NACCHO Aboriginal Health and #Alcohol : Cashless welfare card in Indigenous communities ‘cuts use of alcohol and drugs says new report

“But what we had before the card, which is just open sort of slather of people buying heaps of alcohol with the money that they get, the amount of damage it was doing, I think that this is definitely an improvement on what we had previously,”

I  would support the card being rolled out across the country.

Yes I do, I think this is a more responsible way of actually delivering support and social services to our people regardless of what colour they are,”

Ian Trust, the executive director of the Wunan Foundation, an Aboriginal development organisation in the East Kimberley in Western Australia, said his support for the card had come at a personal cost. SEE ABC Report Photo: A Kununurra resident in WA’s Kimberley holding a cashless welfare card. (ABC News: Erin Parke)

“Inevitably, people would prefer to have fewer restrictions than more restrictions, particularly if you are an alcoholic, but the evaluation and the data shows that it is having a positive net impact on reducing alcoholism, gambling and illicit substance abuse.

The rights of the community, of the children and of elderly citizens to live in a safe community are equally important as the rights of welfare recipients.”

Human Services Minister Alan Tudge said while the card was not a “panacea”, it had led to stark improvements in the trial communities, warranting an extension of the card, despite it not being popular with all welfare recipients. Reported by Sarah Martin in Todays Australian

A cashless welfare card that stops government benefits being spent on drugs and alcohol will be made permanent in two remote communities and looks set to be ­expanded, after trials found it greatly reduced rates of substance abuse and gambling.

The 175-page government commissioned review by Orima Research of the year-long trial.

The evaluation involved interviewing stakeholders, participants and their families.

It found on average a quarter of people using the card who drank said they were not drinking as often.

While just under a third of gamblers said they had curbed that habit.

The Turnbull government will today release the first major independent audit of the cashless welfare system and announce that the card will continue in Ceduna and East Kimberley, subject to six-monthly reviews.

Establishing a clear “proof of concept” in the two predomin­antly indigenous communities also paves the way for the ­Coalition to roll out the welfare spending restrictions further, with townships in regional Western Australia and South Australia believed to be under consideration.

In October, Malcolm Turnbull flagged that an expansion of the welfare card was dependent on the results of the 12-month trial, but praised the scheme’s ­initial success in reducing the amount of taxpayer money being spent on alcohol and illicit drugs.

Under the welfare shake-up, first flagged in Andrew Forrest’s review of the welfare system in 2014, 80 per cent of a person’s benefit is restricted to a Visa debit card that cannot be used for spending on alcohol or gambling products or converted to cash. After year-long trials at the two sites capturing $10 million in welfare payments, the first quantitative assessment of the scheme has found that 24 per cent of card users reported less alcohol consumption and drug use in their communities, with 27 per cent of people noting a drop in gambling.

See full details support and Q and A below from DSS

Binge drinking and the frequency of alcohol consumption by card users was also down by about 25 per cent among those who said they were drinkers ­before the trials began.

Those not on welfare saw even greater benefits, with an average of 41 per cent of non-participant community members across the two trial sites reporting a ­reduction in the drinking of alcohol in their area since the trial started. The report concluded that, overall, the card “has been effective in reducing alcohol consumption, illegal drug use and gambling — establishing a clear ‘proof-of-concept’ and meeting the necessary preconditions for the planned medium-term outcomes in relation to reduced levels of harm related to these behaviours”.

However the audit, undertaken by ORIMA Research, found that despite the community improvements, many people remained unhappy with the welfare restrictions, with about half saying it had made their lives worse, and 46 per cent reporting they had problems with the card.

This view was reversed in the wider community, with 46 per cent of non-participants saying the trial had made life in their community better, and only 18 per cent reporting that it had made life worse.

Many of the reported problems with the card were attributed to user error or “imperfect knowledge and systems” among some merchants. Of the 32,237 declined transactions between April and September last year, 86.2 per cent were because of user error, with more than half found to be because account holders had insufficient funds.

While there was a large amount of anecdotal evidence in favour of the card, there were also reports of a rise in humbugging — where family members are harassed for money — and some reports of an increase in crime linked to the need for cash, including prostitution.

Human Services Minister Alan Tudge said while the card was not a “panacea”, it had led to stark improvements in the trial communities, warranting an extension of the card, despite it not being popular with all welfare recipients. However, he stressed that no decision had been made to expand the card to new sites, which would require legislation.

“Inevitably, people would prefer to have fewer restrictions than more restrictions, particularly if you are an alcoholic, but the evaluation and the data shows that it is having a positive net impact on reducing alcoholism, gambling and illicit substance abuse,” Mr Tudge said. “The rights of the community, of the children and of elderly citizens to live in a safe community are equally important as the rights of welfare recipients.”

The government has introduced the card only to regions where it has the support of community leaders, allowing the Coalition to secure the backing of Labor for the two trial sites despite opposition from the Greens and the Australian Council of Social Service.

Liberal MP Melissa Price, who represents the vast West Australian regional electorate of Durack, said yesterday she was hopeful the card could be rolled out across the Kimberley, the Pilbara and the Goldfields, estimating that about half of the 52 councils in her electorate had expressed an interest in signing up.

“I know it is not popular with everybody, but we are in government and we need to make these decisions to improve people’s lives; if we don’t make changes, nothing changes,” Ms Price said.

Cashless Debit Card Trial – Overview

The Commonwealth Government is looking at the best possible ways to provide support to people, families and communities in locations where high levels of welfare dependence exist alongside high levels of harm related to drug and alcohol abuse.

The Cashless Debit Card Trial is aimed at finding an effective tool for supporting disadvantaged communities to reduce the consumption and effects of drugs, alcohol and gambling that impact on the health and wellbeing of communities, families and children.

How the cashless debit card works

The cashless debit card looks and operates like a normal bank card, except it cannot be used to buy alcohol or gambling products, or to withdraw cash.

The card can be used anywhere that accepts debit cards. It will work online, for shopping and paying bills. The Indue website lists the approved merchants (link is external) and excluded merchants (link is external) for the trial.

Who will take part in the trial?

Under the trial, all recipients of working age income support payments who live in a trial location will receive a cashless debit card.

The full list of included payments is available on the Guides to Social Security Law website.

People on the Age Pension, a veteran’s payment or who earn a wage can volunteer to take part in the trial. Information on volunteering for the trial is available. Application forms for people who wish to volunteer can be downloaded from the Indue website (link is external).

How will it affect Centrelink payments?

The trial doesn’t change the amount of money a person receives from Centrelink. It only changes the way in which people receive and spend their fortnightly payments:

  • 80 per cent is paid onto the cashless debit card
  • 20 per cent is paid into a person’s regular bank account.

Cashless debit card calculator

To work out how much will be paid onto your cashless debit card, enter your fortnightly payment amount into the following calculator.

Enter amount of fortnightly Centrelink payment Calculate

Money on the card 

Use it for:

  • Groceries
  • Pay bills
  • Buy clothes
  • Travel
  • Online

Anywhere with eftpos except:

  • No grog
  • No gambling
  • No cash

   Note: 100% of lump sum payments will be placed on the card. More information is available on the Guides to Social Security Law website.

More information

For more information, email debitcardtrial@dss.gov.au (link sends e-mail) or call 1800 252 604

This weeks NACCHO Aboriginal Health News Alerts will  include

Wednesday Job alerts Thursday NACCHO Members Good News

How to submit ? Email to Colin Cowell NACCHO Media   4.30 pm  day before publication

NACCHO Aboriginal Health #KHW17 #Kidneysfirst :Ten bad food habits that will kill you

 ‘ Almost half of heart-related deaths are caused by 10 bad ­eating habits.

Diets high in salt or sugary drinks are responsible for ­thousands of deaths from heart disease, stroke and type 2 ­diabetes, according to a study. Scientists also blamed a lack of fruit and vegetables and high ­levels of ­processed meats.

Researchers looked at all 702,308 deaths from heart ­disease, stroke and type 2 diabetes in the US in 2012 and found that 45 per cent were linked with “suboptimal consumption” of 10 types of nutrients. They mapped data on dietary habits from population surveys, along with estimates from previous research of links between foods and disease, on to data about the deaths to come up with the figures.”

Originally published in The Australian

This is our last NACCHO post supporting Kidney Health Week / Day

Further NACCHO reading

Sugar Tax     Obesity     Diabetes    Nutrition/Healthy Foods

The highest proportion of deaths, at 9.5 per cent, was linked with eating too much salt, while a low intake of nuts and seeds was linked with 8.5 per cent.

Eating processed meats was linked with 8.2 per cent of deaths and a low amount of seafood omega-3 fats with 7.8 per cent. Low intake of vegetables ­accounted for 7.6 per cent and low intake of fruit 7.5 per cent.

Sugary drinks were linked with 7.4 per cent, a low intake of whole grains with 5.9 per cent, low polyunsaturated fats with 2.3 per cent and high unprocessed red meats with 0.4 per cent.

The research, published in the journal JAMA, also found men’s deaths were more likely to have links to poor diet than women’s.

Key Points

Question  What is the estimated mortality due to heart disease, stroke, or type 2 diabetes (cardiometabolic deaths) associated with suboptimal intakes of 10 dietary factors in the United States?

Findings  In 2012, suboptimal intake of dietary factors was associated with an estimated 318 656 cardiometabolic deaths, representing 45.4% of cardiometabolic deaths. The highest proportions of cardiometabolic deaths were estimated to be related to excess sodium intake, insufficient intake of nuts/seeds, high intake of processed meats, and low intake of seafood omega-3 fats.

Meaning  Suboptimal intake of specific foods and nutrients was associated with a substantial proportion of deaths due to heart disease, stroke, or type 2 diabetes.

Abstract

Importance  In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.

Objective  To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.

Design, Setting, and Participants  A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics.

Exposures  Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.

Main Outcomes and Measures  Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.

Results  In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes.

See for full text

The authors, from Cambridge University and two US institutions, said that their results should help to “identify priorities, guide public health planning and inform strategies to alter dietary habits and improve health”.

In an editorial, Noel Mueller and Lawrence Appel, of the Johns Hopkins Bloomberg School of Public Health, said: “Policies that affect diet quality, not just quantity, are needed … There is some precedence, such as from trials of the Mediterranean diet plus supplemental foods, that modification of diet can reduce cardiovascular disease risk by 30 per cent to 70 per cent.”

Keeping your kidneys healthy

It is important to maintain a healthy weight for your height. The food you eat, and how active you are, help to control your weight.

Healthy eating tips include:

  • Eat lots of fruit, vegetables, legumes and wholegrain bread and rice.
  • At least once a week eat some lean meat such as chicken and fish.
  • Look at the food label and try to choose foods that have a low percentage of sugar and salt and saturated fats.
  • Limit take-away and fast food meals.

Exercise regularly

It’s recommended that you do at least 30 minutes of physical activity most days of the week  – exercise leads to increased strength, stamina and energy.

The key is to start slowly and gradually increase the time and intensity of the exercise. You can break down any physical activity into three ten-minute bursts, which can be increased as your fitness improves

Drink plenty of fluids and listen to your thirst.

If you are thirsty, make water your first choice. Water has a huge list of health benefits and contains no kilojoules, is inexpensive and readily available.

Sugary soft drinks are packed full of ‘empty kilojoules’, which means they contain a lot of sugar but have no nutritional value.

Some fruit juices are high in sugar and do not contain the fibre that the whole fruit has.

The role of the kidneys is often underrated when we think about our health.

In fact, the kidneys play a vital role in the daily workings of your body. They are so important that nature gave us two kidneys, to cover the possibility that one might be lost to an injury.

We can live quite well with only one kidney and some people live a healthy life even though born with one missing. However, with no kidney function death occurs within a few days!

The kidneys play a major role in maintaining your general health and wellbeing. Think of them as a very complex, environmentally friendly, waste disposal system. They sort non-recyclable waste from recyclable waste, 24 hours a day, seven days a week, while also cleaning your blood.

Most people are born with two kidneys, each one about the size of an adult fist, bean-shaped and weighing around 150 grams each. The kidneys are located at both sides of your backbone, just under the rib cage or above the small of your back. They are protected from injury by a large padding of fat, your lower ribs and several muscles.

Your blood supply circulates through the kidneys about 12 times every hour. Each day your kidneys process around 200 litres of blood. The kidneys make urine (wee) from excess fluid and unwanted chemicals or waste in your blood.

Urine flows down through narrow tubes called ureters to the bladder where it is stored. When you feel the need to wee, the urine passes out of your body through a tube called the urethra. Around one to two litres of waste leave your body each day as urine.

Resource Library

Kidneys are the unsung heroes of our bodies and perform a number of very important jobs:

  • Blood pressure control – kidneys keep your blood pressure regular.
  • Water balance – kidneys add excess water to other wastes, which makes your urine.
  • Cleaning blood – kidneys filter your blood to remove wastes and toxins.
  • Vitamin D activation – kidneys manage your body’s production of this essential vitamin, which is vital for strong bones, muscles and overall health.

All this makes the kidneys a very important player in the way your body works and your overall health.

NACCHO Aboriginal Health Report Download : Translating #Indigenous Health Research into Policy and Practice

” A forum on translating research into policy and practice in Aboriginal and Torres Strait Islander health has outlined priorities for action on evidence gaps across the stages of the life course, from maternal and child health through to older adults.

The NHMRC Translating Research into Policy and Practice (TRIPP) Forum Report outlines the outcomes of a forum held in May 2016 that brought together key Aboriginal and Torres Strait Islander researchers and stakeholders to discuss research translation in Aboriginal and Torres Strait Islander health and to identify evidence practice and policy gaps.”

Download the report HERE final_tripp_forum_report_pcic_approved

The report shows that top three priorities nominated by participants in the area of children’s health were social determinants of health, child safety and protection, and parenting and grandparenting.

For youth, the priorities were wellness, mental health and data and demographics, while for adults, they were access to data and bureaucracy, prevention, primary health care and whole system health.

Themes that cut across all areas included social determinants of health, cultural determinants of health, epigenetics, data and demography, nutrition, health system and services, and transitions between the stages of the life course.

Forum aims

The aim of the Forum was to bring Australian Aboriginal and Torres Strait Islander health researchers and key stakeholders together to:

• Identify evidence gaps and evidence practice and policy gaps, informed by the systematic reviews

• Identify and describe the effectiveness of interventions evaluated in Indigenous Australian populations

• Identify and describe other health questions relevant to Indigenous Australian populations

• Provide advice to the CEO on appropriate courses of action to take.

Structure of Forum report

This report is a record of participants’ contributions against the agenda and set questions. Outcomes are provided at the end of the report. There were a number of other issues raised during the Forum that did not relate directly to evidence gaps in Indigenous health, and these were recorded on the day. ONHMRC will discuss these issues with PCIC.

Life course

The stages of the life course were used to identify specific gaps and priorities for Aboriginal and Torres Strait Islander people. This drew upon the whole-of-life approach identified in the Australian Government National Aboriginal and Torres Strait Islander Health Plan 2013- 2023.

The stages used were: Maternal health and parenting; Childhood health and development (birth to early teens); Adolescent and youth health (early teens to mid 20s); Healthy adults (mid 20s +); and Healthy ageing. Priorities were identified in each of these stages as summarised below.

1. Maternal and child health

The top priorities nominated by participants were: pregnancy and childbirth, as well as parenting. Epigenetics and nutrition were tied in third place.

Pregnancy and childbirth is a key area for maternal and child health, and policies should reflect and respect women’s choice to stay in community and to decide who can be present at the birth.

In relation to Parenting, early information to assist families to cope with change is important. Adolescent parenting was recognised as a sub-category also needing to be addressed.

Epigenetics and personalised medicine was identified as the third priority area, particularly the application of new technologies. Epigenetic modifications can be passed from mother to child, with implications for the health of immediate and subsequent generations. Epigenetics was also seen as being an underutilised area compared to its potential.

The issues related to Nutrition included having policies addressing poverty, food availability and food security.

Other issues discussed were:

• Policies and services that support all who ‘parent’

• Families as first teachers (intergenerational, men, communities)

• Indigenous identity and mental health and ‘bullet proofing’ individuals

• Community grounded responses to social and emotional well-being

• Choices around contraception, abortion, infertility (understanding these in an Indigenous context)

• Pre-conception wellbeing (smoking, nutrition).

2. Children

The top three priorities nominated by participants were: social determinants of health; child safety and protection; and parenting and grandparenting.

Social determinants of health and in particular housing, justice and education were the top priority identified. The need to demonstrate a return on investment was acknowledged.

Participants suggested that the education and health sectors do not come together as much as they should, and noted there is no specific Aboriginal community controlled education sector. Dr Chris Sarra’s work was mentioned. Investment in housing and infrastructure would also lead to improvements in health.

Interactions with community supports, the justice system and incarceration were another focus. Victoria’s Commission for Children and Young People was suggested as an effective model. Participants were concerned that the system can be racist and under-resourced, hence jumps too quickly to finding non-Aboriginal carers. Dissemination to lay people and feedback to community from researchers were also noted as issues.

Child safety and protection – participants identified over- and under-sensitivity to cultural factors as an issue, and questioned whether referrals for at-risk children were being made to the extent needed. The question of who is best placed to decide was also raised, though a lack of information on numbers affected also needs to be addressed. It was suggested that evidence could be collected by community engagement officers. Indigenous specific tools or culturally aware tools are needed.

Parenting and grandparenting – this included identifying evidence for effective interventions; cultural practice; and supporting a family focussed agenda.

Other issues discussed (apart from the top priorities) were:

• Social gradients, clustering and models to overcome intergenerational disadvantage

• Food accessibility and nutrition and whether governments were willing to undertake major interventions to address these issues

• Demonstrating return on investment in child health with targeted interventions and making a case to government

• Ability of mainstream services to respond to needs of Indigenous children (as Indigenous children increasingly do not attend community controlled health organisations)

• Importance of non-health workers to child health (social workers, counsellors).

3. Youth

There was general agreement that an adolescent strategy was required. The top three priorities nominated by participants were: wellness, mental health, and data and demographics.

Wellness included culturally appropriate health care services that meet the health and health care needs of young people (primary and community care), while being culturally and emotionally supportive and safe. It was noted that young people are about 50% of the population of Aboriginal and Torres Strait Islander peoples.

Mental health included a focus on resilience and suicide prevention. Adolescence and young adulthood is a vulnerable period with high rates of incarceration, racism (which affects mental health), and trauma/healing. Out of home care and community models of care were suggested as effective supports.

Data and demographics focused on how existing data can be better used to improve understanding of, and provide insight into, the health and wellbeing (and the health care needs) of young Aboriginal and Torres Strait Islander Australians.

Other issues identified included:

• Impact of youth incarceration, parenting, resilience and education

• Dealing with institutional racism

• Sexually Transmitted Infections – for example, syphilis

• Reproductive health, including teenage pregnancy

• Alcohol and other drugs, such as methamphetamine

• Safe health care settings.

4. Adults

The top four priorities nominated by participants were: access to data and bureaucracy; prevention; primary health care; and whole system health.

Access to data and bureaucracy – while this was also identified as a priority for the Youth stage of the life course, the focus here is better sharing of data, particularly across portfolios, and its use by bureaucrats. The National Aboriginal and Torres Strait Islander Health Implementation Plan principles could be used with linked data to prioritise needs and policy, and identify research gaps and needs. Data was seen as a cross cutting issue across all the stages of the life course.

Prevention – this included risk factors and in particular chronic disease. Linking funding to prevention was also seen as important.

Primary health care considerations included workforce, upskilling and relying less on specialists.

Whole system health was contrasted with the tendency of the Medicare Benefits Schedule and Pharmaceutical Benefits Schedule to compartmentalise. Many Aboriginal and Torres Strait Islander health issues cross sectoral boundaries and in order to ensure good access to services, all areas need to be targeted including government, hospitals, academia, community sectors and communities themselves. Participants suggested that it is not just one discipline or department or disease that needs fixing, but a whole system—working on single aspects in isolation will not work.

Other issues included:

• Employment, which brings not just income but social benefits

• Changing parenting, with more aunties and uncles, parents and grandparents taking on that role

• Food choices including affordability and accessibility

• Socioeconomic factors

• Incarceration of peers, mentors and models

• Recognising that women’s health is not just about maternal health. (Paternal health is also a priority)

• Hospital support, with the number of people leaving before discharge a concern

• Domestic violence.

5. Older adults

Participants discussed what ‘elderly’ means in the Aboriginal and Torres Strait Islander context. They noted that Aboriginal and Torres Strait Islander Elders are not the shy and retiring type—they are active people and contribute greatly to the community. It was agreed that ‘older people’ or ‘older adult’ is the preferred terminology as young people can be recognised as elders.

The top four priorities were: advocacy to navigate the system; palliative care; dementia; and the role of older adults.

Advocacy to navigate the system is about ensuring support for family and community and education and awareness of services. Navigating the aged care system was identified as a priority. Mainstream health services should expand to include a focus on Indigenous older adults.

The Dementia priority included having culturally appropriate models of care, developing tools to measure dementia and having strategies to support people. For example the Kimberley Indigenous Cognitive Assessment tool is culturally sensitive and allows medical practitioners to determine the extent of dementia and other cognitive impairments.

In relation to Palliative care, developing death and dying protocols (for example similar to RACGP’s guidance on palliative care and end of life) was identified as a priority. Issues to cover included dying on country; dying with integrity; and keeping elders at home.

Role of older adults – recognise and value the roles that they fulfil including as carers and in leadership positions. This includes awareness of services for carers, valuing and building the capacity of older adults and hearing their positive stories. An example is utilising elders at times of crisis in Cairns with the Murray Street Kids; and valuing their knowledge of traditional medicine. Gaining resilience from elders and building on positive aspects of community are also important. Participants noted the Scandinavian model, which brings together elderly and youth. Developing models of community aged care, looking at what works, describing the benefits and including yarning, history and law were also identified.

Cross-cutting themes

A number of crosscutting themes were identified, such as:

• Social determinants of health

• Cultural determinants of health (language, relationships, identity, place, traditional knowledge, family, culture and kinship)

• Epigenetics and personalised medicine

• Data and demography (how can existing data be better used to improve understanding of, and provide insight into, the health and wellbeing (and the health care needs) of Aboriginal and Torres Strait Islander Australians)

Nutrition (availability and affordability; food security and supply; making food choices; poverty)

• Health system and services (culturally appropriate services that meet the health and health care needs of Aboriginal and Torres Strait Islander Australians)

• Transitions between the stages of the life course.

Solutions

While priorities were identified for each of the stages of the life course, some overall actions that would help address the issues were also proposed. These are:

• Funding

• Advocacy

• Evaluating outcomes of programs and policies

• Overcoming gaps with support of family and others

• Education about services

• Having resources available

• Building capacity of ACCHOs to provide culturally appropriate services

• Building capacity of all services in terms of community development

• Providing choices, culturally appropriate care, services, facilities

• Looking at international evidence

• Partnering/collaborating with NGOs, AMS (some good models already exist)

• Undertaking literature reviews to provide reliable evidence

• Having hospital staff who have skills in dealing with Aboriginal and Torres Strait Islander people

• Having culturally safe places

• An Aboriginal and/or Torres Strait Islander trained workforce

• Giving a voice to consumers

• Cultural practices supported in an urban environment

Forum outcome and next steps

• Priorities were identified across the stages of the life course. These will be used as the basis for a broader report on evidence-practice and evidence-policy gaps in Aboriginal and Torres Strait Islander health

• Participants indicated interest to work further post Forum, in the lead up to the 2017 Research Translation Symposium. NHMRC will follow up on establishing small writing groups for each topic

• The writing groups will further refine each of the proposed topics (e.g. why is this topic important, what is the problem, what is the size of the problem, current practices and implications, what are the options, references) to contribute to the report.

The aim of the evidence-policy/evidence-practice gaps report is to:

• Take advantage of NHMRC’s legislated role to provide advice to governments and the community

• Demonstrate how adopting the findings of research could lead to improved health outcomes

• Demonstrate the impact of NHMRC funding

Raise awareness, celebrate success, acknowledge where there is room for improvement such as care delivered in a manner that not consistent with the best available evidence, and identify research that will address the gap.

Thanks

Thanks to all participants and Dr Sanchia Shibasaki from Think Through Consultants for her facilitation of the day.

 

NACCHO Aboriginal Health supports the @Lungfoundation first ever Australia-wide #Indigenous Lung Health Checklist

cfree

 

 ” Lung Foundation Australia in collaboration with the Queensland Government’s Indigenous Respiratory Outreach Care Program (IROC) have developed the Checklist specifically for the Indigenous community.

It only takes a few minutes to answer 8 questions that could save your or a loved one’s life.

It can be completed on a mobile phone, tablet or computer.

indigenous_lunghealthchecklist_page_2

The Indigenous Lung Health Checklist is narrated by the Lung Foundation’s Ambassador and Olympic Legend Cathy Freeman.

Read or Download the PDF Brochure

indigenous_lunghealthchecklist

Please go to the site as Indigenous peoples are almost twice as likely to die from a lung-related condition than non-Indigenous Australians.

# Indigenous Lung Health Checklist at

http://indigenouslungscheck.lungfoundation.com.au/.

NACCHO Aboriginal Health and #Obesity #junkfood : 47 point plan to control weight problem that costs $56 billion per year

junk

 ” JUNK food would be banned from schools and sports venues, and a sugar drink tax introduced, under a new blueprint to trim the nation’s waistline.

The 47-point blueprint also includes a crackdown on using junk food vouchers as rewards for sporting performance and for fundraising.

State governments would be compelled to improve the healthiness of foods in settings controlled by them like hospitals, workplaces and government events.

And they would have to change urban planning rules to restrict unhealthy food venues and make more space for healthy food outlets. “

Originally published as Move to ban junk food in schools

Updated Feb 21 with press release from Health Minister Greg Hunt See below

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions.see article 2 below  

One hundred nutrition experts from 53 organisations working with state and federal bureaucrats have drawn up the obesity action plan to control the nation’s weight problem that is costing the nation $56 billion a year.

The review of state and federal food labelling, advertising and health policies found huge variation across the country and experts want it corrected by a National Nutrition Policy.

The nation is in the grip of an obesity crisis with almost two out of three (63 per cent) Australian adults, and one in four (25 per cent) Australian children overweight or obese.

Obesity is also one of the lead causes of disease and death including cancer.

More than 1.4 million Australians have Type 2 diabetes and new cases are being diagnosed at the rate of 280 per day.

Stomach, bowel, kidney, liver, pancreas, gallbladder, oesophagus, endometrium, ovary, prostate cancer and breast cancer in postmenopausal women have all been linked to obesity.

Half of all Australians are exceeding World Health Organisation’s recommendations they consume less than 13 teaspoons or sugar a day with most of the white stuff hidden in drinks and processed food, the Australian Bureau of Statistics Health Survey shows.

Teenage boys are the worst offenders consuming 38 teaspoons of sugar a day which makes up a quarter of their entire calorie intake.

Dr Gary Sacks from Deakin University whose research underpins the obesity control plan says it’s time for politicians to put the interests of ordinary people and their health above the food industry lobbyists

“It’s a good start to have policies for restricting junk foods in school canteens, but if kids are then inundated with unhealthy foods at sports venues, and they see relentless junk food ads on prime-time TV, it doesn’t make it easy for them to eat well,” he said.

That’s why the experts want a co-ordinated national strategy that increases the price of unhealthy food using taxes and regulations to reduce children’s exposure to unhealthy food advertising.

The comprehensive examination of state and federal food policies found Australia is meeting best practice in some areas including the Health Star Rating food labelling scheme, no GST on basic foods and surveys of population body weight.

While all States and Territories have policies for healthy school food provision they are not all monitored and supported, the experts say.

Jane Martin, Executive Manager of the Obesity Policy Coalition and a partner in the research, said a piecemeal approach would not work to turn the tide of obesity in Australia.

“When nearly two-thirds of Australians are overweight or obese, we

know that it’s not just about individuals choosing too many of the wrong foods, there are strong environmental factors at play – such as the all pervasive marketing of junk food particularly to children,” she said.

The new policy comes as a leading obesity experts says a tax on sugary drinks in Australia would be just as logical as existing mandatory controls on alcohol and tobacco

Professor Stephen Colagiuri from the University of Sydney’s Charles Perkins Centre claims a ‘sugar tax’ help individuals moderate their sugary beverage intake, in much the same way as current alcohol, tobacco, and road safety measures like seat belts and speed restrictions preventing harmful behaviours.

The UK will introduce a sugar tax next year and in Mexico a sugar tax introduced in 2014 has already reduced consumption of sugary drinks by 12 per cent and increased the consumption of water.

Australian politicians have repeatedly dismissed a sugar tax on the grounds it interferes with individual rights.

However, Professor Colagiuri says “individual rights can be equally violated if governments fail to take effective and proportionate measures to remove health threats from the environment in the cause of improving population health.”

Originally published as Move to ban junk food in schools

ARTICLE 2 Australia would save $3.4bn if junk food taxed and fresh food subsidised, says study 

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O as published in the Guardian

Australian researchers say subsidising fresh fruit and vegetables would ensure the impact of food taxes on the household budget would be negligible. Photograph: Dave and Les Jacobs/Getty Images/Blend Images

Health experts have developed a package of food taxes and subsidies that would save Australia $3.4bn in healthcare costs without affecting household food budgets.

Linda Cobiac, a senior research fellow at the University of Melbourne’s school of public health, led the research published on Wednesday in the journal Plos Medicine.

Cobiac and her team used international data from countries that already have food and beverage taxes such as Denmark, but tweaked the rate of taxation and also included a subsidy for fresh fruit and vegetables so the total change to the household budget would be negligible.

They then modelled the potential impact on the Australian population of introducing taxes on saturated fat, salt, sugar and sugar-sweetened beverages, and a subsidy on fruits and vegetables. Their simulations found the combination of the taxes and subsidy could result in 1.2 additional years of healthy life per 100 people alive in 2010, at a net cost-saving of $3.4bn to the health sector.

“Few other public health interventions could deliver such health gains on average across the whole population,” Cobiac said.

The sugar tax produced the biggest gains in health, followed by the salt tax, the saturated fat tax and the sugar-sweetened beverage tax.

The fruit and vegetable subsidy, while cost-effective when added to the package of taxes, did not lead to a net health benefit on its own, the researchers found.

The researchers suggest introducing a tax of $1.37 for every 100 grams of saturated fat in those foods with a saturated fat content of more than 2.3%, excluding milk; a salt tax of 30 cents for one gram of sodium above Australian maximum recommended levels; a sugar-sweetened beverage tax of 47 cents a litre; a fruit and vegetable subsidy of 14 cents for every 100 grams; and a sugar tax of 94 cents for every 100ml in ice-cream with more than 10 grams of sugar per 100 grams; and 85 cents for every 100 grams in all other products.

The taxes exclude fresh fruits, vegetables, meats and many dairy products.

“You need to include both carrots and sticks to change consumer behaviour and to encourage new taxes,” Blakely said. “That’s where this paper is cutting edge internationally.

“We have worked out the whole package of taxes with minimal impact on the budget of the household, so you can see an overall gain for the government. The government would be less interested in the package if it was purely punitive, but this provides subsidies and savings to health spending that could be reinvested back into communities and services.”

He said taxing junk foods also prompted food manufacturers to change their products and make them healthier to avoid the taxes.

“For those who might say this is an example of nanny state measures, let’s consider that we don’t mind asbestos being taken out of buildings to prevent respiratory disease, and we’re happy for lead to be taken from petrol. We need to change the food system if we are going to tackle obesity and prevent disease.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions. “This is a very good paper,” he said.

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A Grattan Institute report published in November found introducing an excise tax of 40 cents for every 100 grams of sugar in beverages as part of the fight against obesity would trigger a 15% drop in the consumption of sugary drinks. Australians and New Zealanders consume an average of 76 litres of sugary drinks per person every year.

In a piece for the Medical Journal of Australia published on Monday, the chair of the Council of Presidents of Medical Colleges, Prof Nicholas Talley, wrote that “the current lack of a coordinated national approach is not acceptable”.

More than one in four Australian children are now overweight or obese, as are more than two-thirds of all adults.

Talley proposed a six-point action plan, which included recognising obesity as a chronic disease with multiple causes. He also called for stronger legislation to reduce unhealthy food marketing to children and to reduce the consumption of high-sugar beverages, saying a sugar-sweetened beverage tax should be introduced.

“There is evidence that the food industry has been a major contributor to obesity globally,” he wrote. “The health of future generations should not be abandoned for short-term and short-sighted commercial interests.”

Press Release 21 February Greg Hunt Health Minister

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

PDF printable version of Turnbull Government committed to tackling obesity – PDF 269 KB

The Turnbull Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

But unlike the Labor Party, we don’t believe increasing the family grocery bill at the supermarket is the answer to this challenge.

We already have programmes in place to educate, support and encourage Australians to adopt and maintain a healthy diet and to lead an active life – and there’s more to be done.

Earlier this month, the Prime Minister flagged that the Government will soon be announcing a new focus on preventive health that will give people the right tools and information to live active and healthy lives. This will build on the significant work already underway.

Yesterday, we launched the second phase of the $7 million Girls Make Your Move campaign to increase physical activity for girls and young women. This is now being rolled out across Australia.

Our $160 million Sporting Schools program is getting kids involved in physical activity. Already around 6,000 schools across the country have been involved – with many more to come. This is a great programme that Labor wants to axe.

Our Health Star Rating system helps people to make healthier choices when choosing packaged foods at the supermarket and encourages the food industry to reformulate their products to be healthier.

The Healthy Weight Guide website provides useful advice including tips and tools to encourage physical activity and healthy eating to achieve and maintain a healthy weight.

The Healthy Food Partnership with the food industry and public health groups is increasing people’s health knowledge and is supporting them to make healthier food and drink choices in order to achieve better health outcomes.

We acknowledge today’s report, but it does not take into account a number of the Government programs now underway.

Obesity and poor diets are complex public health issue with multiple contributing factors, requiring a community-wide approach as well as behaviour change by individuals. We do not support a new tax on sugar to address this issue.

Fresh fruit and vegetables are already effectively discounted as they do not have a GST applied.

Whereas the GST is added to the cost of items such as chips, lollies, sugary drinks, confectionery, snacks, ice-cream and biscuits.

We’re committed to tackling obesity, but increasing the family’s weekly shop at the supermarket isn’t the answer

NACCHO Invites all health practitioners and staff to a webinar : Working collaboratively to support the social and emotional well-being of Aboriginal youth in crisis

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NACCHO invites all health practitioners and staff to the webinar: An all-Indigenous panel will explore youth suicide in Aboriginal and Torres Strait Islanders. The webinar is organised and produced by the Mental Health Professionals Network and will provide participants with the opportunity to identify:

  • Key principles in the early identification of youth experiencing psychological distress.
  • Appropriate referral pathways to prevent crises and provide early intervention.
  • Challenges, tips and strategies to implement a collaborative response to supporting Aboriginal and Torres Strait Islander youth in crisis.

Join hundreds of doctors, nurses and mental health professionals around the nation for an interdisciplinary panel discussion. The panellists with a range of professional experience are:

  • Dr Louis Peachey (Qld Rural Generalist)
  • Dr Marshall Watson (SA Psychiatrist)
  • Dr Jeff Nelson (Qld Psychologist)
  • Facilitator: Dr Mary Emeleus (Qld GP and Psychotherapist)

Read more about the panellists.

Working collaboratively to support the social and emotional well-being of Aboriginal and Torres Strait Islander youth in crisis.

Date:  Thursday 23rd February, 2017

Time: 7.15 – 8.30pm AEDT

REGISTER

No need to travel to benefit from this free PD opportunity. Simply register and log in anywhere you have a computer or tablet with high speed internet connection. CPD points awarded.

Learn more about the learning outcomes, other resources and register now.

For further information, contact MHPN on 1800 209 031 or email webinars@mhpn.org.au.

The Mental Health Professionals’ Network is a government-funded initiative that improves interdisciplinary collaborative mental health care practice in the primary health sector.  MHPN promotes interdisciplinary practice through two national platforms, local interdisciplinary networks and online professional development webinars.

 

 

 

 

 

 

NACCHO Aboriginal Health and Cashless Welfare Card : NACCHO CEO Pat Turner questions lack of evidence

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“The cashless welfare card is unfair, a form of control and reminds Aboriginal people every day that they are treated as second- and third-class citizens in their own land,”

One of the key issues in many of the areas where the card operates, such as in remote areas of South Australia, is the difficulty of accessing fresh produce at reasonable prices.

Where is the evidence that this card increases this access and enables Aboriginal people to get the healthy food they need?

A person’s dignity can also be lost when having to use such a card which can also have detrimental impacts on both their mental and physical health and wellbeing.”

Pat Turner, the chief executive of NACCHO  national peak body on Aboriginal health

From Melissa Davey The Guardian

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The welfare card was “unfair” and “a form of control”, Turner said in response to a Guardian Australia report from the South Australian town of Ceduna which found welfare recipients on the card felt disempowered and dictated to.

But Turner, who before being appointed to the National Aboriginal Community Controlled Health Organisation (Naccho) was the longest-serving chief executive of the Aboriginal and Torres Strait Islander Commission and spent 18 months as Monash Chair of Australian Studies at Georgetown University in Washington, questioned the evidence from the government’s report

The trial of the card, known as the indue card, began in Ceduna in March and in the Western Australian towns of Kununurra and Wyndham in April. Welfare recipients in those towns now receive 80% of their welfare payments into the indue card, which cannot be used to withdraw cash or buy alcohol or gambling products. The remaining 20% can be withdrawn as cash.

The government, including the prime minister, Malcolm Turnbull, and the human services minister, Alan Tudge, say the card has so far been a success.

In a report released six months into the card’s trial, anecdotal evidence and early data found poker machine revenue in the Ceduna region between April and August last year was 15.1% lower than for the equivalent period in 2015.

There had also been a strong uptake of financial counselling, the report said, with 300 people seeking counselling since the trial began. Anecdotally, there had been a significant decline in people requesting basic supplies like milk and sugar from the Koonibba Community Shopfront in Ceduna, the report also said.

Most people on welfare in the trial towns are Aboriginal.

Guardian Australia has contacted the Department of Health and Human Services for comment.

The strength of data used in the government’s cashless welfare card progress report has been questioned by Aboriginal elders, health economists and the Greens senator, Rachel Siewert.

NACCHO Aboriginal Health and Smoking :Facebook could help lower Indigenous smoking rates,health researchers say

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“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,”

Marita Hefler from the Menzies School of Health Research in Darwin.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,”

After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

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Articles are from Page 8  NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

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

Indigenous people have the highest rates of smoking in the country, but researchers in the Top End believe Facebook could be the most effective way of helping them quit.

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As reported the ABC

Aboriginal people living in remote communities smoke at three times the rate of other Australians, according to research fellow Marita Hefler from the Menzies School of Health Research in Darwin.

Preliminary research into the role of Facebook in helping smokers to quit has found that although the living situations of Indigenous Australians differs widely across the Northern Territory, even those who lack food or clothing may still own a smartphone.

“We know that Aboriginal people use social media at very high rates; it’s been taken up even in remote communities, particularly where people have limited communication through other means,” Ms Hefler said.

Researchers believe Indigenous people use Facebook at higher rates than the overall population, making it one of the most effective ways to reach out.

“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,” Ms Hefler said.

Early findings show that when friends and family talk about quitting smoking on social media, it has a greater effect than traditional hardline anti-smoking ads.

“The people in your Facebook networks influence you the most,” Ms Hefler said.

“In the past, anti-smoking advertising has relied heavily on having a captive audience; we know that smokers don’t like the content they are seeing, but they can’t get away. Now with the advent of Facebook, all you have to do is swipe and the message is gone.”

Cigarettes more popular than fruit in outback stores

Customers in remote Australia spent roughly four and a half times more on cigarettes than fruit and vegetables in 2015-16, said Stephen Bradley, chairman of Outback Stores, a government-owned company which manages 37 businesses in some of the remotest parts of the country.

An incentive program run by Outback Stores to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales, but Mr. Bradley admits more needs to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” he said.

The Federal Government is aiming to close the gap between Indigenous and non-Indigenous life expectancy within a generation.

Indigenous deaths caused by heart disease and strokes have been dropping but on average Indigenous people are still dying 10 years younger than non-Indigenous Australians.

“Smoking in Aboriginal communities looks quite different to what it does in the rest of Australia,” Ms Hefler said.

“There’s historical reasons why the smoking rate is higher: it’s tied up in inter-generational trauma, and we also know the stolen generations are more likely to smoke.”

Using Facebook to quit

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After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

Ms Lowah has been a smoker for more than half her life and agrees the tough traditional anti-smoking ads are too easy to ignore.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,” she said.

The preliminary research findings from Menzies have been welcomed by NT Territory Labor MP Chansey Paech, whose central Australian electorate of Namatjira has a high Indigenous population.

“Both the Territory and Federal Governments have made significant contributions over the last several years to reduce the rates of smoking, so I’m looking forward to reading the report and seeing what the recommendations are, and hopefully reducing the smoking rate in the Northern Territory, which we know is too high,” he said.

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NACCHO Aboriginal Health ” What Works Part 9 ” ; Hon Linda Burney’s Menzies Research Oration ” Community led programs “

 

Shadow Minister for Human Services Linda Burney makes her maiden speech in the House of Representatives at Parliament House in Canberra, Wednesday, Aug. 31, 2016. (AAP Image/Mick Tsikas) NO ARCHIVING

” Paternalism is symptomatic of a view of Aboriginal Australia which sees Indigenous people purely as the problem.

It speaks to that old lie – that Aboriginal people have inflicted this deprivation on themselves, and that governments must save them from themselves.

Despite my pessimism about the current direction of government approaches to the Aboriginal community I do see some cause for optimism.

The communities which are doing best are those which have found ways to support their own initiatives despite failing Government approaches.

I take heart from organisations like Tharawal in Sydney’s South-Western Suburbs – an Indigenous health services ( and NACCHO Member  ) which does not just focus on treating illness when it occurs.

They target what Sir Michael Marmot calls “the social determinants of health” and what the Menzies School of Health Research has worked so hard to identify. Stable housing, early education and social support.

And they are seeing excellent results. You know it is about providing this information to the organisations that already work in communities – it is not a lack of ideas, we know the programs that work and they are community led. ”

Hon Linda Burney MP : ” Truth telling and generosity – Healing the Heart of the nation  : Oration Menzies School of Health Research Darwin 18 Nov 2016

Photo above : the first elected Aboriginal woman in the House of Representatives Shadow Minister for Human Services Linda Burney makes her maiden speech at Parliament House in Canberra, Wednesday, Aug. 31, 2016. (AAP Image/Mick Tsikas)

I open by acknowledging the Larrakia people on whose land we meet today.

I pay my respects to their elders past and present. I also take this opportunity to acknowledge their long struggle for equality, for land rights and for self determination.

I pay tribute to the Larrakia peoples’ determination in the face of denial and I mourn with them the loss of so many elders before their 23 year struggle for land rights could be resolved.

In acknowledging country I do not just pay tribute and respect –

I am acknowledging the fundamental truth that this land has played host to thousands of years of lived human experience.

Cultures evolving and changing since the first sunrise.

I want to thank the school for hosting me today. The world class socio-medical research published by the Menzies School of Health Research will lead to very real improvement in the standard of living for many Aboriginal people.

I also acknowledge today the special guests in the audience;

 Commissioner Mick Gooda, of the Royal Commission in into Juvenile Detention

 Tony McAvoy SC, the first Aboriginal Senior Council

And of course my colleagues;

 Senator Malarndirri McCarthy

 Luke Gosling MP

 Various Northern Territory administrator and MPs.

It is an honour to be invited to deliver the Menzies’ School of Health Research Oration for 2016.

If I can I’d like to offer my thoughts on 4 things –

  1. Truth telling and forgiveness, as I did for the Lingiari Oration in 2007 I want to remind you all of the importance of narrative and the need for truth as the bedrock of our reconciliation process;
  2. Recognition of First Peoples in our constitution – our next great project in truth telling and the one to which we must turn our attention to now;
  3. The perilous state of our Governments’ Indigenous Affairs policy today. and;
  4. The way, as I see it, forward from here.

But I want to start by appealing to your optimism – the facts of our condition can be dispiriting but I am reminded of the lessons taught to me by the late Faith Bandler.

I had the extraordinary honour of being invited by Faith’s daughter, Lilon, to speak at her memorial service in the Great Hall at Sydney University.

Faith more than anyone understood that we are playing the long game – it require understanding and devotion but most of all it requires patience.

The memory of Faith is an appropriate one – it was the work of Faith, along with so many others like Jessie Street and Alan Duncan that convinced the Menzies and Holt Government to hold the 1967 Referendum.

That 10 year campaign saw the revitalisation of the fight for Aboriginal and Torres Strait Islander rights and began the journey of truth telling.

In my first speech to the Australian Parliament I told the story of an older non- Aboriginal woman making her way to the voting booth late on Election Day.

It was cold and dark and her daughter urged her just to give up and go home as she slowly made her way across the park to the local public school– but she insisted.

She said that her opportunity to vote for an Aboriginal woman “was history”. She saw that she had a stake in that election that transcended “bread and butter political issues”, she didn’t need to be an Aboriginal person to understand that.

She knew that the election of an Aboriginal woman was not just a victory for Aboriginal people; it was a part of our shared national history.

Not so long ago that would not have been the case – we had two distinct historical narratives.

A white one and a black one.

“White” Australia (as it was then) had no interest in Indigenous history, and “Black” Australia had no stake in engaging with a “White” future.

That old woman proved to me that we are changing this.

For the 1988 bicentenary campaign our signature poster was “white Australia has a black history.” –

That campaign, led by Kevin Cooke and Reverend Harris (with a young Linda Burney too) sums up the feeling.

I can think of few venues in which it is be more appropriate to discuss the reconciliation movement –

A school of health research; which, along with education, is one of the greatest areas of need for Aboriginal people and,

One named for our 12th Prime Minister; who governed in an era which saw the revitalisation and renewed push for equality and self-determination for our people.

His reign marked a turning point – the beginning of the end for the Australia which was nestled firmly in the bosom of the British Empire.

It was a time of national coming of age.

I am no political fan of Menzies but I think it is true to say that without him there could have been no Whitlam or Keating or Hawke.

Their fiercely independent and inclusive model of Australian identity was born of a rebellion against the era of Menzies.

So in this sense we owe him a debt of sorts.

When I was only 4 years old in 1961, Sir Robert Menzies hosted a delegation of Aboriginal people from mainland states.

They had already been fighting for years to see a referendum held which would grant Aboriginal people equal rights.

There was considerable excitement amongst the attendees, a meeting with Prime Minister was in itself a victory for a community almost completely excluded from the political process at that point.

Menzies served his guests alcoholic drinks.

Our Prime Minister was shocked when informed by one of the attendees that that act was illegal under state law.

Such was the denial of truth and the refusal to see discrimination in our country at that time – the sitting prime minister was, himself, unaware of this discrimination.

It was paternalism in its worst form.

Menzies resigned when I was 9 years old – he had been a constant on the radio and on TV for those who had them, for much longer than that.

This explains to some extent the reverence with which so many look back on this time. To them it was stable and prosperous.

But even looking back through the rose tinted glasses of nostalgia – we cannot help but catch glimpses of the rampant discrimination of that era in the corners of our eyes.

Forced removal; captured so hauntingly in Archie Roaches’ “Took the Children Away, Government or church run reserves dictating the terms on which Aboriginal people could live, and; Government decrees which saw indigenous languages banned or even outlawed.

This was an era in which the Indigenous people of this continent were still considered biologically inferior, in which the White Australia policy still enjoyed bipartisan support.

It was a time in which the voices of women, non-white Australians and marginalised groups were systematically silenced.

So, while I pay my respects to Robert Menzies I cannot deny this truth. Nostalgia and reverence aside, this was an age of acute racism and a total denial of history.

We still considered ourselves an outpost of the British Empire, the millennia of Aboriginal history on this continent not only ignored, it was actively being hidden and destroyed.

I don’t know what Sir Robert Menzies would think of me delivering an oration named for him;

A woman;

An Aboriginal person, and;

A Labor member of Parliament.

Things have certainly changed.

If he didn’t accuse me of being a communist first, he might ask whether we had any political views in common and he might be surprised to hear where things stand today.

The fact is, regardless of political stripe, Menzies and I share some core political beliefs.

Sir Robert Menzies believed that government intervention could be a tool for good; he believed that the role of government was to empower the “forgotten” Australians and; He did saw economic growth as a means to an end not an end unto itself.

In his 1961 election address he noted that “a growing nation must be a healthy one”, and while it would be up to Whitlam to introduce a nationwide health scheme,

Menzies invested significantly in the area.

He was amongst the first leaders in Australia to recognise that the health of the community was a valuable measure of its prosperity.

And while his view of the 1967 Referendum was in some ways conflicted (Menzies himself having campaigned against some proposals) he also oversaw the passage of the 1963 Commonwealth Electoral Act which granted universal suffrage to Aboriginal people regardless of the state in which they were born.

Like the story of all governments when it comes to First Peoples’, Menzies legacy is mixed.

Menzies to some extent defined his generation but he was still a captive of the more exclusionary views of his day.

Truth Telling and Reconciliation

When it comes to the reconciliation process to date, truth telling is important.

Truth telling has been a theme of my public life to date.

In my view the path to reconciliation must be grounded in a fundamental commitment to truthfulness – it is one of the cornerstones of reconciliation.

As Dr Alex Boraine, deputy chair of South Africa’s Truth and Reconciliation Commission, noted at the Melbourne Reconciliation convention in 1997;

“Reconciliation… must be grounded in reality. There are 3 anchors which can keep us on the ground…. The first of these anchors is the experience of truth… of telling, of coming to terms with the truth of our past and the truth understood in this way transcends lies… it rejects denial to come clean in order to build, to heal.”

I told you earlier how surprised Menzies was to hear that the law prohibited serving his Aboriginal guests alcohol.

If not deliberately, then subconsciously, he had chosen not to see this discrimination.

As has much of the Australian community for the majority of our post-colonial history.

We cannot afford to do that.

In the last 30 years we have started to lay the anchor of truth –

We have a curriculum which teaches the truth of our history, we have a political system which now includes a record number of First Peoples and we have almost reached a national consensus about the imperative for action on closing the gap.

This kind of truth telling is not purely symbolic.

Children in our schools now understand that the history of Australia, or at least the

Australian continent, extends far beyond 228 years of colonisation.

And that is important. We won’t really be able to treat the malaise which afflicts

Aboriginal communities until the broader community understands the impact of generational disadvantage and cyclical poverty.

When Kevin Rudd delivered the apology to the stolen generation in the federal parliament he undertook a momentous act of truth-telling.

When that speech concluded two older Aboriginal women handed the Prime Minister and the Opposition leader a coolomon – it was an astounding act of generosity.

For that generosity we owe considerable gratitude, but it also demonstrates in part why the apology was so important.

That act of truth telling opened the door to forgiveness – and without it we cannot see old enmities consigned to the past.

After The Apology, as I walked into the marble foyer of the parliament I ran into Aunty May Robinson, an elder from South Western Sydney.

She held in her hands a black and white photo – and her only words to me when we saw each other were;

“Linda! I bought mum.”

We fell into each other’s arms crying.

Recognition

It is my hope that the Recognition of First Peoples in our constitution will be another of these great moments of truth telling, and that it will pave the way for a greater depth of understanding.

As it stands we have a Constitution which tells the story of western democracy; the Westminster system of government and a thousand years of its development.

But it says nothing of the more than 40,000 years of lived experience on this continent that preceded European arrival.

Our Constitution, the document on which the Parliament I sit in is founded, does not tell the truth. It is a fundamental failing and one that we cannot continue to ignore.

This is a part of the reconciliation process that Dr Boraine talked about almost 20 years ago and it is a fundamental part of our nation building project.

The symbolism of recognition belies powerful consequences.

I saw the feeling of relief on the faces of those old women in the Parliament after the apology and felt the relief of the broader Australian community at finally having acknowledged the truth.

More than anything else Recognition will add another thread to the tapestry of our national identity – a history and a story that we can all share.

I do not concede to any argument that suggests this act will be divisive. The true act of division would be a continued denial of the truth of settlement and invasion.

Recognition and Paternalism

I am also hopeful that Recognition will pave the way to a more consistent and effective approach to Government policy in the area.

For all the talk of “Prime Ministers for Indigenous Affairs” and a bipartisan commitment to closing the gap, we are yet to see the progress we need.

Life expectancy for First Australians is almost 10 years shorter than the rest of the community – the number blows out considerably further for those in rural or remote communities.

Our young people are locked up at ever increasing rates – almost 48% of those in the juvenile justice system are Aboriginal.

Our birthweights are consistently lower, as are our educational outcomes and our average earnings.

We are making slow progress – but it is not enough.

For every year that passes without dramatic improvement in our condition we draw closer to a point at which we will have failed yet another generation.

In the last week of Parliament I attended the launch of a report on the National Aboriginal Suicide Prevention Strategy.

How can it be that for Aboriginal people attending the funerals of young people is so commonplace?

One of the women who attended, Norma Ashwin, a mother who has lost her child, summed up the feeling of her community –

“We have nothing. Our kids have no hope, nothing, just a sense of no belonging… [we have] Lost everything…”

It is easy to see how in the face of this despair, Governments can turn to lazy policy options and to the comfort of the past.

Perhaps in frustration at slow progress Conservatives have done what they usually insist they will not – let the government pick and choose winning initiatives while ignoring community voices.

Conservative forces have continued to drive us back towards the paternalism of the past – from the “10 point plan” on native title and the destruction of ATSIC in the late 1990s — through to the very recent cuts to legal services, defunding of advocacy organisations and of course the denial of support for the National Congress of Australia’s First Peoples.

Half a billion dollars has been pulled out of the Indigenous affairs budget.

The trend is clear.

A concerted effort to silence the voices of Aboriginal leaders and a refusal to accept what we already know to be true —- solutions to our problems need to be found with communities, not imposed upon them.

Don Dale provides a perfect example – the Koori media had reported this story months before any mainstream news agency did and members of the local community will tell you – they had raised these issues before.

Indeed we know now that the both the Federal and State Governments’ were well aware of the issue.

But the story received scant political attention. Key advocacy organisation which could have raised the issues more loudly, either didn’t have the resources or didn’t exist anymore.

Paternalism isn’t just a failed policy approach because it pacifies communities and because it deprives individuals of their rights to self-determination –

It necessarily makes communication one way, from top to bottom.

Inflicting policy decisions on Aboriginal communities and then arriving later for a photo op and twitter post is not a substitute for consultation.

In the 1886 Corranderk petition to the Victorian government William Barak wrote on behalf of his people;

“Could we get our freedom back…to come home when we wish and also to go for our good health when we need it…”

It troubles me that today that I am increasingly asked by our community those same questions today – “can WE offer a solution?”… “can WE provide the services?” … “can WE our own choices?”

Command and control policy from Canberra will not help – at best it might make politicians and public servants in Canberra feel better at not having to hear cries for help

Paternalism is symptomatic of a view of Aboriginal Australia which sees Indigenous people purely as the problem.

It speaks to that old lie – that Aboriginal people have inflicted this deprivation on themselves, and that governments must save them from themselves.

Optimism and a Way Forward

Despite my pessimism about the current direction of government approaches to the Aboriginal community I do see some cause for optimism.

The communities which are doing best are those which have found ways to support their own initiatives despite failing Government approaches.

I take heart from organisations like Tharawal in Sydney’s South-Western Suburbs – an Indigenous health services which does not just focus on treating illness when it occurs.

They target what Sir Michael Marmot calls “the social determinants of health” and what the Menzies School of Health Research has worked so hard to identify. Stable housing, early education and social support.

And they are seeing excellent results.

I also see innovative new approaches, like the University of Melbourne’s first thousand days campaign – recognising that supporting Aboriginal and Torres Strait Islander families in that vital period bears real long term fruit.

Increasing birthweight, providing drug and alcohol support for expectant and new mothers – along with a whole range of other early interventions.

I am optimistic because we know that many of the solutions we need already exist – they are not prohibitively expensive or impossible to institute.

Here at the Menzies School of Health Research for example, you’ve done the research.

You know it is about providing this information to the organisations that already work in communities – it is not a lack of ideas, we know the programs that work and they are community led.

They just require political bravery – and with a record number of First Australians inside our parliament and an increasingly active and determined community outside it, I am confident we can find that will.

I am confident that you can find it on my side of the chamber – I have never had more faith in my party’s commitment to Indigenous Affairs.

I am optimistic because for the first time since colonisation we have a parliament that is beginning to represent the community and we will soon have a constitution that tells the truth.

I talked earlier about Faith Bandler and her long game.

She saw better than most that the campaign for the 1967 referendum was much longer than 10 years – it was a starting point for the project we are still running today.

Martin Luther King Jr said that “The arc of the moral universe [was] long but [that it] bends towards justice”

I think Faith agreed, I know I do.

But Faith more than most saw that it was up to us to shape that arc – and I am confident that we can.

We will have set backs, and we’ve taken some steps backwards but those aberrations do not define the trend.

This is a process of national healing, it is a long journey and it does take time.

To do it we need to tell the truth; and we are starting to do that.

We need generosity; and believe that the First Peoples have that in spades.

And most of all we need to accept that Aboriginal and Torres Strait Islander people are a part of the solution not just the problem.

Most of all I take my optimism from the determination of Aboriginal and non- Aboriginal communities across Australia.

In her first speech to the Federal Parliament not so long ago your Senator for the Northern Territory Malarndirri McCarthy said in reference to her people’s struggle for land rights;

“[We are] battle fatigued, perhaps we are better to acquiesce? But we are here still, and we are not going away.”

I think the sentiment applies far more broadly – now more than ever I believe in our communities’ commitment to addressing these issues.

We are not going anywhere.

NACCHO Overcoming Indigenous Disadvantage #Smoking and Healthy Lives report : Cigarettes favoured over fruit in Outback stores

 

smokes 
” Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

  A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016). “

The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians. Download Chapter 8 or see below

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Read 90 NACCHO articles about Tackling Indigenous Smokes

Or Articles page 8 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

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” Tobacco turnover had remained “consistently high” with 8.34 million sticks sold over the year and tobacco accounting for 19 per cent of all food and grocery sales.

Customers spent 4.4 times more on cigarettes than fruit and vegetables in 2015/16.”

Chairman Stephen Bradley revealed in the annual report of Outback Stores Pty Ltd, the government-owned company which manages 37 businesses in some of the remotest parts of Australia.

Lung cancer is the highest-ranked cancer type among Indigenous people, but the fourth-ranked for non-indigenous Australians.

An incentive program to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales.

 Location of Outback stores across Australia.

Location of Outback stores across Australia.

But the company admitted more needed to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” Mr Bradley wrote.

The government is aiming to close the gap between Indigenous and non-indigenous life expectancy within a generation, halving the gap in mortality rates for under-fives within a decade and halving the gap in employment outcomes.

The company reported 297 Indigenous staff were employed in Outback Stores businesses, which turned over $82.5 million in 2015/16.

Overcoming Indigenous Disadvantage: Key Indicators 2016

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–>The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians. Chapter 8.4

Tobacco consumption and harm[1]

Things that work

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016).

A systematic review of 73 interventions in indigenous communities globally found that there was no single intervention that was more likely to result in a reduction in tobacco use, but rather that more successful programs:

  • use a comprehensive approach inclusive of multiple activities
  • centre Aboriginal leadership
  • make long-term community investments
  • provide culturally appropriate health materials and activities to produce desired changes (Minichiello et al. 2016).

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

Box 8.4.1      Key messages
·      Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

·      A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

 

Box 8.4.2      Measures of tobacco consumption and harm
There is one main measure for this indicator (aligned with the associated NIRA indicator), rates of current daily smokers, measured by the proportion of people aged 18 years and over who are current daily smokers (all jurisdictions; remoteness; age; sex).

Smoking rate data are available from the ABS Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS)/National Aboriginal and Torres Strait Islander Social Survey (NATSISS), with the most recent data available from the 2014‑15 NATSISS. Data for the non‑Indigenous population are sourced from the ABS Australian Health Survey (AHS)/National Health Survey (NHS), with the most recent data available from the 2014-15 NHS.

Previous editions of this report included a supplementary measure on tobacco-related hospitalisations. This is no longer included as the measure only related to conditions directly attributable to tobacco — not most conditions, where tobacco may be a contributing factor but the link is not immediate. Data are also difficult to interpret as they represent less than one per cent of all Aboriginal and Torres Strait Islander hospitalisations and are therefore highly volatile over time.

Tobacco consumption is a subsidiary performance measure for COAG’s target of ‘closing the life expectancy gap (between Indigenous and non-Indigenous Australians) within a generation’ (COAG 2012).

In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking (AHMAC 2015). Among Aboriginal and Torres Strait Islander Australians, tobacco use is the leading risk factor contributing to disease and death (Vos et al. 2007). Studies have found that smoking tobacco increases the risk of developing numerous cancers, heart and vascular diseases, and depression (AHMAC 2012; Cunningham et al. 2008; Pasco et al. 2008). Smoking in pregnancy can lead to miscarriage, stillbirth or premature birth (Graham et al. 2007). Section 6.2 includes information on women reporting smoking during pregnancy.

Compared to non-Indigenous people, Aboriginal and Torres Strait Islander Australians who smoke generally commence at an earlier age and smoke for longer (CEITC 2010, 2014). Recent research (Knott et al. 2016) suggests also there may be fundamental differences in the determinants of smoking and the reasons for quitting, between Aboriginal and Torres Strait Islander men and women.

Research has found that the proportion of Aboriginal and Torres Strait Islander adults who want to quit smoking and those who have made a quit attempt in the past year, are similar to the general population. However fewer Aboriginal and Torres Strait Islander adults have made a sustained quit attempt for at least a month and a lower proportion agree that social norms disapprove of smoking, compared to the general population (Thomas et. al 2015).

Tobacco use is often associated with other lifestyle related health risk factors, such as excessive alcohol consumption and poor diet. Long term risky/high risk drinkers (both males and females) were more likely to be current smokers than those who drank at a low risk level (ABS 2006). Section 11.1 examines alcohol consumption and harm.

In Australia and many other countries smoking behaviour is inversely related to socioeconomic status, with those in disadvantaged groups in the population more likely to start and continue smoking. In addition to long-term health risks, low income groups (such as some Aboriginal and Torres Strait Islander families and communities) are affected by the financial strain associated with tobacco use (Greenhalgh 2015). A recent study in NSW found that more disadvantaged areas were significantly more likely to have higher tobacco outlet densities, with this density significantly and positively associated with smoking status (Marashi-Pour 2015).

Tobacco consumption

Current daily smokers are people who smoked one or more cigarettes (or pipes or cigars) per day at the time of survey interview.

The COAG performance measure and the data presented in this section focus on the proportion of people aged 18 years and over who are current daily smokers. However, as noted, Aboriginal and Torres Strait Islander Australians tend to start smoking at an earlier age than non‑Indigenous people — for 2014-15, in non-remote areas around one in six (16.2 per cent) Aboriginal and Torres Strait Islander 15 to 17 year olds were current daily smokers, compared with one in thirty (3.3 per cent) non‑Indigenous 15 to 17 year olds (table 8A.4.12).

Nationally in 2014-15, the crude daily smoking rate among Aboriginal and Torres Strait Islander adults was 41.4 per cent, a decline from 50.7 per cent in 2001 (table 8A.4.1). Rates varied across states and territories in 2014-15, from 38.8 per cent in SA to 46.2 per cent in the NT (table 8A.4.1). Smoking rates were higher in remote and very remote areas (49.3 per cent and 48.9 per cent) than in major cities (36.3 per cent) (table 8A.4.2). In non-remote areas in 2014-15, smoking was most prevalent among those aged 25–54 years (between 45.4 and 46.5 per cent), with smoking rates much lower for older people (31.3 per cent for those aged 55 years and over). A similar pattern was observed for non‑Indigenous Australians, although the daily smoking rates were consistently lower across all age groups (table 8A.4.12).

After adjusting for different population age structures, in 2014-15 the current daily smoking rate for Aboriginal and Torres Strait Islander Australians was 2.8 times the rate for non-Indigenous Australians (table 8A.4.7). The gap in smoking rates was widest in remote areas (table 8A.4.8).

 

Figure 8.4.1   Current daily smokers aged 18 years and over, 2001 to 2014-15a, b
a Error bars represent 95 per cent confidence intervals around each estimate. b Rates are age standardised.
Sources: ABS (unpublished) National Health Survey 2001; ABS (unpublished) National Health Survey and National Aboriginal Torres Strait Islander Health Survey 2004-05; ABS (unpublished) National Aboriginal Torres Strait Islander Social Survey 2008; ABS (unpublished) National Health Survey 2007-08; ABS (unpublished) Australian Aboriginal Torres Strait Islander Health Survey 2012-13 (core component); ABS (unpublished) Australian Health Survey 2011–13 (2011-12 core component); ABS (unpublished) National Aboriginal and Torres Strait Islander Social Survey, 2014-15; ABS (unpublished) National Health Survey, 2014-15; table 8A.4.7.

Between 2001 and 2014-15, after adjusting for differences in population age structures, the daily smoking rate declined for both Aboriginal and Torres Strait Islander adults and non‑Indigenous adults, leaving the gap relatively unchanged at around 26 percentage points (figure 8.4.1).

Data for smoking rates reported by State and Territory are available by remoteness in tables 8A.4.2–6 and 8A.4.8−10 and by sex in tables 8A.4.11-12.

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

[1]    The Steering Committee notes its appreciation to the National Health Leadership Forum, which reviewed a draft of this section of the report.