NACCHO Aboriginal #Mentalhealth #SuicidePrevention and #RUOKday : If you ask #RUOK ? What do you do if someone says ‘no’? Plus Sponsorships for 10 #Indigenous young people to take participate #chatsafe campaign

R U OK Day today encouraging all of us to check in with others to see if they’re OK.

But what if someone says “no”? What should you say or do? Should you tell someone else?

What resources can you point to, and what help is available?

Read NACCHO Aboriginal Health articles over the past 6 Years

Mental Health 189 posts 

Suicide Prevention 124 Posts

Here is a guide 

Stop and listen, with curiosity and compassion

We underestimate the power of simply listening to someone else when they’re going through a rough time. You don’t need to be an expert with ten years of study in psychology to be a good listener. Here are some tips:

Listen actively. Pay attention, be present and allow the person time to speak.

Be curious. Ask about the person’s experience using open questions such as

what’s been going on lately?

you don’t seem your usual self, how are you doing/feeling?

Validate their concerns. See the situation from the person’s perspective and try not to dismiss their problems or feelings as unimportant or stupid. You can say things like

I can see you’re going through a tough time

it’s understandable to feel that way given everything you’ve been going through.

There are more examples of good phrases to use here.

Don’t try to fix the problem right now

Often our first instinct is wanting to fix the person’s problems. It hurts to see others in pain, and we can feel awkward or helpless not knowing how to help. But you don’t have to have all of the answers.

Instead of jumping into “fix it” mode right away, accept the conversation may be uncomfortable and allow the person to speak about their difficulties and experiences.

Sometimes it’s not the actual suggestion or practical help that’s most useful but giving the person a chance to talk openly about their struggles. Also, the more we understand the person’s experience, the more likely we are to be able to offer the right type of help.

Encourage them to seek help.

Ask:

how can I help?

is there something I can do for you right now?

Sometimes it’s about keeping them company (making plans to do a pleasant activity together), providing practical support (help minding their kids to give them time out), or linking them in with other health professionals.

Check whether they need urgent help

It’s possible this person is suffering more than you realise: they may be contemplating suicide or self-harm. Asking about suicidal thoughts does not worsen those thoughts, but instead can help ease distress.

It’s OK to ask them if they’re thinking about suicide, but try not to be judgemental (“you’re not thinking of doing anything stupid, are you?”). Listen to their responses without judgement, and let them know you care and you’d like to help.

Read more: How to ask someone you’re worried about if they’re thinking of suicide

There are resources and programs to help you learn how to support suicidal loved ones, and crisis support lines to call:

  • Contact the Social and Emotional team at your nearest ACCHO
  • Lifeline (24-hour crisis telephone counselling) 13 11 14
  • Suicide Callback Service 1300 659 467
  • Mental health crisis lines

If it is an emergency, or the person is at immediate risk of harm to themselves or others, call 000.

Encourage them to seek professional help

We’re fortunate to be living in Australia, with access to high quality mental health care, resources and support services. But it can be overwhelming to know what and where to seek help. You can help by pointing the person in the right direction.

The first place to seek help is the general practitioner (GP). The GP can discuss treatment options (psychological support and/or medication), provide referrals to a mental health professional or arrange access to local support groups. You can help by encouraging your friend to make an appointment with their GP.

There are great evidence-based online courses and self-help programseducational resources and free self-help workbooks that can be accessed at any time.

There are also online tools to check emotional health. These tools help indicate if a person’s stress, anxiety and depression levels are healthy or elevated.

What if they don’t want help?

People with mental health difficulties sometimes take years between first noticing the problem and seeking professional help. Research shows approximately one in three people experiencing mental health problems accesses treatment.

So even if they don’t want help now, your conversation may have started them thinking about getting help. You can try understanding what’s stopping them from seeking help and see if there’s anything you can do to help connect them to a professional. You don’t need to push this, but simply inviting the person to keep the options in mind and offering your ongoing support can be useful in the long run.

Follow up. If appropriate, organise a time to check in with the person again to see how they’re doing after your conversation. You can also let the person know you’re around and they are always welcome to have a chat with you. Knowing someone is there for you can itself be a great source of emotional support.

Read more: Five types of food to increase your psychological well-being

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.).

The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

SEE CONFERENCE WEBSITE

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.). The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at jo.robinson@orygen.org.au. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

Anyone seeking support and information about mental health can contact beyondblue on 1300 22 46 36. For information about suicide and crisis support, contact Lifeline on 13 11 14 or the Suicide Callback Service on 1300 659 467

 

NACCHO Aboriginal Health : Coniston NT massacre 1928 descendants reunite to push for national truth-telling process , a theme of the #UluruStatement from the Heart.

We expect up to 400 people to join us for a chance to share the truth about our colonial past with the families of the victims and the murderers.

We want everyone to know that these massacres didn’t happen during some distant past but 10 years after the end of the First World War.

We remember those who lost their lives in that war every year, in every town around Australia. We have a special public holiday for it and lots of memorials everywhere.

What about our fallen loved ones?

Truth telling, along with agreement making and an Aboriginal voice to parliament, is a theme of the Uluru Statement from the Heart.

Central Land Council chair Francis Kelly.

Download the 12 Page PDF 

Coniston-Brochure-2018

Families affected by the Coniston Massacre from around Australia have gathered at a meeting of the Central Land Council outside Yuendumu, getting ready to remember the innocent men, women and children killed during a series of massacres in 1928.

Today they will travel to the remote outstation of Yurrkuru (Brooks Soak), approximately three hours north west of Alice Springs, to commemorate with songs, dances, speeches and prayers the 90th anniversary of the killings.

Yurrkuru is the site of the murder of the dingo trapper Fred Brooks which triggered the revenge parties led by Police Constable George Murray between August and October 1928 that have become known as the Coniston Massacre.

The families of an estimated 100 murder victims are planning to speak at the event, alongside members of Constable Murray’s family and political leaders such as Senator Patrick Dodson and NT Chief Minister Michael Gunner.

Their families unveiled a plaque at Yurrkuru in 2003 and plan to call for annual events commemorating the massacres and for interpretive signs at the many massacre locations.

They also want all school children to be taught about the frontier wars.

Mr Kelly, one of the creators of the documentary Coniston which will be shown at the CLC meeting tonight, said he is particularly pleased to welcome students from surrounding Aboriginal communities to the commemoration.

“Until all Australians know about the crimes committed against our families we can’t move forward as one mob, one country,” he said.

“Other countries with murderous pasts have managed to come together by speaking the truth. If they can do it, why can’t we?”

The Aboriginal man on the 2 dollar coin.His name was Gwoya Jungarai and he was one of the only survivors of one of the last recognised massacres of Aboriginal people, the 1928 Coniston Massacre in Central Australia.

Almost every Australian has seen his face, held his likeness in their hands but how many know his story?

Today Friday the 24th of August 2018 will mark the 90th anniversary of that atrocity. We will remember him as well as those others who did not survive.Lest we forget the Frontier Wars.

Minister for Indigenous Affairs Nigel Scullion Press Release

The anniversary was a solemn commemoration from or the families and descendants of the victims as well as for the entire Central Australian community.

Today community members from Central Australia gathered at Yurrkuru to commemorate 90 years since the Coniston massacre.

The Coniston massacre was a series of killings between August and October 1928, with large numbers of Aboriginal people from the Warlpiri, Anmatyerre and Kaytetye nations killed.

Minister for Indigenous Affairs Nigel Scullion said that the anniversary was a solemn commemoration for the families and descendants of the victims as well as for the entire Central Australian community.

“It is important that we remember the Aboriginal men, women and children who were killed during this dark chapter of Australian history and acknowledge the impact on families and communities that these crimes have on First Nations peoples,” said Minister Scullion.

“Today we also reflect on the resilience of the local Traditional Owners in more recent history. In 2014 I was honoured to join Traditional Owners and deliver a deed of grant to the Yurrkuru Aboriginal Land Trust – handing back land which was central to the Coniston massacre.

The Central Land Council hosted an event to commemorate the massacre at Yurrkuru (Brooks Soak), approximately 60 kilometres from Yuendumu.  The event brought together Aboriginal families from across Central Australia, as well as descendants of those responsible.

“I commend the Central Land Council for this work to ensure that the Coniston massacre is never forgotten.”

NACCHO Aboriginal Health and #Racism Debate #itstopswithme : Download @AusHumanRights Report, Anti-Racism in 2018 and Beyond : “Aboriginal people experience racism in systemic and institutional ways “

“The causes of racism are multiple. It can be caused not just by ignorance but also by arrogance; it can be caused by malice as well as by lazy assumptions.

While is some cases, the causes lay in attitudes and behaviour, in others, they lay within systems and institutions,”

The outgoing Race Discrimination Commissioner, Dr Tim Soutphommasane, has this week called for urgent action on measures to reduce racism at the  launch of his final report before stepping down this week.

Aboriginal and Torres Strait Islander people experience racism in systemic and institutional ways.

In 2016, 46 per cent of Indigenous respondents reported experiencing prejudice in the previous six months, compared to 39 per cent for the same period two years before.

Thirty-seven per cent reported experiencing racial prejudice in the form of verbal abuse, and 17 per cent reported physical violence

In 2015-16, Aboriginal and Torres Strait Islander people accounted for 54 per cent of complaints received by the Commission under the Racial Discrimination Act.

Download report here Anti-Racism in 2018 and Beyond

For many Aboriginal and Torres Strait Islander people, systemic racism is bound up in historical disadvantage and mistreatment. Practices such as that of removing Aboriginal children from their families have caused huge amounts of hurt and pain for individuals, families and communities. This shows up in lots of different ways – poor health, high rates of mental illness and family breakdowns.”

See Section 2 Below 

“On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.”

Pat Anderson is chairwoman of the Lowitja Institute,  (and a former chair of NACCHO) see her opinion article below link ” This article has been read over 22,000 times in past 4 years 

NACCHO Aboriginal health and racism : What are the impacts of racism on Aboriginal health ?

There is an underbelly of racism in this country, of ignorance, and of fear” Senator Pat Dodson responds to maiden senate speech by Senator Anning WATCH VIDEO

True or False? We fact-check Senator Fraser Anning on his comments regarding Muslims, crime and welfare. http://bit.ly/2PdDH8H

Human Rights Aboriginal and Torres Strait Islander Website

 

 

The Report, Anti-Racism in 2018 and Beyond, is part of the National Anti-Racism Strategy – a partnership-based strategy –  which was launched in 2012.

Watch Video

Today’s report reveals the increasing need for strong anti-racism policies and leadership, given the rise of anti-immigration and far-right populism.

“Since 2015, race has dominated headlines and driven public debates in a way that many would not have anticipated when the National Anti-Racism Strategy was last evaluated,” said Dr Soutphommasane.

“Anti-racism efforts must give voice to the individuals and communities who experience it. Racial prejudice and discrimination have profound silencing effects on those who are their targets,” he said.

The Report looks at the multiple causes of racism and the need for organisations, communities and individuals to not only identify racism, but call it out and build strategies that change behaviours.

Dr Soutphommasane says each and every one of us can make a difference.

 1.What is Racism 

Racism takes many forms and can happen in many places. It includes prejudice, discrimination or hatred directed at someone because of their colour, ethnicity or national origin.

People often associate racism with acts of abuse or harassment. However, it doesn’t need to involve violent or intimidating behaviour. Take racial name-calling and jokes. Or consider situations when people may be excluded from groups or activities because of where they come from.

Racism can be revealed through people’s actions as well as their attitudes. It can also be reflected in systems and institutions. But sometimes it may not be revealed at all. Not all racism is obvious. For example, someone may look through a list of job applicants and decide not to interview people with certain surnames.

Racism is more than just words, beliefs and actions. It includes all the barriers that prevent people from enjoying dignity and equality because of their race.

Many people experience racist behaviour.

The Challenging Racism Project has found that 20 per cent of Australians surveyed had experienced racial discrimination in the form of race hate talk, and about 5 per cent had been attacked because of their race. According to the Scanlon Foundation’s Mapping Social Cohesion survey in 2016, 20 per cent of Australians had experienced racial or religious discrimination during the past 12 months.

Some groups experience racism at higher rates. Aboriginal and Torres Strait Islander people, and those from culturally diverse backgrounds, often have to deal with systemic forms of discrimination. Such experiences limit the access that members of these groups enjoy to the opportunities and resources offered to many people from Anglo-Australian backgrounds.

For many Aboriginal and Torres Strait Islander people, systemic racism is bound up in historical disadvantage and mistreatment. Practices such as that of removing Aboriginal children from their families have caused huge amounts of hurt and pain for individuals, families and communities. This shows up in lots of different ways – poor health, high rates of mental illness and family breakdowns.

Migrants and refugees also regularly experience racism, in particular those who have recently arrived. Media reports and commentary that use negative stereotypes about refugees and migrants can fuel prejudice against these groups in the wider community. These attitudes can make it difficult for new arrivals to find housing and jobs, and to feel connected to their communities.

NACCHO Aboriginal Health and the #StolenGeneration : Download #ActionPlanForHealing @AIHW and @HealingOurWay Report that has uncovered an alarming and disproportionate level of #StolenGenerations disadvantage

We now know that around 17,000 members of the Stolen Generations are living across Australia today and that they experience higher levels of adversity in relation to most of the 38 key health and welfare outcomes analysed in the report,” 

Even compared to Aboriginal and Torres Strait Islanders in the same age group, who are already at a disadvantage, Stolen Generations members are suffering more.

It’s important to remember that behind all the data, are real people who are living with adversity every day and who have shared their stories many times over the past decade.

Healing Foundation Board Chair Professor Steve Larkin says the report, which was commissioned by The Healing Foundation, has uncovered an alarming level of social and economic disadvantage for our Stolen Generations and their descendants. See full press release Part 1 below 

Download full report HERE 

aihw-ihw-Stolen Generation Report

While the Rudd-Gillard-Rudd Government failed to commission this important work following the National Apology in 2008, I am pleased that we now have a comprehensive understanding of the demographics and needs of surviving members of the Stolen Generations.

The Stolen Generations have experienced a lifetime of trauma, grief and loss, a legacy which is still felt in families and communities across Australia,

The results are significant and illustrate the enduring devastation of past government policies.

I thank the AIHW and the Healing Foundation for their comprehensive work on this report, the first analysis of its kind.

“These findings will help all governments to better support the Stolen Generations and their families.

Minister of Indigenous Affairs Nigel Scullion see full Press Release Part 2

A Shorten Labor Government will respond to the legacy of pain and trauma that the Stolen Generations, their families and their communities continue to experience today. A Shorten Labor Government will establish a Stolen Generations Compensation Scheme.

To each of the survivors removed from their families, country and culture we will offer an ex gratia payment of $75,000. As well as a one-off payment of $7000 to ensure the costs of their funeral are covered.

See Labor Party Press Release HERE 

Labor Party Stolen Generation response Press Release

 

A new report from the Australian Institute of Health and Welfare highlights the urgent need to overhaul policies and services for Australia’s Stolen Generations and tackle the impact of Intergenerational Trauma in Aboriginal and Torres Strait Islander communities, according to The Healing Foundation Board Chair Steve Larkin.

According to today’s report the Stolen Generations are more than three times as likely to have been incarcerated in the last five years, almost twice as likely to rely on government payments and 1.5 times as likely to experience poor mental health. They are also more likely to suffer chronic health conditions like cancer, diabetes and heart disease.

“For the first time, we have comprehensive data to illustrate a direct link between poor health and welfare outcomes and the forced removal of tens of thousands of children from their families,” said Professor Larkin

“And we can also see the ongoing impact on subsequent generations.”

The AIHW report shows that the descendants of the Stolen Generations consistently experience poorer health and social outcomes, compared to other Aboriginal and Torres Strait Islander people. For example, they are almost twice as likely to have experienced violence, 1.5 times as likely to have been arrested by police (in the last 5 years) and 1.2 times as likely to have used substances (in the preceding 12 months).

Professor Larkin said the level of disadvantage outlined in the report was appalling but should not come as a surprise.

“The Stolen Generations were denied a proper education or a decent wage, which put them at a financial loss right from the start. But more fundamentally, they endured significant childhood trauma when they were taken from their families, isolated, institutionalised and often abused.

“If people don’t have an opportunity to heal from trauma, it continues to impact on the way they think and behave, which can lead to a range of negative outcomes, including poor health, substance abuse, suicide and violence.

“This leads to a vicious cycle of trauma, and its many insidious symptoms, and increasing levels of social and economic disadvantage, across generations,” said Professor Larkin.

“This report shows us that one third of today’s adult Aboriginal and Torres Strait Islander community are descendants of the Stolen Generations and that number is going to keep growing.

“If we don’t break the trauma cycle soon, adversity for our people will keep increasing, the gaps with non-Indigenous Australians will keep widening and so will the cost to the Australian taxpayer.”

Today’s demographic report is the first step in The Healing Foundation’s Action Plan for Healing project, which the federal government funded last year.

Professor Larkin said we need to act quickly to scale up appropriate services, address reparations at a national level and deal with the complex aged care needs that have been outlined in the report.

“We also need a National Intergenerational Trauma Strategy to halt the spread of trauma and attack the root cause of many social and health problems.

“It’s too late for many of the Stolen Generations who died young and tragically because of the poor health and welfare issues outlined in this report, but we can do better for the Aboriginal and Torres Strait Islander people still experiencing the impacts,” he said.

The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to heal trauma caused by the widespread and deliberate disruption of populations, cultures and languages over 230 years. This includes specific actions like the forced removal of children from their families.

Download the Above as a PDF 

HF_Stolen_Gererations_2Page_Infographics_Aug2018_V1 (1)

Part 2 Government  Press Release

The Turnbull Government has today released a landmark analysis conducted by the Australian Institute of Health and Welfare (AIHW) in partnership with the Healing Foundation into the outcomes and current needs of the Stolen Generations.

The Aboriginal and Torres Strait Islander Stolen Generations and descendants: Numbers, demographic characteristics and selected outcomes report found that there are an estimated 17,000 members of the Stolen Generations alive in 2018 who continue to experience significant social and economic disadvantage compared to other Indigenous Australians.

The report estimated that an average of 11 percent of Aboriginal and Torres Strait Islander people born before 1972 were removed from their families.

The Minister for Indigenous Affairs, Nigel Scullion said this report was a critical analysis needed to enable governments to better meet the contemporary needs of members of the Stolen Generations.

“The Turnbull Government will consult with the Indigenous Advisory Council and continue to work with members of the Stolen Generations to ensure that the Stolen Generations and their families receive the support they require.”

The Commonwealth has provided around $50 million to the Healing Foundation since 2009 to support their work and is currently delivering more than $44 million to over 100 organisations to provide social and emotional wellbeing activities including to support members of the Stolen Generations and their families.

The report was commissioned by the Australian Government in partnership with the Healing Foundation. This work was undertaken in response to the Healing Foundation’s Report titled Bringing them Home 20 years on: an action plan for healing,  which recommended a comprehensive analysis to understand the current needs of the Stolen Generations.

NACCHO Aboriginal Health #COAG : Indigenous Health Leadership , Ministers @GregHuntMP @KenWyattMP and Australia’s Health Ministers gather in #AliceSprings to shine a spotlight on #Indigenous health

 

“Australia’s Health Ministers have gathered in Alice Spring to shine a spotlight on Indigenous health, almost 10 years after the Council of Australian Governments (COAG) approved Closing the Gap targets to achieve health equality for First Nations peoples.

While we can reflect on progress – our people, on average, are living longer with fewer dying from chronic conditions – it is equally important to focus on our failure to close the gap in life expectancy, which remains about 10 years.

For sustainable change, however, local family warriors must step up, be respected, acknowledged and encouraged.

The Hon Ken Wyatt Indigenous Health Minister see Part 1 Below

Investigation and investment where it is needed is critical to delivering better health outcomes for First Nations Peoples, to protect lives and save lives

Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.

Kidney disease disproportionately affects Indigenous Australians — research has shown that almost one in five (18 per cent) Aboriginal and Torres Strait Islander people aged over 18 had indicators of chronic kidney disease.

I am delighted that we can announce $327,192 for Monash University to develop a point-of-care test for the diagnosis and management of chronic kidney disease.

Social and emotional well-being was another critical matter for Aboriginal and Torres Strait Islander Australians, especially youth.

The Australian Institute of Health and Welfare has found that the single largest contributor to ill health amongst Aboriginal and Torres Strait Islander Australians is mental health and substance use disorders,” said Minister Hunt.

Five projects across five different states will examine social and emotional well-being issues affecting Aboriginal and Torres Strait Islander infants, children, adolescents and young adults.

They will undertake culturally-informed research looking at the influencing factors, mental health and life-coaching, and fostering wellness.”

Health Minister Greg Hunt see full Press release Part 2

Part 1 Continued from opening quote

For over 65,000 years, First Nations people thrived without a plethora of organisations. We were child, family and community-centred.

Responsibility and authority revolved around a woman, with her key roles as the mother and protector, and equally, around a man, the father and family shield.

This year, I am focusing on five areas – renal health, rheumatic heart disease (RHD), avoidable blindness, avoidable deafness and crusted scabies.

First Nations people experience 7.3 times the burden of chronic kidney disease than other Australians. In the Northern Territory, RHD is 37 times more prevalent and, overall, we endure three times the rate of vision impairment.

Our children suffer, on average, 32 months of hearing loss compared with three months for other Australian children, while remote northern communities have the world’s highest rates of crusted scabies.

We are losing too many lives and not realising the potential of too many more.

In many remote locations, doctors and health workers are joined by fly-in fly-out health practitioners, providing specialist services.

However, we must ensure a local army of individuals on the ground is empowered to monitor for signs of illness.

We need home-based heroes, family warriors, as they were in times past – and still are in functional families.

They need to understand that infections such as skin sores can be precursors to RHD, kidney failure and crusted scabies.

We are not going to fully transform the health of those who are struggling, until they understand with pride and responsibility, the culture that perpetuated healthy lives for thousands of years.

Our mothers and fathers, uncles, aunts and grandparents are the first protectors of our children.

Now extended to 136 communities, the Better Start to Life program is proving the power of engaging with and supporting young parents to understand their responsibilities.

The Turnbull government has invested significantly in these areas but the record $3.9 billion committed to Indigenous health over the next four years will only ever be part of the currency of change.

It’s now time to highlight the heroes within our families, to move from disempowerment to empowerment, away from a deficit model.

I encourage every mother, father, uncle, aunt and Elder to become a warrior for health, joining in and taking responsibility for their own health and the health of their families.

Today we visited the Purple House Renal Clinic in Alice Springs and have seen first-hand the debilitating effects of poor kidney health.

The Government has committed $23.2 million through the National Health and Medical Research Council (NHMRC) to 28 new projects, and has launched a NHMRC Road Map 3 to help chart the direction for Indigenous health and medical research investment over the next ten years.

New research investment will include targeted renal, cancer and social and emotional wellbeing projects aimed at improving Aboriginal and Torres Strait Islander health outcomes.

The five projects together form the first of a series of targeted calls for research by the NHMRC to address Indigenous health priorities. Other calls will include healthy ageing and nutrition.

Minister for Indigenous Health, Ken Wyatt AM, said the new research projects would help to strengthen work already underway to curb chronic disease.

“The renal point-of-care test will complement the Renal Health Road Map that is currently being compiled,” Minister Wyatt said.

“This exciting new research is focused on making a difference on the ground, from reducing smoking during pregnancy and boosting cancer care, to combating diabetic blindness and improving diets.”

“The five social and emotional wellbeing projects are especially welcome, as we continue working with local communities to reduce the rate of suicide.”

Other key research projects announced today include point-of-care testing for blood-borne diseases and sexually transmitted infections, reducing incarceration rates of young women, improving prisoner mental health, burns care, lung health, scabies testing and reducing unborn baby deaths.

The direction of future First Nations research will be informed by the NHMRC’s Road Map 3, which will include a yearly report card and a commitment to spend at least 5% of annual NHMRC funding on Aboriginal and Torres Strait Islander health and medical research.

“Most importantly, the NHMRC Road Map 3 was developed in consultation with communities, First Nations researchers and the broader health and medical research sector to address Indigenous health issues and encourage and strengthen the capacity of Indigenous researchers, now and into the future,” said Minister Wyatt.

The NHMRC has today also released the Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders as well as Keeping Research on Track II.

The Guidelines provide a set of principles to ensure that research is safe, respectful, responsible, high-quality and of benefit to Aboriginal and Torres Strait Islander people and communities.

NACCHO Aboriginal Health and #childtrauma2018 : New Aboriginal-led project,aims to learn how to identify and support #Indigenous parents who have experienced complex trauma in their own childhoods.

 ” Complex trauma can have profound and ongoing impacts on development and physical, social and emotional wellbeing.

 The long-lasting relational effects can impede the capacity of parents to nurture and care for their children, leading to ‘intergenerational cycles’ of trauma “

This blog entry was authored by Dr Catherine ChamberlainSenior Research Fellow at the Judith Lumley Centre; Dr Graham Gee, Clinical Coordinator, Victorian Aboriginal Health Service; and Professor Stephanie Brown, Murdoch Children’s Research Institute

An exciting new Aboriginal-led project, funded by the Lowitja Institute (2017-2018) and the National Health and Medical Research Council (2018-2021), aims to learn how to identify and support Aboriginal and Torres Strait Islander parents who have experienced complex trauma in their own childhoods.

This project will run over four years with the phase one now underway. Those co-ordinating the project will be presenting a paper at the 2018 International Childhood Trauma Conference, and ahead of that presentation, have been invited to share with the professional network of Prosody readers about the project context, aims and opportunities.

Cultures Child, Ink on paper, 2018 © Shawana Andrews 

A father, mother and child wearing possum skin cloaks sitting by a myrnong daisy, the father holds the stem and looks to the daisy as it holds history and knowledge of the ancestors, this gives him strength.  The mother holds a newborn and rests against the stem, it supports her.  Mother and father are on different sides of the stem representing their different paths and roles in caring and nurturing for children. The daisy is in flower but also has a new bud and speaks of future generations and continuity.  The stones below represent a strong foundation of many generations and the stitching on the cloaks represent the relational connectedness of Aboriginal people and worldview. The mother’s hair blows in the wind, representing change.

Context

Complex trauma can have profound and ongoing impacts on development and physical, social and emotional wellbeing.4 The long-lasting relational effects can impede the capacity of parents to nurture and care for their children, leading to ‘intergenerational cycles’ of trauma.2 Attachment theory is often used to explain how disrupted primary carer relationships impact on the capacity to develop the social, emotional and cognitive skills necessary to form healthy interpersonal relationships throughout life.2 It proposes that, in a secure care-giving relationship, a parent responds sensitively to an infant’s cues and the infant’s needs for food, security and comfort.

In times of distress, an infant relies on support from its parent or caregiver. If the parent withdraws or the response is confusing or hostile, conflicting attachment and defense systems are activated, leading to internal confusion and maladaptive behavioural and relational responses. These include structural dissociation, or experiential avoidance and other behaviours that attempt to manage distress and self-regulate but instead create more confusion and harm.

These maladaptive responses can be maintained into adulthood as part of the complex trauma experience,5 with serious effects including smoking, eating disorders, unplanned pregnancies, adverse birth outcomes, psychological illness and adverse birth outcomes.5Broader societal factors can interact and amplify or counteract these effects,2 with the factors experienced by Aboriginal communities having a generally net negative effect.

How might complex trauma impact on the transition to becoming a parent?

It is important for professionals working with parents who have experienced complex trauma to understand what the specific issues for the critical perinatal period, which includes the process of pregnancy and birth and the transition to becoming a parent.

Firstly, the nature of many procedures and experiences associated with pregnancy, birth and breastfeeding leads to a high risk of triggering trauma responses among women who have experienced physical or sexual abuse. In addition, becoming a parent is a major developmental and emotional challenge, particularly for those maltreated as a child.4Parents can experience fear as they respond to their own child’s distress.

Due to structural dissociation and avoidance, their responses are often shaped by re-experiencing conflicting sensations and emotions rather than a thought-out narrative.4 The parent then needs to simultaneously try to manage distress associated with relational trauma, and the child’s attachment needs, and this is turn can give rise to hostile or helpless responses to the growing child’s needs.5 It can lead to an increased risk of victimisation and perpetuating violence.2

The perinatal period offers a unique life-time opportunity for healing from complex trauma

Despite these risks, the transition to parenthood during the perinatal period (pregnancy to two years postpartum) offers a unique life-course opportunity for healing and emotional development 7. Most parents who have experienced maltreatment themselves are able to provide nurturing care for their children 4 especially in a supportive environment. A positive strengths-based focus during this often-optimistic period has the potential to disrupt the ‘vicious cycle’ of intergenerational trauma into a ‘virtuous cycle’ that contains positively reinforcing elements that promote healing.8 Experts suggest that examining these ‘cycles of discontinuity’ demonstrated by most parents experiencing complex trauma is a good place to start to try to understand what support strategies might be acceptable, effective and feasible.2

However, despite these risks and opportunities for healing, particularly during frequent scheduled contacts with health care providers during pregnancy, birth and early parenting years – there are currently no systematic perinatal strategies for identifying and supporting parents who have experienced complex trauma themselves.  This project will begin to address this critical gap.

Aims
The aims of this study are to:

1. Assess the acceptability, validity, safety and feasibility of screening Aboriginal parents during the perinatal period to identify those who have experienced complex trauma.
2. Develop acceptable, safe and feasible intervention strategies that could be offered during the perinatal period (pregnancy to 24 months postpartum) to support Aboriginal parents who have experienced complex trauma, with the goal of promoting healing for the parent and preventing transmission of intergenerational trauma to the child.

These aims will be achieved using community-based participatory action research (CBPAR) approach with four main ‘plan, act observe and reflect’ phases.

Want to know more?


If you are attending the 2018 International Childhood Trauma Conference, please attend our paper presentation!

If you can’t, you can also contact the Principal Investigator:
Dr Catherine Chamberlain
email: c.chamberlain@latrobe.edu.au
We are in the process of setting up a website and regular newsletters three times a year and would love people to get in touch to be included in the list. We also welcome feedback and suggestions at any time.

About the authors:

Catherine Chamberlain, PhD, is a Senior Research Fellow at the Judith Lumley Centre, La Trobe University and National Health and Medical Research Council Early Career Fellow (1088813).  A descendant of the Trawlwoolway People (Tasmania), her research focus’ on applied public health research to improve health for Aboriginal and Torres Strait Islander families in the perinatal period.

Graham Gee, PhD, has worked at the Victorian Aboriginal Health Service in Melbourne, Australia since 2008. He is the Clinical Coordinator and a senior psychologist at the Family Counselling Services. In 2016, Dr Gee completed his PhD on resilience and recovery from trauma among Aboriginal help-seeking clients.

Stephanie Brown, PhD, is a social epidemiologist, health services researcher and Head of the Intergenerational Health Research Group at the Murdoch Children’s Research Institute. A major focus of her work is improving the health, wellbeing and resilience of Aboriginal children and families, women and children of refugee background, and women and children experiencing family violence.

References

1. World Health Organisation. Child maltreatment factsheet. Geneva: WHO; 2016. http://www.who.int/mediacentre/factsheets/fs150/en/

2. Alexander P. Intergenerational cycles of trauma and violence:  An attachment and family systems perspective. New York, NY: W.W. Norton & Company; 2016.

3. (Kezelman & Stavropoulos, 2012)

4. McCrory E, De Brito S, Viding E. Research review: The neurobiology and genetics of maltreatment and adversity. J Child Psychol Psychiatry 2010;51(10):1079-95.

5. Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol. 2014;5.

6. Amos J, Segal L, Cantor C. Entrapped Mother, Entrapped Child: Agonic Mode, Hierarchy and Appeasement in Intergenerational Abuse and Neglect. J Child Family Studies. 2015;24(5):1442-50.

7. Fava NM, Simon VA, Smith E, Khan M, Kovacevic M, Rosenblum KL, et al. Perceptions of general and parenting-specific posttraumatic change among postpartum mothers with histories of childhood maltreatment. Child Abuse Negl. 2016;56:20-9.

8. Segal L, Dalziel K. Investing to Protect Our Children: Using Economics to Derive an Evidence-based Strategy. Child Abuse Review. 2011;20(4):274-89.

NACCHO Aboriginal Health celebrates #AMAFDW18 AMA Family Doctor Week : @amapresident Speech to @PressClubAust #NPC Includes support #ulurustatement #prevention investment #obesity #Chronic Disease funding #MentalHealth

 

” I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.”

AMA President Dr Tony Bartone speaking at the National Press Club 25 July 2018

 ” This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

GPs of Australia, I salute you. We all salute you.

Your hard work and dedication is highly valued. The AMA will always support you and promote you.

Your GP – your family doctor – will ensure that your health needs are met throughout all stages of your life.

Be it immunisation, preventative health care, age specific medical checks, chronic disease management, or aged care, the life long relationship with your GP underpins continuous and appropriate care.

This is especially the case for patients who are from culturally or linguistically diverse backgrounds. For them, GPs truly are their trusted health advocates.”

 ” The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese. ”

Full Speech : Health reform: Improving the patient journey

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

It is a humbling experience to be elected President of such a proud and respected organisation as the AMA.

It is an equally humbling experience to speak here at the National Press Club in Canberra. I thank the Press Club for this opportunity.

I am a GP, and I have been in practice in the northern suburbs of Melbourne for more than 30 years.

Some of you may know that I was inspired to become a GP by watching my own family doctor, who cared for my ill father when I was growing up.

Even now, my mother reflects on the care and dedication my family GP displayed in caring for her family. It’s no surprise that he became an early mentor in my professional life.

I have seen it all as I have looked after the health of my community and my patients, including generations of the same families.

I like to think that my experience has given me some credibility in knowing what works and what doesn’t work in the health system, especially in primary care.

My overarching concern has always been the patient journey – ensuring that people get the right care at the right time in the right place by the right practitioner.

The priorities for me are always universal access to care, and affordability.

Today, I will share my views on what can be done to make our great health system even better – how to improve the patient journey.

I will also introduce you to some of my patients, and reflect on the barriers in their access to timely care, to further illustrate our concerns.

General practice and primary care reform

On the day I was elected, I made it very clear that one of the hallmarks of my Presidency would be stridently advocating for significant investment in general practice.

This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

see intro for text

However, there is something really crook about how GPs have been treated by successive Governments.

They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs.

General practice has been the target of continual funding cuts over many years. These cuts have systematically eaten away at the capacity of general practice to deliver the highest quality care for our patients.

They threaten the viability of many practices.

I talk to my GP members regularly, both metropolitan and rural.

The message is simple – some are at a tipping point and have a very bleak view of the future.

They see general practice becoming increasingly corporatised, burdened with more red tape, and GPs are less able to spend the necessary time with patients.

This is not the future that GPs want to see.

This is not the future that our patients want to see.

We can and must avoid these bleak predictions, but it requires significant real and immediate investment from the Government with a clear pathway to long-term reform.

Let me be very clear about this: we must put general practice front and centre in future health policy development.

We have seen too many mistakes. Too many poor policy decisions.

Despite the Government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients.

Instead of real investment, the Trial largely shifted existing buckets of money around.

It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.

There is no doubt that the challenge of transforming general practice was severely underestimated by policy makers. At least with this model.

But general practice still needs transformation and rejuvenation to meet growing patient demand and to keep GPs working in general practice.

The AMA has a plan for reform of general practice and primary care.

It is patient-centred and focuses on better access to long-term continuous quality care and managing patients more effectively in the community.

It takes the best elements of the ‘medical home’ concept and adapts them to the Australian context.

It is a plan that will require upfront and meaningful new investment, in anticipation of long-term savings in downstream health costs.

In the short term, the AMA plan for general practice will involve:

  • significant changes to Chronic Disease funding, including a process that strengthens the relationship between a patient and their usual GP, and encourages continuity of care;
  • cutting the bureaucracy that makes it difficult for GPs to refer patients to allied health services;
  • formal recognition in GP funding arrangements of the significant non-face-to-face workload involved in caring for patients with complex and chronic disease;
  • additional funding to support enhanced care coordination for those patients with chronic disease who are at risk of unplanned hospital admission – a similar model to the Coordinated Veterans Care Program funded by the Department of Veterans Affairs;
  • a properly funded Quality Improvement Incentive under the Practice Incentive Program – the PIP;
  • changes to Medicare that improve access to after-hours GP care through a patient’s usual general practice;
  • support for patients with chronic wounds to access best practice wound care through their general practice;
  • better access to GP care for patients in residential aged care; and
  • annual indexation of current block funding streams that have not changed for many years … including those that provide funding to support the employment of nursing and allied health professionals in general practice.

In the longer term, we need to look at moving to a more blended model of funding for general practice.

While retaining our proven fee-for-service model at its core, the new funding model must have an increased emphasis on other funding streams, which are designed to support a high performing primary care system.

This will allow for increasing the capability and improving the infrastructure supporting general practice to allow it to become the real engine room of our health system.

It is about scaling up our GP-led patient-centred multidisciplinary practice teams to better provide the envelope of health care around the patient in their journey through the health system.

A good example is the Blacktown Hospital Diabetes Outpatient Clinic in New South Wales.

This Clinic has a waiting time of less than a week because the service is distributed to its catchment GPs with the appropriate funding and support for both personnel and infrastructure.

This is a small example, but a significant one when you consider the scale and prevalence of diabetes across Australia, let alone the western suburbs of Sydney, and the average access times for outpatient hospital clinics.

We cannot continue to do things the way we always have.

The bulk-billing rate should not be the metric by which we judge the performance of general practice.

Chronic conditions have become more prevalent in Australia. The ones causing most concern are:

  • arthritis;
  • asthma;
  • back pain and problems;
  • cancer;
  • cardiovascular disease;
  • chronic obstructive pulmonary disease;
  • diabetes; and
  • mental health conditions.

One in two people now report having at least one of these eight common chronic conditions.

These conditions account for around 60 per cent of the total disease burden, and they contribute to nearly 90 per cent of deaths in Australia.

We must reshape our primary care system to meet these challenges.

We must put in place the funding support that general practice needs to better manage patients in the community – and keep people out of hospital.

Our plan is a smarter and more sustainable blueprint … a better plan for general practice. A better plan for Australians.

Public hospitals

We also need a better plan for public hospitals.

In an election year, voters tend to focus very closely on public hospitals when they are comparing health policies.

Public hospitals are a critical part of our health system. They are highly visible. They are greatly loved institutions in the community. They are vote changers.

The doctors, nurses, and other staff who work in our public hospitals are some of the most skilled in the world.

In 2016-17, public hospitals provided more than six and a half million episodes of admitted patient care. They managed 92 per cent of emergency admissions.

If the state of general practice is crook, then our public hospitals are on permanent code yellow.

Despite their importance, and despite our reliance on our hospitals to save lives and improve quality of life, they have been chronically underfunded for too long.

Between 2010-11 and 2015-16, average annual real growth in Federal Government recurrent funding for public hospitals has been virtually stagnant – a mere 2.8 per cent.

The AMA welcomes that, between 2014-15 and 2015-16, the Federal Government boosted its recurrent public hospital expenditure by 8.4 per cent.

But a one-off modest boost from a very low base is not enough.

I deal with the results of stressed public hospitals every day and manage the impact it has on my patients.

Ollie is a patient with well-controlled Parkinson’s disease. He now also has a recently diagnosed lung cancer, which has been caught early, resected, and appropriately managed.

But he has been denied care for his resulting poor control of his Parkinson’s disease in the same hospital’s neurology outpatient department and referred back to me.

I have been advised that I must source an alternative option for his neurological care.

Another of my patients, Carlo, is a victim of the never ending Federal-State buck passing when it comes to health.

Having developed poorly controlled reflux and having been referred to the local hospital outpatient department for a gastro consult, Carlo was referred back to me.

I was advised that I had to arrange a referral at the same hospital’s diagnostic imaging service for a possible coordination and swallowing problem, which ultimately proved correct.

He was then referred back to the gastroenterology department to manage his newly diagnosed oesophageal condition.

Barbara is another very common example of the funding chaos.

She is a very active 68-year-old lady who was troubled by severe osteoarthritis of the knee for many years. She was placed on a waiting list for surgery two years ago.

She has had to attend our practice regularly for pain management and supportive referrals for physiotherapy, while I continued to manage the consequences of her inability to lose weight due to her exercise restrictions and worsening diabetes and blood pressure profile.

She has just finally had her knee joint replaced.

These are the experiences of everyday patients.

They underpin the troubling headlines that came from the AMA’s 2018 Public Hospital Report Card. Our hospitals are stretched to the limit.

Likewise, the AMA’s Safe Hours Audit is a window into the lived experience of dedicated doctors, struggling to deliver quality care in over-crowded, under-funded hospitals.

But instead of helping the hospitals improve safety and quality, governments decided to financially punish hospitals for poor safety events.

There is no evidence to show that financial penalties work.

Health care is complex. Not all patient complications can be avoided.

The 2020-25 hospital funding agreement does little to improve the situation.

Funding levels stay the same, but public hospitals will have to do more with it to help coordinate patient care post-discharge.

The AMA supports better discharge planning and integrated care, especially for patients with complex and chronic disease.

But this will cost money – and public hospitals need extra funding.

The AMA calls on the major parties to boost funding for public hospitals beyond that outlined in the next agreement.

There must be a plan to lift public hospitals out of their current funding crisis, which is putting doctors and patients at risk.

Governments must stop penalising hospitals for adverse patient safety events.

We need policies to fully fund hospitals. We must help them improve patient safety and build their internal capacity to deliver high value care in the medium to long term.

They must link up and work with primary care to deliver better coordinated care.

I note that Labor has pledged an extra $2.8 billion for public hospitals.

I expect that the Coalition will match that as the election draws nearer.

They do not want another Medi-scare style campaign.

Medical care for older Australians

Older Australians are voters, too.

Aged care was, until very recently, one of the highest profile segments of the health system – but for all the wrong reasons.

It is now emerging as an area in need of significant reform as the population ages and lives longer.

Older Australians all too frequently do not have the same access to medical care as other age groups – a longstanding result of inadequate funding in the aged care system.

This inequity will likely only grow as the Australian population ages with more complex, chronic medical conditions requiring more medical attention than ever before.

We have witnessed numerous consultations and reviews.

Enough! Now is the time for action.

There is already sufficient information to underpin the final recommendations. It is simply unfair and unjust to delay this any further.

An increase in funding for GP visits to aged care facilities would result in many savings, including from reduced ambulance transfers to hospital emergency departments.

Changes to after-hours care remuneration must consider services that are currently provided under ‘urgent’ item numbers to patients in aged care facilities.

We also need to ensure that the critical role that nurses play in caring for older Australians is recognised in those facilities.

The AMA wants to see Medicare rebates that adequately cover the time that doctors spend with the patient assessing and diagnosing their condition and providing medical care.

We want new telehealth Medicare items that compensate GPs, and other medical specialists, for the time spent organising and coordinating services for the patient.

This includes the time that they spend with the patient’s family and carers to plan and manage the patient’s care and treatment.

There must be funding for the recruitment and retention of quality, appropriately trained aged care staff.

And we must reverse the decline in the proportion of Registered Nurses in aged care.

The AMA Aged Care Survey, released today, shows that AMA members who work in aged care have identified the shortage of Registered Nurses – who should be available 24 hours a day – as the biggest priority for aged care reform.

The survey also shows that one in three doctors are planning to cut back on, or completely end, their visits to patients in aged care facilities over the next two years.

This is largely because the Medicare rebates are inadequate for the amount of time and work involved.

The AMA will ensure that aged care gets the attention and profile it deserves in the election campaign.

Private health insurance:

Private health insurance has been in the headlines for much of the past year – again, for all the wrong reasons.

The AMA has always called for a simpler and fairer private health insurance system.

Without the private system, the public system would likely collapse.

But we cannot expect the private system to thrive – or even survive – if there is not value in insurance policies.

Patients are smart – they know there is no point outlaying thousands of dollars every year if the coverage isn’t there.

Affordability means very little without value.

We are clearly at a crisis point in private health insurance. And the Government knows it.

Hence the latest Review, and the recent announcement by the Minister of new categories of policies … and greater transparency.

We support the concept of developing Gold, Silver, and Bronze insurance categories.

We can’t expect consumers to understand the many different definitions, the carve outs, and exclusions of some 70,000 policy variations.

Australians want reasonable and simple things from their insurance.

They want coverage.

They want a choice of the practitioner, and a choice of the hospital.

They want treatment when they need it.

We can’t have patients finding out they aren’t covered after the event, or when they require treatment and it’s all too late.

To that end, we have been very clear – we don’t support the use of restrictions in Gold, Silver, and Bronze.

Restrictions lead people to believe they are covered, when in reality they are exposed to additional costs.

We don’t support junk policies. If a Basic policy category doesn’t provide much coverage, that should be made crystal clear.

We don’t support dismantling community rating. This must be protected to maintain equity of access to private health treatment.

When the objective is to support a strong private health sector to take pressure off the public sector, it makes no sense to financially discourage the patients who are most likely to need access to private health.

We support standard clinical definitions. Whatever is involved for coverage for heart conditions should not vary between insurers and policies.

I urge the Government to continue to work with the Colleges to ensure that these definitions are robust.

There is increasing corporatisation of private health and the market power is shifting in favour of private health insurers.

Insurers, whether private or via Medicare, cannot determine the provision of treatment in Australia.

They cannot and must not interfere with the clinical judgement of medical practitioners.

Australians do not support a US-style managed care health system. Neither does the AMA.

One area we are disappointed with in the recent announcements is pregnancy cover.

It does not make sense to us, as clinicians, to have pregnancy cover in a higher level of insurance only.

Many pregnancies are unplanned – meaning people are caught out underinsured when pregnancy is restricted to high-end policies.

Pregnancy is a major reason that the younger population considers taking up private health insurance.

They are less likely to be able to afford the higher-level policies. We need to make sure it is within reach.

I having female reproductive services at a different level to pregnancy coverage is, to us, problematic, and will leave a lot of people caught out.

There will be much more to talk about as the private health reforms are finalised and bedded down.

Mental Health

As a suburban GP who sees the whole range of health ailments and conditions, an area of special interest to me is mental health.

I do not think the unique role and special skills of GPs are used enough at the front line of mental health care.

The AMA earlier this year called for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults – that is more than seven million people – will experience a mental health condition in their lifetime.

Almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague.

The statistics are startling. For example:

  • More than half a million children and adolescents, aged four to 17, experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.

And yet mental health and psychiatric care are grossly underfunded.

Strategic leadership is needed to integrate all components of mental health prevention and care.

For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

There is no vision of what the mental health system will look like in the future.

Poor access to acute beds for major illness leads to extended delays in emergency departments.

Poor access to community care leads to delayed or failed discharges from hospitals.

And poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

We have repeatedly called for support for carers of people with mental illness, which is often the result of necessity, not choice.

Access to respite care is vital for many people with mental illness and their families, who are the ones who bear the largest burden of care.

Indigenous health

I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.

Prevention

There is not enough time today to cover all the issues I would like to cover in one speech.

I could deliver a whole speech on each of the following topics – medical workforce, rural health, medical research, genetic testing, e-cigarettes and vaping, opioids, medicinal cannabis, scope of practice, asylum seeker health, the NDIS, or palliative care, to name just a few.

I could probably manage a few words about the My Health Record, too. No doubt there will be questions about that.

But I have to talk to you about prevention, if only briefly.

The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

This amounts to a measly 1.34 per cent of all health spending. This is considerably less than comparable countries such as Canada, the United Kingdom, and New Zealand.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese.

The evidence shows that advice to lose weight given by a doctor increases the motivation to lose weight. It also increases engagement in weight loss behaviours.

But the support and advice from doctors can only achieve so much.

Population level measures are needed. We need to see action on a sugar tax, banning junk food advertising to kids, and improving urban planning to help get people moving and active.

Governments have the tools to implement these measures. A sugar tax would be a good start.

In closing, I know the challenges ahead for the health system.

I will dedicate my Presidency to improving health policy so that we have a system that delivers the best possible care to our patients.

The AMA will be a very strong and loud advocate.

There is nothing like a Federal election to help our political leaders share the public’s interest in good health policy.

The election will happen within twelve months, possibly this year.

Along with the members of the National Press Club, the AMA will be watching the political events of this weekend and the coming months with very close interest.

NACCHO Aboriginal Health and #TopEndFASD18 : “Let’s Make #FASD History” says Top End Foetal Alcohol Spectrum Disorder (FASD) forum with 6 key messages to be taken into account addressing FASD:

 ” The forum delegates agreed that there was an urgent need for action to prevent FASD in our Top End communities, and across the Northern Territory.

It is essential that our responses do not stigmatise women or Aboriginal people.

It is important that we don’t lay blame, but instead work together, to support our women and young girls.

Everyone is at risk of FASD, so everyone must be informed the harmful effects of drinking while pregnant.

Our men also need to step up and support our mothers, sisters, nieces and partners, to ensure that we give every child the best chance in life.”

A landmark Top End Foetal Alcohol Spectrum Disorder (FASD) forum* was held in Darwin on 30-31 May 2018

Read over 25 NACCHO Aboriginal Health and FASD articles published over 6 years

“ Territorians want and deserve access to high quality health services,” Ms Fyles said.

Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD “

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin see Ministers Press Release Part 2 below

#TopEndFASD18  Bringing together Aboriginal leaders, FASD experts, Aboriginal community-controlled organisations, government representatives, medical professionals, and Non-Government organisations. Approximately 180 delegates representing 37 organisations across the Northern Territory.

FASD is often considered to be a ‘hidden’ disability, because more often than not, the physical characteristics of the individual are not easily recognised. Instead, an individual may present with learning and behavioural difficulties, which may present for a range of disorders.

As a result, FASD is not easily identified and individuals can go undiagnosed and receive inadequate treatment and support.

The forum heard from the NT Minister for Health and the Attorney General Natasha Fyles, NT Children’s Commissioner, Colleen Gwynne, Professor Elizabeth Elliott, Dr James Fitzpatrick, NOFASD and FASD Hub.

The forum also heard from Aboriginal community controlled organisations Danila Dilba, Wurli Wurlinjang, Anyinginyi Health Services, Aboriginal Medical Services Alliance Northern Territory and the North Australian Aboriginal Justice Agency.

Over two days, the forum delegates discussed the impacts of FASD on individuals, families and communities and acknowledged that alcohol misuse and its consequences are an issue for all Territorians, particularly our most vulnerable. Delegates also heard the evidence on how the prevalence of FASD impacts many of our services, including health, education and justice. Delegates learnt that trauma runs deep, and healing and making the right connections is crucial.

The delegates raised the following key messages to be taken into account in addressing FASD:

 1.Prevention and raising awareness

FASD is entirely preventable, much of its impacts are also irreversible. The harms caused by alcohol in our communities are not acceptable and we will all work together to develop prevention and intervention strategies that are culturally appropriate and relevant for our 2

people and communities. It is acknowledged that current and proposed alcohol control measures in the NT are a critical component of prevention.

2. Collaborative Approaches

The forum identified an urgent need for Aboriginal organisations, government agencies, NGOs and local communities to work together to develop policies and programs for women, men, children and communities in the Top End communities and to contribute to the development of an NT FASD Strategy. This needs to be Aboriginal community-led by the health, education, justice and child protection sectors.

 3.Access to FASD resources

It was evident that there is a need for more investment in developing culturally appropriate tools and resources for local Aboriginal communities and key stakeholders working on the frontline and also at the strategic level.

4.Assessment and Treatment services

An identified priority need is for the establishment of multi-disciplinary neuro-developmental assessment and treatment services that are strategically linked with existing service settings, including primary health care, education, child protection and the justice system.

5.Support for children and families

Research is needed to better understand how best to support children and families with FASD and other related issues that also often affect families, such as trauma. We refer to the Fitzroy Valley as a best practice model, as many strong women and leaders in the community worked in partnership with FASD experts and research institutes.

6.Workforce

The skilling and expansion of the workforce needed for prevention, assessment and treatment of FASD, particularly the community based remote Aboriginal workforce, was identified as an important need.

From this forum, we have heard the experiences about the high levels of despair and sense of disempowerment and hurt of our people and these are sad stories. We were also enlightened by the enthusiasm, dedication, passion and hope from local communities, all professions and services, that want to do more and can do more to make FASD History!

*APO NT will be producing a full report on the outcomes of the FASD Forum over the coming weeks.

Generational Change: Putting the spotlight on Foetal Alcohol Spectrum Disorder

30 May 2018

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin.

“Territorians want and deserve access to high quality health services,” Ms Fyles said.

“Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

“That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

“Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD.

“This strategy was supported by recommendations in the recent Riley Review into Alcohol Policy and Legislation Alcohol Report and is now an important part of the Territory Labor Government’s Alcohol Harm Minimisation Action Plan to deliver sweeping alcohol reforms for generational change.”

The NT Department of Health funded the Aboriginal Peak Organisations NT (APONT) to deliver the 2 day forum.

The themes of the Forum are:

  • Increase knowledge and raise awareness about FASD in Top End communities and the impact of alcohol during pregnancy on the developing baby;
  • Understand the impact of FASD on children, youth and their families
  • Identify the challenges, issues and solutions for governments, service providers and other key stakeholders;
  • Identify culturally appropriate resources, tools and protocols
  • Establish a Top End FASD Network.

Minister Fyles said that Forum provides an important consultation opportunity with the health sector and community to feed into the development of the NT’s FASD Strategy, for release later this year.

“Stories will be shared and ideas and actions generated to inform the Strategy, which in turn will help guide communities and Government to work together in partnerships to prevent FASD,” Ms Fyles said.

“The NT FASD Strategy will promote the screening of alcohol use before and during pregnancy; appropriate multi-disciplinary assessment; early intervention, support and case management; and will develop targeted education campaigns for those who are most at risk from alcohol-related harms.

“This work is supported in our Government’s 10-Year Early Childhood Development Plan to lead cultural change in reducing alcohol consumption and harms in the community.

“Our whole of government approach to respond to FASD will be crucial to preventing this completely preventable lifelong and permanent condition.”

 

NACCHO Aboriginal Health and Teenage #Pregnancy #maternalMHmatters : Download @AIHW Report : Indigenous teenage mothers almost twice as likely to smoke during pregnancy as non-Indigenous mothers. @sistaquit #Prevention2018

 

” Indigenous teenage mothers are over-represented One in 4 (24%) teenage mothers identified as Aboriginal and/or Torres Strait Islander in 2015.

This means that Indigenous women were over-represented amongst teenage mothers, given Indigenous women aged 15–19 account for only 5.3% of the overall population of Australian females of the same age.

The proportion of Indigenous mothers in Australia is higher in Remote and Very remote areas, and teenage Indigenous mothers also follow this pattern

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were 1.5 times as likely to smoke in the first 20 weeks of pregnancy (43% compared with 28%) “

Read Part 2 Below or Download :

NACCHO Download aihw-per-93.pdf

Babies of teenage mothers are more likely to be premature and experience health issues in the first month than babies born to women just a few years older, a new report has revealed.

Teenage mums are also more likely to live in Australia’s lowest socio-economic areas (42 per cent) compared to mums aged 20-24 years (34 per cent), according to the report by the Australian Institute of Health and Welfare (AIHW).

The report, published today , showed the numbers of teenage mothers had dropped from 11800 in 2005 to 8200 in 2015, with nearly three-quarters of teenage mothers aged 18 or 19.

Compared to babies born to mothers aged 20-24 years, more babies born to teenage mothers were premature, had a low birth weight and needed admission to special care nursery.

Despite the negative outcomes for babies, the report showed positive trends for teenage mothers including more spontaneous labours, lower caesarean section rates and less diabetes for teenage mothers.

“The difference between teenage mothers and those in the slightly older age group is due in part to a large number of teenage mothers living in low socio-economic areas,” says AIHW report author Dr Fadwa Al-Yaman.

Dr Al-Yaman said the differences could also be due to the higher smoking rates in pregnancy, with a quarter of teenage mothers smoking after 20 weeks of pregnancy compared to 1 in six of those aged 20 to 24.

A quarter of teenage mothers identified as Aboriginal or Torres Strait Islander, with Indigenous teenage mothers almost twice as likely to smoke during pregnancy as non-Indigenous mothers.

Dr Al-Yaman said risk factors were highly interlinked, with issues such a smoking, low levels of education and employment being concentrated in remote areas.

The teenage birth rate in metro areas is less than half that of regional areas, she said.

“There is a strong link between socio-economic disadvantage and living in remote areas,” she told AAP.

“You need to have access to transport, access to health services and if you have to pay for your transport, sometimes over an hour’s worth, it’s going to take more of your welfare money.”

SISTAQUIT Trial Recruiting Services Now

The SISTAQUIT™ trial aims to improve health providers’ skills and when offering smoking cessation care to pregnant Aboriginal and Torres Strait Islander women.

Pregnancy is an important window of opportunity for GPs and health providers to help smokers quit, however they often lack the confidence and skills to address their patients’ smoking.

This intervention provides webinar-based training in evidence based and culturally competent smoking cessation care for providers working within Aboriginal Medical and Health Services.

The SISTAQUIT™ Team are currently recruiting Aboriginal Medical Services (AMS) and GP practices in NSW, WA, QLD, SA and NT for this study.

To find out more about your service being involved in the SISTAQUIT™ trial please contact Dr Gillian Gould or Joley Manton at the University of Newcastle.

Website

Download the trial brochure here

Download an information sheet here

Part 2 Indigenous Mothers

Indigenous teenage mothers are over-represented One in 4 (24%) teenage mothers identified as Aboriginal and/or Torres Strait Islander in 2015.

This means that Indigenous women were over-represented amongst teenage mothers, given Indigenous women aged 15–19 account for only 5.3% of the overall population of Australian females of the same age.

Indigenous mothers are younger than average

The average age of Indigenous teenage mothers (17.8 years) was lower than for non- Indigenous mothers (18.1 years). Indigenous teenage mothers were 4.5 times as likely to be aged under 15 (1.8%; 35) as non-Indigenous teenage mothers (0.4%; 27) and less likely to be aged 19 (37.4%; 744 compared with 49.1%; 3,048).

More likely to live in remote areas

The proportion of Indigenous mothers in Australia is higher in Remote and Very remote areas, and teenage Indigenous mothers also follow this pattern.

In 2015, the Indigenous population rate for 15–19 year old mothers living in Remote and Very remote areas was 84.9 per 1,000 females, which was 5.5 times the non-Indigenous rate (15.2 per 1,000).

The population rate for 15–19 year old Indigenous mothers was also higher for women living in Major cities at 40.7 per 1,000 for Indigenous women compared with 7.1 per 1,000 for non-Indigenous women.

Fewer and later antenatal visits

Indigenous teenage mothers generally attended fewer antenatal visits than non-Indigenous teenage mothers, with higher proportions of 1 visit (1.5% compared with 0.9%) and 2–4 visits (9.5% compared with 6.1%) and lower proportions of 5 or more visits (86% compared with 91%).

They were 1.1 times as likely to attend their first antenatal visit at 20 weeks gestation or more (25% compared with 23%).

More likely to smoke

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were:

• 1.5 times as likely to smoke in the first 20 weeks of pregnancy (43% compared with 28%)

• 1.7 times as likely to smoke after 20 weeks (36% compared with 21%).

Higher rates of diabetes

Indigenous teenage mothers were 1.2 times as likely as non-Indigenous teenage mothers to have diabetes (6.0% compared with 4.9%) and gestational diabetes (5.1% compared with 4.2%).

Onset of labour, method of birth and perineal status

In 2015, Indigenous teenage mothers were more likely than their non-Indigenous counterparts to have spontaneous labour (66% compared with 62%), and less likely to have induced labour (28% compared with 32%), but equally likely to have no labour (both 6.1%).

Compared to non-Indigenous teenage mothers, Indigenous teenage mothers were slightly more likely to:

• have a caesarean section (19% compared with 18%)

• have an intact perineum (27% compared with 26%).

 

NACCHO Media Alerts : Top 10 Current Aboriginal Health News Stories to keep you up to date

1. Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

3.Nurses PAQ continues political membership campaign spreading false and misleading information about our cultural safety

4.AMSANT has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

5.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People.

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

9.Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

10. Your guide to a healthy Easter : #Eggs-actly  

 

1.Aboriginal sexual health: The Australian : Was the syphilis epidemic preventable ? NACCHO responds

“These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,”

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this.

Read full article in Easter Monday The Australian or Part B below

2.Royal Flying Doctors Service extra 4-year funding $84 million Mental Health and Dental Services

Read full press release here

 

3.Nurses PAQ continues political membership campaign spreading false and misleading information about cultural safety

SEE NACCHO Response

SEE an Indigenous Patients Response

See Nurses PAQ Misleading and false campaign

4. AMSANT  has called for re-doubled efforts to implement the recommendations of the Royal Commission into the care and protection of children in partnership with NT Aboriginal leaders

Read full AMSANT press Release

Listen to interview with Donna Ah Chee

Press Release @NACCHOChair calls on the Federal Government to work with us to keep our children safe

#WeHaveTheSolutions Plus comments from CEO’s @Anyinginyi @DanilaDilba

4.Dialysis facilities worth $17 million are sitting padlocked, empty and unused in WA’s north

Read full Story HERE

6.ALRC Report into Incarceration of Aboriginal and Torres Strait Islander People;

Read Download Full Transcript

Senator Patrick Dodson

Download the report from HERE

Community Groups Call For Action on Indigenous Incarceration Rates

7. Minister Ken Wyatt : Listening to Indigenous Needs: Healthy Ears Program Extended with $29.4 commitment

The Australian Government has committed $29.4 million to extend the Healthy Ears – Better Hearing, Better Listening Program, to help ensure tens of thousands more Indigenous children and young adults grow up with good hearing and the opportunities it brings.

Read Press Release HEAR

8.Tangentyere Alice Springs Women’s Family Safety Group visits Canberra

This week the Tangentyere Women’s Family Safety Group from Alice Springs were in Canberra. They shared with politicians, their own solutions for their own communities, and they are making an enormous difference.
Big thanks to all the Tangentyere women who made it to Canberra.

Read Download the Press Release

TANGENTYERE WOMEN’S FAMILY SAFETY GROUP (FED

9. Minister Ken Wyatt launches our NACCHO RACGP National Guide to a preventative health assessment for Aboriginal and Torres Strait Islander people

Read press releases and link to Download the National Guide

10. Your guide to a  healthy Easter : #Eggs-actly  

And finally hope you had a Happy Easter all you mob ! After you have enjoyed your chocolate eggs and hot cross buns , this is how much exercise you will require to work of those Easter treats .

For medical and nutrition advice please check with your ACCHO Doctor , Health Promotion / Lifestyle teams or one of our ACCHO nutritionists

 

Part B Full Text The Australian Article Easter Monday

There is no reason it should have happened, especially not in a first-world country like Australia, but it has: indigenous communities in the country’s north are in the grip of wholly treatable sexually transmitted diseases.

In the case of syphilis, it is an epidemic — West Australian Labor senator Patrick Dodson ­described it as such, in a fury, when health department bureaucrats mumbled during Senate estimates about having held a few “meetings” on the matter.

There have been about 2000 syphilis notifications — with at least 13 congenital cases, six of them fatal — since the outbreak began in northern Queensland in 2011, before spreading to the Northern Territory, Western Australia and, finally, South Australia.

What’s worse, it could have been stopped. James Ward, of the South Australian Health and Medical Research Institute, wrote in mid-2011 that there had been a “downward trend” over several years and it was likely at that point that the “elimination of syphilis is achievable within indigenous ­remote communities”.

But governments were slow to react, and Ward is now assisting in the design of an $8.8 million emergency “surge” treatment approach on the cusp of being rolled out in Cairns and Darwin, with sites in the two remaining affected states yet to be identified.

It will be an aggressive strategy — under previous guidelines, you had to have been identified during a health check as an active carrier of syphilis to be treated. Now, anyone who registers antibodies for the pathogen during a blood prick test, whether actively carrying syphilis or not, will receive an ­immediate penicillin injection in an attempt to halt the infection’s geographical spread.

This is key: the high mobility of indigenous people in northern and central Australia means pathogens cross jurisdictions with ­impunity. Australian Medical ­Association president Michael Gannon calls syphilis a “clever bacterium that will never go away”, warning that “bugs don’t respect state borders”.

Olga Havnen, one of the Northern Territory’s most respected public health experts, points out that many people “will have connections and relations from the Torres Strait through to the Kimberley and on to Broome — and it’s only a matter of seven or eight kilometres between PNG and the northernmost islands there in the Torres Strait”.

“This is probably something that’s not really understood by the broader Australian community,” Havnen says. “I suspect once you get a major outbreak of something like encephalitis or Dengue fever, any of those mosquito-borne diseases, and that starts to encroach onto the mainland, then people will start to get a bit worried.”

Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.
Olga Havnen, CEO of the Danila Dilba Health Service, says transmission is complex issue in Australia’s indigenous communities.

But it is not just syphilis — ­indeed, not even just STIs — that have infectious disease authorities concerned and the network of Aboriginal Community Controlled Health Organisations stretched.

Chlamydia, the nation’s most frequently diagnosed STI in 2016 based on figures from the Kirby Institute at the University of NSW, is three times more likely to be contracted by an indigenous Australian than a non-­indigenous one.

The rate was highest in the NT, at 1689.1 notifications per 100,000 indigenous people, compared with 607.9 per 100,000 non-indigenous Territorians. If you’re indigenous, you’re seven times more likely to contract gonorrhoea, spiking to 15 times more likely if only women are considered. Syphilis, five times more likely.

As the syphilis response gets under way, health services such as the one Havnen leads, the Darwin-based Danila Dilba, will be given extra resources to tackle it. “With proper resourcing, if you want to be doing outreach with those people who might be visitors to town living in the long grass, then we’re probably best placed to be able to do that,” she says.

But the extra focus comes with a warning. A spate of alleged sexual assaults on Aboriginal children, beginning with a two-year-old in Tennant Creek last month and followed by three more alleged ­attacks, has raised speculation of a link between high STI rates and evidence of child sexual assault.

After the first case, former NT children’s commissioner Howard Bath told this newspaper that STI rates were “a better indicator of background levels of abuse than reporting because so many of those cases don’t get reported to anyone, whereas kids with serious infections do tend to go to a ­doctor”. Others, including Alice Springs town councillor Jacinta Price and Aboriginal businessman Warren Mundine, raised the ­spectre of the need for removing more at-risk indigenous children from dangerous environments.

Children play AFL in Yeundumu. Picture: Jason Edwards
Children play AFL in Yeundumu. Picture: Jason Edwards

However, Sarah Giles, Danila Dilba’s clinical director and a medical practitioner of 20 years’ standing in northern Australia, warns this kind of response only exacerbates the problem. She is one of a range of public health authorities who, like Havnen, say connecting high STI figures to the very real scourge of child sex abuse simply makes no sense. They do not carry correlated data sets, the experts say.

“One of the things that’s really unhelpful about trying to manage STIs at a population level is to link it with child abuse and mandatory reporting, and for people to be fearful of STIs,” Giles says. “The problem is that when they’re conflated and when communities feel that they can’t get help ­because things might be misinterpreted or things might be reported, they’re less likely to present with symptoms. The majority of STIs are in adults and they’re sexually transmitted.”

Havnen says there is evidence of STIs being transmitted non-sexually, including to children, such as through poor hand ­hygiene, although Giles says that is “reasonably rare”. And while NT data shows five children under 12 contracted either chlamydia or gonorrhoea in 2016 (none had syphilis), and there were another five under 12 last year, Havnen points to the fact that over the past decade there has been no increasing trend in under 12s being affected. Where there has been a rise in the NT is in people aged between 13 and 19, with annual gonorrhoea notifications increasing from 64 cases in the 14-15-year-old ­female cohort in 2006 to 94 notifications in 2016.

In the 16-17-year-old female ­cohort the same figures were 96 and 141 and in the 12-13-year-old group it rose from 20 in 2006 to 33 in 2016. Overall, for both boys and girls under 16, annual gonorrhoea notifications rose from 109 in 2006 to 186 in 2016, according to figures provided to the royal ­commission into child detention by NT Health. Havnen describes the rise as “concerning but not, on its own, evidence of increasing ­levels of sexual abuse”.

Ward is more direct. Not all STIs are the result of sexual abuse, he warns, and not all sexual abuse results in an STI. If you’re a health professional trying to deal with an epidemiological wildfire, the distinction matters — the data and its correct interpretations can literally be a matter of life and death.

Indeed, in its own written cav­eats to the material it provided to the royal commission, the department warns that sexual health data is “very much subject to variations in testing” and warns against making “misleading assumptions about trends”. Ward says: “Most STIs notified in remote indigenous communities are ­assumed to be the result of sex ­between consenting adults — that is, 16 to 30-year-olds. Of the under 16s, the majority are 14 and 15-year-olds.” He says a historically high background prevalence of STIs in remote indigenous communities — along with a range of other ­infectious diseases long eradicated elsewhere — is to blame for their ongoing presence. Poor education, health services and hygiene contribute, and where drug and ­alcohol problems exist, sexually risky behaviour is more likely too. The lingering impact of colonisation and arrival of diseases then still common in broader ­society cannot be underestimated.

But Ward claims that an apparently high territory police figure of about 700 cases of “suspected child sexual offences” in the NT over the past five years may be misleading. He says a large number of these are likely to be the result of mandatory reporting, where someone under 16 is known to have a partner with an age gap of more than two years, or someone under 14 is known to be engaging in sexual activity. Ward points out that 15 is the nationwide ­median sexual debut age, an age he suggests is dropping. At any rate, he argues, child sex abuse is unlikely to be the main reason for that high rate of mandatory ­reporting in the NT.

Areyonga is a small Aboriginal community a few hours drive from Alice Springs.
Areyonga is a small Aboriginal community a few hours drive from Alice Springs.

Data matters, and so does how it is used. Chipping away at the perception of child sexual abuse in indigenous communities are the latest figures from the Australian Institute of Health and Welfare showing the rate of removals for that crime is actually higher in non-indigenous Australia.

According to a report this month from the AIHW, removals based on substantiated sex abuse cases in 2016-17 were starkly different for each cohort: 8.3 per cent for indigenous children, from a total of 13,749 removals, and 13.4 per cent for non-indigenous children, from 34,915 removals.

Havnen concedes there is a need for better reporting of child abuse and has called for a confidential helpline that would be free of charge and staffed around the clock by health professionals.

It’s based on a model already in use in Europe that she says deals with millions of calls a year — but it would require a comprehensive education and publicity campaign if it were to gain traction in remote Australia. And that means starting with the adults.

“If you’re going to do sex ­education in schools and you start to move into the area about sexual abuse and violence and so on, it’s really important that adults are ­educated first about what to do with that information,” she says. “Because too often if you just ­educate kids, and they come home and make a disclosure, they end up being told they’re liars.”

These challenges exist against the backdrop of a community already beset by a range of infectious diseases barely present elsewhere in the country, including the STIs that should be so easily treatable. It is, as Havnen is the first to admit, a complex matter.

Cheryl Jones, president of the Australasian Society for Infectious Diseases, says the answer is better primary treatment solutions and education, rather than trying to solve the problem after it has ­occurred. “For any of these public health infectious disease problems in ­remote and rural areas, we need to support basic infrastructure at the point of care and work alongside communities to come up with ­solutions,” she says.

Sisters play in the mud after a rare rain at Hoppy's 'town camp' on the outskirts of Alice Springs.
Sisters play in the mud after a rare rain at Hoppy’s ‘town camp’ on the outskirts of Alice Springs.

Pat Turner, chief executive of peak body the National Aboriginal Community Controlled Health Organisation, is adamant about this. “These (STIs) are preventable diseases and we need increased testing, treatment plans and a ­culturally appropriate health ­education campaign that focuses resources on promoting safe-sex messages delivered to at-risk ­communities by our trained Aboriginal workforce,” Turner says.

The Australian Medical ­Association has called for the formation of a national Centre for Disease Control, focusing on global surveillance and most likely based in the north, as being “urgently needed to provide national leadership and to co-ordinate rapid and effective public health responses to manage communicable diseases and outbreaks”.

“The current approach to disease threats, and control of infectious diseases, relies on disjointed state and commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians,” the association warned in a submission to the Turnbull government last year.

However, the federal health ­department has rebuffed the CDC argument, telling the association that “our current arrangements are effective” and warning the suggestion could introduce “considerable overlap and duplication with existing functions”.

“I think it (the CDC) might have some merit, if it helps to ­advocate with government about what needs to happen,” Havnen says, “but if these things are going to be targeted at Aboriginal bodies, it needs to be a genuine partnership. It’s got to be informed by the realities on the ground and what we know. That information has to be fed up into the planning process.”