, but the change in the extraction method means that data from June 2017 onwards are not comparable with earlier collections.

As the June 2017 collection represents a new baseline for the collection, this report only presents data for June and December 2017.

For 2 indicators (Kidney function tests recorded and Kidney function test results) only December 2017 results are presented due to unresolved data quality issues in June 2017.

See Chapter 2 for more information on the change in extraction method, data quality, and the impact  on the collection, and Appendix E for data improvement projects and the nKPI/Online Service Reporting (OSR) review under way.

Improvements were seen for most indicators between June and December 2017. Although data from these 2 reporting periods are not comparable with earlier reporting periods, an overall pattern of improvement is in keeping with the pattern of improvement previously reported for the period June 2012 to May 2015 (see AIHW 2017). This indicates that health organisations continue to show progress in service provision.

Things to work on

For the 3 process-of-care indicators that did not show improvements—glycated haemoglobin (HbA1c) result recorded (6 months), cervical screening, and Medicare Benefits Schedule (MBS) health assessment for those aged 0–4—the changes were very small (0.5, 0.4, and 0.1 percentage points, respectively).

In the case of cervical screening, this might be due to changes to the cervical screening program, which took effect from 1 December 2017 (see Chapter 4 for details).

Three outcome measures that did not show improvements—HbA1c result of 7% or less, low birthweight, and smoking status of women who gave birth in the previous 12 months—saw changes of between 0.8 and 1.8 percentage points.

Contents

  • 1 Introduction
    • The nKPI collection
    • Structure of this report
  • 2 Data quality
    • Data quality issues
    • Additional considerations for interpreting nKPI data
  • 3 Maternal and child health indicators
    • Why are these indicators important?
    • 3.1 First antenatal visit
    • 3.2 Birthweight recorded
    • 3.3 MBS health assessment (item 715) for children aged 0-4
    • 3.4 Child immunisation
    • 3.5 Birthweight result
    • 3.6 Smoking status of females who gave birth within the previous 12 months
  • 4 Preventative health indicators
    • Why are these important?
    • 4.1 Smoking status recorded
    • 4.2 Alcohol consumption recorded
    • 4.3 MBS health assessment (item 715) for adults aged 25 and over
    • 4.4 Risk factors assessed to enable cardiovascular disease (CVD) risk assessment
    • 4.5 Cervical screening
    • 4.6 Immunised against influenza-Indigenous regular clients aged 50 and over
    • 4.7 Smoking status result
    • 4.8 Body mass index classified as overweight or obese
    • 4.9 AUDIT-C result
    • 4.10 Cardiovascular disease risk assessment result
  • 5 Chronic disease management indicators
    • Why are these important?
    • 5.1 General Practitioner Management Plan-clients with type 2 diabetes
    • 5.2 Team Care Arrangement-clients with type 2 diabetes
    • 5.3 Blood pressure result recorded-clients with type 2 diabetes
    • 5.4 HbA1c result recorded-clients with type 2 diabetes
    • 5.5 Kidney function test recorded-clients with type 2 diabetes
    • 5.6 Kidney function test recorded-clients with cardiovascular disease
    • 5.7 Immunised against influenza-clients with type 2 diabetes
    • 5.8 Immunised against influenza-clients with chronic obstructive pulmonary disease
    • 5.9 Blood pressure result-clients with type 2 diabetes
    • 5.10 HbA1c result-clients with type 2 diabetes
    • 5.11 Kidney function test result-clients with type 2 diabetes-eGFR
    • 5.12 Kidney function test result-clients with type 2 diabetes-ACR
    • 5.13 Kidney function test result-clients with cardiovascular disease-eGFR
  • 6 Discussion
    • Data improvements
  • Appendix A: Background to the nKPI collection and indicator technical specifications
  • Appendix B: Data completeness
  • Appendix C: Comparison of nKPI results
  • Appendix D: State and territory and remoteness variation figures
  • Appendix E: Data improvement projects
  • Appendix F: Guide to the figures
  • Glossary
  • References

NACCHO Aboriginal #Heart Health #NACCHOagm2018 Report 2 of 5 @HeartAust #HeartMaps data release : Heart-related hospitalisations for Aboriginal and Torres Strait Islander Peoples are up to 4.5 x higher than non-Indigenous Australians

 
We know that locally led solutions harness and build on local strengths and wisdom. It is these locally-led solutions that will be the only way to successfully tackle these complex problems contributing to Aboriginal heart health outcomes.
Ultimately, the Heart Foundation believes everyone should be able to live a full and healthy life, no matter where they live or what their cultural background.” 

NACCHO CEO Patricia Turner

We cannot be complacent about the rates of heart disease being experienced by Aboriginal and Torres Strait Islander peoples, as heart disease is responsible for around one quarter of the gap in life expectancy compared to non-Indigenous Australians.
In some parts of Western Australia and the Northern Territory, the hospitalisation rates are over four times higher than for non-Indigenous people living in the same region.”

The new data now available on the Australian Heart Maps was released in Brisbane last week by the Heart Foundation’s Aboriginal Engagement Manager, Corey Turner, and Health Equity Manager, Jane Potter, at the annual conference of the National Aboriginal Community Controlled Health Organisation (NACCHO)

We want to work with communities, local Aboriginal Medical Services and health professionals, taking time to listen and understand the local issues that impact on heart health of communities. Our partners, including NACCHO, are key to this.

Partnerships with Aboriginal and Torres Strait Islander communities and health professionals are critical to addressing the current inequities in heart health says Corey Turner 

Indigenous Australians die from heart disease at double the rate of other Australians, and in some areas, at triple the rate of the rest of the community, according to new data released by the Heart Foundation today.

At a national level, Aboriginal and Torres Strait Islander people are admitted to hospital for a heart condition 2.6 times more often than non-Indigenous Australians.

Even more seriously, in most parts of Australia (33 regions out of 47) Indigenous Australians are hospitalised at rates above this national average. Indigenous women in the Northern Territory are hospitalised for heart conditions over six times more than other Australians.

Ms Potter said Aboriginal and Torres Strait Islander women were suffering the most. “In the Northern Territory alone, Indigenous women are being admitted to hospital with heart failure at six times the rate of non-Indigenous women in the Territory,” said Ms Potter.  “If people are living in the same region, with the same level of access to services, then we’ve got to ask the question – why are the health outcomes so different?”

The Heart Foundation says for Aboriginal and Torres Strait Islander people, there is a historical distrust of mainstream health services:

“This can mean that many will delay seeking medical help at their local clinic (if they have one) in time to prevent being hospitalised. They can also discharge themselves early against medical advice because they are so anxious about being in hospital, beginning a cycle of poor outcomes and repeat admissions.”

But there are broader issues too. “We know that heart health improves with a good education, secure employment, adequate housing and access to affordable healthy food,” Mr Turner said.

 “We know that 24 per cent of Aboriginal and Torres Strait Islander people aged over 15 reported having run out of food in the previous 12 months – in remote areas, as many as 36 per cent. People in remote areas pay the highest prices for food, particularly fresh fruit and vegetables, which are harder to come by.

“It is no coincidence that many of the regions with the highest hospitalisations rates also have lower rates of literacy and employment, as well as housing issues. It’s hard to prioritise your health when there are so many other hardships. These areas have entrenched social and economic challenges and many also have higher rates of smoking and obesity,” Mr Turner said.

Around the nation

  • Western Australia and the Northern Territory have the widest gap in hospitalisation rates between Indigenous and non-Indigenous Australians (almost 400 per cent). Western Australia also had five of the 10 regions with the widest gap.
  • Western Australia had the highest gap in death rates from heart disease, with Aboriginal and Torres Strait Islander peoples in the state dying from heart disease at nearly three times the rate of non-Indigenous West Australians.
  • Northern Territory had the highest rate of heart disease deaths among Indigenous peoples (175.1 per 100,000 people). This compares to NSW, which had the lowest rate (119.9 per 100,000 people). Victoria had the lowest rate of variation in hospital admission rates.
  • South Australia had the lowest difference in rates of heart disease deaths, but even there, Indigenous peoples had a 50 per cent higher risk of dying from heart disease than other Australians.

Filming at the NACCHO AGM Conference

The Heart Foundation is working with eighteen hospitals across Australia as part of the Lighthouse Hospital Project, which aims to create culturally safe experiences for Aboriginal and Torres Strait Islander peoples when they are admitted to hospital for heart problems.

View the Australian Heart Maps.

NACCHO Aboriginal Health and #WorldStrokeDay @strokefdn #UpAgainAfterStroke. One-third to a half of all our mob in their 40s, 50s and 60s are at high risk of future heart attack or stroke but the good news is more than 80 percent of strokes can be prevented.

 ” Around 80 million people living in the world today have experienced a stroke and over 50 million survivors live with some form of permanent disability as a result.

In Australia, stroke kills more women than breast cancer and more men than prostate cancer. It is the biggest cause of adult disability.

While for many, life after stroke won’t be quite the same, with the right care and support living a meaningful life is still possible.

As millions of stroke survivors show us every day, it is possible to get #UpAgainAfterStroke.

While the impact of stroke will be different for everyone, on World Stroke Day (29 October) we want to focus the world’s attention on what unites stroke survivors and caregivers, namely their resilience and capacity to build on the things that stroke can’t take away – their determination to keep going on the recovery journey.

Stroke Foundation World Stroke Day 

Download World Stroke Day 2018 Brochure

 

Recently released Australian National University research, found around one-third to a half of Aboriginal and Torres Strait Islander people in their 40s, 50s and 60s were at high risk of future heart attack or stroke. It also found risk increased substantially with age and starts earlier than previously thought, with high levels of risk were occurring in people younger than 35.

The good news is more than 80 percent of strokes can be prevented.

As a first step, I encourage all the mob to visit to visit one of our 302 ACCHO clinics , their local GP or community health centre for a health check, or take advantage of a free digital health check at your local pharmacy to learn more about your stroke risk factors.

On World Stroke Day we are urging all the mob to take steps to reduce their stroke risk.”

Colin Cowell NACCHO Social Media editor and himself a stroke survivor 3 years ago today 

 The current guidelines recommend that a stroke risk screening be provided for Aboriginal and/or Torres Strait Islander people over 35 years of age. However there is an argument to introduce that screening at a younger age.

Education is required to assist all Australians to understand what a stroke is, how to reduce the risk of stroke and the importance be fast acting at the first sign of stroke.”

Dr Mark Wenitong, Public Health Medical Advisor at Apunipima Cape York Health Council (Apunipima), says that strokes can be prevented through a healthy lifestyle and Health screening, and just as importantly, a healthypregnancy and early childhood can reduce risk for the child in later life.

Naomi Wenitong  pictured above with her father Dr Mark Wenitong Public Health Officer at  Apunipima Cape York Health Council  in Cairns:

Share the stroke rap with your family and friends on social media and celebrate World Stroke Week in your community.

Listen to the new rap song HERE  or Hear

The song, written by Cairns speech pathologist Rukmani Rusch and performed by leading Indigenous artist Naomi Wenitong, was created to boost low levels of stroke awareness in Aboriginal and Torres Strait Islander communities.

Stroke Foundation Chief Executive Officer Sharon McGowan said the rap packed a punch, delivering an important message, in a fun and accessible way.

“The Stroke Rap has a powerful message we all need to hear,’’ Ms McGowan said.

“Too many Australians continue to lose their lives to stroke each year when most strokes can be prevented.

“Music is a powerful tool for change and we hope that people will listen to the song, remember and act on its stroke awareness and prevention message – it could save their life.”

Ms McGowan said the song’s message was particularly important for Aboriginal and Torres Strait Islander communities who were over represented in stroke statistics.

Aboriginal and or Torres Strait Islanders are twice as likely to be hospitalised for stroke and are 1.4 times more likely to die from stroke than non-indigenous Australians. These alarming figures were revealed in a recent study conducted by the Australian National University.

There is one stroke every nine minutes in Australia and Aboriginal and Torres Strait Islander people are overrepresented in stroke statistics. Strokes are the third leading cause of death in Australia.

Apunipima delivers primary health care services, health screening, health promotion and education to Aboriginal and/or Torres Strait Islander people across 11 Cape York communities. These health screens will help to make sure you aren’t at risk  .

We encourage you to speak to an Aboriginal and/or Torres Strait Islander health Practitioner or visit one of Apunipima’s Health Centres or your nearest ACCO to talk to them about getting a health screen.

What is a stroke?

A stroke occurs when the blood flow to the brain is interrupted, depriving an area of the brain of oxygen. This is usually caused by a clot (ischaemic stroke) or a bleed in the brain (haemorrhagic stroke).

Brief stroke-like episodes that resolve by themselves are called transient ischaemicattacks (TIAs). They are often a sign of an impending stroke, and need to be treated seriously.

Stroke is a time-critical medical emergency. The longer a stroke remains untreated, the greater the chance of stroke-related brain damage. After an ischaemic stroke, patients can lose up to 1.9 million neurons a minute until blood flow to the brain is restored.

What to do in case of stroke?

Stroke is a time-critical medical emergency. The longer a stroke remains untreated, the greater the chance of stroke-related brain damage. After an ischaemic stroke, patients can lose up to 1.9 million neurons a minute until blood flow to the brain is restored.

The Australian National Stroke Foundation promotes the FAST tool as a quick way for anyone to identify a possible stroke. FAST consists of the following simple steps:

Face – has their mouth has dropped on one side?

Arm – can they lift both arms?

Speech – Is their speech slurred? Do they understand you?

Time – is critical. Call an ambulance.

But the good news is more than 80 percent of strokes can be prevented.

Part 3

WHEN Aboriginal elder Aunty Pam Smith first had a stroke she had no idea what was happening to her body.

On her way back to town from a traditional smoking ceremony, she became confused, her jaw slack and dribbling.

FROM HERE

Picture above : CARE: Coral and Bill Toomey at National Stroke Awareness Week.

“I started feeling headachey, when they opened up the car and the cool air hit me I didn’t know where I was – I was in LaLa Land,” she said.

A guest speaker at the Stroke Foundation National Stroke Awareness Week event in Tamworth, Ms Smith has created a cultural awareness book about strokes for other Aboriginal people.

Watch Aunty Pams Story

She hopes it will teach others what to expect and how to look out for signs of a stroke, Aboriginal people are 1.4 times more likely to die from stroke than non-Indigenous people.

But, most still don’t go to hospital for help.

“Every time we went to a hospital we were treated for one thing, alcoholism – a bad heart or kidneys because of alcohol,” Ms Smith said.

“We were past that years ago, we’re up to what we call white fella’s things now.”

Elders encouraged people to make small changes in their daily lives, to quit smoking, eat a balanced diet and drink less alcohol.

For Bill Toomey it was a chance to speak with people who understood what it was like to have a stroke. A trip to Sydney in 2010 ended in the Royal Prince Alfred Hospital when he was found unconscious.

Now in a wheelchair, Mr Toomey was once a football referee and an Aboriginal Health Education Officer.

“I wouldn’t wish a stroke on anyone,” Mr Toomey said.

“I didn’t have the signs, the face didn’t drop or speech.”

His wife Coral Toomey cares for him, she was in Narrabri when he was rushed to hospital.

“Sometimes you want to hide, sit down and cry because there’s nothing you can do to help them,” she said.

“You’re doing what you can but you feel inside that it’s not enough to help them.”

Stroke survivor Pam Smith had a message for her community.

“Please go and have a second opinion, it doesn’t matter where or who it is – go to the hospital,” she said.

“If you’re not satisfied with your doctor go to another one.”

NACCHO CEO Pat Turner and @END_RHD_CRE Co- Chair @jcarapetis call for a commitment to eliminate #RHD in Australia and clear plan of action and targets to measure progress

” Aboriginal and Torres Strait Islander children are 55 times more likely to die of rheumatic heart disease than other Australian children. We’re here today seeking a commitment from all political parties to stop this preventable disease from ever taking the life of another child in Australia.”

Aboriginal leaders are here to let politicians know that we are ready to partner with them, and that with their support, ending the disease is achievable,”

Ms Pat Turner AM, Co-Chair of END RHD and CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO), says comprehensive and collaborative action to tackle the disease is needed to ensure Aboriginal and Torres Strait Islander children are given the chance to reach their full potential.

 

See Pat Turner speech in full Part 4 Below

Three Aboriginal brothers – the youngest only three – who are living with deadly rheumatic heart disease (RHD) will today join community representatives, health workers and medical experts at Parliament House, asking for a commitment to end the disease in Australia.

Virtually eliminated from the rest of Australia and most wealthy countries decades ago, rheumatic heart disease remains a scourge in developing countries and remote Aboriginal and Torres Strait Islander Communities, where rates are among the highest in the world. RHD starts with a sore throat or skin sores but can end with permanent heart damage, open-heart surgery and death at a very young age.

Also speaking at the event is one of the world’s leading rheumatic heart disease researchers, Professor Jonathan Carapetis AM, Co-Chair of END RHD and Director of the Telethon Kids Institute, who says a nonpartisan commitment is the next step needed to tackle the disease in Australia.

“I’ve spent 25 years researching rheumatic heart disease, and I truly believe that we’ve never been in a stronger position to eliminate the disease in this country.”

“Aboriginal and Torres Strait Islander organisations are taking the lead and working hand in hand with communities. We researchers are bringing the evidence to support them. If there is one country in the world that should be able to eliminate RHD, it is Australia,” Professor Carapetis said.

The Snow Foundation CEO, Georgina Byron, said event participants are pleased that RHD has become a priority for the Australian Government.

“The Government’s commitment to developing a roadmap to eliminate RHD is a great start, but we need an urgent allocation in the 2019 Federal Budget to commit to immediate action, fund comprehensive primary health care and appropriate educational activities in communities at high risk of RHD. We need to continue to ensure Aboriginal and Torres Strait Islander leadership, and set stretch targets to end RHD,” Ms Byron said.

Aboriginal Communities are taking local action to stop the devastating effects of the disease through community-led solutions. A unique program highlighted today engages Aboriginal Health Practitioners to use traditional languages and new technology, to create a comprehensive local effort to identify and stop RHD.

“With the engagement and participation of traditional owners in Maningrida, the local school, the health clinic, and Malabam Health Board, 13 new cases of RHD were discovered among 450 children, and two children – aged 8 and 12 – needed emergency heart surgery,” says Dr Bo Reményi, paediatric cardiologist and NT Australian of the Year. “At the same time, teachers and health workers were educating children and families about prevention in traditional language and through local metaphors. As one traditional owner recently remarked, ‘it’s been the greatest community collaboration I’ve ever experienced.’”

A comprehensive, community strategy, led by Aboriginal and Torres Strait Islander people, is critical to ending RHD. With strong leadership and political support, we will meet Australia’s commitment earlier this year at the World Health Assembly to prevent, control and eliminate rheumatic heart disease, but we need to take action now so that no child born in Australia from this day forward will develop rheumatic heart disease.

 Part 2 About The Snow Foundation

The Snow Foundation is the creation of brothers Terry and George Snow who have a straightforward view—if you see someone struggling, give them a helping hand.

Since it was established in 1991, the foundation has helped more than 250 groups, more than 240 individuals and provided more than $27 million in funds. Every dollar donated was given with the aim to enable individuals and organisations introduce positive improvement in their lives and their communities.

The foundation has helped with projects big and small, in a broad range of areas such as education, belonging, social change and health. Projects include purchasing vital equipment for people with disabilities, developing microloans to help women escape domestic violence, funding scholarships, providing a home for the homeless, advocating for marriage equality, broadening the impact of excellent palliative care and partnering with community organisations, philanthropy, businesses and governments to improve and save lives whenever possible.

Part 3 About END RHD

END RHD is an alliance of health, research and community organisations seeking to amplify efforts to end rheumatic heart disease in Australia through advocacy and engagement.

END RHD is the first time such a broad-based alliance has come together to pool their collective expertise. END RHD is:

  • Working with the communities most at risk of rheumatic heart disease in Australia. Only through Indigenous-owned, community-led strategies will we be able to successfully tackle the disease.
  • Securing funding and the political will to turn the world class research conducted by the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE) into action.
  • Educating and empowering Australians about the role they can play in ending rheumatic heart disease

The founding members of END RHD are the Australian Medical Association, Heart Foundation, National Aboriginal Community Controlled Health Organisation (NACCHO), RHD Australia based at Menzies School of Health Research, Aboriginal Medical Services Alliance Northern Territory (AMSANT), Aboriginal Health Council of Western Australia (AHCWA), the END RHD Centre of Research Excellence based at Telethon Kids Institute, The Aboriginal Health Council of South Australia (AHCSA), the Queensland Aboriginal and Islander Health Council (QAIHC) and the Aboriginal Health and Medical Research Council (AH&MRC).

Part 4 Ms Pat Turner, CEO of NACCHO and Co-Chair END RHD

Thank you and I too wish to acknowledge the traditional owners. It is wonderful to join you on the country of Ngunnawal and Ngambri peoples. Thank you for your welcome, and to the traditional owners of this land. We are coming together today with Aboriginal and Torres Strait Islander people from around the country, including from remote Maningrida in the Northern Territory. I also want to welcome and acknowledge Minister Wyatt for his leadership on rheumatic heart disease.

Let me begin by saying I believe that today can be the beginning of the end of rheumatic heart disease. Our shared vision is that no child born in Australia from this day forward should die of RHD. We are here – now – to ask for your help in bringing that vision to life.

Rheumatic heart disease begins with a sore throat or a skin sore. For our children, these are common infections – but the impact can last a lifetime. A lifetime which, too often, is cut short.

We are going to hear today about the impact of these infections and the complications they can cause when RHD develops. I will let families and health workers tell their stories about why that happens, and what it means for them.

I want to tell you first why this matters for me.

As the CEO of NACCHO, I spearhead the Aboriginal Community controlled Health Sector where we employ over 6000 staff people working across 300 clinics at the community level to deliver comprehensive primary health care.

Comprehensive care means that we do everything – immunisations and iron infusions, injuries and ischaemic heart disease. Doing everything means that we rarely choose to focus on a single disease. There is so much to be done, we can’t afford to have ‘favourite’ diseases.

But RHD sticks out. It’s the greatest cause of cardiovascular inequality for Aboriginal and Torres Strait Islander people in this country. Non-Indigenous people, literally, just don’t contract it. 98% of people who get RHD in Australia are Aboriginal and Torres Strait Islander people.

We get it because of crowded houses, because – despite our best efforts – showers don’t work, taps don’t run, and clothes don’t get washed. We get it because our clinics are overwhelmed with demand and sometimes skin sores and sore throats go untreated. We get it because rheumatic fever gets missed and sometimes it is too late for treatment.

At NACCHO, we became a founding partner of END RHD not because this disease is a simple fix, but because it is hard. Because it spans from housing to clinics to open heart surgery.

It exemplifies the gaps in prevention in the health system and in outcomes. We are focusing on this because the only possible solution is a comprehensive, Indigenous-led primary care-based strategy of both prevention and treatment.

In pursuing this goal we have an opportunity to work together, collaboratively, in new ways. We believe in that way of working and we believe that it can end RHD.

We’ve been worried about RHD for decades. Young people kept dying and researchers kept writing papers about the problem. We’ve had some dribs and drabs of progress but it was always fragmented – some projects on echo screening, on improving needles for kids with RHD, some on better registers of people living with the disease.

In 2015 the National Health and Medical Research Council funded the END RHD Centre of Research Excellence – the END RHD CRE. The END RHD CRE said they were going to write an Endgame Strategy for RHD. We thought they’d picked a weird name for yet another report on yet another disease.

We carried on with comprehensive primary health care delivery.

But the drum beat about the need to tackle RHD has grown louder, and today, we are at a tipping point.

We heard about the work of Take Heart to tell the stories of people living with RHD.

We saw that movie and we knew that sharing the reality of RHD was going to help everyone see what we already knew – RHD has an enormous impact in community. Then we started to hear about plans for the World Health Organisation to call for action on RHD globally – we know that Australia is one of the few wealthy countries where RHD still exists, and has a real opportunity to show international leadership in ending our domestic disparity.

In 2016, the Australian Medical Association focused their Indigenous Report Card on the issue of RHD and called for targets to tackle RHD by 2031. At the launch of that document, we announced the formation of END RHD – an alliance of organisations working to address the disease together. NACCHO was pleased to be a founding partner – alongside

The Australian Heart Foundation

The Australian Medical Association

Menzies School of Health Research

Telethon Kids Institute

And, critically, NACCHO affiliates in the 5 jurisdictions with high rates of RHD – ACHWA, AMSANT, QAICH, AHSCA and AH&MRC.

The interest of these groups made it clear that RHD isn’t something that we just have to live with or die from. It’s something we can take collective action about.

In May this year we heard that a resolution on RHD was passed at the World Health Organisation in Geneva. All countries must report on their actions to address RHD. The world will be watching Australia particularly closely.

Momentum since then has continued to grow. Minister Wyatt has shown great leadership in convening two roundtables on RHD, discussing the issue at COAG twice this year. Funding has been allocated to begin pilot programs in a small number of communities to prevent new cases of RHD. Other projects supported by philanthropic organisations, including our co-hosts, the Snow Foundation, demonstrate the power of community leadership.

END RHD has been joined by a whole network of supporters who have signed up as charter signatories to END RHD (name or indicate logo – TBD). We are working closely with the END RHD CRE to make sure that their Endgame Strategy isn’t just another report on a shelf, but a really tangible roadmap of what we need to do to tackle this disease.

And so we are here today – at the beginning of the end. And we need you to make it happen. Not just in a report – but in real world.

So we are asking you today:

  • For a commitment to eliminate RHD in Australia.
  • For a clear plan of action and targets to measure progress.
  • For a commitment to achieve those targets through the COAG process.
  • To appoint an Indigenous-led Steering committee to oversee that work.

And I need to let you know what we’re asking you to sign up to:

  • We estimate that it will take two decades to end RHD.
  • It’s going to take money. Some now, and more later. Probably much more – my research friends are running up the numbers to estimate the cost.
  • It’s going to mean working beyond the health sector. We need action on housing and environmental health, which drives this disease.

So there is a long road ahead of us – but that road is transformative. Not just because we can save lives and prevent the human suffering of RHD. That is important. But also, because a comprehensive, community-led approach to primary care and environmental health will help address so much more: ear disease, eye disease, childhood lung infections. RHD is just the start of this new way of working.

END RHD and our partners stand ready to put that new way into practice. We are already working with individuals, families, and communities most impacted by the disease. We are working with researchers to develop the best, and most effective recommendations. We are working with allies outside of health, in business, and in philanthropy to combine our efforts on this disease and all the preventable suffering it represents.

Today we come as a community, to Canberra, to seek a political commitment to support these efforts. Make no mistake – the financial ask is brewing and we expect that to be accounted for – but today, we ask that you hear the RHD story from the people who live it – and ask that you join us to commit, publicly, to end rheumatic heart disease in Australia. To resource that. And to let us lead the way.

 

 

 

NACCHO Aboriginal Children’s Health : Dr @SandroDemaio presents a five-point policy plan using a lifeSPANS approach to address child obesity in Australia: #NCDs #EnoughNCDs @FAREAustralia @AHPA_AU @SaxInstitute

 

” The answer to obesity will never be in telling people what to do, guilting them for making unhealthier choices in a confusing consumption landscape, or by simply banning things. We also know that education and knowledge will get us only so far.

The real answers lie not even in inspiring populations to make hundreds of healthier decisions each and every day in the face of a seductively obesogenic, social milieu.

If we are to drive long‐term, sustained and scalable change, we must tweak the system to ensure those healthier choices become the path of least resistance—and eventually preferred. And I believe we must focus, initially, on our kids.

It is time for a lifeSPANS approach to addressing obesity in Australia.”

Dr Alessandro Demaio ” A $100 Million question ” see Bio in full Part 2

Download this Paper HERE : Demaio-2018-Health_Promotion_Journal_of_Australia

Listen to Dr Sandro’s childhood obesity Podcast HERE 

  ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Compelling populations, individuals or even ourselves to act pre‐emptively on the urgent and massive challenges of tomorrow is notoriously difficult.

The concept is called temporal or future discounting, and it is well documented.1 It is the idea that we prioritise our current comfort and happiness over our future and seemingly distant safety or wellbeing.

This psychological shortcoming plays out in many ways. At the micro level, we may defer until next week what we should do today—that run, drinking more water or the dentist check‐up—as it may not reap benefits for months, or ever. Eventually, we may act on some of these but whether delayed, deferred or denied, it can reap serious health consequences.

At the macro level, it becomes even more problematic. When we combine this “delay what’s beyond tomorrow” phenomenon with short‐term political cycles in the context of systems‐based, slowly evolving and largely invisible future threats, important but not yet imminent issues are not just postponed, but ignored.

Few challenges are a greater threat to the health of Australians, nor better define future discounting, than obesity. At the individual level and in our modern, obesogenic societies, weight gain has become the norm—the biological and social path of least resistance.

Food systems have shifted from a focus on seasonal, fresh and relatively calorie‐poor staples with minimal processing or meat, to an environment where junk foods and processed foods are ubiquitous, heavily advertised, hugely profitable and, for many communities, the only feasible “choice”.

Poor nutrition is now the leading risk factor for disease in our country.2City living has come with benefits, but along with an increasingly automated and digitalised lifestyle, has seen physical activity become something we must seek out, rather than an unavoidable component of our daily lives. Factors such as these have made individual action difficult for most of us and combined with our biology, have contributed to obesity rates more than doubling in Australia since 1980 alone.3

At the policy level, a dangerous, pernicious and unhealthy status quo has evolved over decades. One which sees a population increasingly affected by preventable, chronic disease. One which can only be solved through difficult decisions from politicians and the public to make the short‐term, passive but unhealthy comfort harder; and the long‐term promise of wellbeing more attractive.

One which must see sustained public demand and political commitment for a distant goal and best scenario of nil‐effect, in the face of constant, coordinated and powerful pushback, threats and careful intimidation from largely unprecedented policy counter‐currents.

But opportunities do exist; levers throughout this gridlocked policy landscape that can be utilised to move the obesity agenda forward.

One of those is our kids.

We know that if we cannot prevent obesity in our children, those young Australians will likely never achieve wellbeing.

We know that one in four of our children is overweight or obese and that while 5% of healthy weight kids become obese adults, up to 79% obese children will never realise a healthy weight.45 We know that the school years are a time when major weight gain occurs in our lifecourse and almost no one loses weight as they age.6

Recent evidence suggests early, simple interventions not only reduce weight and improve the health for our youngest kids, but also reduce weight in their parents.78 An important network of effective implementation platforms and primed partners already exist in our schools and teachers around the nation.

Finally, a large (but likely overstated) proportion of Australians may call “nanny state” at even the whiff of effective policies against obesity, but less so if those policies are aimed at our children.

With this in mind, I was recently invited to Canberra to present on how I would spend an extra $100 million each year on preventive health for the nation.

This is the five‐point policy plan I proposed; a lifeSPANS approach to addressing child obesity—and with it, equipping a new generation of Australians to act on tomorrow’s risks, today. This is an evidence‐based package to reduce the major sources of premature deaths, starting early.

1 .SCHOOLS AS PLATFORMS FOR HEALTH

  • $3 million to support the revision and implementation of clear, mandatory guidelines on healthy food in school canteens
  • $3 million to coordinate and support the removal of sales of sugary drinks
  • $13 million to expand food and nutrition programs to remaining primary schools
  • $40 million as $5000‐10 000 means‐tested grants for infrastructure that supports healthy eating and drinking in primary schools
  • $130 million to cover 1.7 million daily school breakfasts for every child at the 6300 primary schools nationally910
  • $140 million left from sugary drink tax revenue for school staffing and programs for nutrition and physical activity

Schools alone cannot solve the child obesity epidemic; however, it is unlikely that child obesity rates can be reversed without strong school‐based policies to support healthy eating and physical activity. Children and adolescents consume 19%‐50% of daily calories at school and spend more time there than in any other environment away from home.11 Evidence suggests that “incentives” are unlikely to result in behaviour change but peer pressure might.12 Therefore, learning among friends offers a unique opportunity to positively influence healthy habits.

Trials have demonstrated both the educational and health benefits of providing free school meals, including increased fruit and vegetable consumption, knowledge of a healthy diet, healthier eating at home and improved school performance. Providing meals to all children supports low‐income families and works to address health inequalities and stigma.10

School vending machines or canteens selling sugary drinks and junk foods further fuel an obesogenic, modern food environment. Sugary drinks are the leading source of added sugar in our diet in Australia and are considered a major individual risk factor for non‐communicable diseases, such as type 2 diabetes.13 Removing unhealthy foods and drinks from schools would support children, teachers and parents and send a powerful message to communities about the health harms of these products.

Finally, it is not only about taking things away but also supporting locally driven programs and the school infrastructure to support healthier habits. Drinking fountains, play equipment and canteen hardware could all be supported through small grants aimed at further empowering schools as decisions makers and agents for healthier kids.

2.PRICING THAT’S FAIR TO FAMILIES

  • 20% increase in sugary drinks pricing with phased expansion to fast foods over three years, unlocking approximately $400 million in annual revenue to add to existing $100 million for prevention
  • More than $600 million in annual health savings expected from sugary drinks price increase of 20%
  • $10 million for social marketing campaigns to explain the new policy measures, and benefits to community
  • Compensation package for farmers and small retailers producing and selling sugary drinks (cost unknown but likely small)
  • Such legislation would also support industry to reformulate or reshape product portfolios for long‐term market planning

Today’s food environment sees increased availability of lower cost, processed foods high in salt, fats and added sugars.14 People have less time to prepare meals and are influenced by aggressive food marketing. This leads to food inequality with those from low socioeconomic backgrounds at greater risk from obesity. Obesity increases the risks of cardiovascular disease, type 2 diabetes, stroke, cancer, mental health issues and premature death.15 There are also wider societal and economic costs amounting to an estimated $8.6 billion spent in the health sector alone annually.16

Food prices should be adjusted in relation to nutritional content. Policy makers must shift their pricing focus to integrate the true societal cost of products associated with fiscally burdensome disease. In 2016, a WHO report highlighted that a 20% increase in retail price of sugary drinks lowers consumption as well as obesity, type 2 diabetes and tooth decay.17

The landmark peso per litre sugar tax from Mexico highlighted the behaviour change potential such policies possess. Sales of higher priced beverages decreased substantially in subsequent years. Importantly, the most significant decreases occurred among the poorest households.18 For Australia, a similar approach is estimated to lead to $609 million in annual health savings and raise $400 million in direct revenue.16

These legislative approaches should be framed as an expansion of our existing GST and would encourage industry to reformulate products, positively influencing the food environment.131517

This is not a sin tax or ban, it is an effective policy and pricing that is fair to families. It is also backed by evidence and supported by the public.19

3. ADVERTISING THAT SUPPORTS OUR KIDS

  • End all junk food marketing to children, and between 6 am and 10 pm on television
  • End the use of cartoons on any food or drink packaging
  • $30 million to replace junk food sponsorship of sport and arts events with healthy messaging and explanation of lifeSPANS policy approach
  • Phased expansion of advertising ban over three years to all non‐essential foods (GST language)

The food industry knows that marketing works, otherwise they would not spend almost $400 million annually on advertisements in Australia alone.20

Three of four commercial food advertisements are for unhealthy products and evidence suggests that food advertising triggers cognitive processes that influence our food choices, similar to those seen in addiction. Studies also demonstrate that food commercials including the use of cartoons influence the amount of calories that children consume and the findings are particularly pronounced in overweight children.21

Fast food advertising at sporting and arts events further reinforces a dangerous and confusing notion that sees the direct association between societal heroes or elite athleticism and the unhealthiest of foods.

Ending junk food advertising to children, including any use of cartoons in the advertisement of food and drinks, is an important step to support our kids.

4.NUTRITION LABELLING THAT MAKES SENSE TO EVERYONE

  • Further strengthen existing labelling approaches, including mandatory systems

Nutritional information can be confusing for parents, let alone children. Food packaging often lists nutritional information in relation to portion size meaning a product with a higher figure may simply be larger rather than less healthy. While the Health Star Rating system, implemented in 2014, has made substantive progress, it remains voluntary.22

Efforts should be made to strengthen the usability of existing efforts and make consistent, evidence‐based and effective labelling mandatory. Such developments would also provide stronger incentives for manufacturers to reformulate products, reducing sugar, fat and salt content.

Clearer and consistent information would help create a more enabling food environment for families to make informed choices about their food.

5.SUPPLY CHAIN SYSTEMS AS SOLUTION‐CATALYSTS

  • Utilise procurement and supply chains of schools and public institutions to drive demand for healthier foods
  • Leverage the purchasing power of large organisations to reduce the costs of healthy foods for partner organisations and communities

Coordinated strategies are needed to support the availability of lower cost, healthy foods for all communities. Cities and large organisations such as schools and hospitals could collaborate to purchase food as collectives, thus driving demand, building market size and improving economies of scale.23

By leveraging collective purchasing power, institutions can catalyse the availability of sustainable and healthy foods to also support wider, positive food environment change.

Part 2

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia.

While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health.

He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark.

He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability.

To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months.

Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition.

From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

NACCHO Aboriginal Children’s Health #Nutrition #Obesity : @IndigenousPHAA The #AFL ladder of sponsorships such as soft drinks @CocaColaAU and junk food @McDonalds_AU endangers the health of our children

 “Aboriginal and Non- Aboriginal kids are being inundated with the advertising of alcohol, junk food and gambling through AFL sponsorship deals according to a new study.

With obesity and excessive drinking remaining a significant problem in our communities, it’s time for the AFL ladder of unhealthy sponsorship (see below) to end,

Children under the age of eight are particularly vulnerable to advertising because they lack the maturity and mental skills to evaluate the messages. Therefore, in the case of the AFL, they begin to associate unhealthy products with their favourite sport and players

We need to ask ourselves why Australia’s most popular winter sport is serving as a major advertising platform for soft drink, beer, wine, burgers and meat pies. It’s sending the wrong message to Australians that somehow these unhealthy foods and drinks are linked to the healthy activity of sport,”

Says the Public Health Association of Australia (PHAA).

Read all NACCHO Aboriginal Health Nutrition / Obestity articles over 6 years HERE 

In the study published this week in the Australian and New Zealand Journal of Public Health, Australian researchers looked at the prevalence of sponsorship by alcohol, junk food and gambling companies on AFL club websites and on AFL player uniforms.

The findings were used to make an ‘AFL Sponsorship Ladder’, a ranking of AFL clubs in terms of their level of unhealthy sponsorships, with those at the top of the ladder having the highest level of unhealthy sponsors.

The study clearly demonstrated that Australia’s most popular spectator sport is saturated with unhealthy advertising.

Download PDF Copy of report NACCHO Unhealthy sponsors of sport

Ainslie Sartori, one of the authors involved in the research confirmed, “After reviewing the sponsorship deals of AFL clubs, we found that 88% of clubs are sponsored by unhealthy food and beverage companies. A third of AFL clubs are also involved in business partnerships with gambling companies.”

Recommendation 

Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand.

The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable.

Policy makers are encouraged to consider innovative health promotion strategies and work
with sporting clubs and codes to ensure healthy messages are prominent

 

The study noted that children are often the targets of AFL advertising. This is despite World Health Organization recommendations that children’s settings should be free of unhealthy food promotions and branding (including through sport) due to the known risk it poses to their diet and chances of developing obesity.

PHAA CEO Terry Slevin commented, “When Australian kids see their sports heroes wearing a uniform plastered with certain brands, they inevitably start to associate these brands with the player they look up to and with the positive and healthy experience of the sport.”

He added, “The AFL is in a unique position to positively influence the health of Australian kids through banning sponsorship by alcohol, junk food and gambling companies. It could instead reinforce the importance of a healthy lifestyle for them.”

“Australian health policy makers need to consider innovative health promotion strategies and work together with sport clubs and codes to ensure that unhealthy advertising is not a feature. We successfully removed tobacco advertising from sport and we can do it with junk food and gambling too,” Mr Slevin said.

The recently released Sport 2030 plan rightly identifies sport as a positive vehicle to promote good health. But elite “corporate sport” plays a role of bypassing restrictions aimed at reducing exposure of children to unhealthy product marketing.

“The evidence is clear – it’s time for Australia to phase out all unhealthy sponsorship of sport,” Mr Slevin conclude

NACCHO Aboriginal Health Pharmacy News : #ACCHO Pharmacy skills will help #closethegap in #heart disease

ACCHOs have a strong history in doing this effectively and appropriately for their communities,

Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

Deputy NACCHO CEO Dr Dawn Casey

With new research showing current cardiovascular disease screening guidelines are missing younger at-risk Aboriginal people, a leading Aboriginal health specialist has highlighted the role pharmacists can play in preventative cardiac care.

The statement Dr Dawn Casey comes following research finding up to half of older Australian Aboriginal and Torres Strait Islander people are at high risk of cardiovascular disease (CVD), and that significant numbers of those in their 20s were also at risk.¹

Continued below

Read over 50 NACCHO Aboriginal Heart Health articles published over past 6 years

Read 8 NACCHO Aboriginal Health and Pharmacy articles

Featured article 

 Read above report HERE : NACCHO Aboriginal Heart Health

From Australian Pharmacist 

Australian National University researchers found 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high absolute primary risk of CVD. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.¹

The study of 2820 people from a 2012-13 health survey² revealed many Aboriginal and Torres Strait Islander people are not aware of their risk and most not receiving currently recommended therapy to lower their cholesterol, and are hospitalised for coronary heart disease at a rate up to eight times higher than that of other Australians.¹

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the high-risk category starts much earlier than this, and indicates the affected group needs to start receiving CVD checks earlier in life, the study authors said.

Dr Casey echoed the positive results of the study, allowing the entire ACCHS sector to better deliver preventative and holistic care.

‘ACCHOs have a strong history in doing this effectively and appropriately for their communities,’ she told Australian Pharmacist.

‘Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

‘Embedded ACCHO pharmacists can use their skills and knowledge work with a range of clinicians in the ACCHO to conduct holistic risk screening and overall management strategy.

NACCHO is currently actively advocating for enhanced integration of pharmacists into ACCHOs models of care.’

NACCHO and PSA are currently working as part of a broader team on two projects to enhance the broader roles that pharmacists’ skills and training can deliver – Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) and Indigenous Medication Review Service (IMeRSe).

‘Pharmacists have a broad range of clinical skills and are often very suitable additions to multidisciplinary clinical teams, especially where chronic disease is prevalent and many medicines required,’ Dr Casey said.

‘Community pharmacists may identify risks within normal client care, for example through a pharmacy-based MedsCheck or an HMR. Where team-based care is working effectively, pharmacies and ACCHOs will liaise and work together to ensure care is optimised across these settings.

‘Pharmacists’ understanding of medicines also involves understanding how medical conditions and risk factors for these conditions apply. Unfortunately there is still sometimes a misconception across Australia that pharmacists really just supply medicines and manage retail businesses. Enhancing professional and clinical services is a key trend across the whole pharmacy sector and NACCHO is an active participant in these developments.’

PSA and NACCHO have collaboratively produced guidelines to support pharmacists caring for Aboriginal and Torres Strait Islander people available at:

http://www.psa.org.au/wp-content/uploads/guide-to-providing-pharmacy-services-to-aboriginal-and-torres-strait-islander-people-2014.pdf

References

1 Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks, E. Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209 (1): 35-41. DOI: 10.5694/mja17.00897

NACCHO Aboriginal Heart Health : Download @AIHW Report on #cardiac care for Indigenous people. Mortality falling but still “much higher” than non-Indigenous pop. Investment needed to #ClosetheGap #ACCHOs @Aus_Lighthouse @END_RHD @HeartAust

 ” Heart-related conditions, such as coronary heart disease, heart failure, and rheumatic heart disease (RHD), contribute substantially to poor health and reduced life expectancy among Aboriginal and Torres Strait Islander people.

Cardiac conditions are more common among Indigenous than non-Indigenous Australians, and there are many interconnected reasons for this, including higher rates of risk factors for cardiac conditions (such as smoking, low levels of physical activity, overweight or obesity, diabetes, and high blood pressure), and poorer access to preventative health services “

AIHW Report Released July 6

aihw-Cardiac Report

Read Previous NACCHO Aboriginal Heart Health : @HeartAust #NickysMessage “Heart disease is the number one killer of Aboriginal and Torres Strait Islander peoples. “

Read also over 50 Aboriginal Health and Heart Articles published over 6 Years

Better Cardiac Care project and selected extracts

The Better Cardiac Care for Aboriginal and Torres Strait Islander People project is an initiative that was developed at the Better Cardiac Care for Aboriginal and Torres Strait Islander People Forum, held in March 2014 (BCCF 2014).

Representatives from various Indigenous and other organisations, as well as Australian Government and jurisdictional health departments attended the forum.

The project aims to reduce mortality and morbidity from cardiac conditions among Indigenous Australians, by increasing access to services, better managing risk factors and treatment, and improving coordination of care.

The forum established 5 priority areas of interventions that health services should undertake to improve cardiac care for Indigenous Australians, which:

  • are aligned with national and international best-practice guidelines for cardiac care and chronic disease
  • were informed by the Essential Service Standards for Equitable National Cardiovascular Care
  • focus on providing sustainable models of care built around partnerships between all health service providers.

SEE AIHW WEBSITE

The 5 priority areas are:

  • primary preventive care—early cardiovascular risk assessment and management
  • clinical suspicion of disease—timely diagnosis of heart disease and heart failure
  • acute episode—guideline-based therapy for acute coronary syndrome
  • ongoing care—optimisation of health status and provision of ongoing preventive care
  • rheumatic heart disease—strengthening the diagnosis, notification, and follow-up of RHD.

A set of 21 Better Cardiac Care measures (Table 1.1) were also developed to track the implementation and monitoring of the priority areas and associated actions

2 Results

Priority area 1: Early cardiovascular risk assessment and management

Priority area 1 of the Better Cardiac Care project is early cardiovascular risk assessment and management. This is based on the premise that all Aboriginal and Torres Strait Islander people with no known cardiac disease should receive:

  • an annual cardiovascular risk assessment
  • appropriate management and follow-up for identified cardiac disease risk factors
  • lifestyle modification advice appropriate to their cardiovascular risk level, as per current guidelines (NACCHO & RACGP 2012).

Primary prevention in the form of early and consistent risk factor identification and management will improve long-term outcomes for Indigenous Australians, reduce the population burden of chronic cardiac disease, and improve the appropriate delivery of care by the health-care system (BCCF 2014).

Three measures were agreed upon within this priority area, and updated data are available for measure 1.1 on health assessments.

The data for measure 1.2 are expected to become available for the next report, which will be provided based on the AIHW data collection on the national key performance indicators for Aboriginal and Torres Strait Islander primary health care.

Measure 1.1: Annual health assessments

This measure reports on the number and proportion of Indigenous Australians who had a Medicare Benefits Schedule (MBS) health assessment in the previous 12 months (Table B.2 in Appendix B contains the list of relevant MBS item numbers included in the measure).

Why is it important?

Health assessments aim to increase preventative health opportunities, detect chronic disease risk factors, manage existing chronic disease, and reduce inequities in access to primary care for Indigenous Australians. Early detection and management of risk factors for cardiac disease (such as smoking, physical inactivity, high blood pressure) can reduce the incidence of cardiac disease and lessen its severity.

All Indigenous Australians are eligible for an annual health assessment, which is listed as item 715 on the MBS.This comprehensive health asessement covers a wide variety of risk factors related to cardiac disease and other chronic diseases, including medical history, nutrition, physical activity, smoking and alcohol intake, living conditions, and body mass index, although it is not a specific cardiovascular risk assessment. People within specified target groups may also be eligible for other types of MBS health assessments (Department of Health 2014), which are referred to as ‘general’ health assessments in this report.

Results

Overall:

  • In 2015–16, more than one-quarter of Indigenous Australians (27%, or an estimated 199,400 people) received a health assessment—about 26% received an MBS item 715 health assessment, and about 1% received a general health assessment (Figure 1.1a).

Time trend:

  • Between 2004–05 and 2015–16, the age-standardised proportion of Indigenous Australians who had an MBS health assessment rose from 2% to 27% for females, and from 2% to 24% for males (Figure 1.1b).
  • From 2014–15 to 2015–16, the overall proportion rose by 3 percentage points.
  • A marked increase occurred from 2010–11, coinciding with the introduction of the Australian Government’s Indigenous Chronic Disease Package.

Sex and age:

In 2015–16:

  • more Indigenous females than males had an MBS health assessment (Figure 1.1b)
  • about one-quarter (25%) of Indigenous children aged under 15 had an MBS health assessment. Among Indigenous Australians aged 15 and over, the proportion rose from 21% among those aged 15–24 to 38% among those aged 65 and over (Figure 1.1c).

State/territory and remoteness area:

In 2015–16, the proportion of Indigenous Australians who had an MBS health assessment was:

  • highest in Queensland (33%), and lowest in Tasmania (9%) (Figure 1.1d)
  • highest in Inner/Outer regional areas combined (29%), and lowest in Major cities (21%)

Priority area 2: Timely diagnosis of heart disease and heart failure

Priority area 2 of the Better Cardiac Care project is timely diagnosis of heart disease and heart failure.

This is based on the premise that all Aboriginal and Torres Strait Islander people suspected of having heart disease or heart failure should receive appropriate initial diagnostic services (such as stress testing or coronary angiography for ischaemic heart disease, or echocardiography for heart failure and rheumatic heart disease) as close to the patient’s home as possible, within acceptable timeframes according to the level of risk and the patient’s condition (BCCF 2014).

Of the 3 measures recommended for this priority area, data are available for:

  • measure 2.1 for Medicare-listed diagnostic items
  • measure 2.3 for cardiologist review of suspected/confirmed cardiac disease

Measure 2.1: Cardiac-related diagnosis

This measure reports on the number and proportion of Indigenous Australians who had 1 or more relevant cardiac-related MBS diagnostic item claims in the previous 12 months, compared with non-Indigenous Australians (Table B.2 in Appendix B contains the list of relevant MBS item numbers included in the measure).The current report includes additional MBS items within measure 2.1, compared with the second national report (AIHW 2016); as such the results are not comparable. Additional MBS items were used to more accurately capture the status of cardiac-related diagnoses, and were obtained from the Cardiac Services Clinical Committee of the Medical Benefit Schedule Review Taskforce (Department of Health 2017).

Why is it important?

People suspected of having cardiac disease should receive appropriate and timely diagnostic services. Categories of diagnostic tests captured by this measure include:

  • diagnostic procedures and investigations—19 items that include various kinds of electrocardiography, and pacemaker and defibrillator testing
  • diagnostic imaging services—25 items that include various kinds of echocardiography, computed tomography scans and angiography (Department of Health 2018).

Results

Overall:

In 2015–16:

  • 64,909 MBS claims for cardiac-related diagnostic items were made for Indigenous patients (age-standardised proportion of 13.2%), compared with 3,178,327 claims for non-Indigenous patients (proportion of 12.1%).
  • 45,932 claims for diagnostic procedures and investigations (age-standardised proportion of 9.3%), and 18,977 claims for diagnostic imaging services (age-standardised proportion of 3.9%) were made for Indigenous patients—both proportions were slightly higher than for non-Indigenous Australians (Figure 2.1a).

Time trend:

  • Between 2004–05 and 2015–16, the age-standardised proportion of Indigenous Australians who had cardiac-related diagnostic items MBS claims rose from 6.8% to 10.4%, with a similar pattern for non-Indigenous Australians (rising from 6.9% to 9.1%) (Figure 2.1b).

Sex and age:

In 2015–16, the proportion of Indigenous Australians who had MBS claims for cardiac-related diagnostic items:

  • rose with increasing age, with the lowest proportion among those aged under 25. It was slightly higher than that of non-Indigenous Australians in all age groups, except for those aged 65 and over, where proportions were higher among non-Indigenous Australians (Figure 2.1c)
  • was lower overall than that of non-Indigenous Australians, for men and women, with Indigenous women having slightly higher proportions than Indigenous men (Figure 2.1d).

Better Cardiac Care measures for Aboriginal and Torres Strait Islander people 2017 11

State/territory and remoteness area:

In 2015–16, the proportions of MBS claims for cardiac-related diagnostic items:

  • ranged from 3% to 13% across states and territories, and from 7% to 8% across remoteness areas among Indigenous Australians (figures 2.1e and 2.1f)
  • were lower among Indigenous Australians living in Major cities and Inner/Outer regional areas combined than their non-Indigenous counterparts (Figure 2.1f).

Priority area 4: Optimisation of health status and provision of ongoing preventive care

Priority area 4 is optimisation of health status and provision of ongoing preventive care. This is based on the premise that all Aboriginal and Torres Strait Islander people with cardiac conditions should receive ongoing multidisciplinary primary health care and specialist physician follow-up as required, to prevent further illness, and to optimise health status (BCCF 2014).

Of the 4 measures recommended for this priority area, MBS data are available for:

  • measure 4.2 for follow-up after receiving a cardiovascular therapeutic procedure
  • measure 4.3 for specialist physician review after a cardiovascular therapeutic procedure

Priority area 5: Strengthening the diagnosis, notification and follow-up of rheumatic heart disease

Priority area 5 of the Better Cardiac Care project is strengthening the diagnosis, notification and follow-up of rheumatic heart disease (RHD) (BCCF 2014). This is based on the premise that:

  • all Aboriginal and Torres Strait Islander people suspected to have acute rheumatic fever (ARF) or RHD should receive an echocardiogram as early as possible
  • new cases should be automatically reported to a central register to help track patients, and ensure ongoing care.

There is no diagnostic pathology test for ARF; instead, its diagnosis is based on a clinical decision (RHD Australia et al. 2012). The clinical manifestation of ARF is non-specific and can be atypical, with delays in both presentation and referral of patients. As a result, ARF can often go undetected in the acute stage, leading to ongoing complications and lifelong morbidity.

Of the 4 measures recommended for this priority area, data are available from RHD registers in Queensland, Western Australia, South Australia, and the Northern Territory for:

  • measure 5.1 for the annual incidence of ARF and RHD
  • measure 5.2 for recurrent ARF
  • measure 5.3 for treatment with benzathine penicillin G doses
  • measure 5.4 for echocardiograms among patients with severe or moderate RHD.

NACCHO Aboriginal Heart Health : @ourANU @Mayi_Kuwayu Report high levels of risk of heart disease and #stroke for young and old #Indigenous Australians can be prevented : Plus @strokefdn Response

Recognising the risk will help save and improve lives and contribute to Closing the Gap in life expectancy.

Heart checks may need to start earlier in order to protect Aboriginal and Torres Strait Islander people but the good news is most heart attacks and strokes can be prevented.

Critical to this is knowing who is at risk and encouraging lifestyle changes, including quitting smoking, and lowering blood pressure and cholesterol levels.

The study also found that many people at high risk of heart attacks or strokes are not aware of it and most are not receiving currently recommended therapy to lower their cholesterol.”

Indigenous Health Minister Ken Wyatt releasing the study

Ken Wyatt Heart study press release

 ” Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.

The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke.

Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk ‘

Download the Report here Heart Stroke Report

OR Read online HERE

ANU researchers have met with Minister for Indigenous Health Ken Wyatt, Aboriginal woman and heart health researcher Vicki Wade and to launch new study on First Nations people heart health.

Aboriginal and Torres Strait Islander people were twice as likely to be hospitalised with stroke and 1.4 times as likely to die from stroke than non-indigenous Australians. 

Stroke can be prevented, it can be treated and it can be beaten. We must act now to stem the tide of this devastating disease

Steps must be taken immediately to increase stroke awareness and access to health checks through targeted action. Federal and state government must come together to address this issue.”

Stroke Foundation Chief Executive Officer Sharon McGowan said the research results were frightening. See Full Press Release Part 2 below

” Australian’s national guidelines currently say heart health screening should begin at age 35 for Aboriginal and Torres Strait Islander people.

However, new research has found there’s a high risk of Indigenous people under 35 developing cardiovascular disease.

The study also shows Indigenous people have a higher risk of developing cardiovascular disease in older age.

Researchers say this information will be important to help identify risks earlier, and prevent disease from developing ”

Dr Norman Swan radio interview LISTEN HERE

Professor Emily Banks

Professor of Epidemiology and Public Health, National Centre for Epidemiology and Population Health, Australian National University, Canberra

Associate Professor Ray Lovett

Head of Aboriginal and Torres Strait Islander Health Program, National Centre for Epidemiology and Population Health, Australian National University, Canberra

Most heart attacks and strokes can be prevented with appropriate treatment. Yet heart disease, including heart attacks, causes 13% of deaths among Australia’s Aboriginal and Torres Strait Islander peoples and is a major contributor to the gap in life expectancy with non-Indigenous Australians.

New findings from a study published today in the Medical Journal of Australia show vast room for improvement in heart health among Aboriginal and Torres Strait Islander peoples.

Who is at risk?

This new research found 10% of Aboriginal and Torres Strait Islander people aged 35-74 years old have heart disease (compared to 9% aged 45-74 in the general population). Another 16% are at high risk of getting heart disease (compared to 11% aged 45-74 in the general population), defined in Australia as a greater than 15% chance of getting heart disease in the next five years.

A heart check involves calculating how likely a person is to develop heart disease over a specific time period (five years in Australia). This involves gathering information from multiple factors including a person’s age, sex, smoking status, whether they have diabetes and their blood pressure and cholesterol levels.

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the “high risk” category starts much earlier than this.

Around 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high risk of heart disease. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.

Too few Indigenous peoples are having heart checks. from http://www.shutterstock.com

Potential to prevent events through medication

Heart disease risk can be lowered through lifestyle changes, including giving up smoking, losing weight and exercising more, as well as using medications that lower blood pressure and cholesterol levels. Generally, all people who have heart disease and those at high risk should be prescribed preventative medications.

Yet this latest evidence shows only 53% of Aboriginal and Torres Strait Islander peoples with existing heart disease and 42% of those at high risk were using cholesterol-lowering medications. We don’t know the exact reasons for this. It could be due to a number of things including people not getting a heart check in the first place, and not continuing to use medications when they have been prescribed.

We don’t know the exact number of Aboriginal and Torres Strait Islander people receiving a heart check, but we do know overall numbers are low and it varies by region. Estimates among Aboriginal and Torres Strait Islander people with diabetes found rates of heart checks ranged from about 3% of people in participating health centres in Queensland, South Australia and Western Australia to around 56% in the Northern Territory.

This highlights the huge potential to prevent future heart attack and stroke in these communities by improving treatment in people at high risk.

What can we do?

These findings highlight multiple actions that can be taken to improve heart disease prevention. First, this new evidence suggests the age to start doing heart checks should be lowered in Australian guidelines. This decision would need to be jointly undertaken with Aboriginal and Torres Strait Islander communities.

GPs and nurses should be proactive in identifying Aboriginal and Torres Strait Islander patients, providing heart and overall health checks, and following up with patients.

The Northern Territory is a good example. There, the number of Aboriginal and Torres Strait Islander peoples receiving a heart check more than doubled after improvements in reporting, monitoring and follow-up. Improving the rate of health checks for adolescents and young adults is particularly important so discussions and treatment decisions can take place early.

Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.

The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke.

Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk.

Part 2 Stroke Foundation  Press Release

 

Stroke Foundation has backed a call for urgent action to prevent stroke in Australia’s Aboriginal and Torres Strait Islander community.

This follows today’s release of a world-first study by the Australian National University (ANU), highlighting the harrowing reality of stroke and heart attack risk in Aboriginal and Torres Strait Islander people.

The research found around one-third to a half of Aboriginal and Torres Strait Islander people in their 40s, 50s and 60s were at high risk of future heart attack or stroke. It also found risk increased substantially with age and starts earlier than previously thought.

Stroke Foundation Chief Executive Officer Sharon McGowan said the research results were frightening.

“We knew the Aboriginal and Torres Strait Islander community had a greater risk of stroke and cardiovascular disease, but the rate was well above the non-indigenous population,” Ms McGowan said.

“Alarmingly, the study also found high levels of risk were occurring in people younger than 35.

“Steps must be taken immediately to increase stroke awareness and access to health checks through targeted action. Federal and state government must come together to address this issue.”

National guidelines currently recommend heart health and stroke risk screening be provided to Aboriginal and Torres Strait Islander people 35 and over. This study highlights the need for screening in much younger people.

Ms McGowan said there was one stroke every nine minutes in Australia and Aboriginal and Torres Strait Islander people were overrepresented in stroke statistics.

Aboriginal and Torres Strait Islander people were twice as likely to be hospitalised with stroke and 1.4 times as likely to die from stroke than non-indigenous Australians.

“Stroke can be prevented, it can be treated and it can be beaten. We must act now to stem the tide of this devastating disease,’’ she said.

“Federal and State Government must do more to empower our Aboriginal and Torres Strait Islander communities to take control of their health and prevent stroke and heart disease – we must deliver targeted education on what stroke is, how to prevent it and the importance of accessing treatment at the first sign of stroke.”

Ms McGowan said stroke could be prevented by managing your blood pressure and cholesterol, eating healthily, exercising, not smoking and limiting alcohol consumption

NACCHO Aboriginal Health and Chronic Disease : #NCDForum @Prevention1stAU Report : Government is ignoring our chronic disease time bomb

  ” One in every two Australians suffer from chronic disease but experts say Commonwealth and State Governments appear blind to the country’s greatest health challenge.

The latest assessment of the country’s chronic disease prevention policy has found that while our health measures in tobacco policy are world leading, Australia has fallen well short in its preventive health efforts in the key areas of alcohol consumption, nutrition, and physical activity.”

A scorecard released today by Prevention 1st found that while government anti-smoking policies are ‘good’, efforts to address alcohol consumption, physical activity and nutrition all rate poorly.

Download report HERE

Prevention-in-Australia-online

Prevention 1st invited experts in tobacco, alcohol, nutrition and physical activity to rate Commonwealth and state government action against the World Health Organization’s (WHO) ‘Best Buys’ and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases.i

Chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, accounts for 66 per cent of the burden of disease, and costs our economy an estimated $27 billion annually.

According to the Australian Institute of Health and Welfare, one-third of chronic disease cases are preventable and can be traced to four modifiable risk factors: tobacco use, alcohol consumption, poor diet, and physical inactivity.

FARE Chief Executive Michael Thorn says that while Australia has been a world leader in preventive health, past glories count for little, when the Prevention 1st Scorecard released today makes clear that our governments are not presently doing enough.

Mr Thorn says a framework already exists around evidence-based, short-term wins and that those World Health Organization recommendations, if implemented, would immediately improve Australians’ health.

“Effective policies are essential and we have those, but those solutions become worthless if government is not prepared to translate those policies into action,” Mr Thorn said

The Prevention 1st Scorecard recommends the implementation of four simple evidence-based measures to address tobacco use, alcohol consumption, nutrition and physical activity.

• The renewal of mass media anti-smoking campaigns that are population-wide and engage effectively with disadvantaged groups.

• The abolition of the Wine Equalisation Tax (WET) and introduction of a volumetric tax for wine and cider.

• Legislated time-based restrictions on exposure of children (under 16 years of age) to unhealthy food and drink marketing on free-to-air television until 9.30pm.

• The implementation of a whole-of-school program that includes mandatory daily physical activity.

Prevention 1st is a campaign led by the Foundation for Alcohol Research and Education (FARE), the Public Health Association of Australia (PHAA), Consumers Health Forum of Australia (CHF Australia), and Dementia Australia.

ENDS