NACCHO Aboriginal Health and #flutracker : ‎@Flutrack You can help protect our mob from the #flu

 

” How much flu we see each year depends on which types of the flu virus are circulating and how susceptible the population is. Aboriginal and Torres Strait Islander people have a higher risk of getting the flu than non-Indigenous Australians.

This may be due to the high proportion of Indigenous Australians with chronic illness, or those living in remote communities may not have seen previous types of the flu that may have offered some protection.

Free vaccine is available for Indigenous Australians who are less than five years of age or over 15 years of age.

In 2016, only 300 Indigenous Australians participated in Flutracking. This meant that it was not possible to see how much flu there was and how well the flu vaccine was working in protecting Indigenous Australians.

From Flu Tracking Via Indigenous X

NACCHO Aboriginal Health Alert : Flu vaccines and other immunisation programs : What you need to know

What the Video Here

Influenza, or the “flu” is a big problem around the world. In Australia, most disease occurs during late winter, but in the tropics, it can occur at any time.

The flu is spread from person to person through the air when a sick person coughs or sneezes and it can cause symptoms such as fever, coughing, soreness in the body or sometimes very serious disease that can lead to death. You are more likely to have serious disease if you are less than five-years of age, elderly or have a chronic illness such as diabetes, renal failure, heart or lung disease or if you are pregnant or smoke.

Aboriginal girls playing on a swing

FluTracking needs your help to protect our mob from the flu.

 

The best way to protect yourself from the flu is by vaccination. Free vaccine is available for Indigenous Australians who are less than five years of age or over 15 years of age.

It is also recommended but not yet funded for Indigenous Australians aged 5 to 15 years of age. You need to be vaccinated every year to be protected as the types of the flu virus that is included in the vaccine changes each year and protection provided by the vaccine does not last a long time.

One way to check how much flu there is in the community and to see how well the vaccine is working is to conduct surveillance of flu symptoms. Flutracking is a community based surveillance system, based out of Newcastle.

It asks people to participate by signing up, and responding to a weekly email by answering two simple questions; whether or not they had symptoms of the flu in the previous week, and whether they had received the flu vaccine. If participants have had flu symptoms, then a few additional questions will follow about whether they have seen their doctor and if they were tested for the flu.

Currently, over 30,000 Australians participate in Flutracking, making it the biggest community surveillance system in the world. However, not all communities within Australia are well represented, which makes it difficult to assess how much flu there is in certain populations and how well the flu vaccine is protecting people.

In 2016, only 300 Indigenous Australians participated in Flutracking. This meant that it was not possible to see how much flu there was and how well the flu vaccine was working in protecting Indigenous Australians.

If more Indigenous Australians join, we will be able to understand how serious the flu is each year and how quickly it will spread.

We will need many Indigenous Australians to join in order to know how well the flu vaccine is working.

We invite all Australians and particularly Indigenous Australians to join Flutracking.

Why should I join and what’s in it for me? You can contribute to one of the largest community-based surveillance systems in the world, and you can help protect our mob from the flu and contribute to improving health outcomes for Aboriginal communities.

Some Flutracking participants enjoy being part of the community of Flutrackers and being involved only takes 10 seconds each week.

With links available to a map of flu activity, you can see how much flu there is in your area, and have the option to hear messages about protecting yourself and your family and community against the flu

. You can change your mind and stop participating at any time. For more information about how we use data, please click here.

This article was sponsored by HNE Health

Aboriginal Health #WCPH2017 #WorldActivityDay : Snapshot report physical activity programs for Aboriginal people in Australia

 

” This is important as sharing information about program practice is an important part of effective health promotion and can serve to guide future initiatives.

The Ottawa Charter outlines a settings based approach to effective health promotion. We found most programs were delivered in community, followed by school, settings. Both have proven efficacy in achieving health outcomes.

They are likely be particularly effective settings for reaching Aboriginal and Torres Strait Islander people given the importance of holistic health promotion and whole-of-community approaches

Capturing current practice can inform future efforts to increase the impact of physical activity programs to improve health and social indicators.

Targeted, culturally relevant programs are essential to reduce levels of disadvantage experienced by Aboriginal and Torres Strait Islanders

Rona Macniven, Michelle Elwell, Kathy Ride, Adrian Bauman and Justin Richards Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, & Australian Indigenous HealthInfoNet

Picture above : Redfern All Blacks recently won the Women’s Division Ella Sevens Rugby Union tournament in Coffs Harbour beating the Highlanders 36-7

Download

 A snapshot of physical activity programs targeting Aboriginal and Torres Strait Islander people in Australia

 

Picture above :The Knight Riders beat the Shindogs 28-21 in the Men’s Final Ella Sevens Rugby Union tournament in Coffs Harbour

Issue addressed

Participation in physical activity programs can be an effective strategy to reduce chronic disease risk factors and improve broader social outcomes. Health and social outcomes are worse among Aboriginal and Torres Strait Islanders than non-Indigenous Australians, who represent an important group for culturally specific programs.

The extent of current practice in physical activity programs is largely unknown. This study identifies such programs targeting this population group and describes their characteristics.

Aboriginal Health

Almost a third of programs aimed to promote physical activity to achieve broader social benefits such as educational and employment outcomes and reduced rates of crime. Health and sport programs are worthy crime prevention approaches.

There are also recognised relationships between physical activity and fitness level and academic achievement as well as social and mental health benefits specific to Aboriginal and Torres Strait Islander populations.

However, a cautious approach to alluding to wider social benefits directly arising from individual programs should be taken in the absence of empirical evidence, as well as the direct effects of standalone programs on health.

Yet the documentation of existing program evaluation measures in this snapshot represents a vital first step in reviewing programs collectively and some have demonstrated encouraging evidence of positive educational and employment outcomes.

There is also some evidence of social benefits, such as community cohesion and cultural identity; derived from sport programs in this snapshot, which are important for Aboriginal and Torres Strait Islander health.

Such programs might therefore contribute to corresponding ‘Closing the Gap’ policy indicators and should be resourced accordingly.

Methods

Bibliographic and Internet searches and snowball sampling identified eligible programs operating between 2012 and 2015 in Australia (phase 1). Program coordinators were contacted to verify sourced information (phase 2). Descriptive characteristics were documented for each program.

Results

A total of 110 programs were identified across urban, rural and remote locations within all states and territories. Only 11 programs were located through bibliographic sources; the remainder through Internet searches.

The programs aimed to influence physical activity for health or broader social outcomes. Sixty five took place in community settings and most involved multiple sectors such as sport, health and education.

Almost all were free for participants and involved Indigenous stakeholders. The majority received Government funding and had commenced within the last decade. More than 20 programs reached over 1000 people each; 14 reached 0–100 participants. Most included process or impact evaluation indicators, typically reflecting their aims.

Conclusion

This snapshot provides a comprehensive description of current physical activity program provision for Aboriginal and Torres Strait Islander people across Australia. The majority of programs were only identified through the grey literature. Many programs collect evaluation data, yet this is underrepresented in academic literature.

 The Famous AFL “Fitzroy All Stars from Melbourne

 

NACCHO Aboriginal Health and #Nutrition : FYI delegates #WCPH2017 Aboriginal traditional foods key role in protecting against #chronicdisease

“We have long understood that native animal and plant foods are highly nutritious.

There is no evidence that Aboriginal and Torres Strait Islander people had diabetes or cardiovascular disease whilst maintaining a diet of traditional foods, and it has been shown that reverting to a traditional diet can improve health.

In addition to demonstrating significant health benefits, traditional foods remained an integral part of identity, culture and country for Aboriginal and Torres Strait Islander people, while also alleviating food insecurity in remote communities.”

Menzies researcher and lead author Megan Ferguson see research paper in full below

Photo above :  Frank told us how the ‘old people’, which literally means his ancestors, lived under the trees, gathered food and fished in the swamp. He said that during the dry, they used to build a sort of rock stepping-stone bridge to access the island in the swamp where they would gather magpie goose eggs.

Photo above  : With a focus to improve community nutrition, over 2000 bush tucker trees and conventional fruits were planted at the Barunga Community, south of Katherine.

Aboriginal people have been using bush tucker for over 50,000 years, but it was hoped the plantation would lure more children onto a free feed of fruit, instead of a portion of chips. Some of the bush tucker fruits being planted include the Black Plum, Bush Apple, Cocky Apple, Red Bush Apple, and White Currant

 ” The bush tucker diet was high in nutritional density, offering good levels of protein, fibre, and micronutrients. It was low in sugar and glucose, and lower in insulin than similar western foods, and the hunter-gatherer lifestyle meant plenty of physical activity. Some animal foods such as witchetty grubs and green ants were high in fat, but most native land animals were lean, especially when compared with the domesticated animals eaten today.

It was this knowledge of the land that sustained the Aboriginal people of the Northern Territory for tens of thousands of years “

Your Complete Guide to Bush Tucker in the Northern Territory

Traditional food trends in remote Northern Territory communities

The majority of Aboriginal people living in remote Northern Territory communities are regularly using traditional foods in their diets according to research from Menzies School of Health Research published in the Australian and New Zealand Journal of Public Health see below

The paper, Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory reports that a nutritious diet including the consumption of traditional foods plays a key role in protecting against chronic disease for Aboriginal and Torres Strait Islander people living in remote communities.

‘Surveys conducted in remote Northern Territory (NT) communities revealed almost 90% of people consumed a variety of traditional foods each fortnight.

‘In relation to food insecurity we also found that 40% of people obtained traditional food when they would otherwise go without food due to financial hardship or limited access to stores,’ Ms Ferguson said.

The list of traditional food reported during the research is extensive and includes a range of native animal foods including echidna, goanna, mud mussel, long-neck turtle and witchetty grubs and native plant foods including green plum, yam and bush onion.

The 20 remote NT communities surveyed reported that traditional foods were available year round.

‘There is still much to be learnt about the important contribution traditional foods makes to nutrition and health outcomes. We need to work with Aboriginal and Torres Strait Islander leaders to understand more about contemporary traditional food consumption. This is crucial to informing broader policy that affects where people live, how they are educated, employment and other livelihood opportunities,’ Ms Ferguson said.

The article will be available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1753-6405

Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia

Objective: To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia.

Methods: Availability was assessed through repeated semi-structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified.

Results: Aboriginal and non-Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT) communities participated in interviews. Aboriginal primary household shoppers (n=73 in 2014) in five of these communities participated in a survey. Traditional foods were reported to be available year-round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy-six per cent reported being food insecure, with 40% obtaining traditional food during these times.

Conclusions: Traditional food is consumed frequently by Aboriginal people living in remote NT.

Implications for public health: Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration.

Aboriginal and Torres Strait Islander Australians have experienced a rapid nutrition transition since colonisation by Europeans 200 years ago, similar to that experienced by other Indigenous populations globally.1 The traditional food system provided a framework for society and was interwoven with culture, a framework that is now eroded by a food system with no distinct cultural ties or values.2 Early reports of Aboriginal people prior to European contact indicate that they were lean and healthy, attributable to an active lifestyle and a nutrient-dense diet characterised by high protein, polyunsaturated fat, fibre and slowly digested carbohydrates.3 The diet was sourced from a wide range of uncultivated plant foods and wild animals and was influenced by the seasons and geographical location; although there were differences in the food sources by location, there were similarities in the overall nutrient profile.3,4 Since colonisation, this nutritious diet has been systematically replaced by high intakes of refined cereals, added sugars, fatty (domesticated) meats, salt and low intakes of fibre and several micronutrients.5–7

There is no evidence that Aboriginal people maintaining traditional diets had diabetes or cardiovascular disease.4 However, the integration of non-traditional foods into the contemporary diet of Aboriginal Australians has led to an excessive burden of lifestyle-related chronic diseases.3 A nutritious diet, such as that afforded by the consumption of traditional foods, plays a key role in protecting against these conditions. Short-term reversion to a traditional diet has demonstrated significant weight loss, improvement in risk factors of diabetes and cardiovascular disease and improvements in glucose tolerance and other abnormalities related to type 2 diabetes mellitus among a small group of Aboriginal Australians.8,9

High levels and a wide variety of polyunsaturated fatty acids, in the context of overall lower fat content, found in native animal foods are one of the benefits of a traditional diet; reported to reduce the risk of developing obesity, type 2 diabetes mellitus and cardiovascular diseases.3,4Traditional foods remain an integral part of the contemporary Aboriginal and Torres Strait Islander diet strongly linked to identity, culture and country. An analysis of national data collected in 2008 reported that 72% of participants aged over 15 years living in remote communities reported having harvested wild foods in the past 12 months;10 and yet there is a dearth of information on the contribution of traditional foods to the contemporary diet of Aboriginal and Torres Strait Islander people.7,11 Most available information is also limited to describing harvesting behaviours and preferences.11 A recent environmental study, for example, in two Australian tropical river catchments reported more than one harvesting trip per fortnight for households in which 42 different animal and plant species were collected over a two-year period. This study also described the food-sharing networks that are likely to play a crucial role in alleviating food insecurity;12 of which 31% of Aboriginal and Torres Strait Islander people living in remote communities report to experience.13Some researchers estimate that more than 90% of foods are purchased and traditional foods contribute less than 5% to dietary energy intake,5 others argue that in some contexts the proportion of purchased foods is much lower.14

This variation likely relates to the diverse study contexts, including where people live, with higher intakes of traditional foods suggested to be consumed in small outstations rather than communities and townships.14 Until recently, most estimates of population level dietary intake have been limited to store-purchased food and drinks,5–7 an extremely valuable source of data, though one the authors acknowledge is limited by a lack of information on traditional food intake. The 2011–13 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS), which included a 24-hour dietary recall, provided the first set of dietary intake data of Aboriginal and Torres Strait Islander people nationally, though it did not aim to provide an estimate of traditional food intake.13This paper explores informant interview and self-report data relating to the: i) availability, ii) frequency and iii) variety of traditional food consumption. It also reports on the role of traditional food in alleviating food insecurity. For this study, traditional food included all native and introduced animal and plant foods procured for consumption. It was conducted as part of the SHOP@RIC study.15

Methods

Sample

A survey of contextual factors, defined as factors that may influence food purchases from the community store, was conducted in each of the 20 communities participating in the SHOP@RIC study, in the Northern Territory (NT), Australia.15 This included a rapid appraisal of traditional food availability through an interview with two key informants who had resided in the community for the previous 12 months. The study was not designed to collect comprehensive data on seasonal availability of traditional foods.

The cohort participating in the customer survey of the SHOP@RIC study15 was drawn from five very remote Aboriginal communities in the NT randomly selected from 20 study communities. All five communities had one food store, most had community-based food programs such as school nutrition and aged care meal programs and all were considered to have access to a traditional food supply from their surrounding lands. Households in each of the five communities were randomly selected and an eligible adult (i.e. community resident, plans to reside in the community for 12 months, >18 years, purchases food from the community store, and is the primary shopper) was invited to participate in a series of three surveys; pre-, post- and six-months post intervention. On completion of each survey, a $20 gift of fruit, vegetables and water was provided. The study aimed to include 150 customers in the cohort.

Data collection

The survey of contextual factors was conducted in English by a research team member, either in person or by telephone, at a time convenient to the key informant. Data were collected at two time points. As early as possible in 2014 and 2015, participants were interviewed about events in the previous year, including traditional food hunted or gathered. Initially, contact was made with the Shire/Council Services Manager of each community, who was invited to participate and recommend another suitable local person to complete the interview. The manager was selected due to their overall knowledge of a broad range of factors affecting store purchases, including population movement, community income and provision of essential services. If this manager could not be contacted, contact was made with someone in the community who was already associated with the main project to determine the most suitable people in the community to respond to these questions.

The customer survey was conducted by a research team, which included an Aboriginal community-based researcher trained in the conduct of the study. Interviews were conducted in English, with translation provided by the local researcher where necessary. The third survey (six months post intervention) was conducted from May 2014 to December 2014, in one community every two months in line with the main study design.15 This survey included a measure of frequency and variety consumption of traditional food in the preceding two weeks and questions to elicit information on the role of these foods in alleviation of food insecurity, the results of which are presented in this paper. A short script introduced the set of questions, noting that these included all hunted and gathered foods, which might be referred to by participants as traditional foods or bush foods, and included introduced species. The questions and response options were: How often do you eat traditional foods? (never, 1 day a fortnight, 1 day a week, 2–3 days a week, on most days, everyday). What type of traditional foods have you eaten? In the last 12 months, were there any times that you ran out of food, and couldn’t afford to buy more? (yes, no). If yes, how often did this happen? (once per week, once every 2 weeks, once per month, don’t know). Are there days when you don’t have enough food and feel hungry? (yes, no). What things can you do to get food on these days? Pictorial resources, with examples of foods known to be consumed across Central Australia and the Top End of the NT, grouped into similar food types, served as prompts. This study did not aim to collect data at the species level as nutrient analysis was not planned. These measures were based on a systematic review of the literature and expert consensus, and were pilot tested in line with the development of the overall customer survey.

Data analysis

The data from the contextual factor survey was entered into an Access database and exported to Excel for analysis. One author (CG) collated the data and verified with MF. Traditional food sources recalled being available over the calendar year and/or at different seasonal periods were described. The quantitative data from the customer survey were described, using Stata Version 14.0 (Stata, College Station, Texas, USA). The qualitative data from the customer survey were managed in an Access database and exported to Excel. One author (CB) allocated each individual food to one of eight categories,16 clarifying any difficult classification of foods with JB and MF.

Ethics

The study was approved by the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, the Central Australian Human Research Ethics Committee and Deakin University Human Research Ethics Committee. Written informed consent was obtained from all participants.

Results

Participants

At least one interview was conducted in each of the 20 study communities for the years 2013 or 2014. In 2013, 30 participants across 19 of the 20 study communities contributed to the contextual data; the participants held roles in the local council, government welfare agency, store, health centre, aged care facility, school and training and employment program. In 2014, 19 participants across 15 of the 20 study communities contributed to the repeat survey, holding roles in the local council, government welfare agency, store, health centre, community men’s program, research institute and training and employment program or were a community resident not in paid employment. In some cases, mobility from employed roles and from the community prevented repeat interview with the same informants each year.

Seventy-three participants aged 18 years or over, most of whom were female (97%), over the age of 35 years (69%) and not in paid employment (56%) contributed to the third customer survey. The participants differed marginally from the original cohort (92% female, 64% >35 years of age, 62% not in paid employment).

Annual availability of traditional food

Traditional foods were consistently reported for all 20 communities to be available year round. Informants reported hunting activity, with someone from all communities recalling a variety of animal foods that were available over the year or that hunting and fishing occurred. Informants from 15 communities across the Top End and Central Australia reported a variety of plant foods available in the previous 12 months. In four of the five communities where no plant foods were reported, it should be noted that data were only able to be collected for one of the two time points.

The survey did not intend to collect data on environmental or other impacts on the availability of the traditional food supply. It is worth noting that informants from three Top End communities and one customer survey participant from a fourth Top End community reported that goanna were in limited numbers or no longer available due to the impact of cane toads. In two Top End communities it was said that turkey were scarce or no longer available and in one of these communities, that the availability of yams had reduced due to environmental damage caused by introduced animals.

Frequency of traditional food consumption

Most (89%) participants reported consuming traditional foods on at least a fortnightly basis, in the two weeks preceding the survey. Seventy-one per cent of participants reported consuming traditional foods at least weekly.

Variety of traditional foods consumed

The variety of traditional foods reported to be available across 20 communities and consumed by participants in the five communities is reported in Table 1. There were a range of different native animal and plant foods and a smaller number of introduced animal foods recalled.

Table 1. List of the varietya of traditional foods reported to be available in communities and to be consumed in the preceding two weeks by a customer cohort.
Community data set (n=20) Participant data set (n=73)
  1. a: Foods listed as per participant response to an open-ended question which did not specify how to identify foods (e.g. as food category [e.g. seafood], food [e.g. fish] or species [e.g. barramundi]). The adjective ‘bush’ and ‘wild’ was provided at times with some foods (e.g. bush turkey and turkey). Occasionally participants used both local and English language; only the English language name is reported here.
  2. b: Echidna was often referred to as porcupine; buffalo as bullocky; cow as beef, cattle or killer.        c: The term shellfish was not used by participants in the customer cohort.
Animals
Native land animals Bandicoot, carpet snake, duck (diving duck), echidna,b emu, goanna (perentie), goose (magpie goose), honey, honey ant, kangaroo, lizard, possum, turkey, wallaby Black-headed snake, duck, echidna,b emu, goanna, goose, kangaroo, turkey
Introduced land animals Buffalo,b cow,b pig Buffalo,b cow,b pig
Fish or seafood Crab (mud crab), crocodile, crocodile egg, dugong, fish (barramundi, black bream, bream, catfish, fresh- and saltwater fish), shellfish (large creek mussel, long bum, mud mussel, mussel, oyster), prawn, stingray, turtle (long-neck turtle, sea turtle, short-neck turtle), turtle egg, water goanna Crab (mud crab), fish (barramundi, black bream, catfish, red snapper), mangrove worm, shellfishc (cone shell, long bum, mud mussel, oyster, periwinkle), stingray, turtle (long-neck turtle, sea turtle, short-neck turtle), turtle egg, water goanna
Witchetty grub Witchetty grubs Witchetty grub
Sugar bag Sugar bag
Plants
Fruit or berry Apple, banana, berry (blackcurrant, conga berry), cashew tree fruit, fruit (not specified), plum (black plum, green plum and sugar plum), sultana Apple, banana, berry, plum (black plum, green plum), raisin, sultana, tomato
Yam or root vegetables Potato, yam Potato, yam (budgu)
Other plants Bean, onion, tomato Bulb (sandy beach bulb), onion
Seed or nut Cashew tree nut Kora (seed)

The role of traditional food consumption in alleviating food insecurity

Most participants (76%) reported experiencing food insecurity. Of the coping strategies identified, 40% related to obtaining traditional food during times they went without food and 53% were borrowing food or money during these times.

Discussion

This exploratory study demonstrates that traditional food makes an important contribution to the contemporary diet of Aboriginal people living in remote NT communities. In 20 remote communities, traditional foods were reported to be available year round. A high frequency and wide variety of traditional foods were reported to be consumed by participants across five remote communities. In this exploratory study, more animal foods than plant foods were recalled to have been consumed and commonly a few animal foods predominated. Accessing traditional foods was reported to be a means of alleviating food insecurity for almost half the people who experienced food insecurity.

There are limited records of the traditional diet of Aboriginal and Torres Strait Islander people prior to European colonisation. Available reports describe gender roles, with women providing daily sustenance through collecting plant foods and small animals and men hunting large animals on a less regular basis, with the balance of plant and animal foods determined by factors including location and season.3 Studies of Canadian Aboriginal people suggest a high intake of traditional animal foods as part of the contemporary diet.17,18 This study suggests that an understanding of the contribution that animal (native and introduced) and plant foods make to the contemporary diet among Aboriginal and Torres Strait Islander people of Australia is warranted.

The frequent self-reported consumption of animal sources of traditional foods, suggests that contemporary population-level dietary assessment using store purchasing data has the potential to over-estimate nutrient deficiencies, particularly of protein, a concern we have previously raised.7,19 In Aboriginal populations elsewhere, it is estimated that traditional foods might contribute anywhere from 10% to 36% of energy and disproportionately to protein and other micronutrients,17,20–23 representing an important dietary contribution. Even weekly or fortnightly consumption of a nutrient-dense food, such as that reported to be consumed in this study, is likely to make an important contribution to the diet.11 Introduced land animal foods, such as buffalos, cattle and pigs, were reported to be hunted and consumed by participants. The contribution of introduced land animals may be influenced by availability and in some areas may be well integrated into the traditional food system.5 In the absence of volume consumption data, it is not possible to draw conclusions on the dietary contribution of introduced land animals. Although these foods contribute to dietary protein intake, the higher quantity of fat and poorer fatty acid profile, compared with native animal foods, is worth noting.3

We have demonstrated that it is possible to measure frequency consumption and to some extent variety of traditional foods consumed – in fact, our impression was that people enjoyed talking about these foods. We acknowledge the limitations of traditional dietary assessment methods, including additional challenges in remote contexts such as the practice of sharing community meals,12,24–27 though also consider that attributes such as the high regard given to traditional food, may aid assessment.24,27,28 Studies have demonstrated how standard tools can be modified to assess individual dietary intake with Aboriginal populations29 and lessons can be learnt from previous dietary survey work in remote Australian Aboriginal communities.15,26

Comprehensive assessment of traditional food consumption would serve a number of purposes. These data would provide an understanding of the different types of traditional foods consumed and the contribution they make to the contemporary diet of Aboriginal people across Australia. This information would assist in developing targeted strategies to ensure sustainable access and increased consumption of traditional foods. This study was not designed to examine differences in consumption of traditional foods across age, gender and other population groups. International studies in Aboriginal populations have found higher intakes of nutrient-poor store foods in young people and higher intakes of traditional foods in older people.17,22,23,30,31 In addition to contributing to improved health through dietary intake, the socio-cultural contribution and opportunity for physical activity that traditional foods provide is important to recognise.21,32,33 The impact that climate change, changes in the natural environment and development policies regarding land and sea use may have on traditional food use and thus health and wellbeing is critical to understand.12,32,34 Although not designed to collect information on environmental and other impacts on traditional food, this study suggests that introduced animals are affecting the availability of small animal and plant foods, at least in the Top End of the NT.

In addition to being nutritionally superior, traditional foods are considered to be a low-monetary form of sustenance, important in a context where people generally have low incomes and where the cost of food is high.12,18,20,35 Similar to our findings, 40% of coastal urban-dwelling Aboriginal people reported increased access of wild resources at times of financial hardship.32 In a small Western Australian outstation, hunting for various types of wild foods has been shown to respond differently to market and economic scarcity.33 The harvest of traditional foods and food sharing networks reduce the reliance on the market economy,10,12 important in a context where high numbers of people report to be food insecure. Others share our opinion that further understanding the role of traditional foods in the diet and in alleviating food insecurity36 is crucial in an environment where few, if any, significant changes are occurring in terms of the high cost of food and prevailing low-income levels.

Data regarding the contribution of traditional foods in the diet and role in livelihoods of Aboriginal people living in remote communities will be important in relation to broader environmental and social policy making. Evidence of the contribution of traditional foods to the contemporary diet of remote Aboriginal people is crucial to informing broader government policy that affects where people live, how they are educated, employment and other livelihood opportunities.10 It has been suggested that the use of traditional foods may be gaining interest nationally and internationally, and in addition to being good for human and environmental health, could provide economic and employment opportunities for Aboriginal and Torres Strait Islander Australians.37 There is a developing interest in sustainability of traditional foods in environmental protection efforts,12 such as working with Aboriginal people to develop adaption strategies to mitigate the impact of climate change on the environment and traditional food supply.32,34 Similarly, traditional food data are used internationally to maintain and improve availability and access to traditional foods as a result of global warming and environmental insults, such as contamination.17,18,21

There are three limitations related to our survey methodology. First, this study relies on self-report data, which is considered to be biased by recall and reporting. To address this, the data were collected through a facilitated recall methodology,38 which improves recall through the use of locally relevant prompts and questions.39 While respondents were asked to recall intake in the preceding two weeks only, it is possible that foods consumed beyond this timeframe were recalled. Second, the individual dietary data was collected from participants in only five remote NT communities; however, these were randomly selected from a larger sample of 20 communities and were spread across the NT. Third, the data were collected based on recall of a two-week period from participants in each community. Normally, frequency consumption data would be collected over a longer period to account for factors such as seasonality, although it has been collected in some studies for shorter periods.17 It was not within the scope of this study to collect longer-term data. The data were, however, collected over a 10-month period from the five communities, two months apart and have been supported by annual availability of traditional foods data from key informants across 20 communities. The key limitation in relation to the semi-structured interviews was that the key informants did not always include an Aboriginal person from each community and so reports of annual availability of traditional foods are likely to be conservative.

Implications

Although focused on availability, frequency and variety, this study provides an important step in improving non-Aboriginal knowledge of the contribution of traditional food in the contemporary diet of Aboriginal Australians living in remote Australia. This study suggests that it is possible to collect data regarding the contribution of traditional foods to diet. These data would complement population-level data collected through community store sales. Data of the nutrient profiles of many traditional foods exists and continues to be built on in Australia. Through a strong collaboration with Aboriginal people, methods for conducting individual dietary assessment of traditional food intake could be developed, which could include methodologies such as repeated 24-hour recall, visual recall40 and food frequency questionnaires, resulting in validated tools for ongoing use in this context. Our limited data, combined with national and international evidence suggest that priorities should include understanding differences across ages, gender, education and employment status and across remote, regional and urban areas in Australia. It is crucial that these processes align with developments in the broader environmental and societal work in this area.

Acknowledgements

The authors are grateful to community residents who provided data and acknowledge that the ownership of Aboriginal knowledge and cultural heritage is retained by the informant. The authors thank Prof Kylie Ball, Anthony Gunther, Elaine Maypilama and Carrie Turner who contributed to the development of the customer survey, those who assisted with pilot testing the customer survey and Federica Barzi who assisted with analyses. The Stores Healthy Options Project in Remote Indigenous Communities was funded by the National Health and Medical Research Council (1024285). The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of the NHMRC. Julie Brimblecombe is supported through a National Heart Foundation Fellowship (100085

 

Aboriginal #Earlychildhood #Obesity Study : We need to reduce the prevalence of overweight/obesity in the first 3 years of life

“People who are obese in childhood are at increased risk of being obese in adulthood, which can increase the risk of cardiovascular disease, some types of cancer, diabetes, and arthritis,”

Research found reducing consumption of sugary drinks and junk food from an early age could benefit the health of Indigenous children, but that this is just one part of the solution to improving weight status.

“We know that Indigenous families across Australia – in remote, regional, and urban settings – face barriers to accessing healthy foods. Therefore, efforts to reduce junk food consumption need to occur alongside efforts to increase the affordability, availability, and acceptability of healthy foods,”

 Ms Thurber, PhD Scholar, from the National Centre for Epidemiology and Population Health at ANU.

A major study into the health of Aboriginal and Torres Strait Islander children has found programs and policies to promote healthy weight should target children as young as three.

Lead researcher Katie Thurber from The Australian National University (ANU) said the majority of Indigenous children in the national study had a health body Mass Index (BMI), but around 40 per cent were classified as overweight or obese by the time they reached nine years of age.

Download the Report Here Thurber BMI Trajectories LSIC

Latest national figures show obesity rates are 60 per cent higher for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians.

In 2013, around 30 per cent of Indigenous children were classified as overweight or obese, and two thirds of Indigenous people over 15 years old were classified as overweight or obese.

Key messages

•  The majority of Aboriginal and Torres Strait Islander children nationally have a healthy Body Mass Index
•  However, more than one in ten Aboriginal and Torres Strait Islander children in Footprints in Time were already overweight or obese at 3 years of age, and there was a rapid onset of overweight/obesity between age 3 and 9 years
•  We need programs and policies to reduce the prevalence of overweight/obesity in the first 3 years of life, and to slow the onset of overweight/obesity from age 3-9 years
•  Reducing children’s consumption of sugar-sweetened beverages and high-fat foods is one part of the solution to improving weight status at the population level
•  To enable healthy diets, we need to (1) create healthier environments and (2) improve the social determinants of health (such as financial security, housing, and community wellbeing). Creating healthy environments is complex, and will require both increasing the affordability, availability, and acceptability of healthy foods and decreasing the affordability, availability, and acceptability of unhealthy foods
•  Programs and policy to promote healthy weight need to be developed in partnership with Aboriginal and Torres Strait Islander communities
•  Despite higher levels of disadvantage, most Aboriginal and Torres Strait Islander children maintain a healthy weight; we need programs and policies that cultivate environments and circumstances that will enable all Aboriginal and Torres Strait Islander children to have a healthy start to life
 

Ms Thurber said improving weight status would have a major benefit in closing the gap in health between Indigenous and non-Indigenous Australians.

“Obesity is a leading contributor to the gap in health,” Ms Thurber said.

“We want to work with Aboriginal and Torres Strait Islander families and communities, as well as policy makers and service providers, to think about what will work best to promote healthy weight in those early childhood years.

“We want to start early, and identify the best ways for families and communities to support healthy diets, so that all Aboriginal and Torres Strait Islander children can have a healthy start to life.”

The research used data from Footprints in Time, a national longitudinal study that has followed more than 1,000 Indigenous children since 2008. It is funded and managed by the Department of Social Services.

Professor Mick Dodson, Chair of the Steering Committee for the Footprints in Time Study and Director of the ANU National Centre for Indigenous Studies, said Aboriginal and Torres Strait Islander children deserve the best possible start in life.

“This study shows just how important it is to support them, their families and their communities to provide a healthy diet and opportunities for physical activity,” Professor Dodson said.

Ms Thurber said using the Footprints in Time study, researchers for the first time were able to look at how weight status changes over time for Aboriginal and Torres Strait Islander children, enabling them to identify pathways that help children maintain a healthy weight.

The research has been published in Obesity.

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

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 ” 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 

fruit-and-veg

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.