NACCHO NEWS ALERT: COAG Health Ministers Council Communique acknowledge the importance #ACCHO’s advancing Aboriginal health

 

  Included in this NACCHO Aboriginal Health News Alert

  1. All issues 11 included in  Communique highlighting ACCHO health
  2. Health Ministers approve Australia’s National Digital Health Strategy
  3. Transcript Health Minister Hunt Press Conference

” The Federal Minister for Indigenous Health, Ken Wyatt, attended the COAG Health Council discussed the Commonwealth’s current work on Indigenous health priorities.

In particular this included the development of the 2018 iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 that will incorporate strategies and actions to address the social determinants and cultural determinants of health.

Ministers also considered progress on other key Indigenous health issues including building workforce capability, cultural safety and environmental health, where jurisdictions can work together more closely with the Commonwealth to improve outcomes for Aboriginal and Torres Strait Islander peoples.

Ministers acknowledged the importance of collaboration and the need to coordinate activities across governments to support a culturally safe and comprehensive health system.

Ministers also acknowledge the importance of community controlled organisations in advancing Aboriginal and Torres Strait Islander health. ”

1.Development of the next iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 COAG Health Council 

Read over 50 NACCHO NATSIHP Articles published over past 50 years

INTRODUCTION

The federal, state and territory Health Ministers met in Brisbane on August 4 at the COAG Health Council to discuss a range of national health issues.

The meeting was chaired by the Victorian Minister for Health, the Hon Jill Hennessy MP.

Health Ministers welcomed the New South Wales Minister for Mental Health, the Hon Tanya Davies MP, the Victorian Minister for Mental Health, the Hon Martin Foley MP, the ACT Minister for Mental Health Mr Shane Rattenbury and the Minister for Aged Care and Minister for Indigenous Health, the Hon Ken Wyatt AM, MP who participated in a joint discussion with Health Ministers about mental health issues.

Major items discussed by Health Ministers today included:

2.Andrew Forrest and the Eliminate Cancer Initiative

Mr Andrew Forrest joined the meeting to address Health Ministers in his capacity as Chairman of the Minderoo Foundation to discuss the Eliminate Cancer Initiative. The Minderoo Foundation is one of Autralia’s largest and most active philanthropic groups. It has established the Eliminate Cancer Initiatve (the Initiative), a global initiative dedicated to making cancer non-lethal with some of the world’s leading global medicine and anti-cancer leaders.

The Initiative is a united effort to convert cancer into a non-lethal disease through global collaboration of scientific, medical and academic institutes, commercially sustained through the support of the philanthropic, business and government sectors worldwide.

Australia has a critical role to play in this highly ambitious and thoroughly worthwhile goal.

3.Family violence and primary care

Today, Health Ministers discussed the significant health impacts on those people experiencing family violence.

Health Ministers acknowledged that health-care providers, particularly those in a primary care setting, are in a unique position to create a safe and confidential environment to enable the disclosure of violence, while offering appropriate support and referrals to other practitioners and services.

Recognising the importance of national leadership in this area, Ministers agreed to develop a plan to address barriers to primary care practitioners identifying and responding to patients experiencing family violence.

Ministers also agreed to work with the Royal Australian College of General Practitioners to develop and implement a national training package.

Further advice will be sought from Primary Health Networks on existing family violence services, including Commonwealth, State and NGO service providers in their regions, with a view to developing an improved whole-of-system responses to the complex needs of clients who disclose family violence

4.Fifth National Mental Health and Suicide Prevention Plan

Health Ministers endorsed the Fifth National Mental Health and Suicide Prevention Plan 2017-2022 and its Implementation Plan.

The Fifth Plan is focused on improvements across eight targeted priority areas:

1. Achieving integrated regional planning and service delivery

2. Effective suicide prevention

3. Coordinated treatment and supports for people with severe and complex mental illness

4. Improving Aboriginal and Torres Strait Islander mental health and suicide prevention

5. Improving the physical health of people living with mental illness and reducing early mortality

6. Reducing stigma and discrimination

7. Making safety and quality central to mental health service delivery

8. Ensuring that the enablers of effective system performance and system improvement are in place

The Fifth Plan also responds to calls for a national approach to address suicide prevention and will be used to guide other sectors and to support health agencies to interact with other portfolios to drive action in this priority area.

Ongoing collaboration and engagement across the sector and with consumers and carers is required to successfully implement the Fifth Plan and achieve meaningful reform to improve the lives of people living with mental illness including the needs of children and young people.

Health Ministers also agreed that mental health workforce issues would be considered by the Australian Health Ministers’ Advisory Council.

5.The National Psychosocial Supports Program

Health Ministers agreed to establish a time-limited working group to progress the Commonwealth’s National Psychosocial Supports program. This will have the objective of developing bilateral agreements to support access to essential psychosocial supports for persons with severe mental illness resulting in psychosocial disability who are not eligible for the NDIS.

Those bilateral agreements will take into account existing funding being allocated for this purpose by states and territories.

6.Strengthened penalties and prohibition orders under the Health Practitioner Regulation National Law

Health Ministers agreed to proceed with amendments to the Health Practitioner Regulation National Law (the National Law) to strengthen penalties for offences committed by people who hold themselves out to be a registered health practitioner, including those who use reserved professional titles or carry out restricted practices when not registered.

Ministers also agreed to proceed with an amendment to introduce a custodial sentence with a maximum term of up to three years for these offences.

These important reforms will be fast tracked to strengthen public protection under the National Law. Preparation will now commence on a draft amendment bill to be brought forward to Ministers for approval, with a view to this being introduced to the Queensland Parliament in 2018. The Western Australian Parliament is also expected to consider legislative changes to the Western Australian National Law.

7.Amendment to mandatory reporting provisions for treating health practitioner

Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible.

Health Ministers agreed that doctors should be able to seek treatment for health issues with confidentiality whilst also preserving the requirement for patient safety.

A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioners that they can feel able to seek treatment for their own health conditions anywhere in Australia.

Agree for AHMAC to recommend a nationally consistent approach to mandatory reporting, following discussion paper and consultation with consumer and practitioner groups, with a proposal to be considered by COAG Health Council at their November 2017 meeting, to allow the amendment to be progressed as part of Tranche 1A package of amendments and related guidelines.

8.National Digital Health Strategy and Australian Digital Health Agency Forward Work Plan 2018–2022

Health Ministers approved the National Digital Health Strategy and the Australian Digital Health Agency Work Plan for 2018-2022.

Download Strategy and work plan here  

The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health.

This Strategy will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control and transparency.

Expanding the public reporting of patient safety and quality measures

Health Ministers supported Queensland and other interested jurisdictions to collaboratively identify options in relation to aligning patient safety and quality reporting standards across public and private hospitals nationally.

Ministers agreed that the Australian Commission on Safety and Quality in Health Care (ACSQHC) would undertake work with other interested jurisdictions to identify options in relation to aligning public reporting standards of quality healthcare and patient safety across public and private hospitals nationally.

The work be incorporated into the national work being progressed on Australia’s health system performance information and reporting frameworks.

 

9.National human biomonitoring program

Health Ministers noted that human biomonitoring data can play a key role in identifying chemicals which potentially cause adverse health effects and action that may need to be taken to protect public health.

Health Ministers agreed that a National Human Biomonitoring Program could be beneficial in assisting with the understanding of chemical exposures in the Australian population.

Accordingly, Ministers agreed that the Australian Health Ministers’ Advisory Council will explore this matter in more detail by undertaking a feasibility assessment of a National Human Biomonitoring Program.

Clarification of roles, responsibilities and relationships for national bodies established under the National Health Reform Agreement

States and territories expressed significant concern that the proposed Direction to IHPA will result in the Commonwealth retrospectively not funding activity that has been already delivered by states and territories but not yet funded by the Commonwealth.

States and territories were concerned that this could reduce services to patients going forward as anticipated funding from the Commonwealth will be less than currently expected.

The Commonwealth does not agree with the concerns of the states and territories and will seek independent advice from the Independent Hospital Pricing Authority (IHPA) to ensure hospital service activity for 2015-2016 has been calculated correctly. The Commonwealth committed to work constructively and cooperatively with all jurisdictions to better understand the drivers of increased hospital services in funding agreements.

10.Legitimate and unavoidable costs of providing public hospital services in Western Australia

Health Ministers discussed a paper by Western Australia on legitimate and unavoidable costs of providing public hospital services in Western Australia, particularly in regional and remote areas, and recognised that those matters create a cumulative disadvantage to that state. Health Ministers acknowledged that Western Australia will continue to work with the Commonwealth Government and the Independent Hospital Pricing Authority to resolve those matters.

11.Vaccination

Health Ministers unanimously confirmed the importance of vaccination and rejected campaigns against vaccination.

All Health Ministers expressed their acknowledgement of the outgoing Chair, the Hon Ms Jill Hennessy and welcomed the incoming Chair Ms Meegan Fitzharris MLA from the Australian Capital Territory.

Health Ministers approve Australia’s National Digital Health Strategy

Digital information is the bedrock of high quality healthcare.

The benefits for patients are signicant and compelling: hospital admissions avoided, fewer adverse drug events, reduced duplication of tests, better coordination of care for people with chronic and complex conditions, and better informed treatment decisions. Digital health can help save and improve lives.

To support the uptake of digital health services, the Council of Australian Governments (COAG) Health Council today approved Australia’s National Digital Health Strategy (2018-2022).

Download Strategy and work plan here  

In a communique issued after their council meeting in Brisbane August 4 , the Health Ministers noted:

“The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health. It will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control, and transparency.”

Australian Digital Health Agency (ADHA) CEO Tim Kelsey welcomed COAG approval for the new Strategy.

“Australians are right to be proud of their health services – they are among the best, most accessible, and efficient in the world.

Today we face new health challenges and rapidly rising demand for services. It is imperative that we work together to harness the power of technology and foster innovation to support high quality, sustainable health and care for all, today and into the future,” he said.

The Strategy – Safe, seamless, and secure: evolving health and care to meet the needs of modern Australia – identifies seven key priorities for digital health in Australia including delivery of a My Health Record for every Australian by 2018 – unless they choose not to have one.

More than 5 million Australians already have a My Health Record, which provides potentially lifesaving access to clinical reports of medications, allergies, laboratory tests, and chronic conditions. Patients and consumers can access their My Health Record at any time online or on their mobile phone.

The Strategy will also enable paper-free secure messaging for all clinicians and will set new standards to allow real-time sharing of patient information between hospitals and other care professionals.

Australian Medical Association (AMA) President Dr Michael Gannon has welcomed the Strategy’s focus on safe and secure exchange of clinical information, as it will empower doctors to deliver improved patient care.

“Doctors need access to secure digital records. Having to wade through paperwork and chase individuals and organisations for information is

archaic. The AMA has worked closely with the ADHA on the development of the new strategy and looks forward to close collaboration on its implementation,” Dr Gannon said.

Royal Australian College of General Practitioners (RACGP) President Dr Bastian Seidel said that the RACGP is working closely and collaboratively with the ADHA and other stakeholders to ensure that patients, GPs, and other health professionals have access to the best possible data.

“The Strategy will help facilitate the sharing of high-quality commonly understood information which can be used with confidence by GPs and other health professionals. It will also help ensure this patient information remains confidential and secure and is available whenever and wherever it is needed,” Dr Seidel said.

Pharmacy Guild of Australia National President George Tambassis said that technology would increasingly play an important role in supporting sustainable healthcare delivery.

“The Guild is committed to helping build the digital health capabilities of community pharmacies and advance the efficiency, quality, and delivery of healthcare to improve health outcomes for all Australians.

“We are working with the ADHA to ensure that community pharmacy dispensing and medicine-related services are fully integrated into the My Health Record – and are committed to supporting implementation of the National Digital Health Strategy as a whole,” George Tambassis said.

Pharmaceutical Society of Australia (PSA) President Dr Shane Jackson said that the Strategy would support more effective medicationmanagement, which would improve outcomes for patients and improve the efficiency of health services.

“There is significant potential for pharmacists to use digital health records as a tool to communicate with other health professionals, particularly during transitions of care,” Dr Jackson said.

The Strategy will prioritise development of new digital services to support newborn children, the elderly, and people living with chronic disease. It will also support wider use of telehealth to improve access to services, especially in remote and rural Australia and set standards for better information sharing in medical emergencies – between the ambulance, the hospital, and the GP.

Consumers Health Forum (CHF) Leanne Wells CEO said that the Strategy recognises the importance of empowering Australians to be makers and shapers of the health system rather than just the users and choosers.

“We know that when consumers are activated and supported to better self-manage and coordinate their health and care, we get better patient experience, quality care, and better health outcomes.

“Digital health developments, including My Health Record, are ways in which we can support that to happen. It’s why patients should also be encouraged to take greater control of their health information,” Leanne Wells said.

Medical Software Industry Association (MSIA) President Emma Hossack said that the Strategy distils seven key themes that set expectations at a national level.“The strategy recognises the vital role industry plays in providing the smarts and innovation on top of government infrastructure.

This means improved outcomes, research, and productivity. Industry is excited to work with the ADHA to develop the detailed actions to achieve the vision which could lead to Australia benefitting from one of the strongest health software industries in the world,” Emma Hossack said.

Health Informatics Society of Australia (HISA) CEO Dr Louise Schaper welcomed the Strategy’s focus on workforce development.

“If our complex health system is to realise the benefits from information and technology, and become more sustainable, we need clinical leaders with a sound understanding of digital health,” Dr Schaper said.

The Strategy was developed by all the governments of Australia in close partnership with patients, carers and the clinical professionals who serve them – together with leaders in industry and science.

The Strategy draws on evidence of clinical and economic benefit from many sources within Australia and overseas, and emphasises the priority of patient confidentiality as new digital services are implemented.

The ADHA has established a Cyber Security Centre to ensure Australian healthcare is at the cutting edge of international data security.

The ADHA, which has responsibility for co-ordinating implementation of the Strategy, will now be consulting with partners across the community to develop a Framework for Action. The framework will be published later this year and will detail implementation plans for the Strategy.

The National Digital Health Strategy Safe, seamless and secure: evolving health and care to meet the needs of modern Australia is available on

https://www.digitalhealth.gov.au/australias-national-digital-health-strategy (https://www.digitalhealth.gov.au/australias-national-digital-health-strategy)

Greg Hunt Press Conference

Topics: COAG Health Council outcomes; The Fifth National Mental Health and Suicide Prevention Plan; support for doctors and nurses mental health; hospital funding; same-sex marriage

GREG HUNT:
Today was a huge breakthrough in terms of mental health. The Fifth National Mental Health Plan was approved by the states.

What this is about is enormous progress on suicide prevention. It has actually become the Fifth National Mental Health and Suicide Prevention Plan, so a real focus on suicide prevention.

In particular, the focus on what happens when people are discharged from hospital, the group in Australia that are most likely to take their own lives.

We actually know not just the group, but the very individuals who are most at risk. That’s an enormous step.

The second thing here is, as part of that plan, a focus on eating disorders, and it is a still-hidden issue. In 2017, the hidden issue of eating disorders, of anorexia and bulimia, and the prevalence and the danger of it is still dramatically understated in Australia.

The reality is that this is a silent killer and particularly women can be caught up for years and years, and so there’s a mutual determination, a universal determination to progress on eating disorders, and that will now be a central part of the Fifth National Mental Health and Suicide Prevention Plan.

And also, as part of that, we’ve included, at the Commonwealth’s request today, a real focus on early intervention services for young people under 16. Pat McGorry has referred to it as CATs for Kids, meaning Crisis Assessment Teams, and the opportunity.

And this is a really important step because, for many families, when they have a crisis, there’s nowhere to turn. This is a way through. So those are all enormous steps forward.

The other mental health area where we’ve made big, big progress is on allowing doctors to seek routine mental health treatment.

There’s an agreement by all of the states and territories to work with the Commonwealth on giving doctors a pathway so as they can seek routine mental health treatment without being reported to the professional bodies.

JOURNALIST:
What has led to the increased focus on eating disorders? Has there been an uptick in the number of suicides resulting from that, or has there been an uptick in the number of cases?

GREG HUNT:
No, this has been silently moving along. It’s a personal focus. There are those that I have known, and then when we looked the numbers shortly after coming in, and dealt with organisations such as the Butterfly Foundation, they explained that it’s been a high level issue with the worst rate of loss of life amongst any mental health condition.

And so that’s a combination both of suicide, but also of loss of life due to physical collapse. And so it’s what I would regard as a personal priority from my own experience with others, but then the advocacy of groups like Butterfly Foundation has finally landed. It should’ve happened earlier, but it’s happening on our watch now.

JOURNALIST:
That would be my next question, is that I’m sure advocacy groups will say this is great that it’s happened, but it’s taken the Government so long. Why is it that you’re focussing on it now as opposed to…?

GREG HUNT:
I guess, I’ve only just become Minister. So from day one, this is one of the things I’ve wanted to do, and I’m really, personally, deeply pleased that we’ve made this enormous progress.

So I would say this, I can’t speak for the past, it is overdue, but on our watch collectively we’ve taken a huge step forward today.

Then the last thing is I’ve seen some reports that Queensland and Victoria may have been upset that some of their statistical anomalies were referred to what’s called IHPA (Independent Hospital Pricing Authority).

The reason why is that some of their figures simply didn’t pass the pub test.

The independent authority will assess them, but when you have 4000 per cent growth in one year in some services, 3300 per cent growth in some years in other services, then it would be negligent and irresponsible not to review them.

It may be the case that there was a more than 40-fold increase in some services, but the only sensible thing for the Commonwealth to do is to review it.

But our funding goes up each year every year at a faster rate than the states’ funding, and it’s gone up by $7.7 billion dollars since the current health agreement with the states was struck.

JOURNALIST:
Is that, sorry, relating to private health insurance, or is that something separate?

GREG HUNT:
No, that’s just in relation to, a couple of the states lodged claims for massive growth in individual items.

JOURNALIST:
Thank you. So was there a directive given today regarding private health policies to the states? Was that something that was discussed or something that …?

GREG HUNT:
Our paper was noted, and the states will respond. So we’ve invited the states to respond, they’ll respond individually.

JOURNALIST:
And regarding that mental health plan, besides their new focus on eating disorders, how is it different from previous mental health plans?

GREG HUNT:
So, a much greater focus on suicide prevention, a much greater focus on eating disorders, and a much greater focus on care for young children under 16.

JOURNALIST:
Is that something that you can give more specific details about? You’re saying there’s a much greater focus, but is there any specific information about what that would mean?

GREG HUNT:
As part of the good faith, the Commonwealth, I’ve written to the head of what’s called the Medical Benefits Schedule Review, so the Medicare item review, Professor Bruce Robinson and asked him and their team to consider, for the first time, specific additional treatment, an additional treatment item and what would be appropriate for eating disorders.

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

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

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

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

From the National Rural Health Alliance Research View HERE

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

Example 1

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

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

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

Example 2

NACCHO provided graphic

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

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

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

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

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

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

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

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

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

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

 


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

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

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

MC

IR

OR/Remote

Percentage

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

13.0

16.7

20.9

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

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

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

14.2

17.6

22.6

24.6

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

14.2

18.6

23.6

24.4

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

85.9

113.1

109.4

126.2

Sources:

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

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

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

 

Smoking – exposure, uptake, establishment, quitting

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

MC

IR

OR

remote

8.8

17.8

19.3

27.8

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

8.5

17.0

18.9

27.5

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

3.6

3.1

4.1

*9.4

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

2.5

2.0

2.7

*2.9

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

16.2

15.4

14.7

15.5

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

17.8

22.7

17.8

28.3

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

54.7

61.1

64.9

67.2

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

2.5

3.4

2.5

3.7

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

20.2

25.9

44.1

45.2

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

21.3

16.8

19.0

15.5

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

29.2

34.2

31.7

32.9

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

46.3

48.0

47.4

45.2

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

35.2

36.3

36.1

36.0

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

53.1

51.5

46.3

45.0

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

4.9

6.0

4.8

7.0

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

6.9

9.3

6.8

10.4

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

13.0

16.7

21.2

18.8

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

10.9

7.8

2.9

n.p.

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

40.1

44.7

42.3

52.7

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

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

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

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

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

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

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

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

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

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

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

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

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

Smoking Trends

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

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

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

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

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

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

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

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

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

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

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

Alcohol

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

Alcohol consumption

MC

IR

OR/Rem

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

16.3

18.4

23.4

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

15.7

17.4

22.0

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

42.7

48.5

46

MC

IR

OR

R/VR

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

23.1

18.9

20.5

17.5

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

60.2

62

56.9

47.6

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

16.7

19.1

22.6

34.9

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

40.4

41.8

38.1

30.8

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

23.5

24.4

23.6

22.8

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

13

14.9

17.8

28.9

Sources:

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

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

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

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

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

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

Alcohol trends

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

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

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

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

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

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

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

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

 

Illicit drug use 2013

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

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

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

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

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

 

Physical activity

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

MC

IR

OR/Remote

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

64.3

70.1

72.4

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

64.8

68.6

71

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

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

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

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

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

7,393

7,388

7,527

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

9,097

9,266

9,160

Sources:

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

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

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

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

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

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

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

MC

IR

OR/Rem

Crude percentage

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

27.5

34.3

34.2

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

28.0

29.7

31.0

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

9.7

10.9

14.2

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

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

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

 

Fruit and vegetable consumption

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

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

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

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

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

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

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

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

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

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

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

 

 

Overweight and Obesity

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

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

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

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

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

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

 

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

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

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

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

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

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

 

High blood pressure

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

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

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

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

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

NACCHO @aihw First report tracking progress against the Implementation Plan goals for the Aboriginal Health Plan 2013–2023

  ” This National Aboriginal and Torres Strait Islander Health Plan 2013–2023 report presents data for each of the 20 goals, and assesses progress against the goals at the national level.”

See full interactive report here

In October 2015, the Australian Government released the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

The Implementation Plan outlines the actions to be taken by the Australian Government, the Aboriginal community controlled health sector, and other key stakeholders to give effect to the vision, principles, priorities, and strategies of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

The Implementation Plan has set goals to be achieved by 2023 for 20 indicators.

These goals were developed to complement the existing COAG Closing the Gap targets, and focus on prevention and early intervention across the life course.

For more information on the Implementation Plan, its vision and the context for its goals, see the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

This report presents data for each of the 20 goals, and assesses progress against the goals at the national level.

For information about the selection of goals, and technical details about each goal, see the Implementation Plan goals for the Aboriginal and Torres Strait Islander Health Plan 2013–2023: technical companion document.

Select from HERE a domain to filter the goals:

NACCHO Aboriginal Health #NAIDOC2017 : Recognising the communication gap in Indigenous health care

 ” The communication gap between health professionals and Indigenous Australians has a significant impact on health outcomes

Limited health literacy is not confined to Indigenous people, but it is greatly magnified for speakers of Indigenous languages in comparison, for example, to non-English speaking migrants from countries where a scientific approach to medicine is practised and where these health concepts are already codified.”

Dr Robert Amery Medical Journal Australia NAIDOC Week 2017

 

Introduction Press Release

Communication gap puts Indigenous health at risk

The need for health professionals to have a stronger focus on communication with Indigenous people has been highlighted by the University of Adelaide’s Head of Linguistics, who says some lives are being put at risk because of a lack of patient-doctor understanding.

In a paper published (Monday 3 July) in the Medical Journal of Australia coinciding with the NAIDOC Week theme of Our Languages Matter – Dr Robert Amery has raised concerns not just about language but also a lack of cultural awareness that also impacts on good communication with Indigenous patients.

Dr Robert Amery, who heads Linguistics within the University of Adelaide’s School of Humanities and is a Kaurna language expert, says poor communication can lead to “mistrust and disengagement with the health sector” among

Indigenous patients, leading to a lack of compliance with treatment, and ultimately poor health outcomes.

He says there’s a 16-year gap in life expectancy for Indigenous people living in the Northern Territory compared with non-Indigenous Australians. Of these Indigenous people in the NT, 70% live in remote areas, and 60–65% speak an Indigenous language at home.

“While many speakers of Indigenous languages living in remote areas can engage with outsiders and converse in English about everyday matters, they often have a poor grasp of English when it comes to health communications and other specialised areas,” Dr Amery says.

Miscommunication can be subtle, and previous studies have shown that while both parties think they have understood each other, they can in fact come away with very different understandings.

“Miscommunication isn’t just about language. Some of these difficulties also arise from the interface of communication and culture, which are often derived from differences in worldview,” he says.

“For traditionally oriented Aboriginal people living in remote areas, understanding of disease causation is fundamentally different. Serious diseases, even accidents, are often attributed to sorcery. Germ theory and the immune system are foreign concepts.

“Silence plays an important role in Indigenous cultures. Indigenous people often respond to questions after a prolonged pause, a concept foreign to those doctors who see silence as impolite in their own cultures.

They compensate by filling the silence and disrupting Indigenous patients’ thoughts. There is a simple solution: pause and allow the patient to think.”

He also suggests healthcare professionals avoid the use of “intangible” conceptual English words and vague sentences, instead focusing on factual communication; that they demonstrate how a medical procedure works; and use simple diagrams to explain medical issues.

“These examples may seem plain and obvious, but astoundingly, despite the many hours dedicated to communication in medical education, such concepts are not taught,” Dr Amery says.

“An investment of time in the consult will have immense payoffs over the long term.”

 Download MJA paper here MJA Dr Robert Amery

Published with permission from Robert Amery and Medical  Journal Australia

 See website for references or PDF

The communication gap is most pronounced in remote areas where cultural and linguistic differences are greatest. The close interdependence of language and culture amplifies the gap, such that communication difficulties in these communities run deeper than language barriers alone.

Life expectancy for Indigenous Australians living in remote areas is considerably shorter than for those living in rural and urban areas.6 Figures are not available for the life expectancy of native speakers of Indigenous languages as a cohort, but the gap in life expectancy exceeds 16 years for Indigenous people living in the Northern Territory,7 70% of whom live in remote areas, and 60–65% speak an Indigenous language at home. The life expectancy gap is, of course, multifactorial, although most studies focus on causes of death.8 The communication gap as a contributor is under-rated and under-researched.1,9

An understanding of the Indigenous language landscape is critical to improving communication. In the 2011 Australian census, 60 550 people, or 11.8% of Indigenous respondents, claimed to speak an Indigenous language at home, and 17.5% claimed not to speak English well.10

More have difficulty with specialised language, with common terms such as infection, tumour, high blood pressure, stroke and bacteria often misunderstood. Native Indigenous language speakers communicate in over 100 different traditional languages and live primarily in the NT, the Kimberley region of Western Australia, northern South Australia and northern Queensland, including Torres Strait.

None of these languages have more than 6000 speakers, and many are now reduced to a mere handful, yet each of these languages is a vast storehouse of knowledge built up over thousands of years. It can be daunting to enter a large English-speaking hospital if you communicate in a language spoken by so few people.

Speakers of some languages have shifted to dominant regional languages, such as Murrinh-Patha (Wadeye, NT), while others have shifted to a creole language, such as Kriol (the Kimberley region and the Barkly Tableland area of the NT and North West Queensland).

Aboriginal people often speak distinctive varieties of Aboriginal English that differ from mainstream English. For most Aboriginal people in remote areas, their Aboriginal English is an inter-language variety, in the same way that Japanese speakers have their own distinctive accent and turn of phrase in English, which may be a challenge for medical personnel to understand.

Data might suggest that only a small proportion (less than 10%) of Indigenous adults under 60 years do not speak English well, and that communication issues would therefore not be significant (Box 1).

However, while many speakers of Indigenous languages living in remote areas can engage with outsiders and converse in English about everyday matters, they often have a poor grasp of English when it comes to health communications and other specialised areas. In a study on comprehension of 30 common legal terms (assault, bail, guilty, warrant, etc),11 200 Yolŋu people (north-east Arnhem Land) were surveyed with over 95% unable to correctly identify the meaning of these terms (Box 2).

A parallel health study has not been conducted, but it is likely that understanding of common specialised health terms would be no better. Personal experience supports this view. In 1990, I taught a short course in medical interpreting to a group of Yolŋu students. In teaching the difference between idiomatic and literal language, I introduced an example (“He chucked his guts up”) that I thought everyone would understand. The Yolŋu students interpreted this idiom literally, thinking he ripped out his intestines and threw them in the air. Even simple little things that might be said, such as “let’s keep an eye on it”, can be baffling, because these expressions are often taken literally.

Proportion of Indigenous Australians who speak an Indigenous language and who are reported to speak English “not well” or “not at all”, 2006 and 2011*

Yolŋu comprehension of 30 common legal terms*

Misinterpretations also arise from the interface of communication and culture, here derived from differences in worldview rather than linguistics. In the 1980s, I talked with Tjapaltjarri (skin name, now deceased), a senior Pintupi Aboriginal health worker, about the location of a relative’s house in Alice Springs. Tjapaltjarri referred to various landmarks such as trees and rocks. I asked him about prominent street names including Bloomfield Street. We conversed with full understanding, but I could not follow Tjapaltjarri’s directions. I never paid attention to these landmarks, he never noticed street names. This was not a linguistic issue. It was literally a matter of different worldview. Extrapolate from this example to appreciate the difficulties first language speakers of Aboriginal languages might have in following medical explanations, even when they seemingly speak good English.

These communication gaps are confirmed in health settings. A study of Yolŋu patients undergoing dialysis in Darwin2 identified, through exit interviews, significant misunderstanding of test results despite both patient and renal nurse having revealed that they were satisfied with the communication.

Trudgen9 discusses a Yolŋu patient suffering from severe diabetes and renal failure who was able to avoid dialysis once his condition was explained to him in meaningful terms, and goes on to estimate that 75–95% of communication with Yolŋu patients fails, even with an Aboriginal health worker involved. Aboriginal health workers are not necessarily trained interpreters, nor is interpreting their primary role, although they are often expected to interpret.

How do we improve? Surprisingly simple communication methods, which are easy to teach within mainstream medical education, can help. Trudgen demonstrates how to explain to a Yolŋu patient their 2% residual renal function.9 Many Yolŋu and speakers of other Indigenous languages do not understand the concept of percentages. A picture of a kidney was drawn, shading in the 2% still functioning and showing the remainder, which was sclerosed (Box 3). The patient responded in shock and, no doubt, with better dialysis participation.

Box 3

Template to explain residual renal function of 2% (hatched area) in an otherwise sclerosed kidney (dots)

Aboriginal patients may not be as trusting of medical implements as others. Refusal of an ear examination, for example, may be overcome by allowing such a patient to look through the otoscope to understand how it works. Silence plays an important role in Indigenous cultures.9,12,13

Indigenous people often respond to questions after a prolonged pause, a concept foreign to those doctors who see silence as impolite in their own cultures. They compensate by filling the silence and disrupting Indigenous patients’ thoughts. There is a simple solution — pause and allow the patient to think.

Studies1,2,3,4,14 have identified a widespread belief among Yolŋu people that information is deliberately withheld, mirroring culturally based misconceptions that lead many professionals to believe that Aboriginal patients do not want to know or that they do not experience pain.15

However, several studies1,4,14 clearly demonstrate the desire of Aboriginal people, both from the Top End and from Central Australia, for information about their illnesses and treatment. Effective communication methods, including the use of interpreters, are grossly underutilised, and frequently there is a failure to recognise that patients do not understand.

In a study of 41 Yolŋu people, only 11 found explanations about diagnosis and treatment satisfactory.4 Other studies have shown that even when patients are satisfied, gross misunderstandings may still exist.2 Trudgen9 again gives an example of how this may occur. A doctor explained to a patient that he “could not tell conclusively why [the patient’s] heart was enlarged”. The patient subsequently interpreted this to be that the doctor had no idea why his heart was enlarged and decided not to engage in treatment. Had the doctor avoided use of “intangible” conceptual English words and vague unrevealing sentences, instead focusing on factual communication, this error could have been avoided.

A failure to develop an adequate understanding does run deeper than words. For traditionally oriented Aboriginal people living in remote areas, understanding of disease causation is fundamentally different. Serious diseases, even accidents, are often attributed to sorcery.16,17 Germ theory and the immune system are foreign concepts.

Traditionally oriented Aboriginal people typically have detailed knowledge of anatomy from hunting, butchering and observing nature,9,18 but the perceived function of the kidneys, lungs, pancreas and other internal organs may be quite different. Finding common ground between these understandings is no easy task, but it is important to understand that it may play into medical treatments in the same way as having insight into the use of alternative medicines does in other cultures.

These examples may seem plain and obvious, but astoundingly, despite the many hours dedicated to communication in medical education, such concepts are not taught. Some strategies are provided in Box 4. There is an urgent need to pay more attention to communication needs of remote Aboriginal people.

Communication strategies

A refusal to take Aboriginal languages seriously not only results directly in less than optimal medical outcomes, but also in mistrust and disengagement with the health sector and non-compliance with treatment regimens.3

An investment of time in the consult will have immense payoffs over the long term. We cannot expect our medical students and colleagues to adapt without teaching.

Concepts are simple to grasp with knowledge of the languages and cultures. Is effective establishment of the Aboriginal patient–doctor relationship not one of the more teachable aspects of communication for generations of doctors?

Education is the way forward to a practical and high impact population of medical staff who contribute to the health and pride of the people who are Australia’s national treasures.

NACCHO Aboriginal Health : Why the @NRHAlliance needs a new Rural and Remote Health Strategy

 

” The National Rural Health Alliance has been leading advocacy to the Government that it is time to develop a new Rural and Remote Health Strategy, together with a fully funded Implementation Plan. 

In developing its thoughts on the need for a new Strategy and its contents, the Alliance is developing a series of discussion papers, with the first now available – considering the reasons why we need a new Strategy and what has been achieved under the 2011-12 Strategy.”

This paper has been prepared to stimulate discussion on an issue of importance to rural and remote health.

The views and opinions in the paper do not necessarily represent those of the National Rural Health Alliance or any of its Member Bodies.

For  The National Rural Health Alliance’s new own Strategic Plan just released and spanning  the period 1 July 2017 – 30 June 2019

The Alliance intends to focus on seven priority areas including: Improving the health outcomes for Aboriginal and Torres Strait Islander Peoples;

 See background 2 below

Download 19 page PDF   need-new-rr-health-strategy

How submit comments

Comments on the paper can be directed to

nrha@ruralhealth.org.au .

A new strategy and plan ?

There is no point in continuing to reference a Framework that is not in use and that is deeply flawed (see background 1 below and in download ) . Whatever document replaces the Framework, it must include outcome measures and set indicators to measure progress against the most pressing needs.

And there must be annual reporting against those outcomes to enable jurisdictions to consider how they are progressing and fine tune their responses as necessary.

Ideally, a new National Rural and Remote Health Strategy should be developed with stakeholder input and introduced with a fully funded Implementation and Evaluation plan.

This should include, but not be restricted to, a rural and remote workforce plan – as pointed out throughout this report, the solutions needed to bridge the divide in the health and wellbeing of the city and the bush deserves and requires far more.

We need concrete, on-the-ground actions, which make a positive difference in the lives of individuals, families and communities in rural and remote Australia.

The Alliance has been an active participant and co-signatory in the development of previous strategies and plans, and stands ready to fulfil that role again.

We must learn from the past and strive to address the inequity of health outcomes that are experienced by the seven million people living outside Australia’s major cities

Background 1 of 2

The National Strategic Framework for Rural and Remote Health (the Framework) was developed through the Rural Health Standing Committee, a committee of the Australian Health Ministers’ Advisory Council, and agreed by the Standing Council on Health, the committee of Ministers of Health, in late 2011. It was launched in 2012. The Framework was developed through a consultative process that included significant input from the National Rural Health Alliance (the Alliance) and other rural and remote health stakeholders, including State and Territory governments.

While the Framework can be accessed through the Department of Health website, it is not in use. No reporting has ever been undertaken to present an update on progress, recognition of the range of policies and programs implemented by Commonwealth, State or Territory Governments to address the goals of the Framework, or to examine the effectiveness of the Framework in addressing those goals.

Further, the health workforce strategy developed as a companion document to the Framework – National Health Workforce Innovation and Reform Strategic Framework for Action 2011–2015 – is also no longer in use, having been archived when the Health Workforce Agency was disbanded in 2014.

At the time, the Alliance called for a National Rural and Remote Health Plan to be developed to operationalise the Framework, but this never eventuated.

The role of a comprehensive Framework to guide and direct better health outcomes in rural and remote communities is critical. Where players from communities, jurisdictional and private health providers and federally-funded organisations come together to meet the challenges of delivering health services in rural and remote communities, it must be through a shared understanding of the issues and a clear vision for the future.

At the outset, the Framework acknowledged that the people who live in rural and remote Australia “tend to have lower life expectancy, higher rates of disease and injury, and poorer access to and use of health services than people living in Major cities”.

Drawing on the Australian Institute of Health and Welfare publication Australia’s Health 2010, the Framework identified key areas of concern with regard to the health of people in rural and remote communities, particularly:

  •  higher mortality rates and lower life expectancy;
  •  higher road injury and fatality rates;
  •  higher reported rates of high blood pressure, diabetes, and obesity;
  •  higher death rates from chronic disease;
  •  higher prevalence of mental health problems;
  •  higher rates of alcohol abuse and smoking;
  •  poorer dental health;
  •  higher incidence of poor ante-natal and post-natal health; and
  •  higher incidence of babies born with low birth weight to mothers (in very remote areas).

The Framework does not include data quantifying these concerns. In referring back to Australia’s Health 2010, the data used to describe the health of people in rural and remote Australia is from 2004-2006 – it was already up to six years old at the time the Framework based on it was launched. It is very difficult to plan appropriately to address inequality when data is this out of date.

Perhaps the biggest gap in the Framework is that it does not link the inequities it identifies in rural and remote health generally to the five goals it develops. While this is largely due to a lack of narrative, what this lack of narrative does is lose the unifying rationale for the five goals and how they will work together to make a difference to the inequities identified in the Framework. If this was simply a lack of a coherent narrative to drive the needed policy responses, it may be excusable. But unfortunately, the lack of this coherent narrative has resulted in:

  •  lack of recognition of the need for baseline indicators against which progress can be measured and reviewed;
  •  loss of the connectedness of the goals – at the Commonwealth level we now see rural health reduced to workforce policy responses without a clear understanding of how those responses will actually lead to improvements in health outcomes and the range of health inequities in rural and remote communities; and
  •  undermining one of the most crucial needs underpinning the Framework as a whole – the need for quality and TIMELY data. The lack of good quality, current, data is apparent as soon as you begin to seek answers to the question “what has the Framework achieved?”

In developing this Discussion paper, the Alliance is seeking to undertake a high level, selective assessment using publicly available data to ascertain to what extent progress is being made in addressing health concerns and inequities in rural and remote Australia, referencing back to the goals and outcomes set out in the Framework.

Where related specific programs stemming from the Framework can be identified and their outcomes assessed, this will be included in the discussion. Given there are nine specific issues identified in the Framework and set out in dot point format above, the Alliance will seek information on only three to discuss whether any change in outcomes following the implementation of the Framework can be assessed accurately, and if so, what outcomes were achieved.

Background 2 of 2

The National Rural Health Alliance’s new Strategic Plan has been released and spans the period 1 July 2017 – 30 June 2019.

Download PDF Copy NRHA_Strategic-Plan

It is a high-level document to set directions, priorities and key areas of activities over the coming two years.  It also includes measures of success and effectiveness, identified as process, impact and health outcomes.

The Alliance intends to focus on seven priority areas including:

  • Unlocking the economic and social potential of the 7 million people living in rural and remote Australia;
  • Improving the health outcomes for Aboriginal and Torres Strait Islander Peoples;
  • Integrating teaching, training, research and development to attract and retain the right workforce;
  • Strengthen prevention, early intervention and primary health care;
  • Developing  place-based, community and individualised local approaches to respond to community needs;
  • Reducing the higher burden of mental ill-health, suicide and suicide attempts; and
  • Securing long-term, sustainable funding  to extend our core work.

These seven priority areas have been strongly influenced by the recommendations coming out of the recent 14th National Rural Health Conference held in Cairns.  Further, these are all areas in which the Alliance believes further efforts and advocacy is required to improve the health and wellbeing of people living in rural and remote Australia.

A common link across all these priority areas is the need for a National Rural and Remote Strategy and associated Implementation Plan. The Alliance will work with members and other stakeholders in the pursuit of such a Strategy and Plan.

The Alliance is currently developing a workplan that will guide specific work streams.

NACCHO Aboriginal Health : MBS Review Taskforce – Next round of public consultation now open

 ” As you are aware, the Medicare Benefits Schedule (MBS) Review Taskforce is considering every one of the more than 5,700 items on the MBS, with a focus of how the items can be better aligned with contemporary clinical evidence and practice to improve health outcomes for all Australians.
 
Today, the recommendations were made available for public consultation for the following clinical committees:
  • Dermatology, Allergy & Immunology
  • Diagnostic Imaging – knee imaging
  • Diagnostic Imaging – pulmonary embolism and deep vein thrombosis
  • Renal Medicine
  • Spinal Surgery
  • Urgent after-hours primary care services funded by the MBS

Examples

The online survey is open from today until Friday July 21, 2017.
 
It is important to note that these recommendations are not final and are being released publicly for the purpose of obtaining stakeholder feedback.

Your input as a stakeholder is critical in shaping the Review. Please use the online surveys (rather than emailing your comments directly) for accuracy and transparency when analysing your feedback.

 

If you have any questions or queries on the Review or the work of the Taskforce please contact the MBS Review Team.

Aboriginal Health #NRW2017 Good News Alert 2 of 2 : Download @AIHW 4th National report Indigenous nKPIs primary health care

 ” This fourth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection presents annual data on indicators collected from the June 2012 to the June 2016 reporting period.

 Information is presented for 22 ‘process-of-care’ and ‘health outcome’ indicators for June 2016, which focus on maternal and child health, preventative health, and chronic disease management.

The report shows continuous improvements for the majority of indicators.

Yes the good news is , improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1 below ).

For 10 of these measures, the change was statistically significant.”

Download HERE NACCHO Resources 7.00 MB

NACCHO AIHW Aboriginal Health 2 National Key Performance Indicators June 2016

Or from AIHW website

You can read NACCHO 1 of 2 HERE

You can read NACCHO 1 of 2 HERE

Data for this collection are provided to the AIHW by primary health care organisations that receive funding from the Department of Health to provide services to Aboriginal and Torres Strait Islander people.

Some primary health care organisations that report receive additional funding from other sources, including state and territory health departments, while a small number are funded solely by the Northern Territory Government (see ‘Chapter 1 Introduction’).

The purpose of the nKPIs is to support policy and service planning at the national and state/territory levels, by monitoring progress and highlighting areas for improvement.

The nKPIs can also be used to improve the delivery of primary health care services, by supporting continuous quality improvement (CQI) activity among service providers.

Over the period June 2012 to May 2015 (the period for which time trend data are available), improvements continue to be made across the majority of measures—indicating that health organisations continue to show progress in service provision.

The good news

Improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1).

For 10 of these measures, the change was statistically significant. The largest improvements (between 16 and 19 percentage points) were seen in data recording practices for the measurement of:

  • alcohol consumption, which rose from 38% in June 2012 to 57% in May 2015
  • birthweight, which rose from 51% in June 2012 to 69% in May 2015
  • smoking status, which rose from 64% in June 2012 to 80% in May 2015.

Results for process-of-care measures related to Medicare Benefits Schedule (MBS) health assessments (for children and adults) exceeded the 2016 trajectory of the Implementation Plan goals for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

Improvements were also seen in 3 of the 5 health outcomes measures for which time trend data were available. For 1 of these, the change was statistically significant:

• Health of clients with type 2 diabetes—those with an HbA1c (glycosylated haemoglobin), with a result of ≤7% in the previous 6 months, rose from 32% in June 2012 to 35% in May 2015. (An HbA1c result of ≤7% is the optimum target encouraged by Diabetes Australia to ensure good glycaemic control and reduce the incidence of diabetes-related illness.)

Things to work on

Results for 3 process-of-care measures related to immunisation against influenza—clients aged 50 and over; clients with type 2 diabetes; and clients with chronic obstructive pulmonary disease (COPD)—and for the 1 process-of-care measure relating to cervical screening saw small decreases of between 1.3 and 2.6 percentage points. However, these were not statistically significant.

Results for 2 health outcome measures showed increases: the proportion of babies born with a low birthweight increased by 0.9 percentage points and people whose body mass index (BMI) score classified them as overweight or obese increased by 4.3 percentage points.

However, these increases were not statistically significant.

These results also remain in line with national data for Indigenous Australians.

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

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

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

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

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

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson Matthew Cooke pictured above at Danila Dilba Health Service NT with AMA President Dr Michael Gannon (right ) and the Hon Warren Snowdon MP Shadow Assistant Minister for Indigenous Health (left )

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” RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

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AMA President, Dr Michael Gannon see full AMA Press Release below

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 ” We have many of the answers, we just need commitment from Govt to help implement necessary changes

Ms Olga Havnen is the CEO of Danila Dilba Biluru Binnilutlum Health Service in Darwin

NACCHO Press Release

The peak Aboriginal health organisation today welcomed the release of the Australian Medical Association’s Report Card on Indigenous Health as a timely reminder of the importance of community controlled services.

The 2016 Report Card on Indigenous Health focuses on the enormous impact that Rheumatic Heart Disease (RHD) is having on Aboriginal and Torres Strait Islander people in Australia with a ‘Call to Action to Prevent New Cases of RHD in in Indigenous Australia by 2031’.

DOWNLOAD the Report Card here :

2016-ama-report-card-on-indigenous-health

AMA RELEASES PLAN TO ERADICATE RHEUMATIC HEART DISEASE (RHD) BY 2031

AMA Indigenous Health Report Card 2016: A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031

The AMA today called on all Australian governments and other stakeholders to work together to eradicate Rheumatic Heart Disease (RHD) – an entirely preventable but devastating disease that kills and disables hundreds of Indigenous Australians every year – by 2031.

AMA President, Dr Michael Gannon, said today that RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

The 2016 Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031 – was launched at Danila Dilba Darwin  Friday 25 November

Dr Gannon said the lack of effective action on RHD to date was a national failure, and an urgent coordinated approach was needed.

“RHD once thrived in inner-city slums, but had been consigned to history for most Australians,” Dr Gannon said.

“RHD is a disease of poverty, and it is preventable, yet it is still devastating lives and killing many people here in Australia – one of the world’s wealthiest countries.

“In fact, Australia has one of the highest rates of RHD in the world, almost exclusively localised to Indigenous communities.

“Indigenous Australians are 20 times more likely to die from RHD than their non-Indigenous peers – and, in some areas, such as in the Northern Territory, this rate rises to 55 times higher.

“These high rates speak volumes about the fundamental underlying causes of RHD, particularly in remote areas – poverty, housing, education, and inadequate primary health care.

“The necessary knowledge to address RHD has been around for many decades, but action to date has been totally inadequate.

“The lack of action on an appropriate scale is symptomatic of a national failure. With this Report Card, the AMA calls on all Australian governments to stop new cases of RHD from occurring.”

RHD begins with infection by Group A Streptococcal (Strep A) bacteria, which is often associated with overcrowded and unhygienic housing.

It often shows up as a sore throat or impetigo (school sores). But as the immune system responds to the Strep A infection, people develop Acute Rheumatic Fever (ARF), which can result in damage to the heart valves – RHD – particularly when a person is reinfected multiple times.

RHD causes strokes in teenagers, and leads to children needing open heart surgery, and lifelong medication.

In 2015, almost 6,000 Australians – the vast majority Indigenous – were known to have experienced ARF or have RHD.

From 2010-2013, there were 743 new or recurrent cases of RHD nationwide, of which 94 per cent were in Indigenous Australians. More than half (52 per cent) were in Indigenous children aged 5-14 years, and 27 per cent were among those aged 15-24 years.

“We know the conditions that give rise to RHD, and we know how to address it,” Dr Gannon said.

“What we need now is the political will to prevent it – to improve the overcrowded and unhygienic conditions in which Strep A thrives and spreads; to educate Indigenous communities about these bacterial infections; to train doctors to rapidly and accurately detect Strep A, ARF, and RHD; and to provide culturally safe primary health care to communities.”

The AMA Report Card on Indigenous Health 2016 calls on Australian governments to:

Commit to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and

Work in partnership with Indigenous health bodies, experts, and key stakeholders to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

“The End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRC) is due to report in 2020 with the basis for a comprehensive strategy to end RHD as a public health problem in Australia,” Dr Gannon said.

“We need an interim strategy in place from now until 2021, followed by a comprehensive 10-year strategy to implement the END RHD CRC’s plan from 2021 to 2031.

“We urge our political leaders at all levels of government to take note of this Report Card, and to be motivated to act to solve this problem.”

The AMA Indigenous Health Report Card 2016 is available at https://ama.com.au/article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease

TIME TO TAKE HEART

Labor calls on the Turnbull government to take heart and address Rheumatic Heart Disease, an entirely preventable public health problem which is almost exclusively affecting First Nation Peoples.

Labor welcomes the release of the Australian Medical Association’s 2016 Aboriginal and Torres Strait Islander Health Report Card, A Call To Action To Prevent New Cases Of Rheumatic Heart Disease In Indigenous Australian By 2031.

Poor environmental health conditions, like overcrowded housing remain rampant in Aboriginal and Torres Strait Islander communities, devastating families and the lives of young people.

As the AMA’s report card suggests, we must build on the success of the 2009 Commonwealth Government Rheumatic Fever strategy, established to improve the detection and monitoring of Acute Rheumatic Fever and Rheumatic Heart Disease.

Funding under the Rheumatic Fever strategy is uncertain after this financial year,” Ms King said.

The Productivity Commission’s report Overcoming Indigenous Disadvantage [OID] released last week found 49.4% of Aboriginal and Torres Strait Islander peoples in remote communities live in overcrowded housing. Additionally, the report details no significant improvement in Aboriginal and Torres Strait Islander Peoples access to clean water, functional sewerage and electricity.

“We know Rheumatic Heart Disease is a disease of poverty and social disadvantage, which is absolutely preventable. Aboriginal and Torres Strait Islander communities, especially in the Top End of the Northern Territory, suffer the highest rates of definite Rheumatic Heart Disease,” Mr Snowdon said.

Labor applauds the work of the Take Heart Australia awareness campaign, and their work to educate and advocate putting Rheumatic Heart Diseases on the public health agenda.

“Like always, Aboriginal and Torres Strait Islander communities need to be front and centre in taking action. The most positive outcomes will come through communities working with Aboriginal and Community Control Health Organisations to design and deliver programs tailored to their needs,” Senator Dodson said.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 noted more than three years ago the association of RHD with ‘extremes of poverty and marginalisation’, these conditions remain and are almost exclusively diseases of Indigenous Australia.

If we are serious about closing the gap, we must take heart, and address this burden of Rheumatic Heart Disease facing First Nation Peoples.

ACTION TO END RHEUMATIC HEART DISEASE (RHD) IN 15YRS

The Heart Foundation has today supported the Australian Medical Association (AMA) call for governments to work together to eliminate Rheumatic Heart Disease (RHD) in 15 years, by 2031.

Heart Foundation National CEO, Adjunct Professor John Kelly (AM) said RHD was an avoidable but widespread disease that kills and harms hundreds of Indigenous Australians every year.

“Considering how preventable RHD is, it is a national shame that our Indigenous population are left languishing.

“The Heart Foundation has strongly advocated from the RHD strategy. We continue to call on the government to fund the National Partnership Agreement on Rheumatic fever strategy and Rheumatic Heart Disease Australia (RHD Australia) with a $10 million over 3 years’ commitment, “Adj Prof Kelly said.

With the AMA predicting that RHD could be eradicated in Australia within 15 years if all governments adopted its recommendations, the time to act is now.

“We need to boost funding for the national rheumatic fever strategy. New Zealand is allocating $65 million over 10 years. A robust approach can put an end to RHD as a public health issue within 15 years,” Adj Prof Kelly said.

This call to action was part of the release of the AMA’s 2016 Indigenous Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031.

“We want a strong and robust strategy to tackle this challenge. We will be working with the AMA to support and advocate for these recommendations which include:

  • A commitment to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and
  • Working in partnership with Indigenous health bodies, experts, and key stakeholders
  • to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

 

NACCHO Aboriginal Health Newspaper : ATSI Health needs more than a 10 year plan – It needs political will

warren

 ” Closing the gap in Aboriginal and Torres Strait Islander health inequality unfortunately remains a persistent challenge for our society.

There is no shortage of statistics and data demonstrating that we need to do better – it can sometimes feel like there is a new report every week flagging indicators of concern.

The real challenge is translating headlines into consistent effort and real results – beyond news and political cycles.

There is legitimate concern that the centrality of ACCHOs to improving health service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples is not being adequately recognised.

I have consistently argued that there are ACCHOs which are the finest examples of comprehensive primary health care in the country.”

Warren Snowdon as Shadow Assistant Minister for Indigenous Health

Article from Page 10 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

This is one of the goals of the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023 – a ten year framework for Aboriginal and Torres Strait Islander health policy. It articulates a vision for closing the gap in Aboriginal and Torres Strait Islander health inequality.

Significantly, the Health Plan was developed by Labor in partnership with Aboriginal and Torres Strait Islander peoples, their community organisations and their peak bodies.

NACCHO was a key partner and collaborator in the development of the plan, as was the National Congress of Australia’s First Peoples.

This is because Labor has a strong commitment to the belief that Aboriginal community controlled health organisations (ACCHOs) and the National Congress are central to improving health outcomes for Aboriginal and Torres Strait Islander peoples and should be partners in developing policy.

Importantly, the Plan has bipartisan support. An Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan was launched in 2015 by the Abbott Government.

Again, this plan was developed in partnership with the National Health Leadership Forum. However, despite this and the strong bipartisan support for the Health Plan, we are now in the fourth year of the Plan and still no resources have been identified for the Implementation Plan.

It is clear that without resources, the vision of the Health Plan will be impossible to achieve.

Although Labor remains committed to working in a bipartisan manner with the current Government to improve Aboriginal and Torres Strait health outcomes, to address the obvious inequalities and to close the gap, this does not mean that Labor will not hold the government to account.

Advancing the priorities of Aboriginal and Torres Strait Islander peoples, communities and their organisations remains an absolute commitment. Working in partnerships is paramount to achieve these.

There are obvious issues with the failure of the current government to develop a comprehensive approach to dealing with the social determinants of health or to demonstrate any real appreciation of how a human rights approach is required in the development of our health policy.

Additionally, we are very aware of the need to address issues of racism to ensure that the health system is not discriminatory.

There is legitimate concern that the centrality of ACCHOs to improving health service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples is not being adequately recognised. I have consistently argued that there are ACCHOs which are the finest examples of comprehensive primary health care in the country.

They are community based and controlled, they are responsive, innovative, accountable and have good governance. Most importantly, they deliver primary care, allied health services and prevention strategies which are examples for the rest of the world. ACCHOs also provide services that are culturally appropriate and safe.

Having said this, there are some organisations that need to do better. They need to be more accountable and reform their governance and their record of service delivery.

NACCHO and the state and territory affiliates have an important role to play in this regard in terms of leadership, accountability and mentoring. They need to be alive to the threats that exist as well as opportunities for the sector to grow further by expanding the reach of services and consequently, achieving better health outcomes for Aboriginal and Torres Strait Islander peoples.

For our part, Labor will continue to review our current policy settings, particularly as we approach the next election.

As a matter of course we will continue to work with NACCHO, the affiliates and their member organisations as well as other health advocacy and membership groups, such as doctors, nurses, health workers and allied health practitioners and of course other health experts from universities and the like.

We acknowledge the need to continue to address the dramatic levels of chronic disease that are endemic in many Aboriginal and Torres Strait Islander communities.

The fundamental importance of good primary care services being readily available is abundantly clear.

In primary health care, broader health policy has an inevitable impact, and this is why Labor has consistently opposed changes to the Medicare system that increase costs or limit services to those who most need Medicare. We are very conscious of the need to protect ACCHOs from the impact of these policy threats.

There is also an absolute need to look at prevention strategies to intervene and stop the onset of chronic disease in the first place. We support the life course approach that drives the National Health Plan as well as the requirement to address the broader social determinants.

In this context we are currently giving priority to what can be done in maternal and child health, parenting and adolescent health.

We need to ensure that all children are born healthy, have a healthy childhood and grow up to be healthy adults, without the chronic disease that has beset their parents and grandparents.

Improvements cannot happen in isolation. There is a concurrent need to do something about the poverty that is such a major driver of poor health outcomes. Policies and strategies around education, employment, housing, drug and alcohol policies, mental health and social and emotional wellbeing as well as food security are integral to elevating and sustaining health outcomes.

We will continue to advocate for the development and provision of appropriate aged care services. And we will continue to support treatment models driven by Aboriginal and Torres Strait Islander peoples that are culturally appropriate from their inception.

Another area where Labor is keen to see more progress is in the health workforce. It is vital that we see more Aboriginal and Torres Strait Islander people across all disciplines, engaged in treating and supporting Aboriginal and Torres Strait Islander people.

Labor recognises that one size will not fit all. There is a need to appreciate and address the difference and diversity that exists for Aboriginal and Torres Strait Islander peoples across the country.

Labor is absolutely committed to both this underlying principle in our policy development process, as well as recognising that the framework we are using remains the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023.

Catherine King and Warren Snowdon  will keynote speakers at the  NACCHO Members Conference in Melbourne

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1. NACCHO Interim 3 day Program has been released -Download
2. The dates are fast approaching – so register today

NACCHO Aboriginal Health Plan #NATSIHP : New advisory group established to assist with implementation plan

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 “ The acknowledgement of racism as a critical component for health in the National Health Plan was a huge step forward and  I’m delighted the Implementation Plan had sown seeds to tackle social and cultural determinants of health , which contributed to 31 per cent of the gap in life expectancy between Indigenous and non-Indigenous Australians.”

Assistant Minister for Health and Aged Care Ken Wyatt see his comments about 18C below

At the #LowitjaConf2016 Assistant Minister Wyatt announced the makeup of a new advisory group established to assist with the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP)

Download PDF copy of NATSIHP implementation plan here

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Download PDF copy of NATSIHP  here

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Marie McInerney from Croakey writes

He said it would include representatives of the Department of Health and Prime Minister and Cabinet and of the Australian Institute for Health and Welfare.

Indigenous health sector representatives would include:

1.Healing Foundation CEO Richard Weston (as co-chair)

2.National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Pat Turner

3.Apunipima Cape York Health Council’s Dr Mark Wenitong,

See NACCHO TV interview here with Dr Mark

4.Central Australian Aboriginal Congress Aboriginal Alice Springs Ms Donna Ah Chee, CEO

See NACCHO TV Interview here with Donna

5.Winnunga Nimmityjah Aboriginal Health Service Canberra Julie Tongs OAM, CEO

See NACCHO TV Interview here with Julie

Jurisdictional members of the National Aboriginal and Torres Strait Islander Health Standing Committee would also join, he said.

BACKGROUND

Read 49 NACCHO Posts about NATSIHP here

The National Aboriginal and Torres Strait Islander Health Plan is an evidence-based policy framework designed to guide policies and programmes to improve Aboriginal and Torres Strait Islander health over the next decade until 2023.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was developed to provide an overarching framework which builds links with other major Commonwealth health activities and identifies areas of focus to guide future investment and effort in relation to improving Aboriginal and Torres Strait Islander health.

On 30 May 2014 Senator the Hon Fiona Nash, Assistant Minister for Health, announced that an Implementation plan would be developed outlining the Commonwealth’s coordinated efforts to improve Aboriginal and Torres Strait Islander health outcomes.

Assistant Minister for Health and Aged Care Ken Wyatt comments about 18C

Speaking to Croakey, he indicated he may support a move, heralded by Prime Minister Malcolm Turnbull, to replace the words “insult” and “offend” with “vilify” in Section 18C of the Racial Discrimination Act, as a move to meet demands from ultra Coalition conservatives while not scrapping the provision.

His comments came as the Federal Government set up a parliamentary inquiry into the Act to determine whether it imposes unreasonable limits on free speech and to recommend whether the law should be changed.

Wyatt said he would always fight to ensure people are not “racially vilified” but he said he did not want to see Parliament persuaded to “repeal” Section 18C.

“I would rather see a reconstruction that has strong words that stood the test against vilification and racism.”

 

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1. NACCHO Interim 3 day Program has been release
2. The dates are fast approaching – so register today

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