NACCHO Aboriginal Health #RUOKDay : Download @RACGP Report underlines crucial role of GPs in #mentalhealthcare

“With a shortage of psychologists and other mental health professionals in rural and remote areas, the role of rural doctors in providing mental healthcare is already absolutely critical, and is becoming more so.

“Feedback from many rural and remote doctors backs up the findings in today’s RACGP report — namely, that there is a significant mental healthcare load in general practice.

“And this area of general practice care is growing.

“Many rural doctors already undertake additional upskilling in advanced mental healthcare.”

President of the Rural Doctors Association of Australia (RDAA), Dr Ewen McPhee

Download a PDF Copy of report

Health-of-the-Nation-2017-report

Read over 150 Aboriginal Mental Health Articles published over the past 5 years by NACCHO

A major report released today on general practice care in Australia shows that the most frequent visits to GPs are for psychological care, demonstrating that the sector plays a critical role in helping patients with their mental health as well as physical health.

The report, General Practice: Health of the Nation, is the first of what will be an annual insight into the state of general practice in Australia, published by the Royal Australian College of General Practitioners (RACGP).

Dr Ewen McPhee continued

“And under the National Rural Generalist Pathway that the Federal Government is progressing, medical graduates training as Rural Generalist doctors will be able to undertake advanced mental healthcare as a key element of their training, alongside other advanced skills.

“Earlier this year, we also welcomed an announcement by the Federal Government that, from November, it will increase access for rural and remote Australians to Medicare-rebated psychological care delivered by video consultations.

“Under the change, psychologists will be able to deliver up to 7 of the currently available 10 face-to-face sessions accessed through a General Practitioner. The rebates for these sessions have previously only been available if provided by a GP.

“This change will help to significantly improve access to tele-psychology services for many rural and remote Australians and the Government deserves full credit for implementing it.”

RDAA has supported concerns raised by the RACGP, however, that despite the fact that over 85% of the Australian population visits their GP each year, the general practice sector receives only 5% of the total annual health budget.

“This should be sending significant warning bells to governments” Dr McPhee said.

“Given the reliance that Australians have on general practice for their primary care — and the ability of investment in general practice to generate significant budget savings by reducing hospital admissions — it is clear that additional investment in general practice needs to be made, sooner rather than later.”

Consumers Health Forum MEDIA RELEASE :

The finding that psychological issues are a leading reason patients see GPs highlights the importance of the GPs’ role as the first base for health concerns in the community.

The Health of the Nation report released by the Royal Australian College of GPs today reveals mental health issues like depression and anxiety are among the most common ailments reported by 61 per cent of GPs.

“That is a disturbingly high figure.  It is also the issue causing GPs most concern for the future,” the CEO of the Consumers Health Forum, Leanne Wells, said.

The next most commonly mentioned as emerging issues by GPs are obesity and diabetes.  The prevalence of these conditions, all of which raise complex challenges for the most skilled GP, underlines the need for a well-coordinated and integrated health system in the community.

“The Consumers Health Forum recognises the GP as the pivotal figure in primary health care who needs more support through such measures as the Government’s Health Care Homes, initiating more integrated care of those with chronic and complex conditions.

“At a recent Consumers Roundtable meeting with Health Minister, Greg Hunt, we set out priorities for a National Health Plan to strengthen Australia’s primary health system, making it more consumer-centred, prevention-oriented and integrated with hospital and social care.

“We also called for more investment in health systems research, shaped by consumer and community priorities, to stimulate services that reflect advances in health sciences and knowledge.

Too often Australians, particularly those with chronic illness, are confounded by our fragmented health system.

We have world class health practitioners and hospitals. But these are disconnected so that patients don’t get the comprehensive top-quality care that should be routine.

“Investing in primary health care led by GPs is the way to a better performing and more consumer-responsive health system,” Ms Wells said.

 

 

NACCHO #Aboriginal Health and #Diabetes @theMJA the @NHMRC #Indigenous guidelines need update

Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening.

Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable “

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

Originally published MJA

Read over 120 diabetes related posts by NACCHO over past 5 years

MORE can be done to increase diabetes screening rates among Indigenous Australians and enable earlier intervention, say experts who are calling for a greater focus on young adults.

A study published in the MJA found enormous variation in diabetes screening rates between different Aboriginal Community Controlled Health Services (ACCHSs).

The proportion of Indigenous adults screened for diabetes at least once in 3 years – as per the Royal Australian College of General Practitioners and Diabetes Australia (RACGP/DA) guidelines – ranged from 16% to 90% between different services.

Overall, 74% of Indigenous adults received a screening test for diabetes at least once between 2010 and 2013, the study found, based on de-identified data on 20 978 patients from 18 ACCHSs.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable.

Extract Overview provided by NACCHO

Download a full copy of 2 nd edition

http://www.racgp.org.au/download/documents/AHU/2ndednationalguide.pdf

Type 2 diabetes is most commonly found in obese adults who develop increasing insulin resistance over months or years. For these patients there is a substantial ‘prediabetic’ window period of opportunity to offer preventive interventions. Screening for diabetes is safe, accurate and cost effective, and detects a substantial proportion of people who may not otherwise have received early intervention.1 This chapter discusses type 2 diabetes in adults who are not pregnant.

The prevalence of type 2 diabetes in Aboriginal and Torres Strait Islander populations is 3–4 times higher at any age than the general population, with an earlier age of onset.2 The precise prevalence is hard to pinpoint; a 2011 systematic review of 24 studies showed prevalence estimates ranged from 3.5–31%, with most lying between 10% and 20%. Diabetes prevalence in remote populations is approximately twice that of urban populations and is higher among Aboriginal and Torres Strait Islander people.3

Aboriginal and Torres Strait Islander men and women die from diabetes at 23 and 37 times the rate of non-Indigenous Australian men and women respectively, in the 35–54 years age group.4 Large scale clinical trials have demonstrated that appropriate management of diabetes can prevent the development or delay the progression of complications such as myocardial infarction, eye disease and renal failure.5

Obesity is a very strong predictor for diabetes; a body mass index (BMI) ≥30 kg/m2 increases the absolute risk of type 2 diabetes by 1.8–19-fold, depending on the population studied. A cohort study of non-diabetic Aboriginal adults aged 15–77 years in central Australia found that those with a BMI of ≥25 kg/m2 had 3.3 times the risk of developing diabetes over 8 years of follow up compared to those with a BMI <25 kg/m2.1 The AusDiab study found that three measures of obesity: BMI, waist circumference and waist-to-hip ratio, all had similar correlations with diabetes and CVD risk.6 Waist circumference performed slightly better than BMI at predicting diabetes in a remote Aboriginal community

The study defined screening tests to include glycated haemoglobin (HbA1c) testing as well as the oral glucose tolerance test and venous glucose level testing.

Barriers to screening included being aged under 50 years, being transient rather than a current patient and attending the service less frequently, the study found. The authors concluded that particular attention should be given to increasing the screening rate in these groups.

The finding that young people were less likely to be tested was “intuitively reasonable”, the authors said, given that the risk of developing diabetes rises with age. However, they suggested that it was still best practice to test Indigenous adults from the age of 18 years, as it provided a “substantial opportunity for limiting the impact of type 2 diabetes”.

Indigenous Australians aged 25–34 years are five times more likely to have diabetes or high blood sugar levels than non-Indigenous Australians of the same age, they noted.

Despite this difference between Indigenous and non-Indigenous people, the National Health and Medical Research Council (NHMRC) only recommends screening Indigenous people for diabetes once they are aged over 35 years, and doing it every 3 years.

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

“Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening,” she told MJA InSight.

“Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent,” she said.

Professor O’Dea said that more widespread use of HbA1c testing could increase the screening rate in Aboriginal communities, particularly among younger people and those who were more transient.

“If screening for diabetes was just a simple opportunistic HbA1c test, you wouldn’t have so many problems getting people to have it done,” she said. “HbA1c testing will give you a good idea of the mean glucose level, and unlike the glucose tolerance test, you don’t have to ask the patient to return in the fasting state.

“If it does turn out that the patient has borderline diabetes, then you can ask if they are prepared to do a glucose tolerance test,” she added.

Study co-author, Associate Professor Christine Paul, said that there was significant variation in the use of HBA1c testing across sites and across time in the study.

“I think it is possible that increasing the use of HbA1c as a screening test may help [to increase screening rates]; however, I don’t think it’s the main answer,” she said. “Clearly some health services need support to get systems in place, regardless of which test they use.”

 

NACCHO Aboriginal Health and Smoking : Survey #Nosmokes How #socialmedia supports positive health behaviour

How does accessing the NoSmokes health campaign support anti-smoking behaviour in Aboriginal and Torres Strait Islander youth?

What is this project about?

The aim of this project is to explore how the NoSmokes health campaign supports Aboriginal and Torres Strait Islander youth to deal with smoking situations. We will also explore whether accessing NoSmokes supports young people to stay quit or resist starting smoking.

What are the benefits of the project?
This project will help us to understand more about how online technology and social media can be used to support positive health behaviour, particularly in relation to smoking. You may also learn more about your own confidence in dealing with a number of different smoking situations.

What will I have to do?

To participate you must use /view

1.NoSmokes Facebook page.

VIEW HERE

2. NoSmokes website.

VIEW HERE

3. NoSmokes YouTube channel.

VIEW HERE

4. NoSmokes  Instagram page

VIEW HERE

5.and be 16 years of age or older.

Your participation is voluntary, so you don’t need to take part if you don’t want to. If you choose to take part, you will complete an online questionnaire answering questions about: your experience with smoking; your experience of NoSmokes, your confidence in dealing with different smoking situations. This will take around 20-25 minutes.

If there are any questions in the survey you don’t like, or that you do not feel comfortable answering, then leave that question and move onto the next one. You can complete the survey on your mobile phone or computer. If you change your mind about participating, or are feeling uncomfortable, you can choose to stop the survey at any time by closing the web page or by not pressing the ‘submit’ button. Any data collected before you withdraw will be deleted at the end of the data collection period.

What will happen to my information?

Only the researcher will have access to the individual information provided by participants. Privacy and confidentiality will be assured at all times. The project findings will be used as part of the researcher’s Honours Thesis project, and will be published on the NoSmokes and Ninti One websites. The research may also be presented at conferences and written up for publication.

Only anonymous information will be gathered – you will not be required to provide any identifiable personal information, such as your name or date of birth. No one will know you have taken part in this research from reading the thesis, reports or other publications.

If you are interested in viewing the results of this research, a summary report will be available on the NoSmokes website http://nosmokes.com.au/ in December 2017. You can also request a copy of the final thesis by emailing Neeti Rangnath on u3105740@uni.canberra.edu.au.

Researcher
Neeti Rangnath
Honours Student
Discipline of Psychology, Faculty of Health
University of Canberra, ACT 2601
Email: u3105740@uni.canberra.edu.au
Supervisor
Dr Penney Upton
Associate Professor in Health
Centre for Research and Action in Public Health
University of Canberra, ACT 2601
Ph: 02 6201 2638
Email: penney.upton@canberra.edu.au
Data storage
During the project, the anonymous data will be stored securely on a password protected computer, and then stored securely on the University of Canberra network server. The information will be kept for 5 years, after which it will be destroyed according to University of Canberra protocols.

Ethics Committee Clearance
The project has been approved by the Human Research Ethics Committee of the University of Canberra (HREC 17-83).

Queries and Concerns
If you have any questions or concerns about this project you can contact the researchers, whose details are provided at the top of this form. If you are concerned about the conduct of this project please contact

Mr Hendryk Flaegel, Ethics and Compliance Officer at the University of Canberra (p) 02 6201 5220 (e) humanethicscommittee@canberra.edu.au

There are no anticipated risks associated with participating in this research. However, if completing this questionnaire makes you feel uncomfortable, sad, or angry about your own smoking or the smoking behaviour of someone you know, you are encouraged to visit the following website to find support with smoking-related issues in your state or territory:

http://www.quitnow.gov.au/internet/quitnow/publishing.nsf 

Consent Statement 
I have read and understood the information about the research. I am not aware of any reason that I should not be participating in this research, and I agree to participate in this project. I have had the opportunity to ask questions about my participation in the research. All questions I have asked have been answered to my satisfaction.

Complete consent and start survey here

 

Aboriginal Health Research : @KenWyattMP #SEARCH a “jewel in the crown” in Aboriginal health research

“Historically, research has tended to be based around academic promotion, not looking at what works and what doesn’t and not designed around the needs of Aboriginal people and by Aboriginal people. That’s where we’ve come from.

But SEARCH was different because it ensured Aboriginal leadership was embedded, Aboriginal people had ownership of the data and the research was culturally appropriate.”

One of the founding Chief Investigators of SEARCH, Sandra Bailey, former Chief Executive Officer of the Aboriginal Health and Medical Research Council-NSW

The SEARCH study into the health and wellbeing of urban Aboriginal children is providing valuable data to inform policy and should be celebrated as one of the “jewels in the crown” in Aboriginal care and research, Federal Minister for Indigenous Health Ken Wyatt told the study’s annual Forum this month.

The SEARCH partners are: The Aboriginal Health & Medical Research Council, the Sax Institute, leading researchers across Australian universities and four NACCHO Aboriginal community controlled health services member : Tharawal Aboriginal Corporation (Campbelltown), Awabakal Ltd (Newcastle), Riverina Medical and Dental Aboriginal Corporation (Wagga Wagga) and Aboriginal Medical Service Western Sydney (Mt Druitt).

Mr Wyatt, who opened the SEARCH (Study of Environment on Aboriginal Resilience and Child Health) Forum in Sydney, said thorough research and data collection was essential in the development of policy.

“We are better off informed by data that comes from our people and often collaborations with research institutes give me guidance,” he said. “It really does inform the way we consider our approach to Closing the Gap”.

VIEW YOU TUBE INTERVIEW

SEARCH is Australia’s largest long-term study of the health and wellbeing of urban Aboriginal children, and involves 1600 children and their families.

It is an active partnership between Aboriginal Community Controlled Health Services and researchers, where these health services set the research priorities and guide how data is collected, interpreted and used.

The Forum showcased the achievements of SEARCH and highlighted significant potential for Australia to make even greater gains, both by looking at ways to further build the evidence on the drivers of health and disease in urban Aboriginal children and their families, and by using the necessary tools, systems and partnerships to put that evidence to work to achieve large-scale change.

Mr Wyatt said SEARCH represented a new way forward in Aboriginal health research, because it put Aboriginal people at the centre of the research process, and sought not only to better understand the health of Aboriginal children, but to make a real difference to the lives of Aboriginal people.

“Together, scientists and families have built Australia’s largest source of ongoing information on urban Aboriginal child health. And because of them, those of us who make policy, or design and deliver programs and services can now access knowledge that just wasn’t available before.”

SEARCH was one of the many “jewels in the crown” – or shining examples of life-changing care and research that were leading to healthier children – that should be celebrated, Mr Wyatt said.

“Walking and working with Aboriginal families is the only way to lock in the significant gains we have made, and to accelerate our future progress, with innovative approaches that also address the social and cultural factors influencing health.”

Addressing an evidence gap

One of the founding Chief Investigators of SEARCH, Sandra Bailey, told the Forum that despite most Aboriginal people living in urban areas, at the time SEARCH was established only 11% of Aboriginal health research focused on understanding health and disease in urban communities.

“Historically, research has tended to be based around academic promotion, not looking at what works and what doesn’t and not designed around the needs of Aboriginal people and by Aboriginal people,” said Ms Bailey, former Chief Executive Officer of the Aboriginal Health and Medical Research Council. “That’s where we’ve come from.”

But SEARCH was different because it ensured Aboriginal leadership was embedded, Aboriginal people had ownership of the data and the research was culturally appropriate, she said.

Ms Bailey said Aboriginal Community Controlled Health Services were able to directly apply the data from the Study to their service planning and delivery.

“Most importantly, Aboriginal people are valued and empowered.”

Building blocks to drive change

Sax Institute Chief Executive Officer Professor Sally Redman said SEARCH data was driving real change, including leading to programs such as HEALs, which had used the findings about high rates of ear infections and hearing loss in urban Aboriginal children to deliver improved services.

SEARCH, while already valuable, would prove even more valuable in the future, she said.

“As the children grow older, we can look at the trajectories of change − what helps some children do well, and some not so well, and the data will be valuable for use in evaluating changes in service delivery,” Professor Redman said.

“We’ve got the process to collect better data about what might make a difference, we’ve got the partnerships in place and we’ve got lots of tools for change. The next phase is bringing it all together to try to function as a real catalyst to change in this space.”

 

Aboriginal #Health #Research debate : Controlled experiments won’t tell us which #Indigenous health programs are working

 ” For example, it is known anecdotally in Alice Springs that some Aboriginal Australians who could benefit from kidney dialysis treatment prefer, instead, to go back to their community to be on country.

While this can be detrimental to their physical health, it has important cultural significance for them.

The RCT approach in this situation would undoubtedly demonstrate the health benefits of kidney dialysis. But understanding this problem in the context of real lives requires different methodologies.

Unless we design research programs to consider why people would rather stay on country than receive effective health treatments, Aboriginal health may not improve.

From the Conversation August 2017

Picture above Some Aboriginal Australians who could benefit from kidney dialysis treatment prefer to go back to their community to be on country instead. WESTERN DESERT/AAP

Read over 40 NACCHO Research posts published over the past 5 years

Described as “one of the simplest, most powerful and revolutionary tools of research”, the randomised controlled trial (RCT) has yielded a great deal of important information in the health sciences. It is usually held up as the “gold standard” for gathering medical evidence.

The RCT can tell us which procedure or treatment is more effective under tightly controlled situations. This evidence is useful and important, but we also need to know things like what people want from health services, which treatments are preferred, and why some people stick to treatment regimes and some people don’t.

These issues are particularly relevant to remote Australia and Aboriginal and Torres Strait Islander health, where high levels of illness and early death persist, and where what applies to the tightly controlled conditions of a laboratory rarely translates.


Read more: Why are Aboriginal children still dying from rheumatic heart disease?


The government is rolling out its A$40 million plan to evaluate Indigenous health programs. The Evidence and Evaluation Framework aims to strengthen reporting, monitoring and evaluation for programs and services provided to Indigenous Australians.

As Indigenous Affairs Minister Nigel Scullion said last year:

When you don’t know anything about any of the programs, then you’re just relying on gut feelings, and that’s not good enough.

So, the framework will provide information about where government money is being spent, what works and why.

However, from a Western biomedical perspective, the randomised controlled trial is afforded an elevated position in establishing what works and why. While some recommend using RCTs to evaluate Indigenous programs, it is critical to keep in mind why this form of evidence-gathering is not always appropriate in this context.

Randomised controlled trials aren’t real life

In health and medical research, the RCT involves randomly assigning people to different groups and giving the groups different treatments. The random allocation to groups precludes there being systematic differences between participants at the start of the study.

At the end of the study, any differences between the groups can be attributed to the treatment and not some other factor. RCTs, therefore, are an elegant and efficient way of ruling out competing explanations for an observed effect.

However, research participants and scenarios in randomised controlled trials are often unlike the patients and settings to which the evidence will ultimately be applied. For example, RCTs have demonstrated that psychological treatments delivered through the internet can be effective for a wide range of disorders. But in real-world settings, adherence rates to internet treatments are very low, so the RCT result has little practical meaning.

The issue of which particular outcome should take priority can also be difficult to resolve through the RCT approach to research. Most RCTs prioritise the clinical perspective, such as a measurable change in a particular health outcome. However, there can be a mismatch between what doctors view as success and what patients and their loved ones perceive as a positive outcome following drug or other forms of treatment.

For example, it is known anecdotally in Alice Springs that some Aboriginal Australians who could benefit from kidney dialysis treatment prefer, instead, to go back to their community to be on country. While this can be detrimental to their physical health, it has important cultural significance for them.

The RCT approach in this situation would undoubtedly demonstrate the health benefits of kidney dialysis. But understanding this problem in the context of real lives requires different methodologies. Unless we design research programs to consider why people would rather stay on country than receive effective health treatments, Aboriginal health may not improve.

How best to gather evidence

Valuable work can be conducted by health professionals and service providers collecting data during their regular daily activities. The model of the “scientist-practitioner” often observed in clinical psychology could be applied to great effect in remote Australia.

This model promotes a seamless transition between science and practice in which the individual is both researcher and clinician. Scientist-practitioners adopt a critical stance to their clinical practice and routinely demonstrate, through evaluation, the value of the service they are providing.

Such a model was used in a GP practice in rural Scotland. Here, they found one simple change in how appointments were scheduled almost doubled the number of patients (in a six-month period) able to access a psychology service within a reasonable time after referral from their GP.

Rather than clinicians advising patients when to attend the next appointment, systems were organised so patients booked appointments in the same way they would to see a GP. The changes were quantified by clinician-researchers who collected these data in the course of their routine clinical practice.

After this change, patients were able to access the service within two weeks of being referred, rather than waiting for seven months as had been the case. Access to services is typically problematic in rural areas, so discovering a cost-effective means of improving access is an important outcome.

The results were so substantial and sudden that they were unequivocal. A large expensive RCT wasn’t necessary to demonstrate this simple change had made important improvements.


Read more: Aboriginal – Māori: how Indigenous health suffers on both sides of the ditch


This sort of approach could easily be applied in remote Australian settings. An RCT is not the only way, nor even the best way in all situations, to eliminate alternative reasons for the treatment outcomes obtained. Many important questions are ignored or refashioned inappropriately when only one methodology predominates.

Especially in the area of Indigenous health, the health and medical community must be guided by what patients want, not just by what health professionals know how to do.

NACCHO Congratulates #Lowitja @LowitjaInstitut 20 years of making a difference in Aboriginal health and wellbeing

 “It has been 20 years since I was asked to be the inaugural Chairperson of the Cooperative Research Centre for Aboriginal and Tropical Health.

One of my fundamental objectives as a Chairperson was to work towards reconciliation between Aboriginal and Torres Strait Islander and Western perspectives of health and wellbeing and encourage a different way of doing research.

That meant bringing the academics and the researchers together with those who are qualified to know what’s needed on the ground. I wanted practical people to investigate the changes that need to be made in Aboriginal and Torres Strait Islander communities to bring about the change we all want to see for our peoples.

I told them that I wanted them to be a courageous organisation committed to social justice and equity for Aboriginal and Torres Strait Islander people, to match words to action, to achieve real, tangible outcomes. “

Dr Lowitja O’Donoghue AC CBE DSG august 2017

 “When these ( ACCHO ) services are set up, it was very clear that the mainstream system was failing us.

So we decided we had to set up our own services… those original AMSs, Redfern and Congress and all the others that followed… were… hotbeds of political activism as well.

We were flexing our muscles in terms of, not only self-management, but self-determination.”

Pat Anderson Lowitja Chair and former NACCHO Chair Interview , 14 November 2014)

 ” Honoured to be marking 20 years of the two decades of Aboriginal-led excellence in research and making a difference.”

The Hon Ken Wyatt Minister for Indigenous Health launching the report  

Paul House welcomes the audience above to country at launch of report Changing the Narrative in ATSI Health Research. Improving our wellbeing

In 2017 Lowitja is celebrating 20 years of Aboriginal and Torres Strait Islander led and focused health research – recognising the journey of the Lowitja Institute and the four associated Cooperative Research Centres (CRCs).

To mark this anniversary they released at Parliament House in Canberra on Wednesday 9 August 2017 a publication titled

 

Changing the Narrative in Aboriginal and Torres Strait Islander Health Research


Four Cooperative Research Centres and the Lowitja Institute: The story so far

Download a copy here  LOWITJA Changing-the-narrative

Changing the Narrative outlines the journey and the successes of the Institute and the CRCs, and showcases how their cumulative efforts have pioneered a new way of conducting  health research in Aboriginal and Torres Strait Islander communities.

It maps the evolution of a new, collaborative and culturally appropriate way of carrying out health research.

It’s an approach driven by Aboriginal and Torres Strait Islander priorities – an approach developed by the CRCs, and embodied in the Institute.

Each of the CRCs and the Institute has progressed the work to develop health research expertise and processes to achieve lasting reform. Efforts are based on key principles of Aboriginal and Torres Strait Islander control of the research agenda, a broader understanding of health that incorporates wellbeing, and the need for research to have a clear and positive impact.

The Lowitja Institute commissioned the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) to write a brief history of our organisation – including audiovisual recordings that highlight the vision of influential individuals.

In addition, the writing, editorial and production work of the Lowitja Institute team have created the hard copy Changing the Narrative publication, and a companion e-book which will be available soon.

Extracts from Report ( for references see report )

Background Aboriginal Community Controlled Health

While this sense of outrage at inequality was being expressed at the universities and in the big cities, little change was occurring in the rural and remote areas of Australia where services for Aboriginal and Torres Strait Islander people were limited.

Those that did exist were segregated and hidden in Aboriginal and Torres Strait Islander welfare departments, missions, reserves and pastoral stations.

In the 1970s, however, there was a significant increase in Aboriginal and Torres Strait Islander health research.11 The results of much of this research confirmed that Aboriginal and Torres Strait Islander life expectancy was lower, and morbidity higher, than for other Australians. In the Northern Territory, these statistics were worse than they had been for non-Indigenous Australians at the turn of the twentieth century.12 Other indicators – such as living conditions, maternal and infant health and chronic disease – highlighted a huge gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

This crucial time of activism followed the 1967 referendum to allow amendments to the Australian Constitution that would give the Commonwealth Government the right to make laws affecting Aboriginal affairs and to include Aboriginal peoples in the national Census.13 It was a movement that was ‘most symbolically expressed through the land rights campaigns, but first gained concrete organisational form through the establishment of the Aboriginal legal aid and health services’.14

Change would not happen until the 1970s. The first Aboriginal Community Controlled Health Service (ACCHS) was established in Sydney’s Redfern in 1971, with the Victorian Aboriginal Health Service in Melbourne’s Fitzroy and the Central Australian Aboriginal Congress (CAAC) in Alice Springs two years later.15 The CAAC prides itself today as ‘the voice of Aboriginal health’, from its beginnings in the early 1970s and on its foundation objective that ‘Aboriginal health must be in Aboriginal hands’.16

However, it was not until 1991 that Darwin’s Danila Dilba Biluru Butji Binnilutlum17 and smaller services like18 Miwatj in East Arnhem Land the following year.19 A noticeable exception was Utopia’s Urapuntja Health Service, which opened in 1977.20

When these services are set up, it was very clear that the mainstream system was failing us. So we decided we had to set up our own services… those original AMSs, Redfern and Congress and all the others that followed… were… hotbeds of political activism as well. We were flexing our muscles in terms of, not only self-management, but self-determination. (Pat Anderson Interview 3, 14 November 2014)

Pat Anderson drew attention to the sense of ‘struggle’ against inefficient government control and past polices and the desperately poor health situation for Aboriginal and Torres Strait Islander peoples that framed their thinking in setting up these Northern Territory community controlled health services.

There was a whole range of Aboriginal national bodies that was set up around that time, but in particular with the health services, that was a very conscious decision to be able to be part of the struggle. We used to sign letters in those days, ‘Yours in the Struggle’, with a capital ‘S’. (Pat Anderson Interview 1, 23 October 2014)

The independence of the ACCHSs was enabled by a wide range of people from within the medical profession in Alice Springs and Darwin:

… When we decided that we were going to set up our own organisation, not a government initiative, doctors and nurses and a whole lot of people, as well as Aboriginal people… worked for nothing in those days. They would donate some of their time. The doctors, for instance, when they finished their shifts, they would come to the AMS and they did that for quite a while… NACCHO remains because it came out of the Aboriginal and Torres Strait Islander local communities. (Pat Anderson interview 3, 14 November 2014)

Aboriginal Health Strategy

The other thread that provides crucial background to the establishment of the CRCATH and changes to the Aboriginal and Torres Strait Islander health research landscape that began to emerge at this time was the 1989 National Aboriginal Health Strategy (NAHS).21

It aimed at developing mechanisms to achieve improvements in Aboriginal and Torres Strait Islander health; in particular it focused on taking into account ‘specific health issues, health service provisions, Aboriginal and Torres Strait Islander participation, research and data collection and ongoing monitoring’. It also aimed at maximising the involvement of Aboriginal and Torres Strait Islander people in their own health care.22

A Working Party was established in 1987, which included stakeholders from across a number of sectors involved in Aboriginal and Torres Strait Islander health, including government, communities and the Aboriginal controlled health sector. Its Chairperson was Dr Naomi Mayers, Director of the Redfern Aboriginal Medical Service. Other members of the group included Associate Professor Ted Wilkes and Professor Shane Houston, both of whom would go on to serve on the Board of the CRCAH. The Working Party carried out consultations with interested parties from across all Australian jurisdictions and received approximately 120 submissions for its consideration.23

The Working Party’s report highlighted many of the Aboriginal and Torres Strait Islander community’s concerns regarding the nature of health research. It noted that research was too often imposed on communities, with the communities having little control or redress, and seldom of actual benefit to them. The report also acknowledged that the pervasive nature of the existing Western-centric approach to research needed to be questioned and re-examined.24 The Working Party called for reform of the research processes in Aboriginal and Torres Strait Islander health and, in particular, for more involvement by Aboriginal and Torres Strait Islander people:

… The community should be involved in framing the questions so that the research is relevant to their needs. The Aboriginal community must actively participate in the research process, be kept fully informed, and have some say in how research findings are publicised and used. Only when research projects are subject to Aboriginal community influence, will they be both relevant and of benefit to the community.25

Shane Houston described the Working Party as ‘visionary’ to ‘embrace this notion that good data and good research could be the bedrock or the springboard on which we built really quite an innovative model and approach to Aboriginal health and research’. This was in spite of the fact that, up to that point, ‘appalling relationships [existed] between Aboriginal communities and researchers’ resulting from ‘countless examples’ of research failing to engage in ethical and effective ways with Aboriginal and Torres Strait Islander communities (Shane Houston interview, 1 December 2014).

Shane Houston was critical of what he saw as the dilution of the recommendations of the Working Party in the final report.26 Nevertheless, he later also recognised that it helped reshape the discussions around some of the most important issues regarding Aboriginal and Torres Strait Islander health and continued to be influential 25 years later. He pointed out that the NAHS was a breakthrough for policymakers and for Aboriginal and Torres Strait Islander community controlled health services, as it carried the debates beyond blaming researchers for their self-interest, and grasped the idea of influencing good and ethical research to create better data.

The report talked about intersectoral collaboration before people were talking in this country about the social determinants of health. It argued the case that housing affected health, that education affected health, that education affected housing. And it did so in a really coherent [way] that both government and communities agreed with. It argued for a reform to the style of service delivery in communities. It argued for more collaborative planning – ongoing planning, joint planning by state, territory and Aboriginal communities in the Aboriginal health arena…

And I think, looking back on it, it was one of those key turning points in the Aboriginal health movement across the country that just flipped the debate, that created a new way of talking about, a new way of engaging [with] and a new way of solving the challenges that we confronted. It was never going to be a panacea that would solve every problem. But it gave us the experience and the tools to approach problems in a new way. (Shane Houston Interview, 1 December 2016 )

NACCHO Aboriginal Rural and Remote Health Research Alert : @RoyalFlyingDoc Health Care Access in the bush Survey

 

” The RFDS survey of country health consumer priorities was released 100 years to the day since the first patient was treated by a pioneering doctor in Western Australia, leading to the founding of the RFDS which is now recognised as Australia’s most reputable charity.

The survey of 450 country people drawn from every state and territory saw one-third of responses (32.5%) name doctor and medical specialist access as their key priority. Addressing mental health (12.2%) and drug and alcohol problems (4.1%) were second and third priorities

Around seven million Australians who reside in remote and rural areas.

Of these, more than half a million live in either remote, or very remote, areas of Australia. Aboriginal and Torres Strait Islander (Indigenous) Australians are overrepresented in remote and very remote areas—almost half (45%) of all people in very remote areas and 16% in remote areas are Indigenous Australians, compared with a 3% Indigenous representation in the total population

The research paper “Health Care Access, Mental Health, and Preventative Health; Health Priority Survey Findings for People in the Bush

DOWNLOAD COPY HERE

RN032_Healths_Needs_Survey_Result_P1_U0FsohZ

Extract : 4.2.4 Indigenous health issues

Few respondents identified Indigenous health issues as important.

This was disappointing since across all remoteness areas, Indigenous Australians generally experience poorer health than non-Indigenous Australians (Australian Institute of Health and Welfare, 2014) in relation to chronic and communicable diseases, mental health, infant health, and life expectancy (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).

However, this result is unsurprising considering the very low proportion of respondents who were Indigenous.

Indigenous Australians are five times as likely as non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions such as diabetes, and three times as likely to die from digestive conditions (Australian Institute of Health and Welfare, 2015b).

Age-adjusted data demonstrated that in 2014–2015 Indigenous Australians were more than twice as likely as non-Indigenous Australians to be hospitalised for any reason (Australian Institute of Health andWelfare, 2016b).

Indigenous Australians are twice as likely as non-Indigenous Australians to be hospitalised for an injury (Australian Institute of Health and Welfare, 2015a), and 1.8 times as likely to die from an injury than non-Indigenous Australians (Henley & Harrison, 2015).

Indigenous Australians are three times as likely to die from chronic lower respiratory diseases and twice as likely to die as a result of self-harm (suicide) than non-Indigenous Australians (Australian Bureau of Statistics, 2016).

Compared to non-Indigenous Australians, Indigenous Australians demonstrate higher age standardised death rates for a number of illnesses and injuries (Australian Institute of Healthand Welfare, 2015c).

Indigenous Australians also experience higher prevalence rates of communicable diseases compared with non-Indigenous Australians, including shigellosis (2.6 times greater), pertussis (whooping cough) (54.3 times greater), and tuberculosis (6 times greater) (Abdolhosseini, Bonner, Montano, Young, Wadsworth, Williams, & Stoner, 2015).

Similarly, life expectancy is lower and mortality rates are higher among Indigenous Australians compared to non-Indigenous Australians.

In 2010–2012, the estimated life expectancy at birth was 10.6 years lower for Indigenous males (69.1 years) compared to non-Indigenous males (79.7 years) and 9.5 years lower for Indigenous females (73.7 years) compared to non- Indigenous females (83.1 years) (Australian Institute of Health and Welfare, 2015c).

Fatal burden of disease studies have also demonstrated the existence of health inequalities— the fatal burden of disease and injury in the Indigenous population is estimated to be 2.6 times that experienced by non-Indigenous Australians, with injuries (22%) and cardiovascular disease (21%) contributing the most to the fatal  burden of disease for Indigenous Australians (Australian Institute of Health and Welfare, 2015b).

Press Coverage : Rural and remote Australians remain deeply concerned about poor access to healthcare, and want the Federal Government to spend more to fix the problem.

That is the key finding from the latest Royal Flying Doctor Service (RFDS) research, released last week as reported ABC

The RFDS surveyed more than 450 country Australians, and one-third nominated access to doctors and specialists as their single biggest healthcare concern.

A third of respondents called for more government funding of services, particularly for mental health and preventative care.

RFDS chief executive Martin Laverty said it raised a question for governments as to whether policies aimed at bridging that gap had failed.

“We have an oversupply of doctors in this country; the problem is, the doctors are simply not all working in areas where they’re most needed,” he said.

“It brings into question the success of repeated programs of Commonwealth governments to encourage doctors to work in remote and country Australia.

“The question for government is, are our incentives for doctors sending them to where they’re most needed?”

Access to doctors in remote areas a challenge

The survey found encouraging news in other areas.

Two-thirds of respondents said they needed to travel for one hour or less to see their GP or another non-emergency medical professional.

But for Australians living in more remote places, a visit to the doctor could mean a 10-hour round trip or more.

RFDS chief medical officer in Queensland Abby Harwood said governments could do other things to improve their access to care beyond putting more bodies on the ground.

“There is a lot of telephone and email consultation going on between people out bush and their GPs, but that requires actually having a pre-existing relationship with a healthcare provider who knows you,” she said.

“Technology such as video-conferencing is a fantastic opportunity, [but] currently the telecommunications infrastructure out in these areas is not quite sufficient to be able to do that reliably.”

GPs not paid by Medicare for teleconference consultations

Unlike specialists, who can bill Medicare for video-conferencing consultations with patients, GPs currently are not paid unless their patient attends a consultation in person.

Dr Harwood said that meant GPs who assisted remote patients over the phone or by teleconference were doing so on their own time and usually out of their own pocket.

“From my experience, most of us would just do it [for free] out of the service that we provide,” she said.

“At the moment it’s either the healthcare provider doing it for free, or the person accessing the GP is paying for it out of their pocket with no subsidy.

“When you consider the petrol bills, how much it costs in fuel to drive a 1,000km round trip, a lot of them would rather pay out of their own pocket to do that [if the doctor is not already doing it for free].”

Dealing with issues before crisis point

Dr Harwood seconded the call for a greater focus on preventative care for rural and remote patients, who were too often only dealing with medical issues once they had reached crisis point.

She said changing that made medical and economic sense.

“[When there’s a crisis] a patient then has to travel in and out of their regional centre or capital city, which obviously causes a lot of disruption and it’s expensive,” she said.

“I don’t think anyone has actually measured the full cost to Australia as a country, taking into account that social dislocation and the economic disruption when people need to leave their properties, leave their workplace.

“It’s been proven over and over again that good primary health care, delivered to people out there on the ground, can often prevent those crises from happening.”

 

Significant boost in GP numbers ‘in all areas’

Assistant Minister for Health David Gillespie, who has responsibility for regional health issues, is on leave.

But in a statement, a federal Department of Health spokeswoman said there had been a significant boost in GP numbers “in all areas of Australia” over the past decade.

“A 2017 budget announcement included funding of $9.1 million over four years from 2017-18 to improve access to mental health treatment services for people in rural and regional communities,” the statement read.

“Currently, Medicare provides rebates for up to 10 face-to-face consultations with registered psychologists, occupational therapists and social workers for eligible patients under the Better Access initiative.

“From 1 November 2017, changes to Medicare will take effect so that seven of the 10 mental health consultations can be delivered through online channels [telehealth] for eligible patients, that is, those with clinically diagnosed mental disorders who are living in rural and remote locations.

“Relevant services can be delivered by clinical psychologists, registered psychologists, occupational therapists and social workers that meet the relevant registration requirements under Medicare.”

Aboriginal Health : Rhetoric to Reality: Devolving decision-making to Aboriginal communities

Delivering services to Aboriginal communities, in a way that involves them as genuine partners and produces effective results, remains an ongoing challenge for public services across Australia.

 ” There are three ways of dealing with people: you can do TO them, FOR them or WITH them. The historic experience for Aboriginal people is the done to, or done for, experience. We need to be doing it WITH them.”

As one of the participants in the research said:

Download the report here : rhetoric-to-reality-report

Delivering services to Aboriginal communities, in a way that involves them as genuine partners and produces effective results, remains an ongoing challenge for public services across Australia.

A new publication, developed by ANZSOG students in conjunction with the NSW Department of Aboriginal Affairs, looks at how the NSW public service can change the way it works with Aboriginal people and better devolve decision making to local communities.

Rhetoric to Reality: Devolving decision-making to Aboriginal communities focuses on what structural and attitudinal changes might be required to deliver better collaborative relationships with Aboriginal communities.

Interactions between Australian public services and Indigenous communities have historically been hampered by a lack of respect, trust and understanding.

The report finds that devolving decision-making to Aboriginal communities should not be seen as an end in itself. It should be a means of practising different ways of working with Aboriginal people that involve sharing knowledge and power, collaborating, and responding to local contexts. If this is done the ultimate result will be better shared outcomes for communities.

Whilst the Australian and international literature highlights many barriers to effective collaboration with Indigenous communities there are very few specific recommendations which go beyond ‘rhetoric’. Rhetoric to Reality provides a range of concrete approaches that NSW Government departments can consider.

 

Shift 1: Connecting to culture, connecting to Country

Key findings

The theme which emerged most clearly from our research was how important it is for public servants to develop and maintain genuine cultural competence. Almost all participants raised some aspect of cultural awareness or competence training as an example of what works and what does not.

Participants felt strongly that the current approach to cultural competence in the public service can be ad hoc, tokenistic, generic and static. Similarly, we found that ideas about cultural awareness, competence, safety or intelligence are not well articulated or understood in the NSW public service. The following statements provided by participants highlight these ideas:

“We’re underdone on comprehensive support for developing cultural competency.”

“I think we can all put our hand up, ‘Yep, job done,’ but then not actually spending any time with Aboriginal communities or adding on that extra layer to think about them.”

“Cultural competency training must be delivered in the most authentic way possible. It has to be real, practical and relevant for staff in their roles.”

“It needs to be honest and delivered by Aboriginal people.”

Research participants considered genuine cultural competence to be critical to changing public sector attitudes and structures. This finding is supported by the literature, which shows that cultural understanding (Zurba et al 2012) and culturally appropriate or safe service delivery (Thomas et al 2015) are important to building relationships with Aboriginal people. Studies have shown that a combination of practices can change structural racism in organisations (Abramovitz & Blitz 2015).

literature also supports the provision of cultural training for staff (Downing & Kowal 2011, Fredericks 2006, Paradies et al 2008). The limitations of cultural awareness training as a stand-alone activity were noted by our research participants and have been noted in previous research (e.g. Downing & Kowal 2011), including the risk of stereotyping, promoting ‘otherness’ and ignoring systemic responses. However, studies have shown it is possible to change prejudiced attitudes towards Aboriginal people through specific education activities (Finlay & Stephan 2000; Pendersen et al 2000 & 2004).

The local decision-making framework recognises that public servants need a level of cultural competence to participate. The Premier’s Memorandum M2015-01 Local Decision Making, states that “NSW agencies will adhere to the principles of local decision-making and ensure staff are educated to respond to the needs of Aboriginal communities in a culturally sensitive and appropriate manner”.

While cultural competence was recognised by our research participants and supported by the literature as a key enabler, the lack of a current framework for the development of genuine cultural competence by public servants persists as a dominant issue in shifting public service structural and attitudinal frameworks.

“The key is having a culturally competent NSW government.”

Below we note a number of recurring ideas for improvement in the understanding and the application of cultural competence in the public service that were raised by research participants.

Accepting that racism and paternalism still exist in the attitudes and structures of the public service and which may be manifested in ‘unconscious bias’ was noted by many participants: “It’s hard to accept we have unconscious bias because people in the public sector are values driven.”

Participants were candid about what they perceive as paternalistic views and subtle forms of racism and bias shown by individuals and institutions: “I believe government and its agencies a lack of faith and trust in Aboriginal people’s ability to make sound decisions in the best interest of their communities.”

Understanding history and the historical trauma experienced by Aboriginal people was viewed as critical. “From a community perspective there is a lot of historical hurt or pain from previous government decisions… You have to let them vent their anger and frustration of the historical decisions that have been made that have had a significant impact on their communities.”

“[A] lot of our staff don’t understand the stolen generation.”

Re-conceptualising cultural competence in the public service as a lifelong journey was seen by many participants as necessary for meaningful change. This includes real experience of working alongside Aboriginal people and communities, and ongoing reflective learning. “We need our staff to keep asking, ‘Why is that the case?’” This finding is supported by the literature, which notes that enhancing a person’s awareness of their biases is critical in reducing modern forms of prejudice and discrimination (e.g. Perry et al 2015).

Building trust was seen as vital. For example, participants talked about public servants, including senior public servants, taking the time before getting down to business to build relationships with Aboriginal people, by having a cuppa on neutral ground, listening and building rapport: “It may take a couple of meetings before you get down to the nitty gritty of developing your relationship with that community.” Building trust and developing genuine relationships were also a strong theme in the literature (Closing the Gap Clearinghouse 2015; Taylor et al 2013; Zurba et al 2012).

Including Country as critical to the development of cultural competence was a universal theme. Participants provided examples of how this could be achieved, including through site-based training, localised activities, travelling

The report’s three key recommendations are that:

  • Cultural competence is most effective when it is localised, ongoing and taught on-Country. Local communities could benefit from being engaged in this teaching.
  • Public-sector leaders who are fully committed to cultural competence are most likely to establish collaboration with Aboriginal communities as a routine approach within government. Examples of successful leadership of this kind should be recognised and publicised across the public sector.
  • Aboriginal public servants should be supported and nurtured, and should be seen as critically important for a culturally competent NSW public service.

Rhetoric to Reality was prepared as part of the capstone Work Based Project subject by ANZSOG Executive Master of Public Administration students Laura Andrew, Jane Cipants, Sandra Heriot, Prue Monument, Grant Pollard and Peter Stibbard. It exemplifies the quality of applied research conducted by ANZSOG’s EMPA students and the potential impact when our students partner with a government agency to help drive change.

The research involved interviews and focus groups with senior executives and frontline public servants in Sydney and regional NSW, to get their perspective on what needed to change to lift the impact of programs on the Aboriginal community.

All recognised the importance of cultural change, and the value of ensuring that successful programs, designed in partnership with local communities, were used as examples to improve results elsewhere.

Rhetoric to Reality will be available across the NSW public service as a valuable resource to ensure that government support for Aboriginal people delivers benefits to those communities.

NACCHO Aboriginal Health @amapresident says Treat Dependence And Addiction As Chronic Brain Disease

Behavioural addictions – such as pathological gambling, compulsive buying, or being addicted to exercise or the internet – and substance dependence are recognised as chronic diseases of the brain’s reward, motivation, memory, and related circuitry,

Substance abuse is widespread in Australia. Almost one in seven Australians over the age of 14 have used an illicit substance in the past 12 months, and about the same number report drinking 11 or more standard alcoholic drinks in a single session.

Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.”

AMA President, Dr Michael Gannon pictured above with NACCHO Chair on a recent visit to NT ACCHO Danila Dilba

Read view over 170 Articles last 5 years NACCHO Alcohol and other drugs

Substance dependence and behavioural addictions are chronic brain diseases, and people affected by them should be treated like any other patient with a serious illness, the AMA says.

Releasing the AMA’s Harmful Substance Use, Dependence, and Behavioural Addiction (Addiction) 2017 Position Statement today, AMA President, Dr Michael Gannon, said that dependence and addiction often led to death or disability in patients, yet support and treatment services were severely under-resourced.

Download copy Harmful Substance Use, Dependence and Behavioural Addiction (Addiction) – 2017 – AMA position statement

“Substance use does not inevitably lead to dependence or addiction. A patient’s progression can be influenced by many factors – genetic and biological factors, the age at which the use first started, psychological history, family and peer dynamics, stress, and access to support.

“The costs of untreated dependence and addictions are staggering. Alcohol-related harm alone is estimated to cost $36 billion a year.

“Those affected by dependence and addictions are more likely to have physical and mental health concerns, and their finances, careers, education, and personal relationships can be severely disrupted.

“Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.

“About one in 10 people in our jails is there because of a drug-related crime.

“Given the consequences of substance dependence and behavioural addictions, the AMA believes it is time for a mature and open discussion about policies and responses that reduce consumption, and that also prevent and reduce the harms associated with drug use and control.

“Services for people with substance dependence and behavioural addiction are severely under-resourced. Being able to access treatment at the right time is vital, yet the demand for services outweighs availability in most instances.

“Waiting for extended periods of time to access treatment can reduce an individual’s motivation to engage in treatment.

“While the Government responded quickly to concerns about crystal methamphetamine use with the National Ice Action Strategy, broader drug policy appears to be a lower priority.

“The recently-released National Drug Strategy 2017-2026 again lists methamphetamine as the highest priority substance for Australia, despite the Strategy noting that only 1.4 per cent of Australians over the age of 14 had ever tried the drug.

“The Strategy also notes that alcohol is associated with 5,000 deaths and more than 150,000 hospitalisations each year, yet the Strategy puts it as a lower priority than ice.

“The updated National Drug Strategy is disappointing. The fact that no additional funding has been allocated to the Strategy to date means that any measures that require funding support are unlikely to occur in the short to medium term.

“The Government must focus on those dependencies and addictions that cause the greatest harm, including alcohol, regardless of whether some substances are more socially acceptable than others.

“General practitioners are a highly trusted source of advice, and they play an important role in the prevention, detection, and management of substance dependence and behavioural addictions. Unfortunately, limited access to suitable treatment can undermine GPs’ efforts in these areas.”

 

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
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